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Home My WebLink AboutWOODLAND PARK LT 10F ~i, ijg.,,l.)L '~ ..o ~ '~-," - ' '~ J GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality . 3500 Tudor Road, Anchorage, Alask~ 99507 279 8686 Time 0f Inspection REQUEST FOR APPROVAL OF I~IVIDUAL SE~ER ~ WA~R FACILITIES FOR 5. Type of Fsctlity to be Inspected: ~ ~~ Well Data: C. Construction~ D. Bacterial Analysis Ye Sewage Disoosal System: A. Installed ~d~_~L 8. Installer C. Septic Tank: 1. Size 2, Manufacturer D. Seepage Pit: 1. Size 2. Material E. Disposal Field: Total Length of Lines Distances: A. Well To: Septic Tank Absorption Area , Sewer Lines , Nearest Lot Line , Other Contamination Bo Foundation to Septic Tank "~ Ab~orptfon Area C, Absorption Area to Nearest Lot Line """~/+Request for Approval ~'~Individusl Sewer & Water Facili~s ~._~--~Page Two .Comments: Disapproved / Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environments! Quality D~AGRAM OF SYSTEM I certify that the information contained in this request for appreval to be a true and accurate representation of the subject sewer and water facilities located at: Siqned Date 06-1220 (a) SAMPLE COI,L~CTED BY DATE COLLECTED 8:~mple Collected Fxom STATE OF ALAS~ OF HEALTH AND SOCIAL DIVtSIOfl OF PUI~LIC H~LT}t BACI'ERgO£OGI{~A[ WATER AflALYS~S' OFFICE ~OBT RESULTS TO READ INSTRUCTIONS, 06-1220 (b) SANITARIAN'S REMARKS BAGTERIOLOGICAL WATER ANALYSIS RECORD ON REVERSE SIDE~ BEFORE COLLECTING, SAMPLE, DIRECTIONS FOR COLLECTING SAMPLES OF VffATER FOR BACTERIOLOGICAL EXAMINATION Read C~ein~ly and Follow ~ns~n~c~o~s Bear in mh~d that water ancdysis deal.~ with materials present in very m/unto qu¢;mtities. The least c,,~c~lessnes~ in collecting ~td hcrn.dJing mcry give riso to results which are misleading. Arrcmge:,r..,~n;~ should be made to hr:rye wc~ler s0c~ple~ reach the laboratory as quickly as possible, A/to> d8 not r;.: th exg~aficcu~ce o~ the bacio~.olog~cel ~lys~_~ fi~ ff-aI:,~,:ed, l%zobvio'ss ~'ev~on~ the labo~a ory. pz¢lc~,.s io ~e~,~t~o~:v,.,~i:~.[e~ in the early ps:,';: of the week but is w~ag to accept ~xple~ at any time. In collecling sc~nples from TAPS or PUMPS pro~eed~ as follows: (u) Thoroughly flush tap or pump by ¢fllowing water to run free~' (c.:~: five minutes. (b) Shut off watex' ~r~d tlcane the outlet with torch or burning paper. The fkrme should not be merely passed over the outlet but shou/d he applied until fimure shows indication of being hot. Flume should be directed against trmide edge. (c) Open fixture so that a small stream flows. (d) Remove bottle from maflhtg tube. Hold bottle by' the lower half in one hand and with the other remove the RErew cap with the fingers, leaving paper protecting cover in place. Fill the bottle to the shouJder. Replace cap with paper cover, screwing iinnl¥ into place but do not apply pressta, e which will split cap. (e) Pack bottle c~refully in mailing tube enclosing this completed information sheet. In colleciing samples from STREAMS and RESERVOIRS proceed as follows: (a) Remove cap and hold bottle as described under (,d) above. (b) Collect sample by holding bottle in a slanting position and sweeping it below the surface in such a mcumer that water that has been in contact with the hauxd is not introduced into the bottle. Avoid collecHng surface scum and bottom sediment. ' DO NOT COLLECT SAMPLES FROM FIRE HYDRANTS, YARD HYDRANTS, DRINKING FOUNTAINS, OR SIMI- LAR OUTLETS WHICH ARE DIFFICULT TO DISINFECT PROPERLY. STERILE WATER SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST FROM: Dept. of Health & Social Services SOUTHEASTERN REGIONAL LABOBATORY POUCH J' JUNEAU, ALASKA 99801 Dept. of Health & Social Services SOUTHCENTRAL REGIONi%L LABORATORY 527 EAST 4th AVENUE ANCHORAGE. ALASKA 89~01 Dept. of Health & Social Services NORTHERN REGIONAL LABORATORY 604 BARNETTE STREET FAIREANKR, ALASKA 99701 06-1220 (a~ .~.. PUBLIC [] NAME STATE OF ALASKA ~ D RTMENT OF HEALTH AND SOCIAL _ RVICE$ DIVISION OF PUBLIC HEALTH Lab. No. an [] BriBed [] Bored [] Other [] ~letal [] Tile' [] Brick or Concrete [] ~etal [] Open Top [] Basement Offset [] Under Mouse Septic Feet, Tank Feet Asbestos Yes D No Diameter of Well Depth Feet Well Casing 7 ~lateria] Diameter DePth Length of Water Depth Drop Pioe From Bottom Feet 0 SaHsfactory [] Questionable [] Unsatisfactory Sanitary Status. Analysis shows this Water SAMPLE to be: r~l~'atisfactory [] Questionable [] Unsatisfactory. If an 'Unsatisfactory' or "Questionable" status is indicated above you should take immediate action as recommended below. 