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Home My WebLink AboutBROOKWOOD BLK 2 LT 12181-2'7_ . Time /~ ~4 2nd Inspection, Time I/,/D~ ~m ~T FOR/APPR0VAL.OF INDIVIDUAL'SEWER ~D -WATER FACILITIES ~Stitutio~ Request: -AlaSka NationaI Bank of;-the. North ' ~ress:h pouch-7-010- 99510 ' ~ claudia phOne-:-278"458i [tess; i ir. L 7 ~ ,_ Residence:. (x) Number of' Bedrooms: ---- " ( ) Number of Bedrooms: :--.-- Construc~on · '' - Bacterial Analysis - ...:._ "_. -. -_ - -. -.- - ;; -lJu='i~; :~_. ,6, Sewage Di~' posal~, .System: On-site system ~ ) public Util:,ty....., ..'- · .-Permit. 9; > -~nstatled' '- ' ' InStaller _. - -Septic T nk Size _' ] _ Menu a< . -_.- AbSorpti~ Area . -:' Soils Rate ~ - Material - _-7, - Distance: Well to septic Tank to ~sorPtion Area -to. Sewer~ines ' - ' Nearest Lot Line ' '' .-' ~ Absorpti~- Area t° Ne~eS~ LOt Line. . -- . .-' .~ .... ~A_ ~ ~ .. _ . _ - _ - ~. ~ ~ _ . MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPAUTY OF ANCHORAG~ DEPT. OF HEAt. TN & ENVIRONMENTAL PROTECTION APR i 1977 RECEIVED 1. Type of Inspection: VA 2. Property Owner: George D. & Patricia Paulsberg Mailing Address: SPA Box 1506-L Anchorage, Ak. 99507 3. Name o'f Buyer: CONKLIN, Charles D. & Sharon J. FHA CONV XXX Day Phone:_ 344-6927 Mailing Address: 1111 E. Name of Lending Institution' 80th Ave. Anchorage, Ak,DayPhone: ALASKA NATIONAL BANK 349-361] Mailing Address: Pouch 7-010 Anchorage; Ak Phone: 99510 Name of Realtor or Agent: Valda Drake - Dynamic Realty 77g-458! Mailing Address: 501 W. Northern Lights Blvd. Phone:_ Anchorage, Ak. 99503 Legal Description: Lot 12 Blk. 2 Brookwood Subdivision 279-7611 Location: 1915 Rainbow St. Anchorage, Alaska 99507 7. Type of Facility to be Inspected: 8. Water SuPply Type of Supply: Single Family Dwelling No. Bdrms.___ 4 Public Utility Individual Community __ If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Subdivision Individual (on-site) XXX If you haVe any question please call me. 278-4581 Claudia Jonas 72-003(3/76) - - Affadavit 172 : · · · · HUFFM~N 163 171 ~ 173 178 Rabbit Creek Area Reference Map-P13 0 ~c~ 1974 JH lOCATION ~TCH APP. TOPO~. FROI NET DROP Form Approved FHA F°~'m 2'573 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 R,?v. July 1958 ', HEALTH AUTHORITY APPROVAL INDIVIDUAL htATER SUPPLY AND SE htAOE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. MORTGAGOR OR SPONSOR; PROPERTY ADDRESS SUBDIVISION NAME BLOCK NO. JLOT NOg Can attic or other area be made into TOTAL NUMBER: BASEMENT ~ New installation additional bedrooms? LIVING UNITS BEDROOMS BATHS (If Yes, how rnany~) WATER SUPPLY BY: SYSTEM DESIGNED FOR ~ Public system [--] Community system [~] Individual NO. OF BDRMS. GARBAGE DISPOSAL SEWAGE DISPOSAL BY: J--J Public system J--] Community system J~ Individual II ~] Yes [] No PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH .... , ,: ~_ , -? ~-- -~__- ,.~ . - -~---~ cz: Z i ..... ~__.L-- _.__ ~ ....... ,,.,. ~.. _ ... ~ _ ,,,~ t It is the opinion of ihe ~] State J--J County ~] Local Department of Health that this individual water-supply system [~ is [-'] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [--] State [] County [] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [] Can be expected to function satisfactorily, and ~] Cannot be expected to function satisfactorily is not likely to create an insanitary condition DATE SIGNATURE TITLE NOTE: The health authority should complete the appropriate opinion statement above and affix date, signature and title in the spaces provide~. Use of th® above grid for Health Department Inspector's sketch as well as use of the back of this form is at the option of the health authority. PART III.~FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the Individual water-supply system be considered [~ Acceptable ['-] Not Acceptable Sewage disposal be considered ~'] Acceptable ['-! Not Acceptable. DATE SIGNATURE j~J CH~. ,~ucn~rEcr DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. July 1958 (~I£) --61 · a~nu!ua. ~ad SUOll~ · w, nu!tu ~ad SUOlIU~" 'pla!A aletu!xoaddV uaaj '~u!s~o jo qldaci '~u!se~ jo adA& uaaj :[a:e,~ jo/[ddns a~enbap~ qs!mrtj m ,h.~m.~!a a~,s!patutu! u.~ Slla~ jo aml!%l jo pJoaaJ ~ua>aJ ~som aa!O · pooqzoqqS!au m ~stumsn~ ~ou a~e [] a~ [] Slla,~ lenp!a!pul · saq~u! 