HomeMy WebLinkAboutROOSEVELT PARK BLK 5 LT 16~lod~
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road· Anchorage, Alaska 99507 279-8686
Date Received ._~C~/~/~/~J
Time of Inspection
Date of Inspection ~h~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Approval Requeste~ By:./~,~.~ ( ~, , ..... .
Number of Bedrooms:
A. Type B. Depth , ,
C. Construction D. Bacterial Analysis
7.. Sewage ~)ts.6osal System: ~L*~A~'~/&-)
A. Installed - B. Installer
C. -.Septic Tank: 1. Size 2. Manufacturer-
D. Seepage Pit: 1. size 2. Material
E. Disposal F~eld: Totel Length of Lines
Distances:
A. Well To: Septic Tank
, Absorption Area
, Sewer Lines
, Nearest Lot Line
· Other Con'taminstion
Foundation to Septic Tank
"~ Ab§orption Area
C. Absorption Area to Nearest Lot tine
Request for Approval of . ..ividual Sawer & War.er Faciliti~.
Page Two
9. Comments:
A, roved__ ( Disapproved
Approva? Valid for One Year Prom Date Signed
Greater Anchorage Area 8orough, Department of Environmental Quality
DIAGRAM OF SYSTSM
I certify that the information contained in this request for approval to be a true
and accurate representation of the sub.~e~t sewer and water facilities located at:
. Signed Date
06-1220 (c0
DATE
STATE OF ALASKA
DEP~.TMENT OF HEALTH AND SOCIAL $~ICES
91ViSIOfl OF PUBLIC HEALTH
BACTERiOLOGiCAL WATER I NALYS S
DATE COLLECTED
[] Other (I~sti
Well [] Dug [] D~ve. [] D~ed [] So~ed
SOURCE: [] Spdng [] C;stem [] Other
Dug Well or C~slern Coast~ctiont B~ck or
When?
pUMP LOCATgDN: [] mWell r'l °ffeet~ [] hI~sement F*1 h~Th]tti~:
Recozds ~n ~ office ~nd~cate ~ WATER SUPPLY to be of:
H an '~nsa~facto~" pr '~u .estionable" status,Is ?, d4,ccrled obove
- 6. ~pmve yo~ ~ sp~g ~ d~ we~ ~ ~ven we~
9. ~ntact yo~ n~est ~ ~H~ De~ent or ~ ~
SANITARIAN'S REMARKS
READ INSTRUCTIONS
ON
REVERSE SlOE
BEFORE,
COLLECTING SAMPLE
06-1220 (bi BACTERIOLOGICAL WATER ANALYSIS RECORD
~st~
DIRECTIONS FOR COLLECTING SAMPLES OF WATER FOR BACTERIOLOGICAL EXAMINATION
Read C, arefull~, crud Fallow Instructions E×acll¥
Bear in mind that water analysis deals with materials present in very r,{,mte qu,mlities. The least carelessness hz
collecting and hcmd~ing LnC~' ~ve rise to results which are misleading.
Arrangement~ should lie m~¢l~ to hcwo wc~te~' ,~cm~ples re,-~zch tht-~ k/borc~ory cm quickly as po~ible. After 48 hours
th~ significm~co of tl .~ b(~ctenolog~ccq cc~.~£1~:L'~ i~ i~op~dYed. Fez ob'vio~'~ reasons the labor¢~to:c.~ p~e/e.~,'~ to receive sccmplss
in the eexly pm, t o! the week bnt ia wfl!i~9' lo accepl samples at cmy th'ne.
In collecting scanples from TAPS or PUMPS proceed as follows:
(a) Thoroughly flush tap or pump by allowing water to rmf. ireely for five minutes.
(b) Shut off water crud flame the outlet with torch or burning papeT. The flame should not be merely passed over
the outlet but ,~hou/d be applied until fixture shows indication of being hot. Flame should be directed c~gainst
inside edge.
(c) Open fixture so that a small stream flow~.
(d)
Remove bottle from mailing tube. Hold bottle by the lower half in one hcmd and with the other remove the
screw cap with the fingers, lecm'ing paper: protecting cover in place. Fill the bottle to the shotdder. Replace cap
with paper cover, screwing itrmly into place but do not apply pressure which will spRt cap.
(e) Pack bottle carefully in mailing tube enclosing this completed information sheet.
In collecting samples from STREAMs and RESERVOIRS proceed as follows:
(a) Remove cap and hold bottle as described under (d) above.
(b)
Collect sample by holding bottle in a slanting position and sweeping it below the surface fit much a manner
that water that has been in contact with the hand is not ~troduced into the bottle. Avoid collecting 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 SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST PROM:
Dept. of Health ~ Social Services
~OUTImASTERN Pm~ONAL L~ORATOR¥
POUCH J
JUNEAU, ALASKA 99801
Dept. of Health & Social Sezvices
SOUTHCENTRAL REGIONAL LABORATORY
527 EAST 4th AVENUE
ANCHORAGE, ALASKA 99501
Dept. of Health ~ Social Services
NORTHERN REGIONALEABORATORY
604 BARNETTE STREET
FAIRBANKS, ALASKA 99701