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Home My WebLink AboutBELLA VISTA #1 LT 13C GAAB-HD-2 Case No. ~ GREATEk ANCHORAGE AREA ~ ~)ROUGH HEALTH DEPARTMENT 327 Eagle S~. -.~' Anchorage, Alaska 99501 279-2511 SEWAGE. DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS THIS IS TO SERVE AS DISTANCES: LOCATION OF INSTAL.'LATION SEEPAGE PIT / .~DRAIN FIELD '?lea ~ ~ P' ~'/~ ,OTHER TO BE INSTALLED By' ~ ~ '/~NTICIPATED DATE OF COMPLETION BELOW :TO B~ILL'ED OUT BY HEALTH ~EPARTMENT 4_~) - ,P~RMIT TO INSTALL A AS OESCRIBEB BELOW. SIzEOF'uNIT TO BE SERVEB '"-'"'- TYPE, SEEPAGE AREA "~00 " DIAGRAM OF SYSTEM · SEPTIC TANK SIZE lealth Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE 527 EAGLE STREET ANCHORAGE, ALASKA 99501 279-2511 RECEIVED / .- / ~/ - p.~A2- INSPECT: / - / ~ - VT TINE: / ,'~' ~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES FOR Address__ /~gO Phone o277-73/,/,,,, 2- 2. Property O~r ~r~a 3. Legal Description T~e of Facility/to be Inspected ~t ,~O~ Number of Bedrooms ~-l~ Well Data: A. B. C. D. E. Phone 5%iq -; ~?Oq ....... Depth /~/~ / Bacterial Analysis Sewage Disposal ~. Septic Tank (If ho~emade~ sho~ dSagram on back) 1. Size 2. Age 3. Manufacturer 4. Installer Approval Request for Sew Page Two ~ ~ater Facilities B. Seepage Pit 1. Size 2. Lining C .... Disposal Field 1. Number of Lines 2. Total Length 7. Required Measurements A. Well to Septic Tank B...Well to Seepage Pit C. Well to Sewer Line //~ D. Well to Property Line E. ~ell to Other Possible Contamination F. Foundation to Septic Tank G. Foundation to Seepage Pit H. Seepage Pit to Property Line ,A..PPROVAL VALID FOR ONE YEAR FROId DATE SIGNED GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT EDll70 ADHW - LAB - 2w DATE STATE OF ALASKA '~ARTMENT OF HEALTH AND WE' ~RE DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS Lab. No. OFFICE PUBLIC SEMI-PUBLIC I'~ INDIVIDUAL l~ REPORT RESULTS TO' NAME ADDRESS OTHER CiTY ADDRESS Of SOURCE SAMPLE COLLECTED BY DATE COLLECTED Sample Collected From [] Other (List) [] Kitchen Tap TIME COLLECTED ~1~~ ~ ~1~ -~'7 ~' Bathroom Tap [] Basement Top Well- [] Dug [] Driven I~ Drilled [] Bored SOURCE: [] Spring [] Cistern [] Other Dug Well or Cistern Construction: Brick or Wails- [~ Wood [] Concrete [] Metal [] Tile [] Concrete Top - [] Wood [] Concrete [] Metal [] Open Top LOCATION: [] In Basement [] Basement Offset [] Under House [] In Yard [] Other Building Sewer Septic DISTANCE TO: or Other Drainage Pipe Feet. Tank Feet, Tile Seepage Cass- Field Feet. Pit Feet. Pool Feet. Privy Fe~, Other Passible Sources of Contamination Asbestos MATERIAL: Building Sewer- [] Cast [] Wood [] Tile [] Fibre ['~ Cement Iron [.] Plastic Joint Material -- Type Records in this office indicate this WATER SUPPLY to be of: -1 Satisfactory [] Questionable [] Unsatisfactory Sanitary Status. Analysis shows this Water SAMPLE to be: [] Satisfactory [] Questionable [] Unsatisfactory. Il an "Unsatisfactory" or "Questionable" status is indicated above you should take immediate action as recommended below. ~ I. Notify consumers water is polluted: Boil or chemically treat this water as outlined in the enclosed leaflet "Drink It Pure." __.2. Increase chlorination sufficiently to meal recommended residual standards. Determine source of contamination and take action necessary to maintain a safe water supply at atl.tlmes. 3. Check chlori~atinn and other mechanical equipment. Make certain it is functioning properly. 4. If alter checking equipment a disinfecting residual is not obtained, please wire this office for emergency assistance or advisory services. S. This is a surface water source and subject to pollution by man and animals. An approved water supply source should be developed. 6. Improve your [] spring [] dug well [] driven well [] drilled well [] cistern. 