HomeMy WebLinkAboutLITTLE BEAR BLK 2 LT 3
PERMIT NO.
APPLICANT
LOCATION
LEGAL
DEF'ARTMEN] ,~ HERLTF.t RN[:, EN',,,'IRONf'IEF,ITRi_ "'ROTECTIO~.,t
25±0 E. TUDOR RD., ANCHORAGE, AK. ~507
276-222i
7~±7 )
ED RI~
BABY BEAR PLACE
L~ 82 LITTLE BEAR SUBD
8]:±0 WELLSLEY COURT
LOT SIZE 84. E10 SQUARE F:'EET
MINIMUM DISTANCE BETWEEN R 14ELL AN[) ANY ON-SITE SEWAGE DISF'OSAL S;YS]'EEM IS
:1.0~.] FEET FOR A PRIYATE HELL OR 200 FEEl' FOR A PUEEIC I.,.IELL.
WELL LOGS ARE RE';~LIR. E[, AND M.IST BE RETURNEP TO THE DEPFIRTME}g WITHIN 3:0 [)E~YS
OF THE I~ELL COMPLETI. ON.
SPECIFICATIONS AND CONSTF.'UCTION [:,IAGRRMS ARE AYAILFIBLE TO INSURE PROPER
I NS'fAL. LAT I ON.
F"EF-:D1 1]. T "¢RLI [:. FLOR C, INIE "¢ E-ZIR F-: P~E: .Oh'~ I S;S;L~EE
I CERTIFY THAT
~: I AM FMM_LIM~. I,tITH THE REb.!UIEEHENT=, FOR CN-z, IfE SEP.IERS AN[:, I.,.IEt..L.S AS SET
FORTH 8Y THE MUNICIPALITY OF ANCHORAGE.
2: ! WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
...........
APPLICANT ED RINNER
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F:'Oi:;]t"f'H E:'¢ THE HLN]:: IF'FIL.]'"f"T' OF F:INCHF_'IB:".FIE~E.
;2: I !.4iLL Ii",I2.:,Tt::ILL THE Z'T'['~;TEH IN FIIZ:IZ:I.';IF.:E:,F:ti'.,tCZ:E l.,.fInt'H THE
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#1: Time
Date
Insp Pratt
/~'~-,MUNICIPALii~~.F ANCHORAGE,'-~,,
DEPARTMEN OF HEALTH AND ENVIRONMEN7 PROTECTION
825 L Street, Anchdra~, Alaska 99501
264-4720
Date Received: September 19, 1977
9:30 a.m. #2: Time #3: Time
9-27-77 Tuesday Date
Date
Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1o Lending Institution Request: Alaska National Bank of the North
Mailing Address: 3301 C Street, Calais II Phone:
2o Property Owner: L.J. Sebring
Mai~ing Address: Star Route A Box 1540C 99507
Phone: 344-3069
3. Legal Description: Lot 3 Block 2 Little Bear Subdivison
4: Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms: Three
Number of Bedrooms:
o
Well System:
Permit #
Individual well (c) Community/Public System ( )
Depth of Well. 80' Well Log on File ( )
Construction
Bacterial Analysis
°
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System ( ) Public Utility ~)
Installed Installer
Manufacturer
Soils Rate Material
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page Two
Department of Health and Environmental Protection
Reguest for Approval of !ndividua% Sewer and Water Facilities
Legal Description: Lot 3 Block 2 Littl'e Bear Subdivision
Co~/Rent s:
Disapproved:
Letter Attached: ( )
]Date:
Date:
Department Worksheet:
MUNICIPALITY OF ANCHORAGE · , ;' r, .. '
J/~ Department of Health and Environmental ProtectiOn~'~ ' ~
,~./~~~ 825 L Street, Anc,h. orage~ Alaska 99501 ~
~.~Z~quest for Approval of Indzvldual Sewer and Water Facilities
"I o
Property Owner: _~,
Mailing Address:
Name of Buyer:
Phone:
Mailing Address:
Phone:
Lending Institution: ~ . _ . _
Mailing Address: _~;j ~ ~,~c ¢ ~/LF~.~ Phone:
Realtor/Agent: ~ /!~,~_~ ~<y~
Mailing Address:
Phone:
Street Location: ~~~ ~_~_~ ,/23'~_~*/z~/ff'
6. Single Family Residence: f~ Number of Bedrooms:
Multiple Family Residence: ( ) Number 6f Bedrooms:
Water Supply: * Individual Well ( ~ Public/Community System ( )
If Individual Well, well depth
If Community System, name of system
Sewage Disposal System: On-site System (
If On-site System, date of installation:
Public System
*NOTE: A well log J.s required on ALL wells drilled since 6/75.
3/77
06-1220fa) Rev. 1973
DATE
ALA -~ DEPARTMENT OF HEALTH AND SOCIAL S,r ~'CES ..
DIVISION OF PUBLIC HEALTH Lab No.
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS OPE,CE
NDIVIDUAL []
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
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED
Sample Collected From [~ Kitchen Tap ~ Bathroom Tap [] Basement Tap
[] Olher (List)
Well- [] Dug [] Driven [] DrilJed [] Bored
SOURCE: [] Spring [] CTstern [] Other
Dug Well or Cistern Construction:
Walls--[] Wood [] Concrete [] Melal [] Tile Brick or
Top -- [] Wood [] Concrete [] Metal [] Open Top [] Concrete
LOCATION:
[] In Basement [] Basement Offs? · [] Under House
[]Ir1 Yard [] Other . ' '
Building Sewer ' ' Septic
DISTANCE TO: or Other Drainage Pipe .F~t. Tank Feet.
Tile Seepage Cess-
Field- Feet. Pit Feet. Pool Feet. Privy- Feet.
Olher Possible
Sources of Conlamipation
MATERIAL: Building Sewer- [] Cast Iron
[] PlasHc Jolnf-Material - Type
[] Wood - [] Tile [] Fibre [] Asbestos
GENERAL: Does Water ~Become Muddy or Discolored? [] Yes [] No
When?
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Questionable
[] Sample too long in transit; sample should not be oYe~ 48
hours old at examination to indlcate rellab[e results. Please
-send new sample.
[] Bottle broken in transit, please send new sample.
Diameter of Well ~ Depth Feet.
Well CasTng
' Mater~a] D~ameter _ Depth
Length of Water Depth
Drop Pipe __ From Bottom Feet.
Offset in ' In UIiIHy
PUMP LOCATION: [] In Well [] Basement [] In Bas~h~ent [] Room'
On Top
[] Of Well [] Other
PURPOSE OF EXAMINATION: Illness Suspected?
New Source of Supply? [] Yes [] No
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
SANITARIAN'S REMARKS
EMB AGAR
Lactose Broth, 24 hrs. 48 hrs. Gram's slain
Coliform Density (Most probable No. per 100cc)
MF Results
This analysis indkates Coliform Organisms to be: . 'A~sent
Present
[] Yes [] No
Repairs to System? [] Yes [] No Signature
oB-l~,o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973 ? .
48 Hours