HomeMy WebLinkAboutWENTWORTH BLK 2 LT 23
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SITE ID (ol 1101 W1470401
sso,S005A9 DC8D I oaf
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'SpenardRoad
Lending Institution Phone
Address Zip Code
Rea,ty Co. · A~.t /~/) ~2~/~/ /~:~_ ~--p/ Phone
Address ._~.?/~').~").~/ ~//; /~ /~-/-/,.~'/~. /v' /I /~ t//7~' ZipCode
Type of Residence
Single Family
~(~Multiple Family No. of Bedrooms_ ~.~'~
[~ Other
Water Supply
~lndividual ~ .~_ ) ~ ') ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Community ' ' '~ For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
C~ Individual Year Individual Installed:
When Connected to Public Utility:
~ Public Utility
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN SE INITIATED.
Date Date Date Date
Inspector Inspector Inspector Inspector
!~e3
MAY '1 3 'o.~
, RECEIVED
( ~,~ ) APPROVED BEDROOMS 'CONDITIONS OF AFPROV,~L
( ) DISAPPROVED
( ) CON?~ONAL ~PPBOVAL'
BATE ~/'/~'~.
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72.023 (31~)
~4ay 20, 1983
Larry ]3. [}aune
3241 E. 42nd
Anchorage, AK 99u0-~
S~lbject~ Lot 23,
Approval for the
be granted until
£~lock 2, Nentworth Subdivision
individual sewer and water facilities
the foliow~ng items have been completed~
well casing s~]ould be sealed so that it
The to[)of the
wate ).' tight.
~lea.. ~ notify this bepartment for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 2u'~-4720.
is
Sincerely,
Robert C.
Associate
Pratt
Environmental Suecial]st
CHEMICAL & GLo,LOGICAL LABORATORIES~F ALASKA, INC.
TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
I.D. NO.
"~' ~ (. > c~.~,...m4 .
Phone NO.
Water Sysmm Name
Mailing..Address
MO. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
} [] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
I
Time Collected
Collecte¢ By
TO BE COMPLETED BY LABORATORY
AnaWsis shows mis Water SAMPLE to be:
~ Satisfactory
[] 0nsatisfactorv
[] Sample too long in transit: samole should
no[ De over 48 hours old at examination
[o ndicate rehable results. Please sena
new sample.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref. No. Result* Analyst
,'/!, ,~, 41% i~ ~ /
I f-t-I
I
I
*NO ol coTonle$/100 mi or NO. of Positive DOctlon$
06-~220 (b)
Rev. 1978
BACTERIOLOGICALWATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAM PLE
~esumptlve 1omi ZOml /Omi 1Omi 1Gml Z,Omi O.Zml
24 Hours
48 Hours
r~--'$ C._pll form/l OGre I
',
~~'-~~'g~U~ilL~r~',..- ,..,,,~. .............. INDIVIDUAL SEWAGE AND WATER FACILITIES
out
in
Triplic/./atg~ ,' }." ? /'
Name of person requesting approval
g. Number'of ~edrooms in house
5. Water Analy~zs:
a. Bacterial
b. Deter~ent "
Well data:
a. Type ~A~)//~,~9 ,
b. Depth ~: p
c. Casing Sizs
Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tank 70 I
3. Seepage Area
Cesspool'
5. Property Line
6. Other sources of p. ossibte contamination
houses, bern, drainage ditch~ etc. . ~:~,5.,. .~,t ·
Sewage disposal system.
a. Age of system ~ ~ .
: ( . ~.~ ~ I/;/ ~:~ <5' ,J~.t .../:L~ >"
b. Septic tank capaclty
c. Name of septic tank manufacturer ~ {~' ·
1, If "home made" show diagram on reverse ~ide of this form.
d.' Disposal field or seepage pit size and type ,,
1. bl~tanoe to property line to house z~,mdation
· e, Percolation. Test ~esuXts
Percolation Test performed by
Use the reverse .side of this form to show diafram. Diagram should include
~he foilowing ~nformation: p~operty linss~.well location, house location,
~peic tank location, disposal area location, location of percolation tes~,
and direction of ground slope.
The infor~t£on on this form is true and correct to the best of my knowledge.
$i~u~of ~lic%nt
TO BE FILLED OUT BY HEALTH DEPART~ENT PERSONNEL
AT'he above described sanitary facilities are hereby approved, subject to the
~llowing cond.i~ons:
Conditions: ~CTk.~
The above described sanitary facilities are disapproved for the following
reasons:
' Signature of ~ ~m '~i[ , ~Date ~:~" [;7'~'
Approval is valid for one yea~ following the date of approval.
CPJ: cw
"r-PARTMENT OF HEALTH AND W[._.;'ARE
DIVISION OF PUBLIC HEALTH
BACTERIOLOGICAL WATER ANALYSIS
PUBLIC [~] SEMI PUBLIC ~ INDIVIDUAL [~] OTHE~
-REPORT RESULTS TO
SAMPLE COLLECTED BY
DATE COLLECTED
Sample Collected From
Well- [] aug [] Driven
SOURCE: [] Spring [~ C[slern
Dug Well or Cistern Consfruclion:
Wails- [] Wood [] Concrete
MATERIAL: Builalng S .... 0 ~:~1 0 Wo~
0 Drilled 0 Bored
00lher
Brich or
0 Open lop
Feet. Privy
[] Yes [] No
When?
OFFICE
~ (~ Records in this office [nd[cole this WATER SUPPLY to be of:
Salisfaclory O Questionable 0 UnsaBsfaclory Sanitary Status.
~; Analysis.shows this Water SAMPLE lo be:
'[] Sal[sfadory [] Questionable [] Un~alisfadory.
SANITARIAN'S REMARKS
Diameter of Well- Depth Feet.
Well Coslng
Malerial _ Diameter --
Lenglh of Water Deplh
Drop Pipe Fram Botlom Feel~
$.ignature
READ INSTRUCTIONS
Date Received
BACTERIOLOGICAL WATER ANALYSIS RECORD
am
-'~ ": '. //?'-.. /. ,g' Time ffece~ved // pr'~='Stah. No.
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
Laclos& Broth
24 hours
48 hours
EMB
BGB
Lactose Broth, 24 hrs. 48 hrs.
Coliform Oensgy.
MF results
.(Mosl probable No. per 100cc.)
This analysis indicates Coliform Organisms to be:
Present