HomeMy WebLinkAboutLITTLE BEAR BLK 1 LT 5
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PERMIT NO.
RPF'L I RRNT
LOCRT I ON
LEGRL
DEF'RF.'.TMENT "HEFILTH FIND EN',,,' I ROi'.,li',IENTFIL ' "SIC 'FE;CT I
,~.,..t.~:'-'R- .-'l E. I"tJDOR F.'.I}.., F-INCHOF.'.RGE., RK. ~_.:-,~4__
~..IEE_L F'EF;;:~-.1 3E 'T-
E[:, RINNER
888'¢ E:ERR PLRCE
L.5 B± LITTLE 8ERR
E3i-C" !4ELLS;LE'-r' CT
LOT _':4 .t" ¢.E "~' ':' 3,1. El~ZI ..... '2; gl llqRE FEET
MINIMUM D.ISTRNC:E E:ETHEEN R WELl_ FIN[:, RN'-r' ON-SITE: SEWRGE [:,ISPOSRL S'¢S'T'EH IS
tE~O FEET FOR R PRIVRTE HELL OR 200 FEET FOR R P.IE:LIC HELL.
NELL LEGS RRE REQLIRED FIND ['lUST BE RETURNED TO THE DEPRRTHENT HITHIN :~:~ [:'R"r'E;
OF THE WELL COMPLETION.
SF'EC:IFICRTIONS RND CONSTRICTION [:IRURHfl-., RRE RVRILRE:LE TO INc]LIRE PROPER
I FISTRLLRT I ON
L. EF..TIF r THRT
!.: I Ftf'I FRMILIFIR WTTH THE RE~UIREi'"IEt"-IT':'; FCF.' CN-:,ITE S.';EHERS FII",IE:, HELLS RS SE-['
FOF.'.TH B'¢ THE i'tlJNICIPFtLIT"r' OF RNC:HF~RRGE.
2: I HILL INSTRLL THE S'¢.STEi"I IN FICCORDRNCE I-,.IITH THE CODES.
?., I GNED' ............................. '~- .........................
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FPLI _.RNT El:' RtNNER
~O-~X ~ MUNICIPALITY OF ANCHORAG~
//~.~ DEPARTME' OF HEALTH AND ENVIRONMEN' '"_ PROTECTION
[~~)~ 825 L Street, Anchorage, Alas~a 99501 .
~'~f~{//~ , ~ 279-2511, ext. 224 or 225
' ;3 ..... ~t6 ~: t4'~ Date Received: May 9, 1977
Time /;:~ ~¢~ ¢2: Time ~3: Time
Date ~¢/~V7 ~ Date Date
Insp /~3 ~.~ Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Amfac MOrtgage Company
Lending Institution Request:
Mailing Address: Phone:
Property Owner: Sebring Builders Phone: 344-3069
N~a~lmng Address:
Star Route A Box 1540C 99507
3. Legal Description: Lot 5 Block 1 Little Bear Subdivision
4:
Family Residence: (x)
>[ultiple Family Residence: ( )
Number of Bedrooms:
Number of Bedrooms:
%~ell System:
Permit %
Construction
Individual well (x) Community/Public System ( )
Depth of Well 80' Well Log on File
Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System ( ) Public Utility (x)
Installed Installer
Manufacturer
Soils Rate Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page ~wo · . '
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5 Block 1 Little Bear Subdivision
Comments:
Affadavit Attached:
Approved:~~
Disapproved:
Letter Attached: ( )
Date:
Date:
Department Worksheet:
06-1220~/~a)
Rev. ,~ 973
NAME
ALA,'-DEPARTMENT OF HEALTH AND SOCIAL SEr 'ES
DIVISION OF PUBLIC HEALTH- - : . La~, No,
INDIVIDUAL AND SEMI-PUBLIC L":---- ; ' '
BACTERIOLOGICAL .-WATER AN'ALYSI.S':
' -.- :.'.~-i. :
ADDRESS
CITY
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
ADDRESS
OF SOURCE
OFFICE
INDIVIDUAL []
DATE
ZIP CODE
~ J _'-,~aly~is sho~ this Water SAMPLE to be:
- -- [] .Unsafisfa~tory--
- ~ Que~tioflable-
'~'~am~}e too long Jn transit; sample should not be over 48
hours old 6t e~aminafion to indicate reliable results. Please
send new sbmp[e.
II
~ Bottle broken in transit, please send new sample.
SANI~ ARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED 'TIME COLLECTED
Sample Collected From '-~] Kitchen Top [] Balhroom Tap
[] Other (List)
Well- [] Dug
SOURCE: [] Spring
[] Basement Top
[] Driven [] Drilled [] Bored
[] Cistern [] Other
Dug Well or Cistern Construction:
Walls--[]] Wood [] Concrete [] Metal [] Tile Brick or
Top -- [] Wood [] Concrete [] Metal [] Open Top [] Concrete
LOCATION:
[] In Basement [] Basemenl Offset ~] Under House
[lin Yard [] Other
Building Sewer Septic
DISTANCE TO: or Other Drainage Pipe Feet. Tank Feet.
Tile Seepage Cess-
Field_ Feet. Pit_ Feet. Pool Feet. Privy ,__Feet.
Olher Possible
Sources of Conlamination
MATERIAL: Building Sewer- [] Cast Iron
[] Wood [] Tile
[] Plastic Joint Material - Type
GENERAL: Does Water Become Muddy or Discolored?
When?
[] Fibre [] Asbestos
[] Yes [] No
D~ameter of Well Depth Feel.
Well Casing
Material Diameter Depth
Length of Water Deplh
Drop Pipe From Bottom Peet.
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 Supply? [] Yes [] No Repairs to System?
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
o6-122o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc
24 Hours
48 Hours '- ' " '
Brilliant Green
24 Hours
48 Hours -~
EMB AGAR
Lactose Bro~'h, 24 hrs. 48 hrs. Gram's slain
Coliform Denslb (Most probable No. per lOOcc)
MF Results
MUNICIPALITY OF ANCHORAGE
//~Q~ Department of Health and Environmental
· ' [~ '~.~1//~--~ xx 825 L Street, Anchorage, Alaska~"~"-~
~~//~~ ' 279-2511, ext. 224, 225
- ~equest for Approval of Individual Sewer and Water ~,~,~i~i~'~
1,Property Owner: ~' r&¢ ~l r~
Mail Address: a~ Z~o ~ S'~'
Name of Buyer:
Mailing Address:
Phone:
Phone:
Lending Institution:
Mailing Address:
Phone:
Realtor/Agent:
Mailing Address:
Legal Description:
Street Location:
Single Family Residence:
Phone
Number of Bedrooms: -
Multiple Family Residence: ( ) Number of Bedrooms:
Se
Water Supply: *Individual Well (~ Public/Community System
If Individual Well, well depth ~'~
If Community System, name of system
Sewage Disposal System: On-site System ( ) Public System
If On-site System, date of installation:
( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77