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Home My WebLink AboutWENTWORTH BLK 1 LT 20LoT ~.~£ATER BNOiOR~GE BRE~ BOROUGH ! .,~,~ LTH DEPBRT~NT 32? EAGLE STREET /LNCHORAGE, ALASKA 99S01 279-2511 RBQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AMD WATER FACILITIES FOR 1. Approval Requested Phone ~ __M~, f.z 3. Legal Description _//~-~-- r~ 4. ?ype of Facility to be Inspected Number of' Bedrooms S. Well Data: ~. Depth C. Size ~ f~Y~C/~ Construction, ~~'~ E. Bacterial Analysis 6. Sewage Disposal System: Ao Septic Tank (If homemade, show diagram on back) 1. Size ~.,/ /~0 ~ ,~ Appr6~al Request for Se~ ~ P/ater Facilities Page T~o B. Seepage Pit 1. Size 2. Lining C...Disposal Field 1. Number of Lines 2. Total Length Required .~easurement s A. P/ell to Septic Tank B. P/ell to Seepage Pit C. D. E. //? Well to Sewer Line ~:~., P/ell te Property ~ine /: /7z- [fell to Other Possible Contamination F. Foundation to Septic Tank G. Fotmdation to Seepage 8. CO~ENTS: DISAPPROVED: DATE: APPROVAL VALID FOR ONE YEAR FROH DATE SIGNED. GREATER /~NOIORAGE AREA BOROUGH HEALTH DEPART~qENT EDllTO April 14, 1971 Peoples National Bank 80? "G" Street Anchorage , Alaska 99501 ATTE1TI'ION MRS. ABLE SUBJECT: Dear~re. Able: Residence at 3311 ~lst Ave. This letter is to inform you that the Greater Anchorage Area Borough--Department of ~.~nvironmental Quality has inspected the sewer and water system at the subject property. The ~.~ater inspection is approved by this department. The sewer system is given a temporary approval until the house can b~ connected to Borough sewer, wh/ch ~lll he later this sunm~er. The e~is~ing system can he ex/'~cted to function properly until this time, without creating any problems. We do not request that Shy funds he held in escro?~ because of the enelos~ letter. Sincerely, Enclosure Rolf Strickland Assistant Director Department of ~hvironmental Quali~y DE ~' 'RTMENT OF HEALTH AND WELF~--'E ~ DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS OFFICE NAME ADDRESS CITY ADDRESS OF SOURCE SAMPLE COLLECTED BY. am DATE COLLECTED TIME COLLECTED pm PUMP LOCAI'ION: [] In Well [] BOaffsSeemf el~, [~ In e ...... t [] Room Analysis shows Ihis Water SAMPLE lo be: Sallsfaclary [] Questionable [] UnsalJsfadory. ff an "Unsatisfactory" or "Questionable" stalus is indicated above you should ta~(e immediale action os recommended below. I. Notify consumers water Js polluted. Boil or chemically treat this water as outlined in the enclosed leaflet "Drink It Pure." 2. Increase chlorlnafion suJJiclenfJy to meet recommended residual slandards. Determine source aJ ¢onfamlnalion and take a¢lion necessary to maintain a safe waler supply at all times. S, Check chlori~atinn and Giber mechanical equipmenl. Make certain it is funclloning properly. 4 If ofler checking equipment a disinfecling residual Js not obtained, please wire Ihis office for emergency assistance or advisory services. S. This is a surface water source and subject to poJlulJon by man and animals. An approved water supply source should be developed. 6. Improve your [] spring [] dug well [~ driven well [] drilled well [~ cistern. 7. Relocale your well to a safe Iocolioa Jn relationship to your sewage disposal system. [] see enclosure 8. Sample log tong in Iransil~ sample ~hould not be over 48 hours oJd at examination to indicate reliable results, please send new sampJe. [] Bottle Brohen in transit, please send new sample. 9. Contacl your nearesl [] Local Health Deparlment or [~ Alaska Division of Public HeaBh, sanilalion office for buJlelins, consullation and SANITARIAN'S REMARKS READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Dale Received .... Time Received ~ ~ab. No. LactoseBroth 10cc 10c¢ 10cc 10c¢ J 10cc 1.0cc 0. icc I 24 hours 48 hours Brillianl Green 24 hours EMB AGAR Lactose Broth. 24 hrs. 48 hrs. .Gram's slain Co!Storm Density (Most prohahle No. per 100cc.) MF resuBs. Reported by This analysis indJcales Coliform Organisms Io be: am .Date pm Absent Present. REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill Out in Triplicate) ~ l~me.of person requesting approval ~~, 2. · ~[.~me' of property~ owner 3. ~al.~ de sc~iptioq 4. [mbex~:of, bedrooms in house $. W. ~te~ Analysis: b. Detemgent, , 6. W~,~ data: a. Type b. Depth. c. Casing Size Distance from well to closest existing 6r proposed: 1. Sewer line 2. Septic tank 3. Seepage Area 4. Cesspool'.. 5. Property Line 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. wage disposal system. b. Septic tank capacity in gallons c. Name of septic tank manufactu~m 1. If "home made" show diagram on reverse side of this form· d.' Disposal field or seepage pit size and type . 1. Distance to property line to house foundation e. Percolatio~ Test ~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, ~utic tank location, disposal area location, location of percolation test, an~ direction of ground slope. 9. The l~[ox~tion on this form is true and correct to the best of my knowledge. Signature of Applicant Date Signed TO BE FILLED OUT BY HEALTH DEPART~-~ENT PERSONNEL [---~The[ above described sanitary facilities are hereby approved, subject to the ~l!owing cond~'lonsi ' Conditions: The above described sanitary facilities are disappmoved for the following reasons: . CPJ:cw AOHW- LAB - ~-W DATE qr ~.RTMENT OF HEALTH AND WEI~,,~E ~-~ DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS PUBLIC ~} SEMI-PUBLIC [~ INDIVIDUAL [] REPORT RESULTS TO . CITY OF SOURCE r ~ TIMR COLLECTED . .. pm OTHER SAMPLE COLLECTED BY DATE COLLECTED Sample Colleded From ~ Other [Ust] Wail * [] Dug [] Driven [] Drilled [] Bored SOURCE: -1 Spring [- Cislern [] Olher Dug Well or Cistern Construction: Br}c~ or Walls - r- wood [] Concrele [] Meta [] 1ile [] Concrete When? Lab, No. OFFICE Records in tbls office indicate this WATER SUPPLY 1o be of: Analysis shows this Water SAMPLE fo be: ~Satisfactory [] Questionable [] Unsaffsfaclory. If an "Unsatisfactory" or "Questionable" sfalus is indicaled above you should take immediate action as recommended below. I. Notify consumers water is potluled. Boil or chemically Ireal Ihls water os oullined in The enclosed ~eaflet "DrJn~ It Pure." 2. Increase chlorinallon sufflcienlly to meet recommended residual standards. Delerm~ne source of ¢onlaminaflon and take acflon necessary to maintain 6. Ira?eve your [] spring [] dug well [] driven well [] drilled well [] clslern. iANITARIAN'S REMARKS READ INSTRUCTIONS ON REVERSE SIDE BE FO RE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Laclose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc O.]cc 24 hours 48 hours Brilliant Green 24 hours 48 hour? EM5 AGAR Laclose Broil 24 hrs. 48 hrs.. Groin's stain Coliform Density .(Mosl probable No, per 100cc.I This analysis indicales Coliform Organisms to be: