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Home My WebLink AboutNORTON PARK #1 BLK 1 LT 1B,zll DEPARTMENT OF HEAL. H&E~I~IRONMENT ..... 825 L Street~-' A~chorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAOILITIE8 DIRECTIONS: Complete all parts on page 1. Incomplet~ requests will not be processed, Please allow ten {10) days for processing, Merrill Lynch Relocation Mgt. Inc. MAItlN~ ADDRESS Contact Real Estate Agent below PROPERTY RESIDENT flf different from above) PHONE 2. BUYER .... PHONE ~o~ ~et sold MAILING ADDRESS '"' L PHONE 4. BEALTOR/AGENT ~ 277-1553 Jack ~lte Company ..... Attn: Elliot Lawson MAILING ADDRESS 3201 C Street, Anchorage, AK 99503 §. [.EGALDESCRIPTION Lot lB, Block 1, Norton Park #1 STREET LOCATION Corner of Ellen and 121st (Northwest Corner) .... off; Klatt Road 6, TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY ?ATER S U PP~-Y- ~] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Other E~ Two [] Five 'i~ Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 3975. For wells drilled prior to that date, give well depth (attach log if available.) SEWAGE DISPOSAL SYSTEM **If individual/on-site, give installation date ~, ~'~ tl~ , [] . ff]D V DUAL/ON:SITE** If system is over two (2) years old an adequacy test is required ~, PUBLIC UTILITY by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72.010(3/78) (9L/~ '^~) 0 i, 0-~L · AB 3.LVCL aaAOlaaaVSlC] [] (a~.eo!~!~,Jao AuedLuo~oe :~sncu Ja]4al) -]VAOlaaav ]VNOI.LICINO0 [] SIAJOOiJQ.:J~] ~ BOq a3AOkldd¥~] $/N3V~IA]OO 'B BU?l :Jo-I :JsBJeau O~. e~V uoJldJosq¥ aU?l ~o-I ls~JeaN aU?lJeMaS ~aJ'g' ~ueJ. 6u!PlOH/O?,daS S3ONtt/$1C] ]~'I~J3$V~ VfUV NOI I d~tOSS¥ "IV/O.L 133 WfilJ. OV-II~N¥1AI )IN'VI :JO adA.L :SUO!SUBLU!p ONIIV~ S;'IlOS ~pBLU~LUOq SI ~IUB.L :H laBq-lV±SNI pa!j,[jaA uop. o@uuoo AJJ-II/R Ol-18rtd I-] O3'l-I¥.LSNI 3J.¥a 3.LIS- NO/'IVrlC] IAIQNI [] uaa~flN J. lU~Uaa IAIEIJ.$AS 'l'g'SOdSlQ 3E)¥'M3S '8 CI'~AlaO:I~ gOq pal~p9A uol:!.oauuoo ~.'lddriS kI3JVM '~ uaal/~nN ~lwuaa X18 [] JarlO:l [] OM/ [] A-111AIV-I a-lal±-IrilAI [] BaH_LO [] 3AI~ [] aB~H± [] aNO [] A~lV~Va a~gNIS [] suuoouaaa 40 uaau~nN 3ONBalS]~ JO adX_L '[ :SNOI£Oa kilO] HO.LO3dSN I ~JO/O3 dSN I HO±D3dSN_I a/b'O 3/va ::t.LVO_ S/Nq~.LNIOdd¥ NOI/DqdSNI C]aAlaO3Ia Bi'va CHEMICAL & G~JLOGICAL LABORATORIES ~,F ALASKA, INC.. TELEpHoNE {907}-279,4014 ANCHORAGE INDUSTRIAL CENTER /~,"--~~ Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I.D. NO. Water System Name Phone No. Mailing Address City State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine s~tmple with lab ref. no, [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. L 3 L I LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. I L Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAl_ WATER ANALYSIS RECORD Date Collected Source Time Received Lab. No. Multiple Tube Reporb Membrepe Fitter: Direct Count Verification: LTB Final Membrane Filter Results Repot tect By 24 Houri Confirmatory 24 Hours 48 H~ours Broth 24 houri: ,Broth 48 hour$~ 10mi Tubes Positive/Total 10mi Portions Collform/100ml Cotlform/100mi Date Timer a.m. 13.111. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received July 21, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1:30 p.m. 7=22-76 Thurs. Appr0v uested by: Fi___rs_t Nation_____al F__ede___ral Savings & Loan Mailing Add~ess: _ ___ __ Phone: Property Own~r~: /~..