'uNtu jo az!$ uaaj-- --'u~tu Ja:~ ~!lqnd ~sa~'~au m a~ums!(I WtlSAS Alddl'tS'tltlYA~ 111ftlOIAIONI--NOIl::)tdSNI :lO ltlOdittl ~aq~o [e!~al~tu li'u!u!q 'SUOlleS 'Xa!2sd~2 p!nbH 'J~aJ [] 'ap!s [] '~uo~j [] ~ au!i ~oI ~sa:mau ::laaj s~uatu~J~dtuo~ jo ~aqtunN 'saq>u! uaaj a~nbs' uaaj uaoj -- 'laaj 'q~da(I 'uoDepunoJ :laaj .06-122B~) Rev. 1978 ALi NAME BACTERIOLOGICAL WATER _. DATE DEPARTMENT OF HEALTH AND SOCIAL S' 'ICES DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC ANALYSIS ADDRESS INDIVIDUAL [] SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO CITY ADDRESS OF SOURCE ZIP CODE Lab No, · .... OFFICE Analysis shows this Water SAMPLE to be: E] Satisfactory [] Unsatisfactory [] Questionable [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. [] Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF V~ATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY ~ DATE COLLECTED TIME COLLECTED Sample Collected From ~ l'-I.'Kitchen Tap [] Bathroom Tap I-- Basement Tap [] Other (List) J Well -- ~ Dug _ [] Driven ~ Drilled \ SOURCE: w Spring ~ [] Cistern ~ Other_ \ [] Bored Dug Well or Cistern Construction: Wa~ls--[] Wood ~ Concrete [] Metal [] Tile Brick or Top -- [] Wood [] Concrete [] Metal [] Open Top [] Concrete LOCATION: [] In Basemeht [] Basement Offset [] Under House (]In Yard E Other Building Sewer Septic DISTANCE TO: or Other Drainage Pipe Feet. Tank Feet, Tile Seepage Cess- Field_ Feet. Pit: Feet, Pool Feet. Privy_ Feet. Other Possible Sources of Contamination ] MATERIAL: Building Sewer- ~ Cast Iron [] Wood [] Tile [] Fibre [] Asbestos [] Plastic Joint Mater~al~ - Type Cement GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No When? Diameter of Well Depth Feet. Well Casing Material Diameter Depth Length of Water Depth Drop Pipe ...... -, From Bottom __ Feet. ..~. ~ ~ ; Offset in n Utility PUMP LOCATION;~ l~n Well [] Basement [] In Bas~ment [] Room On Top ~- ~ -_ ~/, ~ Of We [] Other;./' l' j~/ PURPOSE OF EXAMINATIOn: I ness Sbspected. New Source of Supply? ~ Yes [] Yes [] No [] No Repairs to System? [] Yes [] No Signature __ READ INSTR~UCTIONS ON~ REVERSE] SIDE BEFO,R~ COLLECTINGI SAMPLE 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD ,i ' Rev. 1973 · Date Received _ .~ ~ /, , ' Time Received .... _ ~Lab. No. Lactose 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 100cci MF Results Reported by /- DE~ '- ,~s~t~t~ / p.m. This analysis indicates Coliform Organisms to Present 4. 5. 6. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval)irequested by: ~/?z~/~ Mailing !Address: ~/?~/y~l~ ~C~ ~&~O ~__~l~. PropertY;Owner: ~-~z~.z~ - ~-~ Mailing !Address: ~ ~.~ Legal Description: ~/-y<~ Location: / ~/0~ ~~C~)~ . Type ofifacility to be inspected~ Well Data: A. Type C. Construction ~,~r~.~ .... Sewage Disposal System: A. Installed . b;'~ns~aller C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. DispOsal Field: Total length of lines Phone: 717 ¢ Phone: No. of bedrooms Y-~ B. Depth D. Bacterial Analysis 2. Manufacturer 2. Material 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank : C. Absorption area to nearest lot line LQ-034 (1/7~) , Absorption area , Other contamination , Absorption area , Sewer Lines Page 1 of two pages page ~ of two pages - Req~_~t for Approval of Individual S~ r & Water Facilities Legal Description Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I Certify that the information contained in'his request fOr approval to be a true and accurate ~epresentation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED ]. . Date EQ-034 (1t74) GREATER ANCHORAGE AREt, BOROUGH Department of Environmental Quality 3330 "C" St,, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection: CMRO VA FHA ~<~ Property Owner: ~7~~ ~.S~ Fx~. ~/~/<~/~>~y Mailing Address: ~/~A~ ~ -/~-~ ~ Da~ Phone Name uf Buyer: ~ ~ ~.~ ~.~ ~.~c~. ~ Mailing Address: ~/~ ~~~~ Da~ Phone Name of Lending Institution: ~~~ ]~ Mailing Address: ~S ~. ~ - Phone ~~_~j- Name of Realtor or Agent: ~?~]/~~.~.~Z~,~ Mailing Address: ~_~ ~ ~, Phone, ~- Type of Facility to be inspected: ~.,~_<___ No. Bdrms. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal. System Type ,of S~stem: Public Utility If' ndividual, .date of installation Individual (on-site) z..----~'