HomeMy WebLinkAboutWONDER PARK #4 BLK 7 LT 11LdF
7
3REATER gNOtORAGE gREg BOROUGH
I!EgL~I DEPfiRTb~NT
327 EAGLE STREET
~NCHORAGE, ALASKA 99501
279-2511
INSPECT:
] IU]~.
REQUI!ST FOR APPROVAL OF
INDIVIDUAL SEIqAGE AND WATER FACILITIES
FOR
Type o{ Fac~ligy go be Inspected~~ STREET:. ~ ~_~
Number of Bedrooms__ ~ ~ - '
Well Data:
A. Type
B, Depth_
C, Size
P. Construction_ ~--~ ~/~__
E, Bacterial Analysis
6. Sewage Disposal System:
A. Septic Tank (If homemade, show diagram on back)
1. Size
2. Age_
$, ~4anufacturer
4. Installer
hpproval Request for Se~ ~ ~ Water Facilities
Page Two
B. Seepage Pit
1. Size
2. Lining
C._ Disposal Field
1. Number of Lines
2. Total Length
Required Measurements
A. Well to Septic Tank
B. Well to Seepage Pit
C. IVell to Sewer Line
D. Well to Property Line
E. Well to Other Possible Contmnination
F. Foundation to Septic Tank
G. Poundation to Seepage Pit
Seepage Pit to Property Line
COM~ENTS:
APPROVED:
DATE:
__ DISAPPROVED:_~ ~.,~.
ATE : ,, -
APPROVAL VALID FOR ONE YEAR FROH DATE SIGNED,
GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT
EDll70
ADHW - LA§ · 2W
DATE
STATE OF ALASKA
r '=ARTMENT OF HEALTH AND WI'
DIVISION OF PUBLIC HEALTH
BACTERIOLOGICAL WATER ANALYSIS
Lab. No,
OFFICE
REPORT RESULTS TO
NAME
ADDRESS
Records in thls office [adicale this WATER SUPPLY lo be of:
Anolysil shows Ibis Water SAMPLE to be:
SolJdaclory [] QueUianable [] Unsafisfaclory.
Well. [] Dug [] Driven ~] Dr;Pod [~ Bored
SOURCE: [] Spring [] Cistern E] Olher
Dug Well or CJslern Conslrucflom
Walls · [] Wood [] Co*~ccele [] Melal [] Tile [] Concrele
Top · [] Wood 0 Concrele [] Melal ~ Open Top
LOCATION: ~ In ~osemonl ~ ~sement Ol~sel ~ Under House
GENERAL: Doe~ Water Become Muddy or Disco~ored? ~ Yes ~ No
PURPOSE OF EXAMINATION: Illness SuspecTed? [~ Yes [] No
If an "Unsallsfaclory' or "Questionable" S~alu~ is indicated above
you should fake immediate a¢lJon os recommended below.
__ I. Notily consumers water is polluted. Boll or chemically
froot fhls water as ou~llned in the enclosed Ice,lei
"Drink B Pure."
'~. Increase chlorination sufficiently 1o meal recommended residual standards.
3. Check chlori~atinn and olhor mechanlcal equJpmenl. Make cerlaln ills
6. Improve your [] spring [] dug well [] driven well
~ drilled well [] dsfern.
examination to indicate reliable resuhs, please send new sample.
[~] Botlle Broken in Ironsif, please send new sample.
5ANITARIAN'S REMARKS
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Lodose Broth IOcc IOcc 1Otc tOcc I 1Oct 1.0cc O.Icc__
I
24 hours
48 hours
Brilliant Green
24 hours
48 hours
EMB AGAR
Luclose Brolb, 24 hrs. 48 hrs. Groin's stain
ColiIorm Density IMost probable No. per 100cc.)
ME resu]ls.
Absent
Present
Gf~I~qTER &Dt0gqGE i~J!//gOROUGH
/JEPARTbIENT~p~F,,E~vI RO[,~EI,~'AL OUALITY
., .%XJU IUI}OR I(OAD m
/~,a-IORAGE, ALASKA 99~7
279-8985
RE¢iUEST FOR APPROVAL OF
INDIVIDUAL SD'!ER A,~9 ~IATER FACILITIES
APPROVAL R.. U...JI FOP. S~!F!R '~:' ~A'FER FACILITIES
2, LI~,I:.C~
C, DISPOSAL FIELD
1, JUI.~ER OF LI:.ES__..~ ....
,.. TOTAl.. LENGTH.__
i{~CtUI,RF~ .EASURE~EHTS
A, I!ELL 'FO SEPTIC TA,.K_...
t ~ELL TO S"'~r~
.... ~- AGE PIT_
C,
D,
E,
F,
COH 5~S:
WELL 'FO SE' !ER LI!",E
HELL TO PROPERTY LI:!E ..~'_~_~. ~'7~-~__
"!ELL TO OF.'"~Ek ~ ....... ,.,,..,.. CO;~T/~]Ii' TIOD
FOUHDATIOI! TO SEPTIC
FOUNDATION TO SEEPAGE PIT.
SEEPAGE PIT TO PROPERTY LINE.
(~RI:~A'f~R ANOIIOP, ACE AREA DOROUGII DEPARTMENT OF Ef~IRONMENTAL OUAI.,ITY
DATE
STATE OF ALASKA
D' '~.RTMENT OF HEALTH AND WEIr ~RE
DIVISION OF PUBLIC HEALTlt
BACTERIOLOGICAL WATER ANALYSIS
Lob, No.
OFFICE
NAME
ADDRESS
CITY
A~ORESS
Records in this office indicate this WATER SUPPLY to be of:
[] Satisfactory L] Questionable [] UnsolJsfa¢lory Sanitary Slatus.
Analysis shows this Woler SAMPLE to be:
Solis~a¢lory ~] Quesllonable [] Unsatisfaclory.
Il an "Unsatisfactory" or 'Queslionable" slatus is ;ndicaled above
you should take JmmadJale action os re¢ornme~ded below.
____1. Notify consumers water is polluted. Boll or chemically
I,'e~Jt this waler as outlined in the enclosed Jealle!
"0rink II Pure.'*
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED. am
Well. [] Dug [] Driven [~ Drilled [] §0red
SOURCE: [~ Spring [] Cistern ~] Olher.
Dug Well or Cistern Cor*slrucliom
Wails - [~ Wood [] Concrete [~ Metal E] Tile E] Control
.2. Increase chlorinoffon sufficlenlly Io meet recommended residual slandards.
DelermJno source of confanllnafion and lake action necessary 1o maintain
[] drilled well [] cislern.
GENERAL: Does Water Become Muddy or Oiscolored? [~] Yes [] No
When?
SANITARIAN'S REMARKS
Drop P~pe ~Crorrl eOJlO~t .Feet,
PURPOSE OF EXAMINATION: Illness Suspeded? [~ Yes [~ No
READ INSTRUCTIONS
ON
REVI:RSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS I{ECORD
Lc,close Brolh 10cc 10cc 10cc 1.0cc 0.icc
24 hours
48 hours
EMB AGAR
Laclose §rolh, 24 hfs. 48 hfs Greta's sllHn
Colilorm Density -(Most probable No. per 100cc.)
MF resulls
Reported by
This onalysis indicates Colilorrn OrgonJsms ~o be:
Absent
Presenl