HomeMy WebLinkAboutSPENARD ACRES Block D Lots 1A & 1B
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received .;] . .:~::)- Y-lC
Time of Inspection. :/,;~.' :-~ ,? .~'~'~"~'
Date of Inspection ..?-,>._~ ?_3
RHQUBST FOR APPROVAL OF
I~,)IVIDUAI, SEWER & WATER FACILITIES
FOR
5. Type of Facility to be Inspected:
Number of Bedrooms: ~_ ~ ....
Well Data:
C Constructi on
Sewage DfsOosal
A. Installed B. Installer
C. --Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Size 2. Material
E. Disposal Field: Tot:al Length of Lines
Distances:
Well To: Septic Tank
, Neerest Lot Line
Foundation to Septic Tank
, Absorption Area
Absorption Area to Nearest Lot Line
Other Con'tamination
Absorption Area
· Sewer Lines
9 ~est for Approval of Ir tdual Sawer & Waker Facilitie~
Page Two
9. Comments:
Approval Valid for One Year From gage Signed
Greater Anchorage Area Borough, ger~rkmenk o¢ ~nvironmenkal
DIAGRAM OF SYSTEM
I cerkify that the information conkained in this request for approval to be a true
and accurate representation of the sub.~ect sewer and water facilities located at:
Signed Date
06-1220 (a)
DATE
STATE OF ALASKA
DEP, " '4EN¥ OF HEALTH AND SOCIAL SEP'" ES
DIVISIOfl OF PUBLIC HEALTH
BACTERiOLOGiCAL WATER AflAL¥$ S
lab. No. __
OFFrCS
SEMI,PUBLIC [] INDIVIDUAL [~ OTflER~__
REPOBT RESULTS TO - - -~ ....
NAME
ADDRESS
CITY
ADDRESS
OF SOURCE
SAMPLE COLLECTED BY.
DATE COLLECTEI] TIME COLLECTED ..... -
Ecm~ple CoBected Fxom [~J Kitchen 'lap [] Bathroom T~p [] ]~aaement Ta
[] Olher (List) ·
Well [~] Dug [] Drlveo. El Drilled [] Bored
SOURCE: [] Spring' [] C/slem ~.] Other
Dug Well or Cistern gomlructlon:
Brick or
WalIs- [] Wood [] goncrete [] Melal [] Tile r-i Concrelo
Top- [] ~Vood [] Conctelo ~ Melal [] Open Top
LOCATION: [] rn Basement [] Basement Offset [] Under Hou~
[] IuYa~rd [] Oilier ..........
Bu~Idinq Sower Septic
DISTANCE TO: or Other Dra~naqo Plp~ ...... Feel Tank ..... ' Feet
MATERIAL; Building Sewer - ~ ~st ~ W~d [~ Tile ~ Fibre ~
Iron
GENIAL: D~ea Water Become Muddy or D~lored? ~ Y~s ~ No
When? · -
PUMP LOCATION: ~ In Well ~ Oft~t~mentln ~ fa Bt~moni ~ InR~mUlillty
~ Of Well ~ ~her ·
PURPOSE OF EXAMINATIOH: lllne~ ~pocted? ~ Yea ~ No
NewSourceoiSuppl~? ~ Yea ~ No ~ep~lmtoSyslom9 ~ Yes ~ No
Records in this office indicate this WATEfl SLv/~PL¥ to be off
[] Satisfactory [] Questionable [] Unsalislactory Sanitary Status,
Analys~ ehows this Waler. SAMPLE lo be:
[] Salisfacto~y [~] Queslion~blo ~ U~aiis[actory.
Ii on '~n~is~aclo~" or 'Ouealonable" st~ ~ indicted a~ve
you should take frame.ate action as reco~euded below.
1. Notify consumers water i~ polluted, Boil or chemically
treat th~ water ~ outlined In tho enclosed leaflet
"Dri~ It Pu~e,"
2. Increase chlorination sufficiently to meet ~ecornmended reslduol standords.
Dete~ine sour~ of cont~inalion and take action necea~y to maintain
a ~fe waler supply at all timem
.... 3. Check chlorination ~d other mechaulc~ equipment. Make cetl~in
t~cflo~ng properly,
-- - 4: If after chec~nq e~ipmont ~ ~sinfecHnq ~ealdual f~ not obie~ed, please
wire th~ office for emergency ~lst~ce or adv~ services,
, ~. ThC'is a surlaco waler ~ and sublee~to pollution by mm~ and ~ approved wader supply so.ce should bo developed.
6. ~pxove your ~ ~Hnq ~ dug we~ ~ driven well
~ drilled well ~ c~lem
7, Relocate your well to a ~[e locolion in relaliouship to yom' sewage d~posal
syaem. ~ see end.ute
8, 8ample too tong In tr~sitl e~ple ohould not lm over 48 ho~s old
ex~ination to indicate reli~lo xesulis, please ~nd now s~pte,
~ Bottle Broken ~ u~li, please ~nd new sample.
9, ~ntact your n~rest ~ ~c~ Health Depmiment or ~ Alaska
Division of ~bBc Healfl~, ~nitation office for b~leti~, comulta~ion and
Sig, na:ure
READ INSTRUCTIONS
ON
REVERSE SlOE
BEFORE_
COLLECTING SAMPLE
0~-1220 (b)
BACTERIOLOGICAL WATER ANALYSIS RECORD
, , : ~ . Time Received,--.,~.~--F pm Eob, No, __
· AG/Ill, __ .
....... Greta's ~t~n ......