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Home My WebLink AboutROSEBUD Block F Lot 25 NUISANCE COMPLAINT FORM r , Location of Complaint :. _~(j,~/~, ' · . f_/J ,, ~,. . ~: /'1 ! certify that auch statement of facts is true to th~ ~best of my Jelie~nd~ know- ledge. I requeat that the £~'egoing matter Be investi~a.~d a~fi~t appropriate action thereafter be taken, I am willing to testify to the facts stated in the foregoing complaint in court if necessamy. Complainant Date InvestiKated: Action Taken: REPORT OF ACTION TAKEN DATE COMPLAINANT WAS CALLED REGARDING DISPOSITION OF COMPLAINT: (6-58 10M) ACTION ON REQUEST I~b. No ~253 INDIVIDUAL WATER SUPPLY ALASKA DEPARTMENT OF HEALTH SOUTHGENTRAL REGIONAL OFPICE Section of Sanitation and Engineering FOR BACTERIOLOGICAL WATER ANALYSIS Your recent request for an analysis of a sample from the}_nd ivid. ual .Pri~va.t e .X~/at. er .SupRly serving/4~S~'h & Seward H~wa~ was received 10~5/62 examination has been completed. and Mr. Fred Oates Box- ~-256 Spenard) Alaska Records in this office indicate this Individual Private Wa.mr Supply to be of Satisfactory uesnonable- Unsatisfactory sanitary status. Analysis shows this SAMPLE to be /< Satisfactory_ .Questionable Unsatisfactory. If an "Unsatisfactory" or "Questionable" status is indicated above, you should take immedia'te action as recommended below. · 1. Boil or chemically treat your water supply to protect your family from water-borne diseases as outlined in en- closed leaflet, "Drink It Pure." 2. Improve your spring--See bulletin HSE-6-2 3. Improve your cistern--See bulletin HSE-6-3 4. Improve your dug well --See bulletin HgE-6-4 5. Improve your driven well ~- See bulletin HSE-6-5 6. Improve your drilled well--See bulletin HSE-6-6 7.~ Relocate your well to a safe location in relationship to your sewage disposal system ~ See bulletin HSE-15 8. Bottle broken in teansit, please send new s~ple. 9. Sample too long in transit; sample should not be over 48 hours old at ex~ination to indicate reliable results. Please send new sample. 10. Contact your nearest ~ Local Health Department or ~ Alaska Health Department, Sanitation o~ce for bu~etins, consultation, and assistance. 11. This is a surface water source and subject to pollution by man and animals. An approved water supply source should be developed. Segnatme ) ........ ' '~'"' .... · SENDER; Complete items 1, 2, anti 3. Add your address in the "RETURN TO" space on 1, The following service is requested (check one), [] Show to whom and date delivered ............ [] Show to whom, date, & address of delivery.. 35¢ [] RESTRICTED DELIVERY; Show to whom and date delivered ............. [] RESTRICTED DELIVERY, Show to whom, date, and address of delivery 85¢ LNB/i'ih Sewer/Water Sectlor 2. ARTICLE ADDRESSED TO: City F~el Inc. 3202 Spenard Road Anchoraqe, alaska 99.503 3. ARTICLE DESCRIPTION: REGISTERED NO. I CERTIFIED NO. INSURED NO. 102120 (Al~eyl obtain elgnetuYe of addressee or agent) I have received the article described above. SIGNATURE [] Addressee [] Authorized agent ~'~DATE OF DELIVERY POSTMARK §, ADDRESS (Complete only if requested) 6. UNABLE TI~J~'ER BECAUSE: CLERK'S ACTION ON REQUEST INDIVIDUAL WATER SUPPLY ALASKA DEPARTM3ENT OF HEALTH Section of Sanitation and ]ingineering Lab. No 18253 SOUTHOENTRALREGIONAL FOR BACTERIOLOGICAL WATER ANALYSIS Your recent request for an analysis of a sample from the I,n~divid,ual P. ri~vat, e .W. at~r Supply %~oseDu~ ~UDCL%V~SlOn} setving/4~%h & Seward Hiw~:v was received 10/5/62 and examination has been completed. Mr. Fred Oates Box - ~-~56 Spenard, Alaska Records in this office indicate this Individual Private Water Supply to be of sanitary status. Analysis shows this SAMPLE to be/W~ Satisfactory. Satisfactory ~Q~estionable Unsatisfactory .Questionable Unsatisfactory. If an "Unsatisfactory" or "Questionable" status is indicated above, you should take immediate action as recommended below. 1. Boil or chemically treat your water suppIy to protect your family from wate?borne diseases as outlined in en- closed leaflet, "Drink It Pure." 2. Improve your spring--See bulletin HSE-6-2 3. Improve your cistern--See bulletin HSE-6-3 4. Improve your dug well --See bulletin HSE-8-4 5. Improve your driven well--See bulletin HSE-6-5 6. Improve your drilled well- See bulletin HSE-6-6 7. Relocate your well to a safe location in relationship to your sewage disposal system- See bulletin HSE-15 8. Bottle broken in transit, please send new sample. 9. Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. 10. Contact your nearest [] Local Health Department or [] Alaska Health Department, Sanitation office for bulletins, consultation, and assistance. 