HomeMy WebLinkAboutSUMMIT ESTATES BLK 4 LT 3'071
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#1: Time
Date 10
Insp Bu
.~'% ~"'JNICIPALITY OF ANCHORAGE
DE EN'~': HEALTH AND ENVI RONMENT;i.~ROTECTION
825 E 'L~O~treet, Anchoraa~. Alaska 99501
I ,~ ~V//~[/)z 264-4720
W-l/77,.
-77 Wednesday Date '~~~C~
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: united Bank Alaska
Mailing Address: 645 G Street 99501
Phone:
276-1911
276-5659
2. Property Owner: Steven R. Foster Phone:
Mailing Address: 118 East International Airport Road
3. Legal Description: Lot 3 Block 4 Summit Estates Subdivision
4: Single Family Residence: (x) Number of Bedrooms: Two
Multiple Family Residence: ( ) Number of Bedrooms:
Well System:
Permit #
Construction
Individual well (x) Community/Public System ( )
Depth of Well 90' Well ~og on File
Bacterial Analysis
( )
Sewage Disposal System: On-site System
Permit # Installed 1965
(x) Public Utility ( )
Installer
Septic Tank Size
Absorption Area
Manufacturer
Soils Rate Material
o
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line '
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lo% 3 Block 4 Summit Estates Subdivision
Comments:
Affadavit Attached: ( )
Letter Attached: (
Approved: ~-~
Disapprove~d ~~--~1 ~.
Department Worksheet:
Date: 1/-- ~ ~ --7~
Date: I/-t- 77
· I,~JNICIPALITY OF ANCHORAGE~..~=) ., · JO
· '~ Department of Health and Envmronmental Protection i
~L~ ,~!~%% ' 825 L Street, ~chorage, Alaska 99501
-~'~--~'quest for Approval of Individual sewer and Wate~ 'Fa'c~t.itie's~.
0
o
Property Owner:
Mailing Address: //~ ~//~T ~-
Name of Buyer: ~:~
Mailing Address: N ~
'Lending Institution:
Mailing Address: ~
Realtor/Agent:
Mailing Address:
Legal Description:
StreLt Location:
Phone:
Phone:
Phone:
Phone:
Single Family Residence:
Multiple Family Residence:
Number of Bedrooms:
Number of Bedrooms:
Water Supply: *Individual Well (~ Public/Community System
If Individual Well, well depth ~0 ~-~-
If Community 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.
If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
DATE
' ' DIVISION O5 PUBLIC HEALTH
BACTERIOLOGICAL WATER ANALYSIS
OFFICE
ADDRESS
SAMPLE COLLECTED BY_ an
DATE COLLECTED TIME COLLECTED.
Sample.Collecled From [] Kilchen Top [] Balhroom Tap ~ Basement Tap
Records in Ibis office indicate thls WATER SUPPLY to be of:
[] Satlslactory [] Qaestlonable E UnsaBsfacfory Sanltor¥ Status.
Analysls snows ~hls Water SAMPLE Io be:
~]'Satlsfactory [] Questionable [] Unsatlsfaclory.
Il an "UnsaEsfactory" or "Questionable" stalu! is indicated above
you should tahe mrnedlale action os recommended below.
1. Noffly consumers waler is polluled Boil or cbemlcah¥
treat thJs waler as pull,ned in me enclosed leallet
"Drink It Pure.'·
When? Feel
~iameler of Well Depth
Wel~ Casing Depth
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
®L
· 2. Increase chlorination su~flciently to meet recommended residual stanuuras
DeTermine source of contamination and take action necessary to mainlaln
[] drilled well [] cistern.
SANITARIAN'S REMARKS
BACTERIOLOGICAL WATER ANALYSIS RECORD
/ . ~n,
Lactose Broth .: 1Oct I lOcc IOcc ~Occ IOcc 1.0cc O.lcc
24 hours
48 hours ........
Brilliant Green
48 hours
: - AGAR __
EMff
Lactose Broth. 24 hrs. 48 hrs.- Gram's stain -
(Mosl probable No. per lOOcc.)
Coliform DensUy :
MF resuhs ~.,~ '/ I (:~n~) :
This analysis indicates Colitorm Organisms to ~e: ~Absenl ]
Present