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HomeMy WebLinkAboutTURPIN BLK 3 LT 3 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Sto, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Insoection: CMRO VA ~ FHA 2. Property Owner: · Mailing Address:~Z ~m~ ~ Da.y Phone 3. Name of Buyer: ~z~.~ Mailing Address: , . 4. Name of Lenaing ~nstitution: _~ Mailing Address: Legal Description: Location: 7. Type of Facility to be inspected: /~,~ No. Bdrms. z~ 8. ~ater Supply Type of Supply: Public Utility ~ Individual If Individual~ number of dwellings presently served If Individual, depth of well Sewage Disposal System Type,of S~stem: Public Utility If Individual~ date of installation Individual (on-site) /f~, 4~.~.. _ F?q,Je£t for Approval of Tndividual Sewez' & Water Facilities ?age Two Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM / I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities located at: Signed Date Approval Requested By: Address: GREATER ANCHORAGE AREA BOROUGH Department of Envtronmentel Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received~ Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 2. Prooerty O~ner: 3. Legel Description: Location: 5. FOR Type of Facility to be Inspectgd: Number of Bedrooms: 5. Well Data: ,~ C. Construction 7. Sewage Dts6osal System: B. Depth D. Bacterial Analysis' ! Installer C0 Septic Tank: 1. Size ,~-o 2. ~anufacturer D, Seepage Pit: 1o ~' '~- · Eo Disposal Field: Total.%ength of Lines 8. Distances: A. Well To: Septic Tank ,~-~-- , Absorption Area -~- , Sewer Lines ,~-- ~ Nearest Lot Line /~ ..... ~ Other Contamination-~,,., · B, Foundation to Septic Tank ~__-~C.~.Ab§orptton Area ~/~ C. Absorption Area to Nearest Lot Line ~-~i - it~l- es.~ we~eLi t nspe' c ted S6y~ jC ta~kya-nd cesspool~'/ .~ncho~e :Are6-~ Borqug~_. ~de-bf o~dtnances-' ~eq u t ~e:~J~t 6-..-h:oo k u:A. 't o '.pub 1 t~ SbWe:~:..'b~. ~ay 30~- ~) 974~ ~ ' ~;':'~"T'he'.'~:"~6~n~ syg'~6~' is ~Uh~ionin~sa~i~;f:a'~6{O~i)y.' and 9i v6n '~6'mP~rary Approva).' pending ':esc~-~f· .fun:js .fo~ h~OE'up"~ 'publ~i:c-.~eWeF;'.'~}. ~ ./._ .~-~--:~ :.:_:..... ' '. '~ ;-'-.s~s~--'('c~e~:~al..~la. gka' o~t.li;:ies);.; :.; L.:~;.. ~:-.; you llave any ques:tons concePntng t~;e:{aEO~E,'pl.ease-..'fe~i' this deparLment at 274-4561, extension free to contact Sincerely, Charles F. Sellers, Environmental Control Officer CFS/ko Certtfte:j No. 740086 .~T:O~O~ llVW 1VNOILVNB]INI ~OJ ION l~Gl '~v /o .oS) --O]OlAOUa ]$VB]A09 )ONVBflSNI ON 008£ m~oa S~ (a3elsod snld) PO~--'llVIN 031411~3:3 ~lO:J P ,' :-: ). :,:" 0'!:' -i - REQUEST 0~ APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILIT~IES (Fill~out i~ T~plicate) person ~e que~~ ~~ ~/~' ' ,'. _ · . . -.. 5. ~ate~J~na~sis: a. B a cwce~im~l b. Detergent b. Depth ~ c. Casing Size Distance from well to closest existing om proposed: 1. Sewer line 2. Septic tank 3. Seepage Area g, Cesspool~., 5. PmopePty Line §. Othem sources of possible contmmina%ion, i.e.~ cPeeks~ lakes~ houses, baPn~ drainage ditch, etc. a, Age of s~s~em 1. Y~ / b. Septic tank capacity in gallons . 1. If "home made" show diagram on reverse side of this foPm, d.' Disposal field o~ seepage pit size and type,~f~;/ ~' ~'--/~ / i, Distant% to prope~ line to house fo~dation e. Percol~tio~ Te~t ~esults f. Percolation Test performed by U se he reverse .side of thzs form to show diaEram, Diagram should include .~.~he fo~owlng ~nfo~ation: p~ope~y lines; ,w~ll location, house location, ~ic tank location, ~spgsal area location, location of percolation ~es~, a~ di~etion of ground~slope, The t~tion On this form is tpue ~and comrec~ ~o the besl of my knowledge. SignaTure of Applicant b~e $i~ned ?,,0, BE FILLED OUT BY HEALTH DEPART~,JENT,, PERSO!{NP,[, ~e above described sanitary facilities are hereby approved, 1subject to the ......... ~l!owin~ oon~ons: Conditions: The above described sanitaryfaclllties' ' are disapproved fop the following . ..... ~a~e -:,./. ~:~, ~.,~ ' Appel ls va~zd ~o~ one yea~ ~ol~o~&n~ the date o~ app~ova2. CPJ:cw '~_,. 