HomeMy WebLinkAboutBENTZEN BLK 1 LT 6
,,' MUNICIPALITY OF ANCHO~AGE
f~~ -'" DEPARTM~ OF HEALTH AND ENVIRONMEN . PROTECTION
[[~~ ~tl''h ~ 82.5 L Street, Anchorac, e. Alaska 99501
4: Single Family Residence: ~) Number of Bedrooms:
Multiple Family Residence: ( ) -Number of Bedrooms:
;' ~ 5. ~ell System: Individual well ~) Co--unity/Public System ( )
.~ Permit ~ Depth of Well ~ Well Log on File ( )
. Construction BacteriaI Analysis
6. Sewage Disposal Syst~: On-site System ( ) Public Utility
Permit 9 Installed Installer
, Septic Tank Size Manufacturer
' Absorption Area Soils Rate Material
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line ~ Nearest Lot line AbsorptiOn Area
-
to Nearest Lot Lln:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
Sewer and Water Section, Fourth Floor, 825 L Street,
Attention: Laura Harrison
1. Type of Inspection:
2. Property Owner:
Mailing Address:
ENVIRONMiNf/'~L I.;ROI'iE¢ :'lION
3. Name of Buyer:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
CMRO VA FHA
CONV XX
EUGENE O'NEAL~ JR. AND LORRAINE O'NEAL, husband and wife
2813 Aspen Drive., Anch., 99503
Home 279-1755
Day Phone His Work 272-8255
BERNICE DAVIS
Mailing Address: n/a
Day Phone'
Name of Lending Institution: SPOKANE MORTGAGE CO.
Mailing Address: 3201 "C" Street, Suite 250, Anch.
Phone
277-0543
5. Name of Realtor or Agent: n/a
Mailing Address:
Phone
Legal Description:
Location:
Lot 6, of the plat of Block 1, Bentzen Subdivision
2813 Aspen Drive, Anchorage, Alaska
Single Family No. 8drms.
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply:
Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well 110'
Sewage Disposal System
Type of System: Public Utility XX
If Individual, date of installation
One
Individual (on-site)
EQ-O37 (1/74)
'b a ~e~ Two
Departmea~t of Health and Environmenhal Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description:
Comments: .... - .....
Affadavit Attached: ( Letter Attached
Disapproved: Date:
'Department Worksheet:
27'~t
Spenard Area Reference Map-P7
85
Y
97
December 13, 1977
Eugene O' Neil
2813 Aspen Drive
Anchorage, Alaska
99503
Subject: Lot 6 Blo~k I Bentzen Subdivision
The well on the subject lot is not accessible for inspection
by this department.
Before we may approve ~he request for approval, we will
nee~ to see the well so that we can determine if it is
constructed properly.
If the well is in a pit Led ther well casing is below
ground level, then you will need to fill in the pit
with impervious type soil and raise the casing above
ground level.
If there are any further questions, please contact ~lis
office at 264-4720.
Sincerely,
Robert C. Pratt, R.$.
Sanitarian
P,~/lJh
Spokane P~rtgage Corporation
3201 C Street, Suite 250 99503
RECEIPT FOR CERTIFIED MAIL--30~ (plus postage)
SENT TO
STREET AND NO.
OPTIONAL SERVICES FOR ADDITIONAL FEES
RETURN k~ 1. Shows to whom and date delivered ........... ~5~-'
With deHvery to addressee only ............ 65¢
RECEIPT 2. Shows to whom, dote and where delivered .. 35¢
SERVICES With delivery to addressee only ............ 85¢
DELIVEr-TO ADDRESSEE ONLY ...................................................... 50~
SPECIAL DELIVERY (extra fee required) ....................................
POSTMARK
OR DATE
PS Form
3800
Apr. 1971
NO INSURANCE COVERAGE PROVIDED-- (See other side)
NOT FOR INTERNATIONAL MAIL ~m?o, ~97~ o- ~-~
v-I
ADHW - LAB - 2W
DATE
STATE OF ~ALASKA·
D?'6,RTMENT OF HEALTH AND WE[r"~RE
DIVISION OF PUBLIC HEALTH
BACTERIOLOGICAL WATER-ANALYSIS
Lab, No.
O~FFI(~E
REPORT RESULTS TO
NAME ~'~ .?
