HomeMy WebLinkAboutLot 056B
GREATER ANCHORAGE AREA BOROUGH
Depart~ .~nt of Environmental Quality
3330 "C" Street Anchorage, ~laska 99503 274-4561
~)~/" ~ ~/) / Date Received Auqust 30, 19'76_
~. l'3 T ~ ~ ~ ~.~ Time of Inspection 11:00 a,m.
~ ~ ',~ Date 0f Inspection 9-1-76 Wednesday
Assumption
]. Appr0va] requested by: % Area Realtors, Leslie Foley
Mailing Address:
Property Owner:
Mailing Address:
5437 Northern Lights Blvd.
Jack Cuttle
St&r'Route A Box 474C
Legal Description: Lot 568 Section 9 T12N R3W S.M.
Location:
Phone: 337-9424
Phone: 344-9716
8330 Spruce Street, house # on the house
Type of facility to be inspected
Well Data:
A. Type Individual
C. Construction
Single Family
No. of bedrooms
B. Depth 150'
D. Bacterial Analysis
7. Sewage Disposal System:
A. Installed
C. Septic Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field:
Distances:
A.~Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
8MK~XM~)~X~ Public utility
B. Instal]er
Size 2. Manufacturer
Absorption Area 2. Material
Total length of lines
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
3030
*:hHr'c''' [:OP, API)ROV/!,!- OF
IND~:VII)!.!?d. SE!,!LR ° Y/VI'ER FhC!i]T"-IE~$','i '
Type of ~nspect'ion:>e~O
f4ai'l'infl Add~'ess: Phone
Ntune of Re~]top or Age, ~,,
Type o'F Supp]y:
I'I: Individua'l ,
if In,:lividua'l, ¢!epth of wel'l
Sewage l)'isposa, i System
Type o? S~st;em: Public Ut-i]
'ky ..2-i.- Indiv'idua'l (on--s'i'i;e)
06-1220(a) Eev. 1973
DATE
AL/' DEPARTMENT OF HEALTH AND SOCIAL Si 'CES
DIVISION OF PUBLIC HEALTlt
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
Lab No.
OFFICE
INDIVIDUAL []
lAME
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
)DRESS
CITY
ZIP CODE
ADDRESS
OF SOURCE
Analysis shows this Water SAMPLE to be:
[] 5alJsfaclory
[] UnsafisJactory
~ Questionable
[~ Bample too long in transiU sample should not be over 48
hours old at examination to indicate relTabb results. Please
send new sample.
[] Boltle brokm~ in transit, please send new sample,
SANITARIAN~S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAl. SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED _
~] KJichen Tap [~ Bathroom Tap
Well- [] Dug [] Driven Fi Drilled [~ Bored
SOURCE: [~ Spring E] Cistern [~ OtEer ........
Dug Well or Cistern Constructiom
LOCATION:
Under House
[] Yes [] No
PURPOSE OF EXAMINATION~ Illness Suspected? [] Yes [] No
Now Source of Supply? [] Yes
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
o~-i~o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Locloso BrotE 1Oct 10cc 10cc 10cc 10cc 1.0cc 1.0cc
24 Hours
BrilHanl Green
24 Hours
48 Hours