HomeMy WebLinkAboutAL CROSS BLK 2 LT 11
06-1220(a) ~ev. 1973.
DATE
ALA DEPARTMENT OF HEALTH AND SOCIAL SL CES
DIVISION OF PUBLIC HEALTH
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
Lab No.
OFFICE
INDIVIDUAL []
NAME
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
ADDRESS
CITY
ZIP CODE
ADDRESS
OF SOURCE
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] 'Unsatisfactory
[] Questionable
[] Sample too long in transit; sample should not be over 48
hours old at examination to indicate reliable results. Please
send new sample.
[] Bottle broken in transit, please send new sample.
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED
Sample Collected From [] Kitchen Tap
[] Other (List)
Well- [] Dug ~]] Driven [] Drilled
SOURCE: [] Spring [] Cistern [] Other
Dug Well or Cistern Construction:
Walls--[] Wood [] Concrete [] Metal
Top -- [] Wood [] Concrete [] Metal
LOCATION:
[] In Basement [] Basement Offset
[]In Yard [] Other
Building Sewer
DISTANCE TO: or Other Drainage Pipe_
Tile Seepage Cess-
Field Feet. Pit .--Feet. Pool-
Other Possible
Sources of Contamination
MATERIAL: Building Sewer- [] Cast Iran [] Wood [] Tile
[] Plastic Joint Material - Type
GENERAL: Does Water Become Muddy or Discolored?
When?
Diameter of Well
Well Casing
Material Diameter
Length of
Drop Pipe
Offset in
PUMP LOCATION: [] In Well [] Basement
On Top
[] Of Well [] Other
PURPOSE OF EXAMINATION: Illness Suspected?
New Source of Supply? [] Yes
TIME COLLECTED
[] Bathroom Tap
READ INSTRUCTIONS
[] Basement Tap
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
[] Bored
[] Tile Brick or
[] Open Top ~ Concrete
[] Under House
Septic
_Feet. Tank Feet,
Feet. Privy .__Feet.
[] Fibre [] Asbestos
Cement
[] ~'es [] No
Depth Feet.
Depth .
Water Depth
From Bottom Feet,
In Utility
[] In Basement [] Room
[] Yes [] No
[] No Repairs to System? [] Yes [] No Signature
o6-12')o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973
am
Date Received Time Received pm Lab. No.
Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc
24 Hours
48 Hours
Brilliant Green
24 Hours
48 Hours
EMB AGAR
Lactose Broth, 24 hrs. 48 hrs Gram's slain
Coliform Density (Most probable No. per 100cc)
MF Results
Reported by
This analysis indicates Coliform Organisms to be:
Date
Absent
Present
l~ovember 3, 1977 /
L.T. Kelley ~
700 ~ Street ~
Suite 4 ~
Anchorage
Su~ivision
S~j~t:~s ~1 a~ 12 ~look 2 Ai~Cros, ~
Dear ~. Kel~
Analysis of the second water sample taken on October 14, 1977
indicated severe contamination, probably as a result of a
borken sanitary seal and a short well casing. The lab re~ort
number is 8607.
The water sample results taken after the well upgrade on
October 24, 1977 has been misplaced. Resampling of the
water is advised.
If there are any further questions, please contact this office
at 264-4720.
Sincerely,
Lynn J. Bringle
Principal Code Enformement Officer
L~k~/lJ h
CC:
John Delaney
% Anchorage Police Department
Traffic Section
625 C Street
Anchorage, Alaska 99501
Anchorage
ANC!'i '~" r'
t90~) 279 75!1
October 4, 1977
John Delaney
%.Anchorage Police Department
Traffic Section
625 C Street
Anchorage, Alaska 99501
Subject: Lots 11 and 12 Block 2 A1 Cross Subdivision
Dear Mr. Delaney: ~
Analysis of the water sample taken on September 20, 1977
indicates sever contamination. The water must not be
used for drinking and cooking until the well is disinfected
according to the attached instructions and a resample shows
a satisfactory analysis.
We have informed your tenants, Mrs. Tena Allen, of the
above.
The well serving the property is improperly constructed,
and has failed to meet the Municipality required standards.
It must be upended with a minimum casing of twelve(12) inches
above the ground surface and closed with a sanitary seal of
a type approved by this department. The present seal is broken.
Under a separate cover, I have sent you a copy of the laboratory
results.
I,will be making a second inspection of ~hursday, October 6, 1977
to resample the chlorinated well and check the well construction.
If there are any further questions, please don't hesitate to
contact this office at 264-4768.°
Sincerely,
Lynn Bringle
Principal Code Enforcement Officer
LB/ljh
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P.O., STATE AND ZIP CODE
POSTMARK
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RETURN I~ I. S~o~d~v-~-d ........... 15¢
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~E~EL~ ~o fH re'uiredl
PS Form
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(See other side)
06i22C 'ii BACTERIOLOGICAL WA~-ER ANALYSIS RECORD
Date Received ___'~_
Lactose Broth
24 Hours
48 Hours
Brilliant Green
24 Hours
48 Hours
EMB
Lactose Broth, 24 hrs.
ColiForm Density
MF Results
Reported by __~"~
This anaiysis indicates ColiForm Organlsms to be:
Absent
19
Tuesday
April
1977
0:30
lO:O0
10:3o
11:oo
12:00 ~~~~_
4:00
4:30
5:00
109/256 4/19/77