11. This is a surface water source and subject to pollution by man and animals. An approved water supply source should be developed. REMARKS ~ ALASKA DI:PAKTKfBNT OF HEALTH Division of public Health Laboratories BACTERIOLOGICAL WATER. ANALYSIS Lab. No Source ~3th & Seward Hi~y (Rosebud Subdivision) Ma~ Repo~ ~o M~. Fred OaLes Ad&aw Box - /,-2~6 D~__t~: Coll~_ _~ 1825q Spenard; Alaska 10./5./62 Date Receivea '10/5./62 I ~0cc I ~°c~ / ~°c~I ~°c~I ~°~: / L0cc t 0'~c~ ] / / N~3ATIVE / I Lactose Broth 24 hours 48 hours EMB B"G B Lacto$~ Broth, 24 hfs 48 Ns. Gram% stain Coliform Density. (Mo~t probable N9, per Repo~ by BV Dar- 10/8/62 Absent___XX,X~--~ This .n.lysis iadica,te$ Coliform Org-nisms to be: Present ~ ADH-~.HS~-6-FI (e) IOnt Comple~elT. INDIVIDUAL WATER SUPPLY Section of Sanitation and F. ngineering Request for Bacteriological Analysis Please Look on Reverse of Sheet for Sample Collection ~n~ructions. ~ ~i'i L~b. No ........................................... Water sample COllected (Name of per,on collecting sample): (Date) (Time) Water sample collected from ~Kitchen tap; [] Bathroom tap; [] Basement tap; [] Other (list) ............................ ~:~ ...................... "T ......................... ]; ...................... ~ ................... Address premise where source is Ioea~ed ................................................................................. ' ....................... ~....t .................... · ........ (Mr.) Mail report to (-l'.~s~ ...../~..~.~.~-~..~.. ........ ..~./...~....zf.~-..~.. ................................ .~_~.~.....~..~..~.. .............................. .~f..¢.~..~.:.~.~.~ ................ (Name) (Box No. or street address) (City) Please place an ,X" in the box before items which bast describe your water supply: SOURCE: Well --~Dug, [] Driven, [] Drilled, [] Bored [] Spring, [] Cistern, [] Other (list) ............................................................................................................... [] Creek, [] River, [] Lake, [] Pond .................................................................................................................. DUG WELL OR CISTERN' CONSTRUCTION': Walls- [] Wood~ [] Concrete, [] Metal, [] Tile, [] Brick or Concrete Block Top -- [] Wood, [] Concrete, [] Metal, [] Opefi Top LOCATION': [] In basement, [] Basement offset, [] Under house, ~J In yard Other ................................................ : .................................................................................................................................... DISTANCE TO: Building sewer or other drainage pipe, .~....O._..feet, Septic tank .............. feet, Tile field .............. feet, Seepage pit .............. feet, Cesspool .~/..o..~ .... feet, Privy ..............feet. Other possible sources of contamination (list) ............................................................................................................................................. MATERIAL: Building sewer -- [] Cast iron, [] Wood, [] Tile~ [] Fibre pipe, [] Asbestos cement Joint material -- Type ....................................................................................................................................................... GENERAL INFORMATION': Does water become muddy or discolored? [] yes, [~ no When? ....................................................................................................................................................... Diameter of well......--~--..~..~[..-....~...~. ........................ depth ....... ..~...~... ...... : ........ ~ ............. ~ ............ feet Well casing material ........................................ diameter .................... depth .................................. Length of drop pipe ............................................................................................................................... Water depth from bottom ....... .~... ............................................................................................. :.feet Pump location: [] In well, [] Offset. in basement, [] In basement [] In utility room, [] On top of well [] Other (list) ........................................................................................................ PURPOSE OF EXAMINATION: Illness suspected? [] yes, [] no New source of supply? [] yes, [] no Repairs to existing system? ]~ yes, [] no PLEASE DRAW A SKETCH IN THE SPACE BELOW. THIS SKETCH SHOULD SHOW LOCATION OF HOUSE, WATER SUPPLY SOURCE, SEPTIC TANK~ SEWER,' DRAIN LINES OR OTHER SOURCES OF POLLUTION AND DISTANCES BETWEEN' WATER SUPPLY SOURCE AND ANY OF ABOVE FACILITIES. SAMPLES MUST BE S~JBMITTED IN CONTAINEES PROVIDED BY '1'~: ALASKA DEPARTMENT OF HEALTH