HomeMy WebLinkAboutSPENARD ACRES Block F Lot 3A
,:~-~<~C~ ~_~' MUNICIPALITY OF ANCltORAGr
i/~!?~'i,,xN [\~D~C~TML OF HEALTH AND ENVIRONMEN PROTECTION
~[~'~C{=F~.~, I ~U/~i~' ~ L S%reet, Anchorage, Alaska 99501
~~/~ J .~,~ t.~F~ 279-2511, ext. 224 or 225
Date O~~ Date ~C~-~m~ ~ Date
Insp ~~'~ Insp ~ , Insp --- --
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Coast Mortgage Company
Mailing Address: Post Office Box 1200 99510 Phone:
2. Property Owner: Russell A. Stallcup Phone:
Mailing Address: 3803 Indiana 99503
279-0665
3. Legal Description: Lot 3A Block F Spenard Acres Subdivision
4:
Single Family Residence: (
Multiple Family Residence:
5. Well System:
Number of Bedrooms:
Number of Bedrooms: ?
Permit # Depth of Well
Sewage Disposal System: On-site System
Permit #
Septic Tank Size
Absorption Area
Individual well (x) Community/Public System ( )
Well Log on File
Bacterial Analysis
( ) ?? Public Utility -~)
Installed Installer
Manufacturer
Soils Rate Material
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 3A Block E Spenard Acres Subdivision
Colnulen t s:
Affadavit Attached: ( ) Letter Attached: ( )
Department Worksheet:
06-1220kd
Rev. 1973'
DATE
NDIVIDUA[ []
NAME__
ADDRESS
AL.. , DEPARTMENT OF HEALTH AND SOCIAL SI-,.
DIVISION OF PUBL C HEALTH
INDIVIDUAl AND SEMI-PUBLIC
BA, CTERIOLOG I CAL WATER
SEMI.PUBLiC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
CITY _ZIP CODF
ADDRESS ; / ~ /' "i ~; ' \ '
OF SOURCE ! "! / f' ! ~
COMPLETE THIS SECTION
ONLY IF ,WATER IS AN INDIVIDUAL SUPPLY
SAMPL[ COLLECTED BYe, .-' '
DATE COLLECTFD
[~] O~her .~s~
[].KilchenTc~ [] BalhroomToD []rBasementToD
[] Driven [] Drdled [] Bored
[] Cisterr [] Other_
Dug Well or Cistern Construcl on:
Wolls~ [] Woo£ [] Cancrele [] Meta
Tau- ~- WaDe [] Concr~le [] Meld
LOCATION
[] II~ Bast~ment ~ BasementOffsel
[] In Yard [] Other
Building Sewel SoDhc
DISTANCE TO o~' Other Drainage Pioe__ _ Feet Tank
Tile Seepage Cess-
Field_ Feel. Pit__ Feel PoD Feel Privy
Other Poss~ble
MATERIAL: Building Sewer - [] Cast Iron [] Wood [] Tile
GENERAL Dops Water Become Mudav or Discalorpd?
L~ Tile Brick or
[] aden TOE [] Concr~ie
[] Yes [] No
Well Casing Room
Material Diameter Depth '
Length of Water Deplh
PUMP LOCATION [] In Well [] Basement [] In Basement []
On Tap
[] Of Well [] Olher
Lab No ~L~ : ~
A N A L Y S I S OEE, E
~.rlo ysls shows this RVoter SAMPLE to be:
[] Unsatisfactory
[] Questionable
[] Samde too long m transtt; sample should not be over 48
naurs ola at exominalion lo indicate reliable resuhs. Please
sena new sample.
~ Bo e broken m transil, please senti new sample.
SANITARIAN'S REMARKS
PURPOSE OF EXAMINATION: Illness Suspectecl?
New Source of Supply9 [] Yes
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
[] Yes [] No .
[] No Repairs to System? [] Yes [] No Signature~ /
06.i 220 ib) ':'~ ii .
Rev. 1973 BACTERIOLOGICAL WA:l-ER ANALYSIS RECORD /' -',
Lactose Broth I Occ 10cc I Occ 10cc I Otc 1 Otc 1.0cc
24 Hours
48 Hours
g,1 Hours
48 Hours
EMB AGAR _
Loclose Broth, 24 hrs. 48 hrs. Gram's stain
Coliform Density IMost probable No. per I OOcd
MF Resuhs
,'
This analysis indicates Coliform Orgahisms Io be:
MUNICIPAI..ITY OF ANCHORAGE
DEPARTIVlENT OF I-'IEALTI-~ AND ENVIRONMENTAL PRO'I'ECTION
825 L Street., Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAl.. OF
INDIVlDUAt. SEWER mid WATER FACILITIES
MUNICIPALITY OF ANQ~O,q'AG2
DEPT. OF HEALfH &
F. NVIRONMENTAL PROTECTION
ot:.I- 'J. 1977
RECEIVED
1. Type of Inspection: VA FHA ~" _.CONV~ ...........
2. Property Owner: ?d{~(~_l_ ,~.
Mailing Address:~____~/~ I~1~ ......................... Day Phone:__~
' g Add e .__~_.~[_,_,_..~':~ ...... ~ ........ [hone:
5. Name of Realtor o r A ~ e i' t: ..... ~1 [}Z
Mailin9 Address: ...... AI~LPL_~Z&Z._;E1 ~_D¢ ........... Phone:.
6. Legal Description: /~OT ~%A , F?~-~ r, ~,, ~¢i3¢~9~¢D
Type of Facility to be Inspected: :~__~__ ,~.U[ ~)~-'_~_z~ ....... No. Bdrms._L2J_L~J~J'L]_
Water Supply
Type of Supply: Public Utility. Individual
If Individual, nurnber of dwellings presently served
If Individual, depth of well.
Sewage Disposal System
Type of System:
Public Utility
If Individual, date of installation
I ndivictual (on-site)
72-003(3/76)
Municipalityof
Anchorage
POUCH 6-650
ANCHORAGE, ALASKA 99502
(907) 279-2511
GEORGE ~ SULLIVA~
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(825 "L" Street)
September 14, 1977
Russell A. Stallcup
3803 Indiana
Anchorage, Alaska 99503
Subject: Lot 3A Block F Spenard Acres Subdivision
An inspection of the subject property indicates that the
well casing is below the ground level.
The requirement for wells is that the casing be extended
twelve(12) inches above the ground, closed with a sanitary
seal approved by the department and sloped so as to drain
away from the well casing. This action must be accomplished
before approval of your request can be granted.
If there are any further questions, please contact this
office at 264-4720.
Sincerely,
Principal Code Enforc~r6ent
JK/lj h
Officer
CC:
Coast Mortgage Company
Post Office Box 1200 99510