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Home My WebLink AboutLAKE RIDGE TERRACE BLK 2 LT 10'T'e s/b .- t4UN[CIPAL[TY OF ANCHORAGe',, EAGLE RIVER AREA DEPARTHE OF HEALTH AND ENV! RO~NEN PROTEC!~ION 825 L Street, Anchoraae. Alaska 99501 / , ~,~pi-ll~ .O~O,~ _.-, ~-8~e Received: December Date Sate~_-~ ........ Insp ~ Jz,~..u;5,~ ~ APPROVAL OF INDIVIDUAL SEWER AND WATER FAC(LITIES Lending Institution Request: First National Bank of Anchorage 9 ,sectr~ s ~,: Mailing Propc:rty Owner: Hailing Address: Post Office Box 4-2090 99509 Henry C. ~il~iams Post Office Box 4-1942 99509 Phone: 274-1521 Phone: -2-7-2~ Desc2.1Pu. iol%: Lot 10 Block 2 Lake Ridge Terrace Subdivision 3. Legal .... ' i '~ ' 4: Single Family P, esidence: Multiple Family ResJ. dence: ( ) Number of Bedrooms: Four Number of Bedrooms: 5. Well System: ~_ho.~.v_~dual Well ( :~ Conm:un,.'ty/Public System ( ) Permit {~ Depth of Well WelL!,~'oq.s on Vile ( ) Construction Bacteria]. Ana.i ysis ~ u,~]_lc util~_'hy ( ) Sewage Disposal System: On-s:i_te System ~ o ~, ' , Permit !n stat led Installer Septic Tank Size ........................... bianufacturer Absorption Area Rate Maaerma_ 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page .P ~o Department of Health and Environmental Pro~ection Request for Apprevat ef Individual Sewer and Water Facilikies Legal Description: Lot 10 Block 2 Lake Ridq~ Terrace Subdivision Affadavit Attached: ( ) Letter Attached: ( ) Approved: ~ ~ .~_~_ Date: Disapproved: ~ __ Date: Department Worksheet: '~ATER ANCHORAGE AREA BORO DEPARTMENT OF ENVIRONMENTAL QUAEITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # Performed For Legal Description: This Form Reuorts Soils Depth Feet Soil Characteristics Date Performed Lot /c) Block -z_ Subdivision Percolation T~st Was Ground Water Encountered? ~/m ~?o^ If Yes, At what Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Minute Proposed Installation: S,eeDage Pit Drain Field Demth of Inlet Depth To Bottom Of Pit Or Trench COMMENTS: ~ '/ Test Performed By '-T'/ ._~_.z.y, ~ Data Certified By: Municipality of Anchorage DEPAR. )NTOF HEALTH& ENVIRONMENTALP~ :'ECTION POUCH 6-650 ANCHORAGE, ALASKA 99502 279-2511 ~UNICIPALITY OF ANCHL,,k;,",G2 DEPT. OF HEAt3H ,'-~: ENVIP-.ONMENTAL P~:O1F_C'i IO~ DEC ? 977 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. TYPE OF LOAN I 2. ASSESSORS PARCEL-~J~TB~E~ [] VA [] F.H.A. [] CONV [] I 3. LENDING INSTITUTION 4. REALTOR OR AGENT First National Bank of Anchorage P. O. Box 4-2090 ~ % NO~ Anchorage, Alaska .- ::Florence Wegner 274-1521 5. ~ OWNER (iht/cons) 6. BUYER Henry C. Williams P. O. Box 4-1942 Anchorage, Alaska 99509 N/A ,: 272 2714 7. LEGAL DESCRIPTION 8. LOCATION/STREETADDRESS Lot 10,. Block 2, Lake Ridge Terrace S/D ~N T~ke Ridge Drive 9. TYPE OF DWELLING 10. WATER SUPPLY 11. SEWAGE DISPOSAL SYSTEM E~L~NGLE FAMILY RESIDENCE 4 BDRMS [] PUBLIC UTILITY [] PUBLIC UTILITY [] MULTI-FAMILY RESIDENCE BDRMS E~ PRIVATE ON-SITE ~ ON-SITE YEAR INSTALLED INSTRUCTIONS TO REQUESTOR 1. Complete Items 1 to 11 above 3. Send to address above 5. Response will be returned to lending 2. Remove the carbon 4. Please allow 10 days for processing institution DATE RECEIVED DATE OF INSPECTION TIME OF INSPECTION INSPECTOR TYPE DEPTH YEAR DRILLED PERMIT REFERENCE .~ ET. ~ CONSTRUCTION BACTERIAL ANALYSIS LAB REFERENCE NO. YEAR INSTALLED INSTALLER TANK SIZE MANUFACTURER ~ DIMENSIONS CRIB CONSTRUCTION ~ [] PIT c~ TOTAL LINE LENGTH TRENCH DEPTH GRAVEL DEPTH ~- [] DISPOSAL ~u FIELD c~ FT. FT. FT. TOTAL ABSORPTION AREA PERMIT REFERENCE SQ. FT. 06-1220(a) Rev. 1~73 DATE AL( '~ DEPARTMENT OF HEALTH AND SOCIAL ,r ?ICES DIVISION OF PUBLIC HEALTH Lab No. INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS OEE CE INDIVIDUAL J~/ SEMI-PUBLIC [] REPQRT RESULTS TO ADDRESS CITY ADDRESS OF SOURCE CHLORINE RESIDUAL PPM J~ Vl. ~.