HomeMy WebLinkAboutROOSEVELT PARK BLK 3 LT 4
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alask~ 99507 279-8686
Time of ~nspection
Date o¢ Inspection /
1. Approval Requested BY:
Address:
2. Property Owner: I ~-~-
REQUEST FOR APPROVAL· OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Phone:
.Phone ,r~O 77
3. Legal Description:
4. Locst on:
5. Type' of Facility to be Inspected:
Number Of Bedrooms:
6o,. Well Data:
C. Construction
Depth
Bacterial Analysis'
Sewage Disoosal System: P~~
A. Installed ........ ~ .................. ~ ....... B-,~-'-'I~s t~ 1I~ ....
C. Septic Tank: 1. Size 2. Manufacturer ~..
D. Seepage Pit: 1. Size 2. Uaterial
E. Disposal Field: Total Length of Lines___
Distances:
A. Well To:
B.
Septic Tank ~ , ^bsorpt~on Area ~ .., Sewer Linea
, Nearest Lot Lin , Other Contamination ~-
Foundation to Septic T~nk~---- "> AbSorption Area --'-
C, Absorpti6n Area to Nearest Lot Line
Request for Approval of ~ndividual Sewer & Water Facilities
. Page T~o
9. Commen~s:
Appr~alid for One Year From Dar,e, Signed
Greater AnchorageS'Are8 Borough, DeFartment of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for appreval to be a true
and accurate representation of the subject sewer and.water facilities located at:
Signed Date
05-1220 (a)
DATE:
STATE OF ALASK;.
P~/P'-TMENT OF HEALTH A~tD
DIVISION OF PUBLIC HEALTH
BACTERIOLOGICAl WATER ANALYSIS
OFFICE
DISTANCE TO: or OlherDraisagePipe Feet. ~c
pURPOb'I~OFEXAMINATION:IIInessSuspe=ted? [] Ye~ [] No
3. Chhck chloHnation .and other mechanical equipment. Make cerlcdn it is
tunclinning properly,
4J If after check/no equipment a disin£ecfing residual is not obtained, please
wke this office for emergency a~ist~nce or adviso~ services.
5. This'is a susface wa er source crud subject to pollution byman and c~imals.
An approved water supply source should be developed.
· $, {rnp~oveyour -] spring [] dug well [] driven well
[] drilled well [] cistern
7. Relocate your well to a sale localion in relationship to your sewage disposaf
8. Sample ina long fn t~ansit; sump e should not be over 48 hours old at
examination to.indic~in xelinble results, please send new scuuple.
[] Botlle Broken in tzcu~.li, please send new sample.
9. Contact your.neoz~st [] Loc~IHealthDeportment or []
Div{sion of Public Health, sunitation alike for bu{letins, consullation and
SANITARIAN'S REMARKS '
READ INSTRUCTIONS
REVERSE SIDE
BEFORE,
COLLECTING SAMPLE
06-1220 (b) BA'CTE;RIOLOGICAL WATER ANALYSIS RECORD
AGAR
D(~te
DIRECTIONS FOR COLLECTING SAMPLES OF WA?ER FOR BACTERIOLOGICAL EXAMINATION
R~ad ~c~efull¥ and Follow Instructions E×actl~
Bear in mind that water analysis de(ds with materials present in very ~n~t, ute quantities. The least ccrrelessness in
collecting and handling may give ~ise to results which ure misleading.
Arrangements should be mc~de to have water sons, pies recxch tho L,~.barutory as quickly ets possible. A(le:¢ 48 hours
the significc, nce of the bactr,'riolopicGl c~.cxl]?'sh~ i~3 i~.~.l~cO~'o~L ! o~ obv~.oc,_-'~ ~easons the laboratory p~efe~.,~ to receive scunple~
in the early part of the week but i~ willing to accept sccaxples at any time.
In collecting scanples it'om 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 crud flcane 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 agah~i
inside edge.
(c) Open fixture so that a small stream flows.
(d) Remove bottle from mailing tube. Hold bottle by the lower h(d~ in one hand und with the othm' remove the
screw cap with the fiugers, leaving paper.' protect!*~.g cover in place. Fill the bottle to the shoulder. Replace cap
with paper cover, screwh~g firmly into place but da not apply pressure which will split cap.
Pack bottle carefully in mailing tube enclosing th~ completed Information sheet.
(e)
In collecting samples from STREAMS and RESERVOIRS proceed as follows:
((d
(b)
Remove cap and hold bottle as described under (d) above.
Collect sample by holding bottle in a slanting poettion and sweeping it below the surface in such a manner
that water that has been in contact with the hand is not introduced into the bottle. Avoid collecling surface
scum and bottom sediment.
DO NOT COLLECT SAMPLES FROM FIRE HYDRANTS,
YARD HYDRANTS, DRINKING FOUNTAINS, OR SIMI-
LAR OUTLETS WHICH ARE DIFFICULT TO DISINFECT
PROPERLY.
STERILE WATER SAMI~LE BOTTLES ARE AVAILABLE UPON REQUEST FROM:
Dept. of Health ~ Social Services
SOUTHEASTERN REGIONAL LABORATORY
POUCH J
JUNEAU, ALASKA 99801
Dept. of Health ~ Social Services
SOUTHCENTEAL REGIONAL LAI$OBATORY
527 EAST 4th AVENUE
ANCHORAGE, ALASKA 99501
Dept. of Health & Social Services
NORTHERN REGIONAL LABOEATOR¥
994 B/diNETTE STREET
FAIRBANKS, ALASKA 99701