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Home My WebLink AboutSASSE #1 LT 6Olo- iia- Io - 000 GREATER ANCHORAGE ARE Department of Environmental Quality "C" Street, Anchorage, Alaska 99503 274-4561 Date Received April 27, 1976 Time of Inspection 3:30 p.m. Date of Inspection 4-28--76 Wednesday REQUEST FOR APPROVAL OF Les INDIVIDUAL SEWER & WATER FACILITIES FOR V.A. 1. Approval requested by: Veteran's Administration Mailing Address: Phone: 2. Property Owner: Lawrence L. and Anne M. Carleton Phone: 274-1864 Mailing Address: 1204 West 36th Avenue 3. Legal Description: Lot 6 Sassie Subdivision 4. Location: 1.204 West 36th Avenue 5. Type of facility to be inspected Single Family No. of bedrooms 3 6. Well Data: Individual A. Type _ C. Construction 7. Sewage Disposal System A. Installed C. Septic Tank B. Depth D. Bacterial Analysis 0NXX1hXXYxyXXXffi Public Utility B. Installer 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area �, Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank, Absorption area _ C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Re( st for Approval of Individual ; ar & Water Facilities Legal Description Tot. G Sassie Subdivision Comments Approved Disapproved Date Approval .,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to De a true ana accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date nrrri. MUNICIPALITY OF ANCHORAGE €'.tv✓I``�'�'"��'`)' �r %�:--uor: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 REQUEST FOR APPROVAL OF l• 1 r (: INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA_ � FHA —.CONY 2. Property Owner: a u.2 / eZL2C- P : -4- :VzU CL Mailing Address: 6) °1C Day Phone:—, -2- 3. Name of Buyer:_.,� , [� l/o Mailing Address: Day Phone: 4. Name of Lending Institution: Mailing Address: ' Phone:__ 5. Name of Realtor or Agent: Mailing Address:/ �- !� N �� Phone:_c 6. Legal Description: C,7 7z Location:—,': 62 �� i: �l = v 7. Type of Facility to be Inspected: �t' �� No. Bdrms. 8. Water Supply Type of Supply: Public Utility-- - Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility--7L:—Individual (on-site) If Individual, date of installation 72-003(3/76) 06-1020(a) - Rev. 1973 - DATE ALA DEPARTMENT OF HEALTH AND SOCIALS[ CES DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ Questionable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. - ❑ Bottle broken in transit, please send new sample. INDIVIDUAL ❑ SEMI-PUBLIC ❑ CHLORINE RESIDUAL PPM REPORT RESULTS TO COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY DATE COLLECTED TIME COLLECTED Sample Collected From []'Kitchen Tap ❑ Bathroom Top ❑ Basement Tap ❑ Other (List) — Well - ❑ Dug ❑ Driven ❑ Drilled ❑ Bored — SOURCE: ❑ Spring ❑ Cistern ❑ Other------- Dug ther— -- Dug Well or Cistern Construction: Walls -❑ Wood ❑ Concrete ❑ Metal ❑ Tile Brick or Top - ❑ Wood ❑ Concrete ❑ Metal ❑ Open Top ❑ Concrete LOCATION: ❑ In Basement ❑ Basement Offset ❑ Under Hoose [-]In Yard ❑ Other Building Sewer Septic DISTANCE TO: or Other Drainage Pipe ----Feet. Tank Feet. Tile Seepage Cess - Field Feet. Pit -- Feet. Pool Feet, Privy Feet. Other Possible Sources of Contamination - MATERIAL: Building Sewer- ❑ Cast Iron I] Wood ❑ Tile ❑ Fibre ❑ Asbestos Cement ❑ Plastic Joint Material - Type _ GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No When? — --- Diameter of Well Depth Feel. Well Casing Material Diameter Depth Length of Water Depth Drop Pipe _ From Bottom Feet. Offset in In Utility PUMP LOCATION: ❑ In Well ❑ Basement ❑ In Basement O Room On Top [] Of Well ❑ Other -- PURPOSE OF EXAMINATION: Illness Suspected? ❑ Yes ❑ No New Source of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes ❑ No Signature READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lab No. OFFICE SANITARIAN'S REMARKS 06-1220 rot BACTERIOLOGICAL WATER ANALYSIS RECORD Rev, 1973 - -' am Date Received - Time Received pm Lab. No. Lactose Broth locc loco loco locc locc I.Occ 1.Occ 24 Hours 4B flours Brilliant Green 24 Hours 48 Hours se EMB — Lactose Broth, 24 hrs Coliform Density — MF Results Reported by - This analysis indicates Coliform Organisms to be: AGAR 48 hrs.----- Data rs. --Date Absent - Present Gram's slain (Most probable No. per 100cc) �1.%y 3, 19764. j. 429 _5,i�,Ia , 4z z J. € s t ; { t r€.. fir t i,,a r :(;' ant: M. x.5 i. 10o 'e:rt ufwia'lq zimst be 'P'+;dt+` kiln€:1 above tbo ti:#e pek; n . o approval Y#l',I i)e C-maiauwd if ClAw";S am ,F''C-rnwO If 71OU h4VOiftlAy Ci3VLOh0,X j,UasticmR,, .pl—ocr?e c,4 nntavt R at