HomeMy WebLinkAboutTURPIN BLK 2 LT 14o
I..oT
.Pag~ Two ~
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 14 Block 2 Turpin Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Disapproved: Date:
Department Worksheet.:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L S~ree~, Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
VA FHA
CONV_ XXX
2. Property Owner: Robert L Culpepper
Mailing Address: ~t~ 6410. Bast 8th
Name of Buyer: Janet M. Hall
Day Phone:_ 333-1394
Mailing Address:_ Box 692, Chugiak, Ak.
4. Name of Lending Institution: National Bank of Alaska
Mailing Address: P.O. Box 3-3859
5. Name of Realtor or Agent: Tanner-McGowan'
Mailing Address: 3766 Arctic Blvd.
Day Phone: Business: 279-1611
Phone:_ 279 2506 X43-Shirley Jones
Phone: 274-2521
6. Legal Description: Lot 14, Block 2 Turpin
Location:
SFR
No. Bdrms. 4
Individual
X
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
9. Sewage Disposal System
Type of System: Public Utility
if Individual, date of installation
Individual (on-site)
72-003(3/76)
DATE
sTATE OF ALASKA
r./-'":~RTMENT OF HEALTH AND WE["'~iRE
DIVISION OF PUBLIC HEALTH '
BACTERIOLOGICAL WATER ANALYSIS
Lab. No.
OFFICE
REPORT RESULTS TO'
NAME
ADDRESS
ADDRESS
OF SOURCE
READ INSTRUCTIONS
ON
REVERSE SIDE
BE FO RE
COLLECTING SAMPLE
Records in this office indicate this WATER SUPPLY to be of:
[] Sallsfacfory [] Ouesllonable [] Unsatisfadory Sanitary Status.
If aa "Unsalisfactory" or "Questionable" status ~s indicated above
you should take immediate acgan as recommended below,
Notify consumers water is polluted. Boil or chemically
treat thls water as outlined in the enclosed leaflel
"Drink Ir'Pure."
2. Increase chlorination sufficleall¥ to meel recommended residual standards.
Determine source of contamination and take adion necessary ~o maintain
a safe water supply al ag limes.
q. Check chlori~alia~ and other mechanical equipmeflL Make certain it is
functioning properly.
~. II alter checking equipment a disinfecting resldua is nal oblained, please
wire Ihls oifice for emergency assls~ance or aclvisory services
5. This is a surface water source and subjed to pollugon by man and animals
An approved waler supply source should he developed
6. Improve your [] spring [] dug well [] driven wel~
[] drilled well [] c~stern.
7. Relocate your well to a sa~e location in relatlonship Io your sewage
disposal system. [] see enclosure
8. Sample too long ia trans~h sample should hal be over 48 hours old at
examlnafion to indicate tellable resulls, please send new sample.
[] Boltle Broken ia transiL please send new sample.
9. Contact your nearest [] Local Health Deparlment or [] Alaska
Division of Public Heallh, sanitation office for bulletins, consullalion and
SANITARIAN'S REMARKS
Signature '
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Received ~ ~ i ~ am
: ~: : Time Received pm Lab. No.
Lactose Broth IOcc IOcc 1Oct 1Otc ~ IOcc 1.0cc 0.1cc
I
24 hours
48 hours
BrillianlGreen
24 hours
48 hours
EMB AGAR,
Lactose Broth, 24 hfs, 48 hrs. .Gram's stain
Conform Density (Most probable No. per I OOcc.)
MF resulls.
Reporled by Dale
This analysisindicates Colilorm Organismslo be: Absenl
Presenl