HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 2 LT 11Zot) iA K
He~
h and Environmental Prote
Fourth Floor West;
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
INSPECTION REPORI' ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
TILE DI'{AIN FIELD: (~?b~ /_/L/'
TOTAL LENGTH
DIS1ANCE fROM WELl. _FOUNI)ATION ~-. .NI ARES¥ LOI LINE . .OF LINE
SI"_ E PAGE PIT:
Log Crib Rings/craB SIZIz: DtAME3 Eli ._DEPI'H __. [)I%TANCE FHOM: WELL .........
IOYDL EI F[C-HVE
BIJILI.)ING FOLJNDATIOf"I .... NEARESl [_OF LIN[£ ..... ABSORPTION AflFA (WAI_L AREA) ......... SQ, I [
Well Dist. a%~ce TO: Lot Line
Bldg: Sewer Line:
±pe
ti: of Bedrooms5. _~- --
Installer: ~ --
Remarks: ~ ~ ....
Lnb
De
rtment of tlealth and Environmer ' Protection
Aneho?ngo, Alaskn 99507
8011,S 1.0(; - PI,',II()I,ATION TI.ZST
Depth
Feet
11 -
12-
13-
'-51as grouSi-d-~-ater en?untered?
If yes, aL whaL depth?
Reading I)iite Gross Time Net Time Depth to Water Net Urop
· :'::'x ::~:: :::':: :'::: :.:'. :::[ :::::.:: '::'::::: :: ~i~]: ~{~7:.F::::: :":: :: :.:x:'::: :.: :":.'. :~::':: :':::::.
-Proposed installaCJ~}l'}'"}~b~)Tge Pit Urain liold
Performed ..... ~ ........ ='" .................................
~1: Time
Date
In sp
DEPA'TTMEN
~25
MUNICIPALITY OF ANCFIORAGE
]F HEALTH AND'ENVIRONMENT,
L, Street, Anchorage, A].as],a
264-4720
[)ate Received:
10-.~f77 Wednesday
PROTECTION
g9501
October 12,
~]? ime
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER [,ACILI.PIES
LendJ.ng Institution Requesu: St__at~e of Alaska Veteran's Administratzon
Mailing Address:, 907 West Northern Lights Blvd. Phone:
2. Property Owner: Dick_W_~_i_q~~
Mail. lng Address: Star Route ABex 1585A 99507
Phone: 344-4214
De~crlptzon. Lot 11 Block 2 Zodiak Manor Subdivision
3. Legal ~' ' ' '-' '
Single Famil~ Residence: (~ Number of Bedrooms: Two
Multiple Pamily Residence: [ ) Number of Bedrooms:
Well System:
Permi h
Construction
Individual well (~ Community/Public System (I)
Depth of Well 111' Well Log on Fi].e
Bacterial Analysis
( )
6. Sewage Disposal System: On-site System (x) Public Utility ( )
Permit :~ Installed 1977 Instal let
Sepnic Tank Size
Manufacturer
Absorption Area
Soils Rate
Material
7. Distances: Well to
Septic Tank _~__~
to Absorption Area _ __
to Sewer Llne
Nearesu Lot line .~d~____.
Absorption Area
to Nearest Let Line
Page. Two
Department of Health and Envirenmental Protection
Request for Approw~l of Individual Sewer and Water Facilities
Legal Description: Lot 11 Block 2 Zodiak Manor Subdiviszon
Cor~ents:
Affadavit At~ached: ( ) Letter Attached: (
Approved:
Disapproved:
Date:
Dat~:_/t_', .'/' ? I
.IUNICIPALITY OF ANCHORA6E
Department of Health and EnvironmentalPrOtec~,,~?' "~ r ,
99501
264-4720
.. .
