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HomeMy WebLinkAboutLAKEHURST BLK 7 LT 6B MUN C PAL TY OF ANCHORAGE . DE~._C,;. i,",!.T: ~'T ON DEPARTMENT OF HEALTH&ENVIRONMENTALPROTECTI6~~/IR©I ~' ~ql"~- ;' ~ ....  825 k Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 RECE!~ED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete ~11 parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PRO~RTY OWNER PHONE ~AILI~6 ADDRESS P~E~TY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAI LING ADDR ESS 3. ~E~ING INSTITUTIO~ I PHONE ~hPHONE ~Alkl NG AD~E~ STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ,~ [] One [] Four SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ,,~ Three [] Six 7, WATE~ ~SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM " ~J~_ INDIVIDUAL/ON-SITE** ~1 PUBLIC UTILITY [] Other 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 (og if available.) **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIs SIDE FOR OFFICIAL USE ONL'Y DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONI-' [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] 'rwo [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER - []Septic Tank or ElHolding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCE~ Septic/Holding'rank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to Dearest Lot Line 5, COMMENTS [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [~'~DISAPPROVED DATE BY (Title} -- LEGAL DESCRIPTION 72-010 (Rev. 3/78) CL,~'~_~.~"..L 8~ eEOLOelC&L LABORATORIES OF ALASKA. INC. P.O. BOX 4-1276 ANCHORAGE, ALASKA 99509 4649 BUSINESS PARK BLVD. Drinking Water Analysis Report for Total coliform Bacteria TELEPHONE (907) 279 ~.014 TO BE COMPLETED BY WATER SUPPLIER City State Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose SAMPLE NO. LOCATION 4 I Zip Code [] Treated Water [] Untreated Water Time Collected Collected By ?, TO BE COMPLETED BY LABORATORY LABORATORY: NA~ ~ ADDRESS CITY · Date Received Time Received Analytical Method: [] Fermentation Tube X Membrane Filter Lab Ref. No. I Result* Ar]air. st No. o! colonial 1100 mi. or No. of Pollllve portions. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source ). NO. Presumptive 10mi 10ml lOml 10mi 10mi 1.0mi 0.1mi 24 Hours 24 Hours 48 Hours EMB Broth 24 hours: MulUple Tube Report: Membrane Filter: Direct Count Broth 48 hours.. 10mi Tubes Positive/Total 10mi Portions / ./ / ..~ Cot]form/lO0ml April 25~ 1979 Sharon ~ichols 8922 Jewel '2errace Anchorage, Alaska 99502 Subject: ~ ~A-~-q~. Block 7 Lak~hurst Subdivision Approval for your individual sewer and water facilities will not be granted until the following item has been co~'~pleted~ Th~ well casing is extended twelve(12) inches above ground level,with a s~%itary seal to that it is air and water tight and the ground sloping a~ay from the casing. ~ot~y this department for a re-inspection when this descr~pancy has been corrected. If there are any further questions~ please contact this office at 264-4720. Sincerely, Robert C. Pratt~ Associate Specialist llCP/ljw ~ V Securit~ Pacific ~4ortgage 1011 ~ast Tudor Road 99507 Stacy Hudgins % Marston Real Estate 6345 ~hur~%n 99502 April 18, 1979 sharon Nichols 8922 J~wet Terrace Anchorage, Alaska 99502 Subject: ~ Block 7 L~kehurst Sut~livision Approval for your individual sewer and water facilities will not be granted until the following items have boen co~pleted~ (1) The well casing needs to be exposed and located for our inspection. ~ The water analysis report be deliverea totthis office from Chem L~b~ 5633 B Street~ for our r~view. Notify this aepart~%~%t when the descrepancy has been corrected so that a re-inspection can be made. If there are any further questions~ pleas~ contact this office at 264~4720o Sincerely, Robert C. Pratt~ R.~. Associate specialist RCP/ljw Security ~aclf-.c ~4ortgage 101! East Tudor P~oad 99507 Stacy ~tudgins % Marston Real Estate 6345 Thurman 99502