ADDRESS ~'~' ~ ~ ~
CITY ~ '
ADDRESS / r '~- r --
SAMPLE COLLECTED BY '" : (/ J ~"
DATE COLLECTED \ ~? ' :. ~ ' ? h -TIME COLLECTED ~ t rC:
Sample Collected From ~[~ K tchen Tap r-i- Bathroom lap -.i--I Basement Tap
SOURCE: [] Spring [] Cistern [] Other
Dug Well"or Cistern Construction:
Walls - [] Wood [] Concrete [] Metal E} Ti'la [] BriCkconcreteOr-
Top - [] Wood [] Concrete [~ Metal [] Open Top
LOCATION: [] In Basement ~. Basement Offset [] U ~der House- -
[] In Yard [] Other
Buildi ~J Sewer Septic
DISTANCE TO: or Other Drainage Pipe ~r-- r--~ ~ Feet. -Tank , - . , ,,Feet,
Tile Seepage Pool Feet.' Priv~y ,; Feef~
Field I Feet. Pti F. eet. Cass- .
Other Possible
Sources al Contamination
MATERIAL: Building Sewer - [] Cast [] Wood [] Tile [] Fibre ~ []Cemenf.Asbest°s
Iron
[] Plastic Joint Material -- Type
GENERAL: Does V~titer Become Muddy or Discolored? [] Yes ~ No
When? -
Diameter ot Well Depth
Well Cosing
Material Diameter ~Depth
Length of Water Depth
Drop Pipe From Bottom
PUMP LOCATION: [] In Well [] Offset In [] Ir~ Basement
Basement.
On Top
[] Of Well ' [] Other
[] Yes [] No
PURPOSE OF EXAMINATION: Illness Suspected?
N;ew Source of"Supplv? [] Yes [] No Repairs to System? [] Yes [] NO
Feet,
Feet,
[] In Utility
Room
READ INSTRUCTIONS
ON
REVERSE SIDE.
BEFORE
COLLECTING SAMPLE
Records in this office indicate this WATER SUPPLY to be o1:
[] Satisfactory [] Questionable [] gnsatisJoclory Sanitary Status.
Signature
BACTERIOLOGICAL WATER ANALYSIS RECORD
pm Lab. No,
Date . ,, Time Rece've
Lactose Broth - 10cc -1-0cc ' 10cc 10cc I 0cc 1.0cc 0.1 cc
24 hours ' "
48 hours :
Brilliant Green -
24 hours - , ,
48 hours
EMB AGAR
%r 48 hrs. Gram's stain
Lactose Broth, 2~ hrs.
Densffv :- (Most probable No. per 100cc.)
Colilorm
MFresults ~.' , ' ,
Present
Analysis shows this Water SAMPLE to be:
[~ Satlstactory [] Questionable [] Unsatisfactory.
If an ?'Unsatisfactory" or "Questionable" status is indicated above
y~.U~should take immediate action as recommended beJOw, .
' -~1. Notify consumers wafe'r is polluted. Boll or chemically
treat this' Water~c~s"outlined ~in the enclosed leaflet
"Drink It P, ute."
' 2. Increase chlorination sufficiently to'meet recommended residual standards.
Determine source of confamlhatio~and:take action necessary to maintain
a safe water supply at al -! thes
' , , 3 Chec~ thlorinatian and other mechanical equipment, Make certain it is
fun~tic~ning properly. . ~ ~,
...4 If ~fjer ch'acklng equipment a:'~islnfect ng residual is not abra,ned, please
wlr~tthJs offi~'fo~ eme~'gency assJstOnce or ad~,isory services.
,, i 'iS. This Is a.surfa~e water saur¢~-aad'sub|~ct to palliation by man*~and animal~- · An approved water supply source should be deve~op'~d.
Improve your I-~ spring [] dug well [] driven well·
[] drilled well [] cistern,
- 7. Relocate your well to a safe location in relatlonship to your sewage
' disposal system. [] see enclosure
· 8 Sample too ~,ng n transit' .... sarape sboud not'be over 48 hour~s, old at
examination to indicate reliable results, please send new sample. ;
[] I~ottle Broken in transit, please ~end new sample,
nearest [] Local Health Department or [] Alaskc~
Division of Public Health, sanitation office for bulletins, consultation and
iANITARIAN'S REMARKS