~a-Reques~ for Approval of Indzv].aua~ Sewer and wAt,~[ [acili'Zies
:., ,, /' ~/
owner,_
Mailin~ Address: ~ ~/ /_.~ 0~,.,[~J~7 Phone:
2 o
Lending Institution: /~ ~/~7~_z~,,~ ~,
, '
Mailing Address: Phone
Street Location: ~d./~2, ~_.~_~,~ ~,
~'' (~) Number of Bedrooms:
6. ozngle Family Residence: ~_~
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: *Individual Well (~) Public/Con. unity System
If Individual Well, well depth ~_
If Community System, name of system
Sewage Disposal System: On-site System 0<) Public System
If On-site System, date of installation: X-~tu~.) /~]gY 0
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
06-122~(a) Rev. 1973'
DATE
ALASI~ :£PARTMENT OF HE/~LTH AND'SOCIAL SER DS
EIIVISION OF PUBLIC UEALTH "r ~
IIIBIVI[)UAL AND S£MI.PUBL1C
flACTERIOLOGICAL WATER ANALYSIS
Lab No.
OFFICE
ND VIDUAL, []
NAME
SEMI-PUBLiC [] CHLORINE RESIDUAl, PPM
REPORT RESULTS TO
ADDRESS
CITY ZIP CODE
Analysis shows lh[~ Water SAMPLE to beJ
[] SaHslactory
[] Unsatisfactory
[]- QuesRonabJe
[] Sample too long in transit; sample should not be over 48
hours old at examination 1o indicate reliable results. Please
send new sample.
[] Boltle broken in transit, please send new sample.
SANITARIAN'S REMARKS
COMPLETF THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
DATE COLLECTED : ~ / TIME COLLECTED
Depth Feet.
PURPOSE OF EXAMINATION: Illness Suspected? [] Yes [] No
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Lactose 8rolh 10c¢ 10ce lOcc 10c¢ 1Otc !,0¢c 1.0cc
24 Hours
48 Hours .:
EMB AGAR
Lactose Broth, 24 hrs, _ 48 hrs. Gram's slain
DIRECTIONS FOR COLLECTING SAMPLES OF WATER FOR BACTERIOLOGICAL EXAMINATION
Carefully and Foltaw Instructions L~×actly
Beat' in mh~d that water analysis deals with materla~s present in very rn]nute quaDtities. The least care-
lessness in collecting and handling may give rise to results which are misleading.
Samples are accepted at the regional laboratories in the early part of the week (Monday-Wednesday)
unless there is an emergency or prior arrangements have been made. Arrangements should be made to
have the water samples reach the laboratory as quickly as possible and within 48 hours after collection.
After 48 hours, the significance of the bacterlolog[cal analysis is impaired.
collecting samples from TAPS or PUMPS proceed as follows:
la) Thoroughly flush tap or pump by aiJowlng water to run freely for five minutes.
lb)
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.
lc) Open fixture so that a small stream flows.
(d)
Remove boJtle from mailing tube. Hold bottle by the lower half in one hand and with the other
remove the screw cap with the fingers, leaving foil protecting cover in place. Fill the bottle to
the shoulder. Replace cap with foil cover, screwing firmly into place but do not apply pres-
sure which will split cap.
(e) Pack bottle carefully in ma~llng tube enclosing this completed information sheet.
DO NOT COLLECT SAMPLES FROM FIRE HYDRANTS, YARD
HYDRANTS, DRINKING FOUNTAINS OR SIMILAR OUTLETS
WHICH ARE DIFFICULT TO DISINFECT PROPERLY.
STERILE WATER SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST FROM:
Dept. of Health & Sodal Services
Sautheastern Regional Sanitarim~
Pouch J
Julleau, Alaska 99801
Dept. of Health & Social Services
Norlhern Regional Sanitarian
Fairbanks, Alaska 99701
Or D[slHd Offices ]n Fairbanks, Juneau, Ketchikan~ Kodiak, Nome, Palmer, Soldotna and Valdez. Consult ]oc~[ teJephmte directory for
DATE
r ?ARTMFNT OF HE,~LTH AND WE ~RE
DIVISION C)F PUBLIC HEALTH
BACTERIOLOGICAL WATER ANALYSIS
REPORT RESULTS
CiTY
SAMPLE COrrECTED
DATE COLLECTED
When?