2, 3, 4, 5, Water Analysis: a. Bacterial Well data: b. De th_ c. Casing Size 0 Distance from well to closest existing or proposed: 1. Sewer line 2. Septic tank 3, Seepage A~ea 4. Cesspool' 5. Property Line 6. Other sources of possible contamination~ i.e., creeks, lakes, houses, barn~ drainage ditch, etc. Sewage disposal system. a0 b. Age of system /(.~/d,W/l .. / Septic tank capacity in gallons Name of septic tank manufacturer If "home made" show diagram on reverse side of this fo~'m. d.' Disposal field om seepaKe pit size and type 1. Distance to property line to house foundation e, Pereolatioa~Te~t ~esults f. Percolation Test performed by Use the reverse side of this form to show diagram. Diagram should include -~he foilowing information: p~operty lines~well location, house location, ~ptic tank location, disposal area location, location of percolation test, and direction of ground slope. The information On thiy~ form is true and correct to the best of my knowledge. S~nature' Of Applicant Date Signed \ TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSON~E[, ~T'he above described sanitary facilities are hereby approved, ,s~bject to the ~llowing condii'ions: Conditions: ~7¢~>~4 The above described sanitaryfacilities' ' ' are disapproved for the following reasons: Approval is valid for one year following the date of approval. CPJ: cw ~o.~s - 5M ~ zab. mo.. ~ ~:~/~/ INDIVIDUAL WATER SUPPLY // ~ ALASKA DEPARTMENT OF HEALTH ~outhcentral ]~e~cm~ DAiYE OFFICE Section of Sanitation and Engineering ACTION ON REQUEST FOR BACTERIOLOGICAL WATER~ ANALYSIS Your recent request io~ an analysts of a sample from the Individual P~ivale Water Supply examlnatlon has been completed. Records in this oliice indicate this Individual P~ivate Water Supply to he of Satistactory__Questlonable )~ Unsatisfactory Analysts shows this SAMPLE to be Satlsfacto~y Questionable. Unsatisfactory. If an "Unsatisfactory" or "Questionable" status is indicated c~hove, you should take immediate action as recommended below. closed leaflet, 'fDrtnk It Pure." 2. Improve your spring-- See bulletin HS£-6-2 3. Improve you~ cistern -- See bulletin HSE-6-3 4. Improve your dug well--See bulletin HSE-6-4 5. Improve your driven well-- See bulletin HSE-6-5 6. Improve your drilled well- See bulletin HSE-8-8 7. Relocate your well to a safe location in ~elatlonship to your sewage disposal system -- See bulletin HSE-15 8. Bottle broken in t~ansit, please send new sample. 9. Sample too long in transltl sample should not be over 48 hours old at examination to indicate reliable results. 10. Contact your nearest [] Local Health Department or [] Alaska Health Department, Sanitation office for bulletins, consultation, and assistance. should be developed. SANITARIAN'S REMARKS'~ .-t''~ z t ~ ~. ~ :g 'j ' - ADi~HSE-6-FI (e) t~ :!;'~!~ ~'t ~ TAKE WAqttR SA~,IPLE TO:' ' "~'~ ' " Laborer -, ~.:5 Si~h Ave. INDIVIDUAL WATER ~.JPPLY PA. dI. sKA DIgPARTiVI~2~T OF Section of Sanitation and ~--Eineering Request for BacteriologiCal Analysis, This Form Must Be Filled Out Completely. L~ .ou, ' 945 ,?.ixth ZWe. I r lease Look on Reverse o! [ Sheet for Sample Collection ] Instructions. ~ ! Lab; No ...........~ ............................... Water sample collected by ........ ..~7..I..:....~-...~.--~...--~..-.D.--. :T-'-~-~-- .................................... -/-. -~------~/-- -~--./-- ......... /. ......... .~...O. ..... (Name of person collecting -sample) t (Dat~) (Time) Water sample collected from [i~Itchen tap; [] B~throom tap; [] Basement tap; [] Other (list)~ d. m t~t/_. ~?) ...................... -1.... ~ '/~1' ............................................... * .............................. Address premise where source is located.....,~b.A..O....?-)..tJ, E..L.-n....--..°- ........... q..--~-. -~-f%t': -~-----...-?-..-Q.-6~--~--.< ........................... (Mr.) ' ~, ~ '' ._.r/.:~.