1. Notify consumers water is polluted. Boil or chemically treat this water as outlined in the enclosed leaflet "Drink It Pure." 2. Increase chlorination sufficientlv to meet recommended residual standards. Determine source of contamination ant take action necessary to maintain a safe water supply at all times. 3. Check chlorination and other mechanical eouinment, Make certain it is functioning propedv. 4. If after checking equipment a disinfecting residual is not obtamed, ptease wire this office for emergency assistance or advisory services. 5. This is a surface water source and subject to pollu[,ion by man ane animals. An approved water supply source should be developed. 7. Relo~te your well to a safe location in relationsh[~ to voar sewage dlsposa[ system. ~ see enclosure 8. Sample too long in transit sample should noz be over 48 hours old at examination to indicate re~iable results, please seno new sample ~ Bottle Broken in transit, please send new sample. 9. Contact your neares[ ~ Local Health Depa~ment or ~ Alaska Division of Public Health, sanitation office for ~ulletins, consultation and assistance. SANITARIAN'S REMARKS READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE ADDRESS CITY ADDRESS ~OF SOURCE 06-1220 (b) SAMPLE COLLECTED BY DATE COLLECTED 5/ j2) l I--(~:5 TIMECOLLECTED SEMI-PUBLIC [] INDIVIDUAL J~], OTHER F{EPORT RESULTS TO BAC;~ERIOLOGICAL WATER ANALYSIS RECORD LactoseBroth -~- 10cc 10cc 10cc 10cc 10cc 1.0cc 0.1cc 24 hours 48 hours Brilliant Green 24 hours i EMB AGAR Lactose Broth, 24 hrs. 48 hrs. Gram's stain -Coliform Density {Most probable No, per 100cc.] -MF results Detergent Test Date ' / ~ ')* l ! "7 '''? am · . ~ ~_ ,. ' 'b BACTERIOLOGICAL WATER ANALYSIS OEEIC Records in this office indicate this WATER SUPPLY to be of: DIFIECTIONS FOi~ COI,I .t:C I IN(:~ SAMPLES OF WAT!M~ FOR BACI EtdOI.,OGI(~AI. EXAMIN/\TION Head CaYefully and Follow Instructions Exactly · . , Bear in mind that water analysis deals witb materials present in vow minute quantities. Tbe least carelessness in collecting and handling may give rise to results which are misleading. ,~rrangements should be made to have water samples reach tho laboratory as qLdckly as possible. After 48 hours tl~e significance of the bacteriological analysis is impaired. For obvious reasons the labora[ery prefers to receive samples in tho early parL of the week but is Willing to accept samples at any time. In collec[in9 samples h'om TAPS or PuMPs proceed as F~llows: (a) Thoroughly flush tap or pump by allowing water to run freely for 'five minetes. (b) Shut off water and flame tile outlet with torch or burning paper. The flame should not be merely passed ovei' the oudet but should be applied until fixture shows indication of being bot. Flame should be directed against inside edge. (c) Open fixture so that a small stream flows. (d) Remove bottle from roailing tube. Hold bottle by the lower half in one hand and with the other remove the screw cap with the fingers, leaving paper protecting cover in place. Fill the bottle to the shoulder. Replace cap with paper cover, screwing firmly into place bLIt do not apply pressure which will split cap. (e) Pack bottle carefully in mailing 'tube enclosing this completed information sheet. IR collecting samples from STREAMS and RESERVOIRS proceed as follows: (a) Remove cap and hold bottle as described under (d) above. (b) Collect sample by holding bottle in a slanting position and sweeping it below the surface in such a manner that water that has been in contact with 'the hand is not introduced into the bottle, Avoid collecting surlace scum and bottom sediment. DO NOT COLLECT' ,sAMPLEs FROtVI FIRE HYDRANTS, YARD HYDRANTS, DRINKING FOUNTAINS, OR S/MI- LA, OUTLEARE OIFFIC.L rrO I I, INI:EC - PROPERLY. STERILE WATER SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST FROM: Dept. of Health & Social Services Sou'rHEAS'FERN REGIONAL LABORATORY POUCH J JUNEAU, AL'ASKA 99801 De'pt, of Hea'lth & Social Services SoU'rHCENTRAL REGIONAL LABORATORY 527 EAST 4TH AVENUE ANCNORAGE, ALASKA 9~501 Dept, of Health & Social Services NORTHERN REGIONAL LABORATORY 604 BARNETTE STREET FAIRBANKS, ALASKA 99701