HomeMy WebLinkAboutHOLLOWBROOK Block 6 Lot 3UoliowbrooK
s/D
L 3 g
DA~ RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSPECTO%
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF HEAL~'H
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION MA~
Telephone 264-4720
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND
DIRECTIONS: Complete all parts on page 1, Incomplete reques~ will not be processed. Please allow te~' ~10) days for processing.
1. PROPERTY OWNER PHONE
MAI LI~ ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
~ PHONE
MAI LING ADDRESS
3. LENDING INSTITUYION
MAILING ADDRESS
PHONE
4. REALTOR/AGENT
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
'2&
6. TYPE OF RESIDENCE
S
INGLE FAMILY
[] MULTIPLE FAMILY
7. WATE~R S/]UPPLY
~ INDIVIDUAL*
/[] COMMUNITY
[] PUBLIC UTI LITY
NUMBER OF~BEDROOMS
[] One [] Four [] Other
( Two [] Five
Three [] Six
* ATTACH WELL LOG, A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.) ~-~
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
r-] INDIVIDUAL/ON -SITE DATE INSTALLED
r-]PUBLIC UTILITY
Connection Verified
INSTALLER
E]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Absorption Area to nearest Lot Line
5. COMMENTS
~ APPROVED FOR ._~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
.CHEMICAL~ & GE~-~'~OGICAL LABORATORIES (~-" ALASKA, INC.~
-'- . TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Drinking Water Analysis Report for Total ColifOrm Bacteria
TO BE COMPLETED BY WATER SUPPLIER,
WATER SYSTEM:
I.D. NO.
Water System Name PhoneNo. :f
Mailing Address
City State ~i!0 Code
Mo. Day Year
SAMPLE TYPE:
;El Routine
/'rq Check Sample (for routine sample
with lab ref. no. )
r- Special Purpose
SAMPLE
NO.
1
2
3
4
5
LOCATION
TO BE COMPLETED BY LABORATORY
Analys~s shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Samole too long in transit; sample should
qot be over 48 hours old at examination
to 'and cate reliable results. Please send
new samole.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Ref. NO, Result*
I
*No, of colonies/100 m or NO. of PoSitLve IDOrtlODS,
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 [b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
Th le ReCelve¢l -- Lab, NO.
Presumptive 10mi 10mi Z0ml 10mi 10mi 1.0mi 0.1mi
· 24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
EMB Broth 24 hours: Broth 48 hourl=
Multiple Tube Report: 10mi Tubes Positive/Total 10mi Portlorla
Membrane Filter; Direct Count Collform/100ml
Verification: LTB , RGB.
Final Membrane Filter ReSults ' '''') Collform/lOOml
Reborted By -,.).. ,-' Date
~4arch 2i~ 1993
Dennis Hackewberger
511 ~. 76th
Anchorage, Ak 99502
Subjects Lot 3, Block 6, Hollow Brook Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the followincj items have been completed.~
o The top of the well casin%) should be sealed so that it is
water tight.
~ Exposed electrical wires to the well head are in violation
of the F~unicipality of Anchorage codes and must be encased
in conduit.
~'he water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our review.
Please notify this Depart~-~ent for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this o~fice at 264-4720.
Sincerely,
Jhig6/ej/Ei
Robert C. Pratt
Associate Environmental Specialist