~ z~P coDE shows this Water SAMPLE to be: [~Satlsfactory [] Unsatisfactory [] Questionable [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate relJable~ results. Please send new sample. [] Battle broken in transit, please send new sample. SANITARIAN'S REMARKS COMPLETE/T~IIS SECTION ONLY IF WATER IS/,ATN I~DIVIDUAL SUPPLY SAMPLE COLLECTED gATE COLLECTED Sample Collecled Prom ~ KUchen Tap ~ Bathroom Tap ~ Basement Tap ~ Other (List) Well -- [] Dug [] Driven [] Drilled SOURCE: [] Spring [] Cistern [] Other Dug Well or Cistern Construction: Walls--[] Wood [] Concrete [] Metal Top -- [] Wood [] Concrete [] Metal LOCATION: [] In Basement [] Basement Offset []ln Yard ' [] Other. Building Sewer DISTANCE TO: or Other Drainage Pipe Feet. Tile Seepage Cess- Field- Feet. Pit Feet. Pool- Other Passible Sources of Contamination MATERIAL: Build[ng Sewer - [] Cast Iron [] Wood [] Tile [] Plastic Joint MaterTal - Type GENERAL: Does Water Become Muddy or Discolored? ~ When? [] Bored [] Tile Brick or [] Open Top[] Concrete [] Under House Septic Tank Feet, Feet. Privy Feet. [] Fibre [] Asbestos Cement [] Yes [] No Diameter of Well Depth Feet. Well Casing Material Diameter Depth Length of Water Depth Drop Pipe From Bottom Feet. Offset in In Utility PUMP LOCATION: [] In Well [] Basement [] In Basement [] Room On Top [] Of Well [] Other 06-1220~) Rev. 1973 DATE ALI~ , DEPARTMENT OF HEALTH AND SOCIAL,S ICES DIVISION OF PUBLIC HEALTH : INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS Lab No. OFFICE INDIVIDUAL [] NAME ADDRESS CITY ADDRESS OF SOURCE SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO 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 [] Other (List) ~ Well -- [] Dug [] DHven [] Drilled [] Bored SOURCE: [] Spring [] Cistern [] Other_ Dug Well or CisTern Construclion: Walls--[] Wood [] Concrete [] Metal [] Tile Brick or ,Top -- [] Wood [] Concrete [] Metal [] Open Top [] Concrete LOCATION: [] In Basement [] Basement Offset [] Under House []ln Yard [] Other Building Sewer Septic Tank Feet, DISTANCE TO: or Other Drainage Pipe Feet. Tile Seepage Cess- Field Feet. Pit Feet. Pool __ Feet. Privy- .Feet. Other Possible Sources of ContamlnaHon MATERIAL: Building Sewer- [] Cast Iron [] Wood [] Tile [] Fibre [] Asbestos [] Plastic Joint Material - Type GENERAL: Does Wafer Become Muddy or Discolored? [] Yes [] No When? : ~ D]ameter of Well Depth Feet. Well Casing Material Diameter Depth Length of Water Deplh Drop Pipe From Bottom Feet. Offset in In Utility PUMP LOCATION: [] In Well [] Basement [] In Basement [] Roam On Top [] Of Well [] Olher Analysis shows thls Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Questionable [] 'Sample too long in transit; sample should not be over 48 . hours old at examination fo indicate reliable results. Please send new sample. [] Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS PURPOSE OF EXAMINATION: Illness Suspected? [] Yes New Source of Supply? [] Yes [] No Repairs to System? READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE [] No [] Yes [] No Signature 064220 (bi BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. t973 Date Received ~ I · Time Recelved Om Lab. No. Laclose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc 24 Hours 48 Hours Brilliant Green 24 Hours 48 Hours EMB AGAR Lactose Broth, 24 hrs. 48 hrs, Gram's stain . Coliform Density (Most probable No. per 100cc) MF Results Reported by Dale This analysis indicates Collform Organisms to be: Absent Present