//e:. ~.:. ........ Mall report to (Name) (Box No. or street address) (City) Please place an "X" in the box before lte)~ which be~t describe your water supply: SOURCE: Well -- [] Dug, [] Driven, [~/Drilled, [] Bored [] Spring, [] Cistern, [] Other (list) ............................................................................................................... [] Creek, [] River, [] Lake, [] Pond ................................................................................................................. DUO WELL OR CISTERN CONSTRUCTION: Walls- [] Wood, [] Concrete, [] Metal, [] Tile, [] Brick or Concrete Block Top -- [] Wood, [] Concrete, [] Metal, []Open Top LOCATION: [] In basement, [] Basement offset, [] Under l~ouse, [~ yard Other ..................................................................................................................................................................................... DISTANCE TO: Building sewer or other drainage pipe .............. feet, Septic tank .............. feet, Tile field .............. feet, ~Seepage pit .............. feet, Cesspool .............. feet, Privy ..............feet. Other possible sources of contamination (list) ............................................................................................................................................. MATERIAL: Building se~er -- [] Cast iron, [] Wood, [] Tile, [] Fibre pipe, [] Asbestos cement Joint material -- Type ....................................................................................................................................................... GENERAL INFORMATION: Does water become muddy or discolored? [~es, [~ When? ....................................................................................................................................................... Diameter of well.....~... ............................................. depth .......N...~.....:= .................................... feet Well easing material......5....?-..C..e...[ .................. dtameter...&~.( ......... depth .................................. Length of drop pipe ............................................................................................................................... Water depth from bottom ............................................................................................................ feet Pump location: [] In well, [] Offse/; in basement, [i~n basement In utility room, [] On~ --,t ,, --t°P of well other (t t, ............ PURPOSE OF EXAMINATION: Illness suspected? [] yes, [] no New source of supply? [] yes, [] no {/(* 4 Repairs to existing system? [] yes, [] no Remarks: ..................... ! ................................................................................................................................................................................... PLEASE DRAW A SKETCH IN THE SPACE BELOW. THIS SKETCH SHOULD SHOW LOCATION OF HOUSe, WATn~ SUPPLY SOURCE, SEPTIC TANK, SEWER, DRAIN LINES OR OTHER SOURCES OF POLLUTION AND DJSTANCES BETWEEN WATER SUPPLY SOURCE AND ANY OF ABOVE FACILI'A'M/iS. SAMPLES MUST BE SUBMITTED IN CONTAINERS PROVIDED BY Tfll~ ALASKA DEPARTMENT OF HE&LTli q£ MEMORANDUM TO. File FROM Albert L. Kinstrey, Jr., Sanitarian I DATE SUBJECT il May 19~ W. E. Armbruster Lot 3, Block 3 Turpin Subdivision I observed soil conditions, good gravel layer beneath organic overlay, while looking over cast iron pipe and septic tank installations. Overlay was 2 ~ 3 feet in thickness. A copy of surveyed installations will be forwarded to us for our files. ALKJr /ah GREATER ANCHORAGE HEALTH DISTRICT 217 E Street P.O. Box 968 Anchorage, Alaska BR 6-3351 Name of Buyer: Name of Seller: Property Address: ~/- Legal Description of Property: VA LOAN INSPEGTION FORM File Reference: Priority: rfp ~ D/L Phone number where buyer can be contacted: Mailing Address O~ Buyer :~ ~ ~ ~ ~] [ .~ e / (Sanitarian)