HomeMy WebLinkAboutLAKEWAY BLK 1 LT 15A
· DATE RECEIVED
INSPEcTIoN APPOINTMENTS (~..-~'L-~.L.¢?.~ ~- '
DATE DATE DATE
,,.,s..c-ro.
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF I: ~>,LTH &
825 L Street - Anchorage, Alaska 99501 ~N~IRONMEi'qTAL ~<,~.'TECTION
i~ ENVIRONMENTALTelephoneSANITATION264.4720 DIVISION
DIRECTIONS: CompJete all parts on page 1. Incomplete requests will not be processed. Please aJlow ten (10) days for processing.
PROPERTY OWNER
MAILING ADDRESS
2. BUYER PHONE
M~I~I~ ~DD~
4. ~L~O~/A~T ] PHON~
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
[] SINGLE FAMILY
MULTIPLE FAMILY
NUMBER O~F ~B EDROOMS
[] One [] Four
[] Two [] Five
[~ Three [] Six
~]~/ Other__
7. WATER SUPPLY
[] INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* 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.) ~.~ ~ g !
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.
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 DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] I NDIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size:. If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
\- -
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
~ DISAPPROVED
DATE BY
. . .. CHEMICAL & GE~,_~OGICAL LABORATORIES t,. ALASKA, INC.~
~,'~ TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
~ ......... ~ Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name Phone No.
Mailing Address
State Zip Code
City
Mo. Day
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Year
£ Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows th~s Water SAMPLE to be:
_[~] Satisfactory
[] Unsatisfactory
[] Sample too 1cng in transit; sample should
not be over 48 hours old at examination
[o indicate reliable results. Please send
new sam Die.
Date Received - ,'~ .~> +~ ' . r
Time Received
Analytical Method:
[] Fermentation Tube
El' Membrane Filter
Lab Ref. No.
"'~" I~z
I
I
Result* Analyst
*No. of colonies/100 rm. or NO. of Positive porl~ons.
READ INSTRUCTIONS
BEFORE
COLLECTING SAM PLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
Presumptive 10mi /0mi 10mi 10mi ;10mi 1.0mi 0.3mi
24 Hours
48 HOurs
Conflrmstory
24 Hours
48 Hours
£MB Broth 24 hours: Broth 48 hours:
Multiple Tube Report: ].0mi Tubes Positive/Total 1Omi Portions
Membrane Filter: Direct Count Collform/10Oml
Verification= LTB BGB__
Final Membrane Filter Results (' Collform/~OOml
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M. SULLIVAN,
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
May 30, 1980.
Charles L./Rose M. Robinson
4726 West 88th Avenue
Anchorage, Alaska 99502
Subject: Lot 15A Block 1 Lakeway Subdivision
Approval for your individual sewer and water facilities
can not be granted until the following items have been
completed:
.~~1) The water analysis report be delivered to this
office from Chem Lab, 5633 B Street, for our
review.
(2)
Expose the well for our inspection to determine
proper construction. If the well is hand dug a
new well will need to be drilled; if the well is
a drilled well the well casing needs to be extended
twelve(12) inches above ground level and sealed
with a sanitary seal so that it is air tight.
This will need to be reinspected when it has been
completed.
If there are any further questions, please call this
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
CC:
National Bank of Alaska
Mortgage Loan Department
Pouch 7-025 99510
Steve Carlson
% Towne & Country Realty