HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 6 LT 3Zoo K
1
GREATER ANCHORAGE AREA BOROUGN
DEPARTMENT OF ENVIRONMENTAL
3500 'TUDOR ROAD
/? ANCHORAGE, ALASKA
/ 279-8686
QUALITY
99507
DATE RECEIVED
INSPECT:
TIME:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
APPROVAL REQUESTED BY: ,,~.,.:=-¥~..6~ /.-L./~ , ~.;~:',L: /
ADDRESS: : . :z.~ /~.
. · )- ,$66 I
PHONE: ,'
PROPERTY OWNER :" ~ /~'-
LEGAL DESCRIPTION: '~:':~:¢,//
INSPECTED
'': -
?
TYPE FACILITY TO BE
NUMBER OF BEDROOMS
WELL DATA:
A. TYPE (
B. DEPTH
C. SIZE
O. CONSTRUCTION ~"/~~,
E. BACTERIAL ANALYSIS
SEWAGE DISPOSAL SYSTEM.
A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK)
1. SIZE
2. AGE
3. MANUFACTURER
4. INSTALLER
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
SEEPAGE PIT
1. SIZE
2. LINING
DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK &
B. WELL
C. WELL
D. WELL
E. WELL
F. FOUNDATION TO SEPTIC I'ANK
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
COMMENTS:
TO SEEPAGE PIT
TO SEWER LINE
TO PROPERTY LINE
TO OTHER POSSIBLE
CONTAMINATI
APPROVED_ .~_~2~ ~' ~ ~
DATE:
DISAPPROVED:
DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED,
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL
QUALITY
lear rn Approved
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WA?ER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PARY I.--TO BE COMPLETED BY FHA
INSURING OFFICE
Anchorage
MORTGAGOR OR SPONSOR
Alaska §taLe Bank
SUBDIVISION NAME
Zodiak
TOTAL NUMBER:
BASEMENT
MORTGAGEE
Lester Howard
SERIAL NO.
'ill :013123
PROPERTY ADDRESS
g40'l JupiLer Drive
[ GL OCI~ NO. LO~NO.
] New installation
additional bedrooml?
(if Yes, how many¢O
WATER SUPPLY RYz
[] Pnblic system
SEWAGE DISPOSAL RYI
[~Public system
[_.~ Community system
Community system
Individual
Individual
SYSI'EM DESIGNED FOR
Yes [] No
PART II.wTO BE COMPLETED BY HEALTH DEPARTHIENT
HEALTH DEPARTMENT INSI:ECTOR'S SKETCH
It is the opinion of the [] State [] County [] Local Department of Health that this individual water-supply system
U} is [] is not satisfactory asa domestic water supply for the subject property,
of the [] State [] County [5~] Local Department of Health that this individual
It
is
the
opinion
sewage-disposal
sys-
tem with proper maintenance:
[~] Can be e×pected to function satisfactorily, and
is not likely to create an insanitary condition Publ t C Sewer E'~ Cannot be expected to function satisfactorily
Nov. I5, 19[1 / ( ,,,;~ . [ Environmental Specialist
NOTE: The health authority rhould complete the appropriate opinion stoternent above end affix date, signature and title in the
Ute of the above grid for Health Department Inspeptor'~ sketch as well as use of the back of thl~ form Is at the option of the
health authority.
PARY III.~FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the
Individual water-supply system be considered ~] Acceptable [] Not Acceptable
Sewage disposal be considered [] Acceptable [] Not Acceptable.
DATE SIGNATURE
C.lEE ARC.'ECT
D P. UF , FOR C.IEE ,.C,lt Ct
HEALTH AUTflORIT~ APPROVAL
INDIVIDUAL WAYER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
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ADHW - LAB - 2W
DA?E
RTMEN¥ OF HEALTH AND WI!' E
DIVISION OF PUBLIC HEALTH
BACTERIOLOG~CAL WATER ANALYSIS
Lab.
OFFICE
REPORT R£SULT$ TO
Records in this office hldlcale th~s WAYER SUPPLY to be
SotJslaclory [] Oue/lionable [] Unsatldactory Sanilary Stolul.
SAMPLE COLLECTED BY_
DAYE COLLECTED
Sample Collected From
~J O~her (List)
om
TIME COLLECTED ,om
When? __
[~ drilled well ~] clslern.
SANITARIAN'S REMARKS
Signature
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Received .Time Received pm Lob No.__
' .....
EMB ~ AGAR
Luclose Brolb, 24 hrs 48 hrs. Greta's slain
Coliform Density (Most probable No, per IOOcc.)
~F results
arc,
Absent
DATE
DEP- '"'~IENT OF HEALTH AND WELF~~
DIVISION OF PUBLIC HEALTH
BACTERIOLOGICAL WATER ANALYSIS
PUBLIC
SAMPLE COLLECTED BY.
DATE COLLECTED TIME COLLECTED. p~m
Sample Colleded From [~ Kilcben Trip [] Balhroom Tap ~ Basement Tap
E] Olher lust)
Well. ~ Dug [] Driven [~ Drilled [] [Iored
SOURCE: [] Spring [] Cistern C] Olher
Dug Well or Cislern Construction:
Walls · [] Wood ~] Concrele ~ /~etal [] Tile ~] Concrete
Top - ~ Wood ~ Co,role ~ Me,al ~ Open Top
When?
If an "Unsofls~aclory' or "QueslJonable" status is indicaled above
you should take immediate action as recommended below.
1. Noilly consumers water is polluted. Boil orr chemically
treal this waler as oullined in Ihe enclosed leaflet
"Drink It Pure."
--2. Increase chlerin(~fian suffic[enlly to meet recommended residual slandcsrds.
Delermino source of contamlnolJan and f(~ke aclion necessary to maJnlaJn
a safe waler supply at all times.
--3. Check chlori~olinn and oiher mechanical equipment. Make certain Jf is
functioning property.
[] drilled well [~ cistern.
SANITARIAN'S REMARKS
Signalure
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Brilliant Green
24 hours
48 hours
EMB
am
Reported by
This analysis indicates Cobforn~ Organisms Io be:
Absenl