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Home My WebLink AboutCREST VIEW BLK A LT 12OIO-Z3 I- 16 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received INDIVIDUAL SEWER & WATER FACILITIES FOR Time of Inspection Date of Inspection 1. Aoproval Requested By: ~,.~_,~/~ ~1~ Address: 2. Property Owner:~~L~~ 3. Legal Description= Z /~ ~ ~..~:--, 4. Location: ~/~.'~ .~v'. ~'~-- 5. Type of Facility to be Inspected:/~OV~ Number of Bedrooms:~ 6. Well Data= Phone A. Type~ -~~ Depth C. Construction , . D. Bacterial Analysis· 7.- Sewage Dls.°osal System= A. InstalIed ~' C. --Septic Tank: 1. Size~O0 2. Manufacturer D. Seepage Pit: 1. Size 2. Material E. Disposal Fie]d= Total. Length of Lines Distances: ~ A. Well To: Septic Tank , Absorption Area , Sewer Lines , Nearest Lot Line · Other Contamination B. Foundation to Septic Tank '~> Abgorption Area C. Absorption Area to Nearest Lot Line - Req~e~..t for ApProval of Ir ,idual Sewer & Water Facilities Pa~e T~o ~ ~ A ~_~o~al Valid for One Year 'From Date Signed Greater Anch ad--rea Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities located at: Signed Date Clyde (~ett, Brokez 3727 SPENARD ROAD. SUITE #2 ANCHORAGE, ALABU*A 99803 Phone: 274-2026 The Q~eeter Anehorele Ar~a ~ MeaXth Oepartamnt saves It's epproveX to the subject facilities dM To a prtor VA epprovaA. A heterial Analysis and a l)eter~ent Test ~er~mmed on the rater supply tndAeated SAn,~re,ty, CJ'J/e~ ~ ADH-H~B~FI(~) INDIVIDU~A~ WATER SUPPLY ALASKA DEPARTMENT OF I~ALTH Section of 5~zitatlon and Ermine'ins ACTION ON REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS Your recent request for an analysis of a sample from the Individual Private Water Supply e~ramination has been completed. Records in this office indicate this Individual Private Water Supply to be of'/~' ~Satlsfactory Questionable Unsatidactory sanitav/status. A-~!ysis shows tb~s SAMPLB to be ~/' .%dsfactoty Questionable Unsatisfactory. If an "tJnsatisfactoty" or "Questionable" status is indicated above, you should take immediate action as recommended below. 1. Boil or chemically treat you~ water supply to protect your family from water-borne diseases as outlined in en- ~ leaflet, '~l~ink It Pure." 2. Improve your spring--See bulletin HSB-6-2 3. Improve your cistern--See bulletin HSB-6-3 4. Improve your dug well- See bulletin HSE-6-4 5. Improve your driven well--See bulletin HSE-6-5 6. Improve your drilled well--See bulletin HSF.-6-6 7. Relocate your well to a safe location in relationship to your sewage disposal system--See bulletin HSE-15 8. Bottle broken in transit, please send new sample. 9. Sample too long in transit; sample should not be over 48 hours old at examination to indicate zeliable x~aulta. Please send new sample. 10. Contact your neaxest [] Local Health Department or [] Alaska Health Department, Sanitation office for bulletins, consultation, and assistance. 11. This is a surface water source and subject to pollution by man and animals. An approved water supply source should be developed. SANIT~'S RBMARKS. ADH~HgE-6-FI This Form Mu~t Be Filled Out Completely. WAKE WATER SAMPLE Laboratory, 945 Sixth Ave. Monday, Tuesday, Wednesday A/ASWA DEPARTMENT OF na;LLTH Section of Sanitation and Engineerlnw INDIVIDUAL'~VA,':rER SUPPLY Sheet fOr Sample Colleetion .~!~ ~, , .~ Request for Bacteriological Analysis t b. No ................... -49-7-- .......... (~ame of ~n ~H~ng ~mple) (Date) (T~e) Water ~mple coH~d from ~ ~hen tap; ~ B~thr~m ~p; ~ B~ement ~p; Addr~ praise wh~re ~ce ~ l~a~d ......................... [ ..... {. .............................. ~~ .............................................................. mfl report; to (Mm) ~~ ~ 4d.~{. .... .... (~'~e) ................................. (Box No. or street ~'~'~'{"~0_ _. ~' (Clty~ Please place an "X" ~ ~e box before t~ms w~ch b~t desc~e ~ water supply: ~E: Well -- ~ Dug, ~ D~ven, ~ D~, ~ Bo ed ~ ~- ~ Sp~g, ~ C~tem, ~ Other (Hst) ............. ,~ .............................................................................................. = ............ .................................................................................... DU~ ~LL ~tal, ~ or OR C~TERN CON~UOTION: Walls -- ~ Wood, ~ Concret~ ~ ~e, Brick Concrete Block ~tal, Top -- ~ W~d, ~ Ooncretd,~ ~ ~en Top ~CA~ON: ~ In basement, ~ B~ement offset, ~ Under no~e, ~In O~er ......................................................................................... .= ...................................................................................... D~T~CE ~: Bmldmg sewer or other d~tnage pt~..~.......feet, Septic rank ~ ..... feet, ~le field .............. feet, ~eepage pit ./~.~...feet, Ce~ol .............. feet, ~t~ ......... ~ .... feet. O~er ~sible so~c~ of con,ruination (l~t) ........ ' ..................................................................................................................................... ~~: Bufld~g ,wet -- ~ Cast ~, pTood, = Tile, ~ ~bre pipe, = ~bestos cement 5o~t aate~a -- ~pe ....... ~.~ ........... : ........................................................ :- .................................................... GE~ ~R~ON: Does ~ter become muddy or discolored{ ~ yes, ~ no ~en? ............................................ .~. ......................................................... ?~ ....... ,; ............................... Diame~r of well ................... ~ ............................. depth .............. ~....~ ......................... We~ c~g mate~al....~~ ................. ~ameter....~ ............ p .................................. Le~ of ~op pi~ ......................... ~.~ ............................................................................................ Water depth from ~t~m ............................................................................................................ ~ ~ ut~ty r~m, ~ On top of we~~~ ~ Other (~t) ........................................................................................................ .P'~SE DRAW A S~H ~ ~ SPACE B~W. ~ SK~CH~HO~D SH~ ~CA~ON OF HOUSE, WA~ S~PLY SO,CE, S~~_~, D~ L~S OR O~ SOURCES OF ~~ON ~ D~T~ L~E~N WA~ SUPP~~ ~ ~_~ ~ ~ ~A~' MUST ~ SUB~~ ~ CO~~ PRO~ED BY ~ ~S~ D~~ OF ^D.. Hs~ - .~_~o."s - ~...~ ALASKA DEPARTMENT' OF H7 SANITARY INSPECTION Name of Manager Sir' An inspection or your plant h~ this day ~en made, and you are notified~ (X) 5n column marked with (U). The defe=s not~ shoed be corr~ed~ , ,. 2. Building 3. Ventilation '~ H~ting 5. Lighting 6. Plant ~yout 7. Rodent Control 8. Inse~ 9. Water Supply 11. Refuse Disposal 12. Toilet Facilities 13. Hand-washing facilities 1~. Equipment 15. Construction C, eans ng 17. Sterilization ~8. S~o~age. 19. Handling 20. Refrigeration 21. Wholesomeness of f~d and drink 22. 'Storage, Display 23. Personnel, Cle~iness 24. ~mmunicable disease control 25. ~ling 26. Adulteration 27. Misbranding 28. Premises Clean REMARKS: HEALTH DEPARTMI~NT