-fPerry & Shirley Cowles Phone: 344-8391 Mailing Address: Star Route A Box 178-C 99507 3. Legal Description: Lot lB Block 1 Norton Park Subdivision 4. Location: Corner of Ellen & 121 street, see map Partt 5. Type of facility to be inspected __Single Family 6. Individual B. Depth D. Bacteria] Analysis 7. Public Utility Well Data: A. Type C. Construction Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: 1. E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank B. Installer 1. Size 2. Manufacturer Absorption Area 2. Material Total length of lines , Absorption area , Other contamination C. Absorption area to nearest lot line No. of bedrooms 4 , Absorption area 67' , Sewer Lines EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re st for Approval of Individual ~ ~r & Water Facilities Legal Description Lot lB Block 1 Norton Park Subdivision Comments Approval Valid for one year from date signed Date 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) MUNICIPALITY OF ANCHORAGE -~ OF HEALTH AND ENVIRONMENTAL PROTECTION": DEPARTMENT 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA 2. Property Owner'.L~L //~ ~ ~,~//~d-? ~6 FHA CONY Phone: 5 Y'/'- & ¢ / 3. Name of Buyer: Mailing Address: Day Phone: Name of Lending lnstitution.'/~//~.~ / ~L~.~./'~/~/ ~'~L~ f~ Mailing Address:/~'~/~J -~/~'~;kl~'X ,'}~t/~ ~'~¢~-Phone: 5. Name of Realtor or Agent: X~]~/~ ~'/~ Mailing Add ress'...~2~/ 6. Legal Descri pt ion:/'~//~A?"/z~ If Location: Type of Facility to be Inspected: Water Supply Type of Supply: //~/~// Public Utility If Individual, number of dwellings presently served If Individual, depth of well No. Bdrms. /7/ / Individual Sewage Disposal System Type of System: Public Utility Individual (on-site). If Individual, date of installation 72-003(3/76) 0f-1220(a) Rev. 1973 DATE ALAS, JEPARTMENT OF HEALTH AND SOCIAL SEI ~S DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS Lab No, OFFICE INDIVIDUAL [] SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO NAME ADDRESS CITY ADDRESS OF SOURCE ZIP CODE COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY TIME COLLECTED [] Kitchen TaJ~ [] Bathroom Tan [] Bored SAMPLE COLLECTED BY [] Tile Brick or [] Open Top[] Concrete [] Under House Septic Tank FeeJ, Feet. Privy [] Fibre [] Asbestos Cement [] Yes [] No DATE COLLECTED Sample Collected From [] Other (hist) WeB- [] Dug SOURCE: [] Spring E) Driven [] Drilled [] Cistern [] Other Dug Well or Cistern Construction: Walls--J~ Wood [] Concrele [] Melal Top -- [] Wood [] Concrete [] Metal LOCATION: [] In Basement [] Basement Offsel []In Yard [] Other Building Sewer DISTANCE TO: or Olher Drainage Pipe Feet. Tile Seepage Cess- Field Feet. Pit Feel. Pool Other Possible Sources of Conlaminalion MATERIAL: Building Sewer- [] Cast Iron [] Wood [] Tile [] Plastic JoJnt Material - Type GENERAL: Does Water Become Muddy or Discolored? When? Diameter of Well( Depth Feet. Well Casing MolerJal Diameter Depth Length of Waler Depth From Bottom Feet. Drop Pipe Offset in in Utility PUMP LOCATION: [] In Well [] Basement [] In Basement [] Room On Top [] Of Well [] Other _ PURPOSE OF EXAMINATION: Illness Suspected? [] Yes New Source of SuppJy? [] Yes [] No Repairs to System? READ INSTRUCTIONS ON Analysls shows this Water SAMPLE to be: [] Salisfaclory [] Unsatisfactory [] Questionable [] Sample too long in lranslt; sample should not be over 48 hours old at examlnat[on to ~ndicate rellable results. Please send new sample. ] . [] Bottle broken in lrans~t, please send new sample. SANITARIAN'S REMARKS [] No [] Yes [] No Signature 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Bev. 1973 ~ am Date Received / ::: '; ,! ' ~_Time Received ' /pm LPb. No, . REVERSE SIDE BEFORE COLLECTING SAMPLE .c~close Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc 24 Hours 48 Hours Brilliant Green 24 Hours 48 Hours EMB -- AGAR Laclose Broth, 24 hrs. 4B hfs, Groin's sla(n ColiForm Density (Most probable No. per 100cc) MF Resulls Dale Reporled by This analysis indicales Coliform Organisms to be: ' Absent Present