HomeMy WebLinkAboutWOODLAND PARK #2 BLK 4 LT 15
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received ~x--/~-7~Z'
Time of Inspection
Date of Inspection
1. Approval requested by:
Mailing Address:
2. Property Owner:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
4.
5.
6.
Mailing Address:
Legal Description:
Location:
Phone:
~' 1/ J ~)~A ~-.z-~ Phone:
Type of facility to be inspected cSU._~z3/..~?'~
Well Data:
A. Type ~,~/~-- ~/'~' ~. Depth
C. Construction
7. Sewage Disposal System:
A. Installed
No. of bedrooms
D. Bacterial Analysis
B. Installer
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
2. Manufa tur, e'~ -::- :~"' "" ' '~'
2. Material
8J Distances:
A. Well to: Septic tank
, Absorption area
, Sewer Lines __
Nearest lot line
,, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Le~gal ~gescription / ~ ·
Comments
g pproved Disapproved
Approval ,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
Date
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)
O6.1220(a) Rev. 1973
DANTE
AL ..~ DEPARTM[NT OF I~EALTFI AND SOCIAL SE. .S
DIVISION (]F~PUBLIC HEALTH
INDIVIDUAL ~ND SEMI-PUBLIC
BAC TE RI 0 LOG I CA ,--.-WAT ER
INDIVIDUAL []
SEMI PUBLIC ~..--~- CHLORINE RESIDUAL PPM - '
REPORT RESULTS TO
C,T Ca4 'CZ--
ADDRESS
OF SOURCE
ZIP CODF
COMPLETE THIS SECTION
ONLY,.I_F~WAT~R IS AN INDIVIDUAL SUPPLY
SAMPLeCOLLECtEDBY ~ ' (/
DATE ~OLLECTED .~.--~
SaMo[e Co~leded Fearn .~.~gc~ en To o
[] Olher [LisU
LOCATION ~ J~4 ~-~s-e ~1 e n I [~] ~ ...... t Offset
~Y
k/TiME COLLECTED_
[] Bored
~ Yes E] No
Lob NO
OFPICB
ANALYSIS
Ano vs~s snows this Woter SAMPLE to be-
SANITARIAN'S REMARKS
Well Casing
Lenglh of
In UtiJ~t y
O Yes ~] No ~i~,';?"~./__
06-1220Rev. 1973(bl ,B,~CTERIOLOGICAL WATER ANALYSIS RECORD ,¢' }_ t.j ~
Dale Rece,ved ,~ / '~..'~.~ q ~.. Timer ...... d ~ ~.~b No.
Lactose Broth I Oct I 0cc 10cc I 0c¢ 10cc 1.0cc 1.0cc
AGAR
EMB
Lactose Brolh, 24 h~s 48 hrs. O~am's slain
Coliform Densily : IMosl probable No. per 100cd
ME ResuBs
READ INSTRUCTIONS
ON
REVERSE SiDE
BEFORE
COLLECTING SAMPLE
Date [1 ?~' p.m.
DIRECI'IONS FOR COLLECTING SAMPLES OF WATER FOR BACTERIOLOGICAL EXAMINATION
P,e~d ,~c~ref~ll'/a~l Pollo'cz Instructions F.x(*cJ'ly
,Steer in mind that waler analysis clec~ls with rno, hals preset~t in very minute qucmtJties. T[m least carelessness
lit colJeciing and ha~dlir~g may give rise, to results which are misleading.
Sera,pies o~e ¢~ccepled at the regior~al bi:oratories in the c¢~rly part of the week (Mol~dc~y-Wednesdciy) ui]less
there is (J~ emergency or prior orrangerr~ents have been cnade. Arrangements should be made Io helve the
rearer samp[es reach the Ic~borotory os quicldy as possible and within 4~'~ bents offer collection. After 48 hours, the
significance of the bacteriological analysis is impaired. -
In collecting samples from TAPS or PUMPS proceed as follows:
(a) Thoroughly flush tap or pump by allowing water to run freely for 'Five minutes.
Shut off water and flame the outlet with torch or burning paper. The flame should not be merely
passed over the outlet but should be applied until fixture shows indication of being hot. Flame
should be directed against inside edge.
(c) Open fixture so that a small stream flows.
(d)
Remove bottle from rnailing tube. Hold bottle by the lower half in one hand and 'with the other
remove the screw cop with the fingers, leaving foil protecting cover in place. Fill the bottle to the
shoulder. Replace cap with foil cover, s¢rewli~g fir~i~ly J~llo pl(~¢e bt~l do ~ot f~pl~ly [~'essnre wl~icb
will split
(el Pock bottle carefully in reoillec,1 tube enclosir g this co~p eted information sheet.
DO NOT COI.LECI' SAMPLES FROM FIRE HYDRANTS, ",'AR[)
[IYI)RANF,~, DRINKING FOUNTAINS OR SIMILAR OUTI.EIS
'VVI tlCI I ARE DIFFICULT 10 I)ISINFECT PROPERLY.
STERII.E WA'rE R SAM > E BOTTLES ARE AVAILABEE UPON REQUEST FROM~
Dept. of ~le(~llh & Soc[¢~[ Services
h)uch J
Jun¢c~u, Ah~ska 99801
Dept. of Health & Social Services
Southcel~tral Regional Sanitarian
838 Denali Street, MacKay Bldg.
Anchorage, Alaska 99501
Dept. of J leaith & Social Services
Northern Regional Sanitarian
604 Bornette Street
Fairbanks, Alaska 99701
Or DistriO Offices in Fairbanks, Ju~eou, Ketchikan, Kodiak, Nome, Palmer, Soldotna and Valdoz. Consult local telephone directory for
sanitation offices located in these comrnu~]ities. Anchorage area - conlact Greater Anchorage Area Borough Deporlment of Environ-
aradley ~eCourt
3211 Lots Drive
,~nChorage, Alaska
99503
SUB~[CT: ~ell serving Lot 15, glock 4, ~oodland Park Subdivision
Oear~. HcCourt:
The well tn your basement cannot be approved at this time. If the
~ell casing is brought above ground 1eve1 and sealed this Department
can then give approval providing the bacterial analysts ts satisfactory.
If you have any questions, please feel free to contact me at 274-4561,
extension 137.
Sincerely,
Robert C. Pratt,
Environmental Control Officer
ReP/ko