7. Relocate your well to a safe location in relationship to your sewage disposal system. [] see enclosure 8. Sample too long in transit; sample should not be over 48 hours old at examinalion to indicate reliable results, please send new sample. [_~ Bottle Broken in transit, please send new sample. 9. Contact your nearest [] Local Health Department or [] Alaska Division of Public Health, sanitation office for bulletins, consultation and assistance. GENERAL: Does Water Become Muddy or Discolored? [] Yes When? [] No Diameter of Well. Depth Feet. well Casing 'Material Diameter Depth Length of Water Depth Drop Pipe From Bottom Feet. In Utility PUMP LOCATION: [] In Well [] Offset In [] In Basement [] Room Basement On Top [] Of Well [] Other PURPOSE OF EXAMINATION: illness Suspected? [] Yes [] No New Source of Supply? [] Yes [] No Repairs to System? [] Yes [] No SANITARIAN'S REMARKS Signature READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD om Date Received JAN ! -~ 197_ t~m. Received pm Lab. No. Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 0.1cc 24 hours 48 hours Brilliant Green 24 hours 48 hours EMB AGAR Lactose Broth, 24 hrs. 48 hrs.. Gram's stain Coliform Density (Most probable No. per 100cc.) MF results Reported by This analysis indicates Coliform Organisms to be: am Date pm Absent Present ~a~u~y 2~, 1972 ~.!r, Palter lg£7 E. ~imond Boulever~l Anciiorm.~r.. Alaska This f~ei:artr,~nt was unable t(; ir,~sF~ct ti~". w(:I1 or'~ th{'. Sul>'~Ct lot. lye can therefore neither ar~rov;~ nor disa~,rov~'~ t~c ~.~(.er S.yste~. If you ~av.~:~ any ,~u(~stlons ~:!o not ~csitat~ t~:; contact this of~ic~.~, St ncer~ly, Lynn S, E~vi ronmen &~l Speci~lts~; cc.' Civ~llan ~tltt~r¥ l~eferr~ Office r,J~)ruary 7, lg72 ~,'~r. ~alte. r Stephen ~,~7 £ ~;i,,'~nd ~oulevard J~,nc~orage, Alaska 995(12 Subject: Lot l~, Bella Vista Subd(vtston,~l. ~'>ea.r !r. Stephen: An ii~s~,ection of the ~ell at the subject property revealed that the ~.~ell anc'~ nressure tank vmr¢ l~ated in a pit, Before this De~)art~nt's ca~ he c~tven for tJ~c .~,ater syst~J, the pressure, tan~ and oth~'r relational equtp,~)ent ~ill need to b(~ relocated a~-ove ground or in the apartr~eF~t inC. .Also, ti~e ~<(:ll casing v,tll need to ,he extendr, d above ground, the well eauipped ~-,iti:.. a pttless a~apt~r and the v'ell pit fill~d in ~'tth dirt. Sinco'. the ~,ell is :)reseP, tly a~ artesian ~'¢ll, you n~a.v r,,eed to nrovide a sr~all ~,-ull house a~und ti~e casinQ. If you i~ave any questions regarding the above, please do not hesitate tm contmct this office-. Sincerely L.¥nr~ S. Coad E)~vt to,mental Special tst st cc: Civilian i.;ilttary Referral Office '~ game .of person requesting approval 2. ~,~an~q of prope~tyjowner , , . ~, ,.,, _ ~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in~ Tmiplicate) Numbe~,.:.of J)e~rooms in house , ,~_,; ~,. ,~ Water,.Anals~is: ~ ~ a. Bacterial . b. DetePgen~ " . We 11 dar a: a. Type . / · c. Casing Size /~; ~ d. Distance from well to closest existing or proposed: i. S,we~ line, f~.~ Z~_. · 3. Seepaf. e Area ~t,~. t~/'/~~ ~4, Cesspool.~~~._., p ! 5. roperty Line ~ . Other sources of Possible contamination, i.e., creeks, lakes, houses, barn, drainaEe ditch, etc. --~. Sewage disposal system. '~~ b. Septic tank capacity in gallons c. Name of septic tank manufactum~.P . 1. If "home made" show dia~Pam on reverse side of this fo~m. d.' Disposal field ore__seepage pit size and type ./~/,~ /~ /~~ 1. Distance to~prope~y line ~ ~ / - , , to house foundation, ~ ~ / Percolatio~Te'st'results f. Percolation Test performed by,, , ................. _ .... . Use the reverse ,side of this form to show diafram. Diagram should include ~..%he foil,owing information: p.