HomeMy WebLinkAboutTHEL-RAY PARK BLK 1 LT 5kt 010 14-o0o Department of Enviromlental Quality ~/b~~' Street, Anchorage, Alaska 99503 274-4561 ~ Date Received November 22, 1976 'rime of Inspection ~~ '1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: REQUEST FOR APPROVAl. OF INDIVIDUAL SEWER & WATER FACILITIES FOR ViA. Security Pacific Mortgage 319 West 5th Avenue Margaret Anderson 4200 Northwood Drive Date of Inspection 3. Legal Description: Lot 5 Bl.ock 1 Thel-Ray Park 4. Location: 4200 Northwood Drive Phone: 272-9501 Phone: 278-2727 Type of facility to be inspected Duplex Well Data: A. Type Individual C. Construction Sewage Disposal A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: Total Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank System: 1. Size 1. Absorption Area length of lines No. of bedrooms 3 B. Depth 15]_' D. Bacterial Analysis , Sewer Lines __ B. Installer 2. Manufacturer 2. Material , Absorption area , Other contamination , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) 'Page 1 of two pages Page 2 of two pages - Rec, it for Approval of Individual S ~r & Water Facilities Legal Description Lot 5 Block 1 Thel-Ray Park Comments Approved Disapproved A~LO~>~N_ Date .[y W '-~? -~ // Approval ,Valid for one yc~r from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MONICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV 2 © ,:, 1976 RECEIVED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA XX 2. Property Owner: ANDERSON, Margaret (Mrs.) Mailing Address: FHA CONV__ 4200 Northwood Drive, Anchorage Day Phone 278-2727 Name of Buyer: Mailing Address: CRONIN, Gary J. 525 West Irving, Anchorage (Works on Platform--will not return until Day Phone 11/28) Name of Lending institution: Security Pacific Mortgage copporation Mailing Address: Name of Realtor or Agent: Mailing Address: 319 West 5th Ave. 99501 Phone 272-9501 Larry Freeman .... SHERLOCK REALTY 2506 Fairbanks Street. Anchorage Phone 278-2727(24hr answering) 6. Legal Description: Location: Lot 5, Blk 1 THEL-RAY PARK S/Division 4200 Northwood Drive~ Anchorage~ Alaska 99504 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 151 feet 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation DUPLEX DWELLING ~XM~tt~M~ No. Bdrms. ~ 3 (reported) Inclividual duplex only Individual (on-site) EQ-037 (1/74) GATE STATE OF ALASKA Dr-%RTMENT OF HEALTH AND WEL?"~E \ -? DIVISION OF PUBLIC HEALTH ~ ~ BACTERIOLOGICAL WATER ANALYSIS REPORT RESULTS TO NAME . AOORE$S r Records in fhis olBce indicalo lhis WATER SUPPLY to be of: [] Solisiadory [] Quesllonnble [] Unsafisfaclory Sanilar¥ Slalu$ I an "Unsalislaclory" or "Quesfionable" sfalus is indicated above you should lake immediale aclion as recommended below ~ Noilly consumers wmer ~s Dollufed. Boll or chemica y SAMPLE COLLECTED BY DATE COLLECTED Sample Collected From ~ Other (Lisl om SANITARIAN'S RI"MARI(S READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPI.,E BACTERIOLOGICAL WATER ANAt¥SIS RECORD are 24 hours AGAR 48 hrs. Qm ~.chorag~, Alaska 9950]. REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (['il]. out in T~iplicate) / Name .of person requesting approval_ [./~, Name of property~ owner Number of 3~edrooms an house Water Analysis: a. Bacterial b. D~tergent ....... Well data: c. Casing Size d. Distance from well to closest existing or proposed: Sewer line 2, Septic tank 3. Seepage Area 4. Cesspool' 5. Property Line 6, Other sources of possible contamination, i,e,, creeks, lakes, Sewage disposal system, b. Age of system____ _ Septic tank capacity in gallons Name of septic tank manufaetu~gr houses, barn, drainage ditch, etc. If "home made" show diagram on reverse ~ide of this form. d,' Disposal field or seepage pit size and type 1, Di~e. ance tO prop~m%7 line to house t~ m. datzon e, Persola'tion. Test f. Percolation Test performed by ........... , Use the reverse side of this form to show diagram. Diagram should include · %he foilowing iuformation: ppoperty lines~.well location, house location~ s6ptlc tank locatlon~ disposal area location, location of percolation test, and direction of ground slope. The l~£om~r~?ion on this form is true and correct ~o the beet of my knowledge. ' s Signat~e Of ~ppii6~n~ ..... Da~-glg~ed / T,~O BE FILLED OUT BY HEALTH DEPARTt.IENT PERSONNEL ~The above described sanitary facilities are hereby approved, subject to thee / ........ ~6'llowin~ eon¢i~ons: Condit ions: ~X~-~ ~) ? >~ The above described sanitaryfacziztzes ..... are dzsapproved for the following reasons: - · · Date "~/ ~,'.~, :'~,~.:~. Appro,R~l'i~' va].ld for ohs year f~iiowing the date of approval. CPJ: cw STATE OF ALASKA DEr` "TMENT OF HEALTH ANDWELF' DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL :WATER ANALYSIS 'E Lab, No, OFFICE OTHER NAME ADDRESS SAMPLE COLLECTED BY : ~semenl~]lnTap DATE COLLECTED ~ ~__ TIME COLLECTED pm Diameter o[ Well. Deplh Well Casing Malarial Diameter Deplh Records in this ollice indicate this WATER SUPPLY fo be of: [] Safisloctory ~] Questionable [] Unsalldadory Sanitary Status. __ I. Notify consumers waler is polluled. Boll or chemicolly Ireol Ibis waler os oullJned in the enclosed leallel "Drink II Pure." [] drliled well [] cistern. SANITARIAN'S REMARKS ' : : ~I ' ~' READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Date Received Laclose 8rolh 24 hours 48 hours EMB ..'") : /'~,' ' /",,:. __Timo Re¢olved ., (Pm }Lab. No ' ..... ' BGB .(Mosl probable No. per IOOcc.) Reported by i/? ? Dete~ ?his analysis indicales Coliform Organisms to be: ' Absenl