HomeMy WebLinkAboutTRI-LAKES BLK 1 TR 4A1OIZ. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 TIME: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES FOR ADDRESS: PHONE:. 2. PROPERTY OWNER: ~/~ ~y~ ~/ PHONE: 3. L'EGAL DESCRIPTION: ~'/~'~J/~ ~/'//~"~ 4. tYPE FACILITY TO BE T~ISPECTED:.~'~ STREET: NU~IBER OF BEDROOMS: <~/~Z~f WELL DATA: B. DEPTH C. SIZE D. E. CONSTRUCTION ~Y~'~ BACTERIAL ANALYSIS 6. SEWAGE DISPOSAL SYSTEM: SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK) 2. AGE 3. ~ MANUFACTURER 4. INSTALLER APPROVAL REQUEST ~R SEWER & WATER FACILITIES 'PAGE TWO B. SEEPAGE PIT 1. SIZE 2. LINING C. DISPOSAL FIELD 1. NUMBER OF LINES 2. TOTAL LENGTH 7. REQUIRED MEASUREMENTS A. WELL TO SEPTIC TANK B. WELL TO SEEPAGE PIT ,/~© C. WELL TO SEWER LINE D. WELL TO PROPERTy LINE E. WELL TO OTHER POSSIBLE CONTAMINATION F. FOUNDATION TO SEPTIC TANK G. FOUNDATION TO SEEPAGE PIT H. SEEPAGE PIT TO PROPERTY LINE 8. COMMENTS: GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY DATE STATE OF ALASKA L'"-~ARTHTENT OF HEALTH AND WE/-'~RE DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS PUBLIC [~ SEMI'PUBLIC[] INDIVIDUAL [~ REPORT RESULTS TO NAME OTHER ADDRESS ADDRESS OF SOURCE SAMPLE COLLECTED BY ' z ~/' ~'"' "'" DATE COLLECTED - TIME COLLECTED Records i. this office indi¢ole this WATER SUPPLY to be of: [] Safisfaclory [] Questionable [] Unsatisfactory Sanitary Status. Analysis shows this Water SAMPLE to be: [~ Satisfactory E] Questlonab~e [~ Unsatisfactory. If on "Unsatisfactory" or "Questionable" status is indicated above you should take immediate action as recommended below. 1. Notify consumers water is polluted. Boil or chemlcally treat ~his waler as outlined in the enclosed leaUet "Drink It Pure." 2. Increase chlorinalion sufficienll¥ to meet recommended residual standards. Determine source of contamination and take Delian necessary to maintain a safe water supply at all times ~t, Check chlorii~al]nn and other mechanica~ equipment. Make certain il is funcEonlng properly. 4. If after check~ng eaumment a dJslnlecEng residua is aal oblained, please wire Ibls office for emergency assistance or advisory services. [] Under House [] No 5. This is a surface water source and subiecl to pollulion by man and animals. An approved water supply source should be developed. 6. Improve your [] spring [] dug well [] driven well [~ drilled well I-- cistern. 7. Relacale your well to a safe location in relafionshlp la your sewage d~sposal system. [] see enclosure 8. Sample too long in transit: sample should hal be over 48 hours old at examlnation to indicate reliable results, oleose send new sample. [] Bott~e Brohen in lranslf, please send new samale 9. Confacl your neares~ [] Local HeaJlh De~arlment or [] Alaska Division o~ Dubllc Heabh. sanilation office lot bulletins, consultation and assistance GENERAL: Does Water Become Muddy or Discolored? [~ Yes When? Well Casing Dro~ Pipe tram Bottom Feet SANITARIAN'S REMARKS Signolure READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Date Received - Time Received Pm Lab. No . Lactose Broth 10cc 10cc 10cc 10cc I 10cc 1.0cc 0.1cc I 24 hours 48 hours Brillianl Green . 24 hours 48 hours am Reporled byr ' r Dale This analysis indicates Coliform Organisms to be: Absenl Presenl DIRECTIONS FOR COLLECTING SAMPLES OF WATER FOR BACYERIOLOGICAL EXAMINATION Read Carefully and Follow Instructions Exactly Bear in mind Ihal water analysis declJs wifll nlclleriaJs present in very mlnuJe quanlilies. The JeasJ carelessness in collecHng end handling may give rise Io results which are misleading. Airangements should be made to hove walel samples ~eoch the laboralory as quickly as possible. After 48 hours lhe significance et Jhe boclerioJogicoJ analysis is impaired. For obvious reasons Ihe Jobololory p~eJers 1o receive samples in Ibe early parlo[lhe week but iswiJJing Ia occepl samples el any lime. In collecth]g samples from TAPS or PUMPS ploceed as follows: (a) [boroughJy tlush laI) or pump hy allowing wolel 1o run freely fei five minules. (b) Shul off waler and flame Ibe outlel wilh larch or burning paper, fha flame should hal be merely passed over lhe oulJel bu[ should be applied unlil tixture shows indicalion of being hal Flame should be directecl againsl inside edge. (c) Open fixlure so lhal a smell slrdam flows. (d) Remove bollle fronl mailing tube. Hold bollle by lbe Jewel half in one hand and wilb lhe olher remove lhe screw caI) wilb lbo lingers, leaving poi)er plolecling cover in place. Fill Ilia bolllo 1o Ihe shoulder. Replace cap wilil paper cover, screwing firmly inlo place but do nol apply pressure which will splg cap. (o) Packbollle carefully in moilingJube enclosing thiscompleJed information shoal. In collecling samples from STREAMS and RESERVOIRS proceed as follows: (a) Remove cap and bold boltle as described under (d) above. (b) Collecl sample by holchng boltle in e slanling position and sweeping il below ll~e sulface in such a manner wcger Ihal has been in conlacl wilh lbe hand is nol inh'oduced inlo Ihe bollle. Avoid collecting surfoce scum end bottom sedimenl. DO NOT COLLECT S MPLES FROM FII?J , HYDRANTS, Y RD HYDRANTS, DRINKING FOUNT. INS OR SIMI- L,AR OU' 7,.ETS 7]ICII A ',E D FFICULT DISINFECT PI O ERL STERILE WATER 5AMPI.E BOTTLES ARE AVAILABLE UPON REQUESI FROM: I)opL c,f Hoolfll & Welfare [)opt. of Health & Welfare SOUTHCENTRAL REGIONAl. LAf~OR^TORY Dept. of Ilealth & Welfare