HomeMy WebLinkAboutTURNAGAIN #2 BLK 5 LT 4
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
4
~/~ ~'~'~'~'~'"~ Date of Inspection
REQUEST FO~APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
requested by: --~/.~
Mailing Address: Phone:
2. Property Owner:
Type of facility to be inspected
Well Data:
A.
~. Construction
Sewage Disposal System:~._~.i.~>~,
B. Depth
D. Bacterial Analysis
A. Installed
Installer
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
2. Manufacturer
2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
, Absorption area
, Sewer Lines ,
Nearest lot line
Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74)
Page 1 of two pages
P~_age ~,of two pages - Re.st for Approval of Individual ~er & Water Facilities
"4
Legal Description
Comments
Approved ~-~ ~/~ Disapproved Da t e ~/~[~f~
Approval .Valid for one year 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
E0-o34 /1/74)
06-1220
~' DATE
$1AI~
DEP, - MENT OF HEALTH AND SOCIAL SF"VlCES
DIVISION OF UBLIC HEALTH /
BACTERIOLOGICAL WATER ANALG$1$
PUBLIC []
NAME
AODRESS
SEMi-PUBLIC r'~'~INDIVIDUAL [] OTHER
REPORT RESULTS-TO
CITY
ADDRESS
,OF SOURCE
SAMPLE COLLECTED BY
'/-,//'?~/
DATE COLLECTED ?
SamPle Collected From
[] Other (Listl
TIME COLLECTED
ZIP
CODE
Well I-] Dug r'l Driven
SOURCE: [] Sp[ing [] Cistern
Walls -- ~-I Wood [] Concrete
Top -- [] Wood [] Concrete
LOCAT(ON: [] In Basement
[] 'In Yard r'l Other
DISTANCE TO: or Other Drainage Pioe
Cast [] Wood
MATERIAL: Building Sewer -- []Iron
GENERAL: Does Water Be~bme Muddy or Discolored?
When?
PUMP LOCATION: [] [n Well
On Top [] Other
-1 Of Well
~] Drilled r~ Bored
[] Other
[] Mete [] Tile [] Concrete
[] Metal [] Open TOp -
[] Basement Offset [] Under House
SepBc
Asbestos
Diameter Deoth '
Water Depth
PURPOSE OF EXAMINATION: Igness Suspected? []Yes []No
New Source of Supply? [] Yes [] NO ReDairs to Svstem7 [] Yes
Lab. No
OFFICE
Records in this office indicate this WATER SUPPLY to be of:
[]Satisfactory []Questionable ClUnsatisfactorv Sanitary Status
Analysis shows thisWater SAMPLE to be:
5'lS~atisfactory [] Questionable [] Unsatisfactory.
[[ an "Unsatisfactory" or "Questionable" status is indicated above
you should take immediate action as recommended below,
I. Notifv consumers water is polluted. Boil or chemicagy
treat this water as outlined in the enclosed eaflet
"Drink [t Pure."
2. Increase Chlorination sufficientlv to meet recommended residual stanDarDs.
Determine source of contamination and take action necessary to maintain
a safe,~vater supply at all times.
3. Check chlorination and other mechanical equipment. Make certain it is
functioning properly.
4. If after checking equipment a disinfecting residual is not obtained, please
wire this office for emergency assistance or advisory services,
5. This is a surface water source and subject to pollution by man and animals.
An approved water supply source should be developed.
E. Improve your []spring []dug well []driven well []drilled well Ocistern
7. Relocate your well to a safe location in relationship to your sewage disposal
system. [] see enclosure
S. 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.
9. Contact your nearest [] Local Health Oepartment or [] Alaska
Division of Public Health, sanitation office for bulletins, consultation and
SANITARIAN'S REMARKS
Signature
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
06-1220 (bi BAi3'FERIOLOGICAL WATER. ANALYSIS RECORD
Date Received '~ Time Received -. ~----.-P~'-'~t~' NO.
Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 0.1 cc
24 hours ...... ~
EMB AGAR
--Lactose Broth, 24 hrs. 4~ hrs. Gram's stain
Coliform Density (Most probable No. per 100cc.)
--Mr results
~'~'~ Date~
--Reported by (-~ A,
This analysls in'mates Coliform Organisms to be:
Present
February 16~ 1972
Greater Anchorage Area Borough
Department of Environmental Quality
3500 Tudor Road
Anchorage, Aalska 99507
Dear Sir:
This letter is to confirm the agreement that I~ Sidney Abbott,
will have upgraded the existing well on Lot 4, Block 5, Turna-
gain Subdivision #2, to meet the requirements of Title 7,
Division 1, Chapter 2, Subchapter 1 of the Alaska Administrative
Code~ on or before July 15~ 1972.
DATE: February 16, 1972 Sincerely~
Mr. Sidn~/y//Abbott
This is to certify that on the 16th day of February, 1972, before
me, the undersigned Notary Public in and for the State of Alaska,
duly commissioned and sworn, personally appeared Mr. Sidney
Abbott, known to me and to me known to be the individual named
in and who executed the foregoing instrument, and acknowledged
to me that he signed and sealed the same as his voluntary act and
deed for the uses and purposes therein set forth.
IN WITNESS WHEREOF, I have hereto set my hand and official seal
the day and year first above written. .. ....
o mm i s s i o n E x p i r e s · M~ ~mmi~s[oll