~operty lines; .well location, house location, P~pt~C tank location~ disposal area location, location of percolation test~ and~ direction of ground slope. The l~,fox~t,ion on ~his form is true and correct to the best of my knowledge, S!gnature of Applicant ba~e Si~n'~d TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL above described sanitary facilities are hereby approved~ subject to the Conditions: y~~-sub ject to __ ]Q7D when ~y~ilable. connection to ~anitary ~wer$ ,spring ,, The above described sanitary facilities are disapproved for the following reasons t · , Approval is valid for one year following the date of approval. CPJ: cw ADHW - LAB - 2W DATE STATE OF ALASKA r' '~ARTMENT OF HEALTH AND WEs '~.RE DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS Lab. No. oPhc~ PUBLIC E~ SEMI'PUBLIC E3 INDIVIDUAL {---] OTHER REPORT RESULTS TO ADDRESS : CITY · ADDRESS Of SOURCE SAMPLE COLLECTED BY. DATE COLLECTED ~ ~ ~ ~: ~-' . ,' ~' TIME COLLECTED Sample Collected From ~ ~her (List] Well. [] Dug J'-] Driven .~] Drilled [] Bored SOURCE: [] Spring [] Cistern [] Other Dug Well or Cistern Construction: Brick or Walls- ['~ Wood [] Concrete [] Metal [] Tile [] Concrete Top - [] Wood [] Concrete [] Metal [] Open Top LOCATION: [] In Basement I'-I Basement Ogees [] Under House [] In Yard [] Other Building Sewer Septic DISTANCE TO: or Other Drainage Pipe Feet, Tank Feet. Tile Sp~tepage Cass- Field Feet. Feet. Pool Feet, Privy Feet Other Possible Sources of Contamination Asbesto~ MATERIAL: Building Sewer - [] Castlron [] Wood [] Tile [] Fibre [] Cement [.] Plastic Joint Material - Type GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No When? Diameter of Well _ Depth Feet. Well Casing Material Diameter Depth Length of Water Depth Drop Pipe From Bottom Feet, In Utility PUMP LOCATION: [] In Well []BasementOffset In [] In Basement [] Roam On Top [] Of Well [] Other PURPOSE OF:EXAMINATION: Illness Suspected? [] Yes [] No New Source of Supply? [] Yes [] No Repairs to System? [] Yes [] No Records in this office indicate this WATER SUPPLY to be of: [] Satisfactory [] Questionable [] Unsatisfactory Sanitary Status. ,~,'nalysis shows this Water SAMPLE to be: Satisfactory [] Questionable [] Unsatisfactory. If an "Unsatisfactory" or "Questionable" status is indicated above you should take immedlota action as recommended below. I. Notify consumers water is polluted. Boil or chemically treat this water as outlined in the enclosed leaflet "Drink It Pure." 2, Increase chlorination sufficiently to meet recommended residual standards. Determine source of contamination and take action necessary to maintain a safe water supply at all times. 3. Check chlori~atinn and other mechanical equipment. Make certain it is functioning properly. 4, If alter checking equipment a disinfecting residual is not obtained, please w~re this office for emergency assistance or advisory services. S. This is a surface water source and subject to pollution by man and animals. An approved water supply source should be developed. 6. Improve your [] spring [] dug well [] driven well [] drilled well [] cistern. 7. Relocate your well to a sale location in relationship to your sewage disposal system. [] see enclosure 8. Sample, too long in transit; sample should not be over 48 hours old at examination lo indicate reliable results, please send new sample. [] Bottle Broken in transit, please send new sample. 9. Contact your nearest [] Local Health Department or [] Alaska Division of Public Health, sanitation office for bulletins, consultation and assistance. SANITARIAN'S REMARKS Signature READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS~RECORD Date Received I .... ~ :'~ ' '~ '~' Time Received ' ' ' ' 'P~ Lob. No." Lactose Broth 1Otc tOcc lOcc 10cc lOcc 1.0cc 0.1cc 48 hours - Brilliant Green 24 hours 48 hours EMB n AGAR .... Lactose Broth, 24 hrs. ', ' 48 hrs. Gramme stain Coliform Density ;;'- '-~ ' ,~ ' (Most probable No. per 100cc.] MF results Reported by . This analysis indicates Coliform Organisms to be: am Date pm Absent Present