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Home My WebLink AboutZODIAK MANOR ALASKA BLK 4 LT 20Lo'l" 2.o MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 826 L Street - Anchorage, Alaska 995{]1 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACI LITI ES DIRECTIONS~ Complete all parts on eage 1. Incomplete requests will not bo processed. Please allOW ten (10) aays for ~rocessing. / PHONE 1. PnOPERTYOWNERLouis D. Reber q916)334-.9994 MA~LJN~ ~ODRESS 4819 Donovan Dr., Carmicl~ael, California 95608 PROPERTY RESIDENT (If different from above] I PHONE Lawrence R. Curry [ 344'~208 '2, BUYER PHONE Lawrence R. Curry 272-4166 MAILING ADDRESS 3250 East 40th Ave., ~nchorage, Alaska LENDING INSTITU-ION Lomas & Nettleton, 99504 JPHONE 274-7661 MAILING ADDRESS 4449 Business Park__~lvd,, Anchorage, 4. REALTOR/AGENT Precision Realty/Myron E. Briscoe Alaska 99503 PHONE' 276-8110 MAI _lNG ADDRESS 444~ Business Park~lvd;.B. ldg. '2N" Anchorage, Alaska 99503 LEGAL D ESCRIP~'IL~N .... Lot 20, Block 4, Zodiak Manor Subdivision STREET LOCATION 8536 Pluto Drive, Anchorage, 6, TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY Alaska 99504 NUMBER OF BEDROOMS E] One [~ Four [] Two [] Five [] Tnree [] Six Other__ 7. WATER SUPPLY INDIVIDUAL~ []] COMMUNITY [] PUBLIC UTI L TY 8, SEWAGE DISPOSAl. SYSTEM [] ~IDIVIDUAL/ON-SITE [~ PUBLIC UTI LITY ATTACH WELL LOG. A well Icg is reauired for al wells drilled since June 1975. For wells drilled ~rior to that date. give denth (attach Icg if available.) **lf individual/on-site, give installauon date. If system is over two (2) years old an adequacy test m reauired by tins Depar[mem. NOTE: THE INSPECTION FEE MUST ACCOMPANV EACH REQUEST BEFORE-' PROCESSING (;AN BE INITIATED. 72-alol3/78) I THIS SIDE FOR OFFICIAL USE ONL DATE RECEIVED INSPEC'RON APPOINTMENTS TIME TiME TIME DATE DATE DATE ]NSPECTOR INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SlX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIV!DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER E]Septic Tank or [] Holdin§ Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA M~TERIAL 4, DISTANCES Septic/Holding Tank [Absorption Area Sewer Line Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~3-~'~APP ROV ED FOR BEDROOMS E] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE 8Y (Title) LEGAL DESCRIPTION , 72-010 (Rev. 3~78) ALASK' 'PARTMENT OF HEALTIt AND SOCIAL SI 'CES DIVISION OF PUBLIC ItEALTH Lab. No. _ BACTERIOLOGICAL WATER ANALYSIS Office PLEASE MAIL RESULTS TO: NAME. ADDRESS ..... CITY_ ~ ' ' i.. .... ZIP CODE Sample collected by ~ t Phone No. Date Collected Time Sampling Address Specific place of collection ~EASON FOR SAMPLE SUBMISSION: [] Illness suspected [] Health Regulated Establishment [] Other WATER SAMPLE SOURCE [] Well Type of casing ' [] Improved (Enclosed, Covered) Spring [~} Surface (Reservoir, stream, lake) [] Holding Tank [] Other · San tafian's Signature: Analysis shows this WATER SAMPLE to be: [~ satisfactory [] Unsatisfactory [] Questionable [] submit other sample [] Sample too long in transit '~o indicate reliable results. Sample should not be over 48 hours old at time of examination· [] Bottle broken or leaked in transit. [] Other SANITARIAN'S REMARKS i/; ~__.~A D_ LNST R~J Cl- IQN,.S. BEFORE COLLECTING SAM RL~ 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 MuLtiple Tube Report:. 1 Membrane Finer: Direct Count~ ] i ~~? .Collf orm/lOOml GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received / ~ ~ ~ Time of Inspection 1. Approval requested by: ~ ~,~ - Na~ing Addcess: ~ ~_ /~ ~ Phone, 2. P~ope~ty O~nec: )~~ Phone: Nailing Addcess: 4. Location: ~,~-~& ~ 5. Type of facility to be inspected ,~/~ ~"~ No. of bedrooms 6. Well Data:~ ~ A. Type ~~/-~--. B. Depth C. Construction 7. Sewage 9~sposal A. Installed _ B. Installer '~ 2. Manufacturer Size C. Septic Tank: 1. D. Seepage Pit: 1. Absorption Area '---- 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank ----- , Absorption area Nearest lot line ~c>' ! B. Foundation to septic tank Other contamination ~-- , Absorption area C. Absorption area to nearest lot line , Sewer Lines EQ-O3q (1/74) Page 1 of two pages Page 2 of two pages - Request for Approval of Individual S~,,er & Water Facilities Legal Description Comments '~ ' ~oval Valid for one year from date signed VGreater Ancho~e Area Borough, Department of Environmental Quality 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-O34 (1/7q) DATE DEPA ,lENT OF HEALTH AND SOCIAl, SI' 'CIES DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS Lab. No. __ OFFICE REPORT RESULTS TO NAME ADDRESS ZIP CITY CODE ADDRESS OF SOURCE . · SAMPLE COLLECTED BY DATE COLLECTED TIME COLLECTED [] Other (List) PUMP LOCATION; r~ Ill Well [] Basement [] In Basement [] Room On Top [~ Of Well [] Other Records in this office indicate this WATER SUPPLY to be of: [~] Satisfactory CI Questionable [] Unsatisfactory Sanitary Status, Analysis shows this Water SAMPLE to be: O ~atisfactory O Questionable [] Unsatisfactory. If an "Unsatisfactory" or "Questionable" status is indicated above you should take immediate action as recommended below. I. Notify consumers water is polluted. Boll or chemically treat this water as outlined in the enclosed leaflet "Drink It Pure." 2 lcrease chlorination sufficiently to meet recommended residual standards, Determine source of contamination and take action necessarv to maintain a safe water supply at all times, 3. Check chlorination and other mechanical equipment, Make certain it is functioning properly. 4, If after checking equipment a disinfecting residual is not obtained, please wire this office for emergency assistance or advisory ~ervices, B. This is a surface water source and subject to pollution by man and animals. An approved water supply source shotdd be developed. S. Improve your []spring []du0 well Odriven well C]drilled well I~ cistern 7, Relocate your well to a safe location in relationship to your sewage disposal system. ~] see enclosure 8. Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results, please send new samp[e. [] Bottle Broken in transit, please send new sample. 9, Contact, your nearest [] Local Health Department or [] Alaska Division of Public Health, sanitation office for btdletins, consultation and SANI'I'ARIAN'S REMARKS REAl;) INSTRUCTIONS 06.1220 {b) BACTERIOLOGICAL WATER ANALYSIS RECORD Date Received Time Received pm Lab. No. __ _ ON REVERSE SIDE BEFORE EMB COLLECTING SAMPLE rose Broth 10cc 10cc 24 hours 48 hours li~nt Green 24 hours 48 hours Lactose Broth, 24 hrs. -Coliform Density__~ -MF results 48 hrs. 10cc 10cc 1,0cc 0,1cc AGAR (Most probable No. per 100cc.) -Detergent Tffst -Reported by ~ I This analysis indicates Coliform Organisms to be: Ab{eat pm