6. Imr~roveyour [] spring [~ dug well E] drlvenwell
~ drilled well ~] cistern
SANITARIAN'S ~EMARKS
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
24 hours
EMB
BACTERIOLOGICAL WATER ANALYSIS RECORD /,,
PlREC'i'ION-~; FOt~ COI,I.[iCi'IN(¢ ~A~PLI:~, OF WA'I'ER FOR BAC. TEItlOLOGICAL EXAMINA'flON
Reed Corefully and Follow lnstrucEons Exactly
Boor in mincl lhot water onolysis deals v.,ilh male,ioJs plesenl in veJy minulo ClUCmlilies. [ho Jeost carelessness
coJ[ocling crud hondiing moy give rise lo i osuJls which ore misloacling.
Ar~angomonls should be made to have wote~ s¢lmi}Jos leach Ihe [aJ)olcdoly as quickly os possible. After 48 houls
s]gniticclnce of lbo boct01ioJogicoJ cmoJysis is impoh ecl. For obvious roasol/s Jho JoJ)orololy piofols 1o receive snmRJes ill the
OCli ly pcll f of tile week J]ul is willing Io (lccel)l sclmpJes cd ony limo.
In co]lecUng sanlpIr~s h'om TAPS o~ PUMPS f)~ocoocl cm foliows:
(o) Thoroughly flush lop o~ pumf~ by cl[[owir/g walel fo Cun freely [o~ ~ive ininules
(J)) SJlLll off wotol croci JJomo fl1(; outim wiri~ leech o~ J)ulnil/g per, eh Tho flame should nol bt: m~;~e]y possod ove¢ Ihe
outlel J)ul should ho uRl)J[of] ul]JiJ fixhJre sJ]ovys incJicclUon o[ being hol I:[omu should be cJirodecl ogoiRsJ [nsicle
edge.
(c) Open [ixluro so Ihat o smell shocln~ f~ows.
(d) Remove bollle [lom mailbag lube Hold bollle [)y tho Jewel hall in one hancJ and wilh tho olhoJ lemovo the scCew
o~p with tho ~ingors, leaving p(JpoJ j)lOlOC[iRg corel in piece. Fiji the boltle fo tho shoulder. Replace coI) wilh poper
covel, screwing [irm[y inlo j)loco Ddt cio ~/ol apply pressulo which will spiii col).
(o) Pack I)otfle corMully in mailing hJJ)o unclosing lhis complelod i~[oimation sheet.
In collecBng samples flora SI REAMS ond RESERVOIRS ploce~!d as follows:
(o) Ren/ove cop ond hold J)oltle (is des¢libed undol (d) cl[)~ re.
(h) Collacl somple I)y I~ol(hng DoiiJe in c: slanling posilion ond sweeping il bolo,,,, lbo su~faco in such o nlanneJ thcd
S1EI]iLE WATER SAMPLE BOTtlES ARE AVAILABLE UPON REQUES] FROM:
SOU¥11EASTERN REOIONAI IABORA'~ORY
POUCII J
JUNEAU, ALASKA 99801
J)el)l, o[ I JeaJJJl i?, Wel¢are
SOUUICENfRAI. [[EGIONAL LABORATOf(Y
bepL oJ Ileal~h ,~ Welfare
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HFALTH & ENVIRONMENTAL PROTECTION
Environmental Health Division
CASF RE, VIEW WORKSHEET
CASE NUMBER: ~ DATE RECEIVED:
SUB VISION OR PROJECT TITLE:
COMMENTS DUE BY:
( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWE-R AVAILABLE
( ) COMMUNITY WATER AVAILABLE
COMMENTS: