The URL can be used to link to this page

Home My WebLink AboutSPRUCE HEIGHTS BLK 2 LT 2OOq Lo' 2. lO Febr~y 1958 Avenue ~d Olive May S~tie !o ~ashtns~ Dea~ ~r, Allen~ V.A, Uo, 30~6"261 Application F,o, D/L 1238~TAAA ~nopec~t~ wee ~e a~ ~C 2, Block 2, 9p~ce Subdivtol~, ~e sub- A ~a~er se~ple teke~ the 31s~ of Jm~u~Ey w~8 ~d ~0 be 8atis~actoL~y, VEL-3; truly yourso ce: AlCert Sune~u ADH ×d'-~ Lab. No. INDIVIDUAL WATER SUPPLY ALASKA DEPARTMENT OF HEALTH Section of Sanitation and Engineering ACTION ON REQUEST FOR BACTERIOLOGICAL WATER F, outhcent, ral OFFICE g/~IALYSIS Your recent request for an analysis of a sa~nple bom the Individual Private Water Supply LOt. 2v receivea ~4'~ and ex~inailon has been completed. Satisfactory Records in this office indicate this Individual Private Water Supply to be of Questionable Unsatisfactory sanitary status. Analysis shows this SAMPLE to be ~'~ Satisfactory C~uestionable Unsatisfactory. If an "Unsatisfactory'* or "Questionable" status is indicated above, you should take immediate action as recommended below. 1. Soil or chemically treat your water supply to protect your family from water-borne diseases as outlined in en- closed leaflet, "Drink It Pure." 2. Improve your spring -- See bulletin HSE-$-2 3. Improve your clstern -- See Bulletin HSE-$-3 4. Improve your dug well--See bulletin HSE-8-4 5. Improve your driven well -- See bulletin HSE-$-5 8. improve your drilled well- See bulletin HSE-6-$ 7. Relocate your well to a safe location in relationship to your sewage disposal system-- See bulletin HSE-15 8. Bottle broken in t~crnsit, please send new sample. 9. Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. 10. Contact your nearest [] Local Health Department or [] Alaska Health Department, Sanitation for bulletins, consultation, and assistance, 11. This is a surface water source and subject to pollution by man and anlmals. An approved water supply source should be developed. SANITARIAH'S REMARKS o~gnaru~jn "- , This Form Must Be 1~ ]3N~I'~J~)UAL WATER SUPPLYISh,eet for Sample Collection Out ~Completely. ~S~A D~T~NT S~tion of SanCtion ~d ~-~ee~ I Requ~t for Ba~etiological water sampe c y ~...~:~] ............................................... / ................................................................. (Name of person c~ple) (Date) (Time) Water sample collec~d from ~ Ki~hen tap;~ ~ Ba~hr~m tap; ~ Basement.tap~ , ~ ~ - ........... : ............. Addr~s prem~e where so~rce' ~a ............................. : ............................ - .......... ~-----y-y~ ................................................... Please place an "X" In the box before l~ms which b~t describe your water supply: SO.CE: Well ~ ~ Dug, ~ Driven, ~Dd~ed, ~ Bored ~ Spr~~, ~ C~tem, ~ Other (~ls~) ....... :..: ........ ~ ........................................................................................... [] Creek, [] River, [] Lake, [] Pond ......................................... , ........................................................................ DUG WELL OR CISTERN CONSTRUCTION: Walls-- [] Wood, ~] ~oncrete, [] l~etal, [] Tile, [] Brick or Concrete Block Top -- ~rood, ~,~oncrete, [] Metal, [] Open Top LOCATION: [] In basement, [] Baseme trf~set, [] U~use, [] In yard Other ..................................................................................................................................................................................... DISTANCE TO: Building sewer or other drainage pipe .............. feet, Septic tank .............. feet, Tile field .............. feet, Seepage pit .............. feet, Cesspool .............. feet, Privy ..............feet. Other possible sources of contamination (list) ............................................................................................................................................. lVIA'i'~a~LA-L: Building sewer -- [] Cast iron, [] Wood, [] Tile, [] ~lbre pipe, []~Asbestos cement Joint material -- Type ....................................................................................................................................................... GENERAL INFORMATION: Does water become muddy or discolored? [] yes, [] no When? .............................. .~...-....~ .......................................................... ~: ................................................. Wen c asirfg~m~t erial..... [ - ~ ........... diameter .................... depth .................................. Length of drop pipe ............................................................................................................................... Water depth from bottom ............................................................................................................ feet Pump location: [] In well, [] Offset in basement, [] In basement [] In utility room, [] On top of well [] Other (list) ....................................................................................................... Do you suspect illness from this supply? [] yes, [] no Remarks: ......................................................................................................................................................................................................... PLEASE DRAW A SKETCH IN THE SPACE BELOW. THIS SKETCH SHOULD SHOW LOCATION OF HOUSE, WA'l'~ SUPPLY SOURCE, SEPTIC TANK, SEWER, DRAIN LINES OR OTI-IF_~ SOURCES OF POLLUTION AND ~)ISTANC ,'ES BETWEEN WATER SUPPLY SOURCE AND ANY OF ABOVE FACILI'I'L~S. SAMPLES MUST BE SUBMITTED IN CONTAINERS PROVIDED BY THE ALASKA DEPARTMENT OF HEALTH 7th Av~ue ~d Olive ~ay ~$rec~ ~n ~eu~ Dear ~r. Allen: Application ;o. D/L 1231~TA,a-A made o£ the ~ater ~nd se~age ~acilities located st L~ 2~ Block ~p~uce Helihts Subdivision, *£ht~ property is connected to a~ll Very ~uly yeu~s~ ~a~en V, Povell cc: ~r. ~iney, SC~O