HomeMy WebLinkAboutWENTWORTH BLK 1 LT 23
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
FOR
~. A~proval Re.~eated ~y: ........ £ ~X~O
Address:
2. Prooerty Owner:
Date Received
Time of Inspection
Date of Inspection
Phone:
3. Legal Description:
4. Location: 3~(7// ~
5, Type of Facility to be Inspected:
Number of' Bedrooms: ~' 6
nstruct'on
C. Co ~ ,
7. Sewage Disoosal System:
B. Depth___ ~C~/
D, Bacterial Analysis ,,
A. Installed
8. Installer
C. Septic Tank: 1. Size
D. Seepage Pit: t. Size
2. Manufacturer
2. Material
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 Seotic Tank
Absorption Area
Absorption Area to Nearest Lot Line
Request for AF;prove/~f ~ividual Sewer & Water Fac~lit{~
Page Two , / / ~ ,
Aporoved Dieaeproved Date /
A~rova] X;alid for One Year Prom Date S~gned
Greater Anchorage Area Borough, Department of Env-:ron~enta] Quality
DIAG~^M OF S,STEN~
I certify that the information contained in this request for approval to be a true
and accurate representatlon of the subject sewer and water facilities located at.'
Signed Date
06-1220 (a)
DATE
DEPA~*'~EflT OF HEALTH AND SOCIAL SEP'"~ES
-.~ DIVISION OF PUBLIC flEALTfl .~
ACTERIOLDGICA[. WATER AflALY${S
'
OFFICE
Recor~ ~n th~ office b~d,ic~te this WATI~ -qUPPLY to he of;
[] see encIomlre
SANITARIAN'S REMARKS
READ, INSTRUCTIONS,
ON
REVERSE SIDE,
BEFORE.
COLLECTING. Ed~MPLE,,
06-1220 (b)
BACTERIOLOGICAL WATER ANALYSIS RECORD
GRE~TER ANCHORAGE AREA BOROUGH'-~
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORA6E, ALASKA 99S07
~ /.~ DATE RECEIVED:
FOR
APPROVAL
ADDRESS:
PHONE:
PROPERTY
LEGAL
REQUESTED BY:
OWNER:
DESCRIPTION: d~ J~? . /~?~:;C~ /, /x-J?x/P//L2~F/;,b/~//-J0.
TYPE FACILITY TO BE INSPECTED:
STREET:
NUMBER OF BEDROOMS:
WELL DATA:
A. TYPE ( .~].I.I~,p .~D. 77 -3?55
B. DEPTH ~0 '
C. SIZE
D. CONSTRUCTION
E. BACTERIAL ANALYSIS
6. SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK)
l. SIZE
2. AGE
3. MANUFACTURER
4. INSTALLER
REQUEST FOR SEWER & WATER FACILITIE"~~
APPROVAL
PAGE TWO
CONTAMINATION
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
l, NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E. WELL TO OTHER POSSIBLE
F. FOUNDATION TO SEPTIC TANK
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
COMMENTS[ ' ~
APPROVAl VALID FOR ONE YEAR
DISAPPROVED:
DATE:
FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY
~'4~rch 17, lg72
Shenm~m Real ~st~te
International Airport
Subiect: S~.m,~r and l~ater Facilities~ for Lot 23.~ Blo.~' r~. l>
Wentwor!h Subdivision,
Dear S~r,
An itlSOection oft,.h~ sewer and wator Cacilities on t~o subj,?ct
F, ro~ertv w~ m~.~. ~,, thi~ office on Hatch 15 lq7~
Th~ well s~>)-vin~!
T,!e water sa~ml,~
sari sf~ct~rv,
,u',~-a a~; ~he f~iI~e Of i!~S~eCi;lO~) prov(~d i.o tlc~
adjoining. . s ,,,s,~r~r,. ., ~it , [-)ov~nvf, r, "''~a(~ stt~)jec'~ lot is avaitablo
to r~ublic sty ....
This Del~artment will give tem[~orary ar~l]roval for th~ sewer
to the ~uhlic sewer this sU~)l)~ler.
hesitate to contact this office.
Sincerelv~
Timothy L. Rumfett
Sanitarisn
cc: Veterans Administration
DATE
DE[,~ ~ITMENT OF HEALTH AND WELF/' "~E
DIVISION OF PUBLIC HEALTH ~'--*/
BACTERIOLOGICAL WATER ANALYSIS
Lab. No.
OFFICE
PUBLIC J~l SEMI-PUBLIC O INOIVIDUAL ['~1
REPOR~ RESULTS TO'
OTHER
NAM E
ADDRESS
Records ;n this office indicate this WATER SUPPLY to be of:
Salisfactory [] Questionable [] Unsatidadory Sanitary Status,
Analysis shows this Water SAMPLE to be:
~.Safisfactory [] Queslionabfe [~ Unsatisfactory.
If an "Unsatisfactory" or "Questionable" status is indicated above
you should la~e ~mmediale action as recommended below.
em
When?
Oiameler of Weft Depth Feet.
Well Casing
PUMP LOCATION: [~ In Wag [~ Offsel In [~ In Basemenl [~ Room
[~ OI Well (~] Other
PURPOSE OF EXAMINATION: Illness Suspected? I~ Yes ~) No
1. Notify consumers water is polluted. Boil or chemically
treat this water as outlined in fBe enclosed leaflet
"Drink It Pure."
__ 2. Increase chlorination su~ficlenfly fo meet recommended residual standards.
Determine source o~ confamlnation and take eolian necessary to maintaln
a safe waler supply at all times.
3. Check chlori~alian and o~her mechanical equipment. Make certaln it is
funclioning properly.
4. II after checking equipmenl a dlsinlecling residual is not oblained, please
wire this olfice for emergency asslstance or advisory services.
§. This is a surface wafer source and subjecl to pollution by man and anlmals.
An approved waler supply source should be developed·
6. Improve your [] spring [] dug well [~ driven well
[] drilled well [] cistern.
__7. Relocate your well to a safe location in re~ationshlp to your sewage
disposal system. [] see enclosure
8. Sample fao long in transit; sample should not be over 48 hours old at
examinotlon to indicate reliable resuhs, please send new sample.
[] Baffle Broken in transil, please send new sample.
9~ Confacl your nearest [] Local Health Department or ~ Alaska
Division of Publlc HeaBh, sanilafion olfice for bulletins, consuBotlon and
SANITARIAN'S REMARKS
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Laclose Broth 10cc i0cc 10cc 10cc I 10cc 1.0cc 0,1cc
I
Brillionl Green
24 hours
48 hours
EMB AGAR
Laclose Broth, 24 hrs. 48 hrs.. Gram's stain
Colilorm Density (Most probable No. per 100cc.)
MF resuBs em
pm
Reported by
This ana[ys~s indicales Coliform Organisms ~o be:
Date
Absent
Present