HomeMy WebLinkAboutLAKE SPENARD PARK BLK 4 LT 3 OF RESUB
APPLIC ,,,T FILLS OUT UPPER HAL[' )NLY
.~opertyOwner '~(J{~c'-~'~-"J(~'~/"/' ~'~)~'~ ~ Phone
Mailin~:~ddro~~ ~ Zip Code
Buyer
:~. - ~: ~.
Address Zip Code
Lending institution~ ~
Address ~ ~ ~ d~ ~ Zip Code
Realty Co. & A~nt
Address Zip Code ~
Legal Description ~ ~ ~ ~0~ ~ . ~. ~~ }' ~. [~[
Type of Resi~nce
~ Si~Family
~ltiple Family ~o. of Bedroo~
~ Other
~lndividual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date,,give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed:_
~ Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
inspector Inspector Inspect°r ~'~,i
Inspector
' ......... -~ MUNICIPALITY OF ANCHORAGE
~, ENVIRONM2NTAL PROTECTION
RECEIV[D
~) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
(
( ) D~SAPPROVED
( ) CONDITIONALAPPBOVAL'
DATE ,
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
CHEMICAL & GEOt. OGICAL LABORATORIES 0~ 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.
,/':: ;,< 4,. ?:' ~
Phone No.
Water System Name
Mailing Address
City State _ _ .:Zip Cede
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION ~- ,- .. ~ -- /.~/
I 4... ~ -.
['" L :' ? :? /;'
2 [ :''/':~'?~.: -' ">q%< ;'-'"-'-';
Time Collected
Collected By
TO BE COMPLETED BY LABORATO RY
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
--I Sample too long in transit; sample should
not be over 48 hours old au examination
to indicate reliable results. Please send
new sample.
.., / ~ ~ '.'~
Date Received .' ,,- ; '"
Time Received
Analytical Method:
[] /Fermentation Tube
~.Membrane Filter
Lab Ref. No. Result* Analyst
/
I~','~''' '
I ~
I [-1-]
I I--I-I
· No of colomes/lO0 mi. or No. of Positive )orisons.
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
elvecl __ Lab. NO,
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
EMB Broth 24 hours:
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Filter Results
Reported By
Broth 48 hours:
10mi Tubes Posltlve/'rotal lOml Portions
Collform/100ml
BGB
Collform/100ml
Date
b..yE RECEIVED
INSPECTION APPOINTMENTS "
TIME I TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
MU N IC(tlS)A~y~lF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 LStreet-Anchorage, Alaska 99501 AU(}~ ~ 1981
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing,
1. PROP~Y~WNER ~HONE
MAI LIN~AD~ ~ , __
4. REALTOR/AGENT ' ' d t PHONE
MAILING ADDRESS
' NU¥'BER OF BEDROOMS
[] one [] Four ~ Other~
6. TYPE OF RESIDENCE
[] SINGLE FAMILY [] Two [] Five
~' [] Three Six
MULTIPLE
FAMILY
7. WATER
[] INDIVIDUAL'~
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
[;~;;k"q~-~ LI C 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) ~/~,r-~/~" -~
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRI LLEI;,
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] IN D IVI DUAL/ON -SIT E DATE INSTALLED
[]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
4, DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
PPROVED FOR /--'~
MS
[] CONDITION'AL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M. SULLIVAN,
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
August 6, 1981
Steve Burseth
Box 271
Anchorage, Alaska 99510
Subject: Lot 3 Block 4 Lake. Spenard Park Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1) The water analysis report needs to be submitted
to this office from the Chem Lab, 5633 B Street,
for our review.
(2) Expose the well for our inspection to d~termine proper
construction. Please call this office for another
appointment when the well has been located.
If there are any further questions, please call this
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska USA Federal Credit Union
Pouch 6613 99502