HomeMy WebLinkAboutWONDER PARK BLK 1 LT 5LoT
5
A~(,~hora~, Alaska 99501
LOt 5 block I Wondor Park
Thi~ d~partm~nt ~an net locate ~h%% well on the subject
If the well is below 9round luw~l ig will ~ee~ to be
e~l:ended abov~ 9ro~lnd twelve (12) inohes~ an(l w:;.ll nec~d
to be ~ea.l~d with a sanitary seal.
Stnc~ ~4unteipal wa~:(,~' is readily availablc~, we, would give
approval via ~onfi~mation from th~ Public Water Utility
~unio~,pal water, th~ %~all will n~ad ~o b~ physically
di~conl~eoted from t:i~ water
If you d~cida to up~3ra4e your w~ll, you ~y (~acrow n~one, y
If there are any q~l~t;ions, pl~as= ~onaac~ this offic~ at
276-2221, extension 285.
~tobert C. Pratt..
Sanitarian
David ]lord
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description: Lot 5
4.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received December 8,
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Cony.
Security Pacific Mortqage
319 West 5th Avenue Phone:
Jan K. & Gail A. Sieberts Phone:
1976
10:00 a.m.
12-8-76 Wednesday
Pratt
272-9501
Location:
Block 1 Wonder Park
4705 Kenai Avenue 99504
Type of facility to be inspected __Single Family
Individual
Public Utility
No. of bedrooms 3
B. Depth
D. Bacterial Analysis
Well Data:
A. Type
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
B. Installer
2. Manufacturer
2. Material
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines
C. Absorption area to nearest lot line __
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - R~ est for Approval of Individual wer & Water Facilities
~egal Description
Lot 5 Block 1 Wonder Park
Comments
Approved_~,
Disapproved Date
Approval ,Valid for one year from date signed
Greater Anchorage Area 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-034 (1/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 274-456~
REQUEST FOR APPROVAL OF
INDIVIDUAL SFWER and WATER FACILITIES
Type of Inspection:
CMRO VA FHA CONV XX
2. Property Owner:
Mailing Address:
3. Name of Buyer:
Mailing Address:
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
S~RTS: ,Tan K. and Ga%l A,
~ ~b~';~t~-~-~''/ Day Phone
HOP. D, David R, (Now in property on rental basis)
4705 Kenai Avenue, Anchorage Day Phone
Security Pacific Mortgage Corporation
319 West 5th Avenue, Anch. Phone 272-9501
TOTEM REALTY .... Bob Baer or Violet Hulce
work: 277-7561
Anch. Tele, Utility
724 East 15th Ave.
Phone 272-0571
6. Legal Description: Lot 5, Blk i WONDER PARK S/D
Location: 4705 ](anai: Av~nue~ Anchorage~ Alaska 99504
7. Type of Facility to be inspected: _
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Residence No. Bdrms. 3
Individual XX
Individual (on~site)
E0-037 (1/74)
AOHW-LAB-2W
STATE OF ALASKA
D'-"ARTMENT OF HEALTH AND WEt 'RE
DIVISION OF PUBLIC HEALTH
BACTERIOLOGICAL WATER ANALYSIS
Lab. No
10834
OFFICE
Records in this olfice indicate this WATER SUPPLY lo be of:
Anblysis shows Ibis Waler SAMPLE to be:
~"/al~sfacfory [] Questionable [] UnsalisfacJory.
____1, Notily consumers water is polluted. Boll or chemically
1real lhis water as outlined in the enclosed ieaflel
"Drink If Pure."
__2. Increase chlorlnallon sulfidenfly fo meet recommended residual standards.
Determine source o~ conlamlnaflon and fake aclion necessary Io m~JinfaJn
a sale Mater supply al all times.
--3. Check chlorination and'olher mechanical equipmenl. Make certain it is
funcgoning prope fly.
4. If after checking equlpmenl a disinfecting residual is not obtained, please
S. This is a surlace waler source and subjecl fo pollution by man and animals.
An approved wafer supply source should be developed.
6. Improve your [] spring [] dugweB [] drivenwell
When?
Feel.
Feet
[] Of Well [] Olher
PURPOSE OF EXAMINATION: Illness Suspected? [] Yes [] No
[] drilled well [~] cistern.
7. Rel0cale your welt lo a su[e location in relationship lo your sewage
disposal system. [] see enclosure
__B, Sample Ioo long in Iransib sample should not be over 48 hours old at
examination Io indicate reliable results, please send new sample.
[] Baltic Broken in fransil, please send new sample.
9. Contact your nearest [] Local Heallh Department or [] Alaska
Division al Public HeaJlh, sanila~on office Jar bulleHns, consuilaflon and
assistance.
SA NITARIAN'S REMARKS
Signature
~ifAIl: UP P, LASKA
t"~RTMENT OF HEALTH AND WF2"~,RE
_. '~ DIVISION OF PURl. lC HEALTHL~ /
BACTERIOLOGICAL WATER ANALYSIS
ADDRESS
SAMPLE COLLECTED BY
Yes E] No
When?
6. Improve your [] spring [] duEwell [] driven well
~] drilled well [] cislern.
SANITARIAN'S RI:MARKS
READ INSTRUCTIONS
ON
REVFRSE SIDE
BEFORE
COLLECTING SAMPI. E
BACTERIOLOGICAL WATER ANALYSIS RECORD
Dote Received-- ~ r ~
LadoSe Brolh
24 hours
48 hours
Brilliant Green
24 hours
48 hours