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Home My WebLink AboutPALOS VERDES BLK 2 LT 3 DA~'~R EC EI'~ E'D "' INSPECTION APPOINTMENTS TIME TIME T"--7'~~' TIME ~ / DATE DATE DATE/ / , INSPECTOR MUNICIPALITY OF AN~Mu~A~E MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~NVIRONMENTAL PROTECTION 82~ L Street - Anchorage, Alaska 99501 t 6 1981 E~VIRONMENTAL SANITATION DIVISIOB REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing, 1. PROPERTYOWNER [ PHONE MAJ~ING ADDRESS PROPERTY RESIDENT (If different from above) ~ 'ff PHONE 2. BUYER z ' ' ' PHONE ~A~UNG AD~S~ 3. LENDING INSTITUTION J PHONE MAI LING ADDRESS ' - f 4. REALTOR/AGENT ~ / J PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION / ' '/ 6. TYPE OF RESIDENCE ~ / ' ' -NUMBER oF~BEDROOMS [] One [] Four [~ SINGLE FAMILY ~.~ ~ Two [] Five [] MULTIPLE FAMILY ~ [] Three [] Six 7. WATER SUPPLY .~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] Other * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) Iq /~ l.'- YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/7~ THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY E~] ONE [] THREE [] FIVE [~ OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY ~_~ ,[-~;NDIVIDUAL DEPTH OF WELL [] COMMUNITY ! DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. sEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~]'INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER ~pticTank or ~Holding Tank Size:~ OL~ If Tank is homemade SOILS RATING give dimensions: ~ ~ ~,-~ TYPE OF TANK~ ,~ MANUFACTURER ~ ' , TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line ~ Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line ~ CO~DITIO~Ak A~BOVAk {letter must accomoang certificate} ~ DISAPPROVED DATE BY 72-010 (Rev. 6/79) CHEMICAL & GEOLOGICAL LABORATORIES t~,,'< ALASKA, INC.~ ~ · ' "~ TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 .B Street Drinking Water Analysis Report for Total Coliform Bacteria ~ TO BE COMPLETED BY WATER SUPPLIER Water System Name z Phone No, Mailing Address City State "Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref: no. ) [] Special Purpose [] Treated Water' [] Untreated Water SAMPLE NO. I 3 4 I LOCATION Time Collected Collected By TO BE CO MPLETED BY LABORATORY A..n_~.[ysis shows this Water SAMPLE to be: ~"Satisfactory [] Unsatisfactory [] Sample too long ntransit; sam~leshould not be over 48 hours old at examination [o r~dicate reliable results. Please send new sample. J Date Received /' Time Received " Analytical Method: [] Fermentation Tube r~' Membrane Filter Lab Ref. No. Result* Analyst I ~ I I *No. of colonies/100 mi. or NO. of Positive DOrbOnS. 06-1220 Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD READINSTRUCTIONS BEFORE COLLECTING SAMPLE Date Collected Source Time Received -- ).m. Lab. No. P~,esumot lye 3.0mi 1.0mi 10mi /0mi 10mi loOml 0.1mi 24 Hours 48 HOURS Confirmatory 48 Hours EMB Broth 24 hours: Broth 48 hours: Multiple Tube Report: 10mi Tubes Posltlve./'rotal 10mi Portlmts Membrane Filter: Direct Count Collform/100ml Verification: LTB BGB Final Membrane Filter Results Collform/100ml Eagle River Area GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "c" Street, Anchorage, Alaska 99503 274-4561 Date Received March 3, 1977 Time of Inspection Date of Inspection ~ INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. ]. Approval requested by: Alaska Bank of the North Mailing Address: Pouch 7-010, Caliais #2 2. Property Owner: Art Dittbrender Mai]in9 Address: Box 2260 palos Verdes Drive % Claudia Jones Phone: 279-4581 Phone: 694-9985 99577 Legal Description: Lot 13 Block 2 Palos Verdes Subdivision Location: Meadow Creek Drive Type of facility to be inspected Well Data: A. Type Co~m~unity C. Construction Single Family No. of bedrooms 3 7. Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: 8. Distances: A. Well to: Septic tank Nearest lot line B. Depth D. Bacterial Analysis Public Ut~ility B. Installer 1. Size 2. Manufacturer 1. Absorption Area 2. Material Total length of lines , Absorption area , Other contamination , Sewer Lines , Absorption area B. Foundation to septic tank C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Req~'t for Approval of Individual S r & Water Facilities L~e~al 'Description Lot 13 Block 2 Palos Verdes Subdivision Comments ~~ ~/~~ ~ ~~ ~zS ~_~__~ Approval Valid for one year from date signed Greater Anchorage Area 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 and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) 1. Type of Inspection: 2. Property Owner: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES /~UNICIPALITJ' OF ANCI IORJ',GE DEPT. O;~ I J:/,,l'l'i-i C< ENViRONMEkti-,,~,i. p~<o't I:CTION' CMRO VA FHA CONV .. Mailing Address: Phone ~--' ~ ~/ 5. N ameofRealtororAgent: ~r~ ~ / ~ ~~ ~, Legal Description: ~--~)? Location: Type of Facility to be inspected: ~' ~%"-~M.~,-~, No. Bdrms. ~ Water Supply ~}~/~~ Type of Supply: lic Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation LQ-037 (1/74)