HomeMy WebLinkAboutWENTWORTH BLK 2 LT 24
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
"C" Street, Anchorage, Alaska 99503 274-4561
Date Received February 1, 1977
Time of Inspection 11:00 a.m.
Date of Ins0ection 2-4-77 Friday
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Buchholz
1. Aoproval requested by:
4.
5.
6.
Mailing Address:
Property Owner:
Mailing Address:
Legal Description:
Location:
Phone:
John & Vance Kay Jones Phone:
% 115 West Northern Lights Blvd, #208
Lot 24 Block 2 Wentworth Subdivision
349-2340
3251 East 42nd Avenue
E. Disposal
Distances:
A. Well to:
Type of facility to be inspected Duplex
Well Data:
A. Type Individual B. Depth
C. Construction .~_.~._~.~Q~_. Bacterial Analysis
~ewa§e Disposal S tem: uti
A. Installed ~ller
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorptio~ Area 2. Material
Field: Total length of lines
No, of bedrooms 6
Approx 60 '
Septic tank
Nearest lot line
Foundation to septic tank
, Absorption area
, Other contamination
, Absorptiom area
C. Absorption area to nearest lot line
, Sewer Lines ,
EQ-034 (1/74) Page 1 of two pages
?ageo2 of two pages - Req.~st for Approval of Individual ~_~_~r & Water Facilities
Legal Description Lot 24 Block 2 Wentworth Subdivision
Comments
,/_
Approv~l/~Zalid for one year from date signed
Greater Anchorage ~a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ,O34 (1/74)
' ' %~,! .MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECl'ION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 ?'~ ~ 1977
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES RE EI_ ED
1. Type of Inspection: CMRO VA FHA CONV__
4. Name of Lending Institution:
Mailing Address: Phone:
5. Name of Realtor or Agent: u~
6. Legal Description:
.>
Type of Facility to be Inspected:
Water Supply
Type of Supply:
No. Bdrms. ~
If Individual, number of dwellings presently served
If Individual, depth of well ~) ~'
~,
Sewage Disposal System
Type of System:
Public Utility ,Individual
Public Utility
Individual (on-site)
If Individual, date of installation
72 003(3/76)
06-1220 (a)
DATE
PUBLicO SEM,-PUBL'00
DEPA .; ENT OF HEALTH AND SOCIAL S£ ICES
DIVISION OF RUBLIC HEALIH
BACTERIOLOGICALWATER ANALYSIS
NAME
ADDRESS
ZIP
CODE
SAMPUE COLLECTED BY
DATE COLLECTED
Samph~ CoJlected From [] Kitchen TaD
Other (List(
TIME COLLECTED_
D Bathroom TaD [] Basement Tap
. Weft [] Dug r~ Driven
SOURCE: [~ Spring r"l Cistern
Dug W~eg or Cistern Construction:
~alls - [-1 Wood [] Concrete
[] Drilled [~ Bored
Brick ol
[] Metal [] Tile [] Concrel
PUMP LOCATION: [] In Well [] Basement Room '
[~ Of Well [] Other
PURPOSE OF EXAMINATION: Igness Suspected? CIYes ~] NO
06-1220 lb)
READ INSTRUCTIONS Date Received
Lab. No.
OFFICE
Records in this office indicate this WATER SUPPLY to be of:
[]Satisfactory []Questionable O Unsatisfactorv Sanitarv Status·
Analvsis shows this Water SAMPLE to be:
~;)./Satisfactory [] Questionable [] Unsatisfactory,
.
If an "Unsatisfactory" or "Questionable' status is indicated above
VOU should take,,Drinkimmediatelt Pure."acti°n as recommended below.
Notifv consumers water is polluted. Boil or chemically
treat this water as outlined n the enclosed leaflet
2. Increase chlorination sufficiently [o meet recommended residual stanaaros.
Determine source of contamination and take action necessary to maintain
a safe water supply at a I times.
3. Check chlorination and other mechanical ecJipment. Make certain it is
functioning properly,
4. If after checking equipment a disinfecting residual is not obtained, please
wife this office for emergency assistance or advisory services.
5, This is a surface water source and subject to pollution by man and animals.
An approved water supply source should be developed.
6. Improveyour r-lspring []dugwell Cldrivenweg •drilledwell []cistern
7. Relocate yourwell to a safe ocation in relationship to your sewagedisposal
Sample too~long in transit; sample should not be over 48 hours old a[
examination to indicate reliable results, please send new semele.
[] BotEe Broken in transit, please send n~w sample.
9. Contact y~our nearest [] Local Health Department or OAlaska
Division of Public Health, sanitation office for bulletins, consultation and
SANITARIAN'S REMARKS
BACTERIOLOGICAL WATER ANALYSIS RECORD
~'~/z/'J/~~ 7 Time Received -~ ~ab, No.
. oN
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
Lactose Broth] 10cc 10cc 10cc 10cc 10cc 1.0cc 0.1 cc
EMB AGAR
--Lactose Broth, 24 hrs. 48 hrs. Greta's stain
--Coliform Density (Most Drobable No. per 100cc.)
--Mr results
--Detergent Test /~ '
--Reported by ~'~; Date
I This analysis indicates Coliform Org/anisms to be: