HomeMy WebLinkAboutPALOS VERDES BLK 4 LT 10/4
~qUNICI'PALITY OF ANCHORAGF ~ ,~/1
Street, Anchorage, Alaska 99501 - ...
279-2511, ext. 224, 225 '-
Date Received: March 29, 1977
2nd Inspection: Time
Date ~/-'77 .~/'~.uZ~.
Date
Inspector
Inspector
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: United Bank Alaska % Debbie
Mailing Address: 645 G Street 99501 Phone: 276-1911 x 56
2. Property Owner: Frank/Janie Whiton Phone: 694-9651
Mailing Address; Box 121 Meadow Creek Drive 99577
Legal Description: Lo% 10 Block 4 Palos Verdes SUbdivision__
4. Single Family Residence: (~ Number of Bedrooms: 3
Multiple Family Residence: ( ) Number of Bedrooms:
Depth ~/~
Bacterial Analysis
Well Data: Type Public
Well Log Filed
Sewage Disposal System:
Permit ~ /F_~¥7
Septic Tank Size
Absorption Area
On-site system (') Public Utility
Installed '~/~ Installer ~/~ '
~ Manufacturer ~
~ Soils Rate -~ Material
Distances: Well to Septic Tank ~/~
to Sewer Lines -~ Nearest Lot Line
Absorption Area to Nearest Lot Line --~
to Absorption Area
~: · ~ .... '~'. , ~ [~ ~".::'~:: '~'D!epa:r'~men~'~:,bf;?He'a:lth and EnVironmental '~rotecti~°n '~.~ !
.'~ Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 10 Block 4 Palos Verdes Subdivision
comments:
Affadavit Attached:
Approved:
Disapproved:'
Letter Attached: (
Date:
Department Worksheet:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
-RECEIVED
1. Type of Inspection: CMRO VA
2. Property Owner: F
Mailing Address: ~-,~-~L-~ /~J~/q~ /~
3. Name of Buyer: ~_/b~/x~/
FHA_ CONY
Day Phone: ~/SZ' - ~'~'~/
Mailing Address: ,~/V,~,'-/~,~-¢-~'~/ /~/-~ -~-~¢,~'-¢~z Day Phone:
4. Name of Lending Institution: ~' ~ ~'~ ~lc~ ~,'
Mailing Address: ~¢~f~¢~. ~ Phone: ~
Mailing Address: ~ ~/~ ~ ~5~77 Phone: ~7~//~
6. Legal Description: ~ ~ ~/~ ~ Z~c,~d ~ ~ 4~._~- ~p ~5
Location: ~ ~'~"g~ ~, ~c~ ~~ ~/~-~
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
Public Utility z~' .Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System:
Public Utility
Individual (on-site)
If Individual, date of installation
72-003(3/76)
06-1220~} Rev. 1978
ALA~__?EPARTMENT OF HEALTH AND SOCIAL S~_~ES
DIVISION OF PUBLIC HEALTH ~Lob No.
INDIVIDUAL AND SEMI-PUBLIC
DATE BACTERIOLOGICAL :'WATER ANALYSIS o.,cE
: Analys~s shows this Water SAMPLE to be:
INDIVIDUAl.: ~] SEMI-PUBLIC [] ' CHLORINE RESIDUAL"PPM [] Satisfactory
REPORT RESULTS TO [] Unsatisfactory
- ?(- ..... .; , /, ~- /-: ./, ":i [] Questionable
i' . 'h Sample too long in transit; sample should not be over 45
....' '' l~ ~P I . ~'r ' ?' ,' ,?-.J ~, ,,~,'~[, i</ ,: ~.¢::, '~ _: ',~. : hours old at examination to indicate reliable results. Please
ADDRESS send new sample.
' r ' ' ' [] Bottle broken in transit, please send new sample.
CITY :' ~: / " .... ;- ~ '- ZIP CODE : '" ' ;~ ';
OF SOURCE ;- ' ,- ,," -:-' , ~, ~' ~ ' ' ':~.~ - .
,- ~ SANITARIAN'S. REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY "
DATE COLLECTED ~.. ~... ,, ' '~" TIME COLLECTED
Sample CoJJecled From [] Kilchen Tap ~ [] Bathroom Tap [] Basement Tap
[~ Other (List)
Well- [] Dug [] Driven /~ Drilled [] Bored
SOURCE: [] Spring [] Cistern [] Other
Dug Well or Cistern Construction:
Walls--[] Wood [] Concrete [] Metal [] Tile Brick
Top -- [] Wood [] Concrete [] Metal [] Open Top [] Concrete:',:
LOCATION:
[] In Basement [] Basement Offset [] Under House
[lin Ygrd [] Other
Bud ng Sewer: ~ Septic
Tank F~et.
D~STANCE TO: or Other Drainage Pipe Feet.
Tile Seepage Cess-
Field Feet. Pit Feet. Pool Feet. Privy Feet.
Olher Possible
MATERIAL: Building Sewer- [] Cast Iron [] Wood [] Tile [~ Fibre [] Asbestos
[] Plastic Joint Material - Type
GENERAL: Does Water Become Muddy or Discolored? [] Yes [] J',l~o
When? __
Diameter of Well Depth
Well Casing
Material Diameter Depth
Length of Water Depth
Drop Pipe From Bottom
Offset in
PUMP LOCATION: [] In Well [] Basement [] In Basement
On Top
~ Of Well [] Other
Feet.
In Utility
[] Room
PURPOSE OF EXAMINATION: Illness Suspected?
New Source of Supply? [] Yes [] No
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
[] Yes [] No '=~
Repairs 'to System? [] Yes []':No Signature
06-]2~o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973
- 1Otc 1acc lOcc lOcc 1Otc 1.0cc 1.0cc
Lactose Broth
24 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 ~
This analysis triplicates Coliform Organisms to be:. Absent/"-%
DIRECTIONS FOR COLLECTING SAMPLES OF WATER FOR BACTERIOLOGICAL EXAMINATION
Read Carefully and Follow Instructions Exactly
Bear in mind that water 'analysis 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 torch 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 thelower 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) Pack 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 A~E DIFFICULT TO DISINFECT PROPERLY.
STERILE WATER SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST FROM:
Dept. of Health & Social Services Dept. of Health & Socia! Services Dept. of Health & Social Services
Southeastern Regional Sanitarian SouthcentraJ Regional Sanitarian Northern Reglonal Sanitarian
Pouch J 338 Denall Street, MacKay BIrig. 604 Barneite Street
Juneau, Alaska 99801 Anchorage, Alaska 99501 Fairbanks, Alaska 99701
Or District Offices in Fairbanks, Juneau, Ketchikan, Kodlak~ Nome, Palmer, Soldotna and Valriez. Consult local telephone directory for
sanltatlon offices Iocateri in these communities. Anchorage area--contact Greater Anchorage Area Borough Department of Environ-
mental Quality.