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Home My WebLink AboutPALOS VERDES BLK 1 LT 13iSIo k. / REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality Anchorage, Alaska 99503 274-4561 Date Received July 30, 1976 Time of Inspection 10:30 a.m. 8-2-76 Monday Neale voa. l. Approval ·requested by: First National Bank of Anchorage e Mailing Address: Post Office Box 720 Property 0wner: Jerry W. Spence' Phone: Phone: 694-9151 Mailing Address: Post Office Box 756 3. Legal DescriPtion: Lot 13 Block 1 Palos Verde Subdivision 4. Location: 213 Meadow Creek Street 5. Type of facility to be inspected 6. Well Data: Individual A. Type C. Construction Sewage Disposal System: A. Installed C. Septic Tank: 1. D. Seepage Pit: 1. Single Family No. of bedrooms Size Absorption Area B. Depth 176' D. Bacterial Analysis Public Utility B. Instal ]er 2. Manufacturer 21 Material E. Disposal Field: Distances: .~·: . A. Well to: Septic tank Nearest lot line B. Foundation to septic tank Total length of lines , Absorption area , Other contamination , Absorption area , Sewer Lines C. Absorption area to nearest lot line EQL034 (1/74) Page 1 of two pages Page 2 of two pages - Re, st for Approval of Individual ,'~er & Water Facilities L~gal Description Lot 13 Block 1 Palos Verde Subdivision Comments Approved Date , u / Approval Valid for one year from date signed Greater Anchorage Ar~a Borough. Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this reauest for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) DATE INDIVIDUAL NAME ADDRESS CITY ADDRESS OF SOUP. CE 'ALASi~'DEPARTMENT OF HEALTH AND SOCIAL SE[."' :ES ~ '"' DIVISION OF PUBLIC HEALTH ~"'~ Lab, INDIVIDUAL AND SEMI'PUBLIC BACTERIOLOGICAL: WATER ANALYSIS SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO ~.j : .:,.,; ,, ,-~ ::'~ , :. :~_ ..... ' . i:' · . ZIP CODE COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY . ; . , DATE COLLECTED / ~. TIME COLLECTED Sample Collected From ,~ Kitchen Tap [] Bathroom Tap [] Basement 'rap [] Other (List) Well -- [] Dug [] Driven [] Drilled [] Bored SOURCE: [] Spring [] Cistern [] Other_ Dug Well or Cistern Construction: Walls--I~ Wood [] Concrete [] Metal [] Tile Brick or Top -- [] Wood [] Concrete [] Metal [] Open Top [] Concrete LOCATION: [] In Basement [] Basement Offset [] Under House []in Yard [] Other ' Building Sewer Septic Tanlr Feet. DISTANCE TO: or Other Drainage Pipe _Feet. Tile Seepage Cess- Field peet. Pit- Feet. Pool -- Feet. Privy I~&e~: Other Possible Sources of Contamination MATERIAL: Building Sewer- [] Cast Iron [] Wood [] Tile [] Plastic Jo~nt Materlal - Type GENERAL: Does Water Become Muddy or Discolored? When? [] Fibre [] Asbestos Cement [] Yes [] No Diameter of Well Depth Feet. Well Casing ' Material Diameter Depth Length of Water Depth From Bottom Feet. Drop Pipe Offset in In Utilily PUMP LOCATION: [] In Well [] Basement [] In Basement [] Room On Top [] Of Well [] Other OFFICE Analysis shows this Water SAMPLE to be: I~1 Satisfactory [] Unsatisfactory [] Questionable [] Sample too long in transit; sample should not be over 48 hours old at exam:nation to ~nd~cate reliable results. Please send pew sample. [] Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS PURPOSE OF EXAMINATION: Illness Suspected? [] Yes New Source of Supply? [] Yes [] No Repairs to System? READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE [] No [] Yes [] No S~gnature 06-1220 (b) B~(~TERIOLOGICAL WATER ANALYSIS RECORD Date Received /r"~(' L~ :~ Time Received Lactose Broth : 10cc 10cc 10cc 10cc 10c¢ 1,0c¢ 1.0cc 24 Hours Brilliant Green 24 Hours 48 Hours Lactose Broth, 24 hrs. 48 hrs. Groin's stain . : Coliform Density - (Most probable No. per lb0cc) ' "k MF Results · ~" ,~'~? ...... Date , This analysis indicates Coliform Organisms t0 be: .Absent "~ Present DIRECTIONS FOR COLLECTING SAMPLES OF WATER FOR BACTERIOLOGICAL EXAMINATION Read Carefully and Follow Instructions Exactly Beat' in mincl that water anaJysls deals with materials present in very minute quantities. The least care- lessness in collecting and handling may give rise to results which are misleading. Samples are accepted at the regional laboratories in the early part of the week (Monday-Wednesday) unless there is an emergency or prior arrangements have been made. Arrangements should be made to have the water samples reach the laboratory as quickly as possible and within 48 hours after collection. After 48 hours, the significance of the bacteriological analysis is impaired. In collecting samples from TAPS or PUMPS proceed as follows: (a) Thoroughly flush tap or pump by allowing water to run freely for five minutes. (b) Shut off water and flame the outlet with tm'ch or burning paper. The flame should not be merely passed over the outlet but should be applied until fixture shows indication of being hot. Flame should be directed against inside edge. (c) Open fixture so that a small stream flows. (d) Remove bottle from mailing tube. Hold bottle by the lower half in one hand and with the other remove the screw cap with the fingers, leaving foil protecting cover in place. Fill the bottle to the shoulder. Replace cap with foil cover, screwing firmly into place but do not apply pres- sure which will split cap. (e) Pock bottle carefully in mailing tube enclosing this completed information sheet. DO NOT COLLECT SAMPLES FROM FIRE HYDRANTS, YARD HYDRANTS, DRINKING FOUNTAINS OR SIMILAR OUTLETS WHICH ARE DIFFICULT TO DISINFECT PROPERLY. STERILE WATER SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST FROM: Dept. of Heallh & Social Services Southeastern Regional Sanitarian Pouch J Juneau, Alaska 99801 Dept. of Health & Social Services SouthcenlraJ Regional Son',ration 338 DenalJ Street, MacKay Bldg, Anchorage, Alaska 9950~ Dept. of Health & Social Services Northern Regional Sanitarian 604 Barnette Street FaJrbanks, Alaska 99701 Or Dislrkt Offices il~ Fairbanks, Juneau, Ketchikan, Kodiak, Nome, P,~lmer, Sold0tna and Valdez, Consult local telephone directory for sanitation offices Iocaled in these comrnunit|es, Anchorage area~cdntact Greater Anchorage Area Borough Department of Environ- mental Qucdffy, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1. Type of Inspection: 2. Property Owner: 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES CMRO VA J .FHA Mailing Address: '.-~,O ,"~ D X. 7 ~'~-'~--~ Day Phone: 3. Name of Buyer: ..3o~ Mailing Address: 4. Name of Lending Institution: CONV. Mailing Address: Phone: 5. Name of Realtor or Agent: Mailing Address: Legal Description: ~.}~/ ~0~- //3 Location: c:>~/3 /"~e_~L("~/:)~) ~,~. ~ Phone: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Public Utility ~ If Individual, number of dwellings presently served If Individual, depth of well J~--'~ /L--'"~', No. Bdrms. ,Individual Sewage Disposal System Type of System: Public Utility Individual (on-site). If Individual, date of installation 72-003(3/76)