HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 2 LT 10
He;
th and Environmental Protc
Fourth F].oor West
825 L Street
Anchorage, Alaska 9950].
279-251]., x 224, 225
............ IN'sPECTION RI'PORt' ON-SIT[! SEWAGE DISPOSAL 5YSTi!I'A
SEI~TIC TANK:
DIS]ANCE ~ ~ NUMBER OF
PADAP Y/~) GA LOi :
TII.E [),RAIN FIEi-D:_~~
TOTAL t Ef,}G FI
SEEPAGE PIT:
Log Crib RJngs/~RIB SIZ[_: UIAfl,,1EI[ R _ DEPFII_ __ DISTANCE FROM: WELL .................
'IOIAL EFFECTIVE
BUIL[JHqG F'OLJIqDATION .., NEAF{Lbl LOI[ INL ._ AL~SORPTION Al{FA (WALL AREA) .SQ. ~ 1
Well
Class: Depth:
Well Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials:
~ of Sedroom~g
Installe. r.-"
Rema r k s.
'z-~"~W~'~'~'~'~ ~UN iC~/PA'L! TY OF ANCHORA6E
DEPARTMENT ~.It~AI~H AND ENVIRONMENTA,~ VROTECTION
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska Btatebank
Mailing Address: 3].0 East Northern Lights Blvd.
Phone~79-7637
2o Property Owner: Dick Wright
Mailing Address: Star Route A Box 1585A 99507
Phone: 344-4214
3. Legal Description: Lot 10 Block 2 Zodiak Manor Subdivision
Single Famil~ Residence: ~) Nnmber of Bedrooms: Two
Mu]_tiple Family Re~dence. ( ) Number oi Bedrooms:
Well Sys~em: Individnal well ~) Conununity/Public System ( )
Permit Depth ef well 111' Well Log on File
Construction Bacnerial Analysis
( )
Sewage Disposal System: On-site System (~ Public Utility ( )
Septic Tank Size 4~/~_~) .... Manufacturer _~~
7. Distances: Well to Septic Tank / ~ '~' 'to Absorption Area
to Sewer Line Nearest Lot line
Absorption Area
to Nearest Let Line
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 10 Block 2 Zodiak Manor Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached: )
Disapproved. [~ Date!:
Departmenn Workshee'a:
MUNICIPAL-ITY OF ANCHORAGE
//~_~ Department of Health and Environmental Protection
//~[~i~ 825 L Street, Anchorage, Alaska 9950.1
' uest for Approval of Individual Sewer and WateR'F,acilities
Mailing Address: ~z-~ ~-~z-~/~f~J-~ C.~_~.~j~;.Phone:
o
o
Name of Buyer:
Mailing Address: _
Lending Institution: ~.)~ L~ ,~z~
'g/~)
Mailing Address:
Mailing Address: ~.~ ~ ~._ Phone:~j?L
o
Legal Description:
Street Location: _~-~
Single Family Residence:
Multiple Family Residence:
(~() Number of Bedrooms:
( ) Number of Bedrooms:
Water Supply: *Individual Well (~) Public/Co~mnunity System
If Individual Well, well. depth _////_
If Co~nunity System, name of system
Sewage Disposal System: On-site System ~() Public System
If On-site System, date of installation: _~- ~
( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
06-1220(~) Rev. 1973
DATE
ALASi~, d[PARTMENT OF UEALTH AND SOCIAL SER,...r~S
DIVISION OF PUBLIC HEALTH Lat, No.
iNDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS oP CE
INDIVIDUAL E]
NAME
SEMI-PUSLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
ADDRESS
CITY ZiP CODE
ADDRESS ,
OF SOURCE i ' i :: : ~ ~
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY ~ ~-
GENERAL: Does Wafer Become Muddy or Discolored?
When?
E] Yes [] No
Analysis shows Ihis Water SAMPLE lc* be:
[] S~lisfactory
[] Unsafisfaclory
[] Questionable
[] Sample too long in transit; sample should not be over 4S
hours old at exc~mJnaUon to indicate reliable results. Please
SANITARIAN'S REMARKS
06.1220 Cb) BACI~ERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS ga,~ Received
ON
.actose Broth 10cc 1Oct 1Oct 1Otc 1Oct 1.0cc I.Occ
24 Hours __
48 Hours ' ? ' ~' :
48 Hours ,
, ] tI
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
~ P~sent !
06-]220(a) R~v. ~973
DATE
ALASk,, ,~EPARTMENI' OF HEALTH AND SOCIAL SER,
DIVISION OF PUBLIC HEALTH
INDIVIDUAL AND SEMI.PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
INDIVIDUAL
IAME
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
ADDRESS
CITY
ADDRESS
OF SOURCE
ZIP CODE _
Lab No,
OFFICE
Analysis shows this Water SAMPLE to be:
[] Sc~lisfaclory
[] Unsal[sfactory
.,
[~] Ques]ionable
[] Sample too long in transit; sample ~houJd not be over 48
hours old at examJnaBon to indicate reliable resull~. Please
send new sample.
[] Defile broken in transit, please send new sample,
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER I$ AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
...... TIME COLLECTED
[] KJfchen Tap [] Bathroom Tap
[] Basement Top
[)ATE COLLECTED
[]
Top -- [] Wood [] Concrete [] Melai []
MATERIAL: Building Sewer - [] Cast Iron C] Wood [] Tile [] Fibre [] Asbeslos
GENERAL: Does Water Become Muddy or Discolored?
When?
[] Yes [] No
[~ Of Well [] Other
PURPOSE OF EXAMINATIONz Illness Suspected? [] Yes [] No
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
o~.19~o Ih) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973
EMB AGAR
06-1220(a) Rev. 1973
DATE
ALASK~ /PAR?MENT OF HEAL1H AND SOCIAL SER~ .~
DIVISION OF PUBLIC HEALTlt
INDIVIDUAL AND SEMI.PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
Lab No. __
OFFICE
INDIVIDUAL [~
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
ADDRESS
CITY --
ZIP CODE
ADDRESS
OF SOURCE
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY !~ !' '
DATE COLLECTED TIME COLLECTED
LOCATION~
[] In Basement I] Basement Offset [] Ullder House
GENERAb Does Water Become Muddy or Discolored? [] Yes []
[] Of Well [] Oilier
Analysis shows lhJs Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Questlonable
[] Sample ~oo long in lransH; sample should not be over 48
hours old al examJnaHan fo bdkate rellable results. Please
send new sample,
[~] Baltic broken in transU, please send new sample.
SANITARIANIS REMARKS
PURPOSE OF EXAMINATION: Illness Suspecled? [] Yes [] No
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLEC'rlNG SAMPLE
o6.1~go Ibl BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973
48 Hours --
(Most probable No. per 100cc)
Reporled By !' : '/~'~