HomeMy WebLinkAboutUPPER CHINOOK ACRES LT 1ALoT
,./ ~ GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
/ ~' 3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received ~////~
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
~ INDIVIDUAL SEWER & WATER FACILITIES ·
1. Approval requested by: J~_.'Y-~-~.,~
Mailing Address: ~.~. /2, ~ fL -- ff~/ PhOne: ,~- ~m.~. Xa~-~
2. Property Owner: ~..m_, ~c~.~/ Phone:
Mailing Address:
3. Legal Description:
o
Location:
Type of facility to be inspected
Well Data:
C. Construction
Sewage Disposal System:
A. Installed /.~/
C. Septic Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field:
No. of bedrooms ~-'
B. Depth ,s"~'~ ~
:~ D. Bacterial Analysis
B. Installer
Size /~ 2. Manufacturer ~o/~c~
Absorption Area ~ /~' 2. Material
Total length of lines '~---~-----~
Distances:
A. Well to: Septic tank / ~ ~ , Absorption area
Nearest lot line Jo-f~ , Other contamination
B. Foundation to septic tank /~' , Absorption area
C. Absorption area to nearest lot line ~ o '
Sewer Lines
EQ-O34 (1/74) Page 1 of two pages
(~--~ 2-'lr
Page 2 of two pages - Req..~st for Approval of Individual S. ,e & Water Facilities
Legal D~scription
Approved ~/~j ~6~ Disapproved Date ~-~/~,"¥?y
(~J ~ Approval Valid for one year from date signed
v Great~ Anchorage 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-034 (1/74)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
"C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type o7 Inspection: CMRO VA
2. Property Owner: ~/////~I~
Mailing Address: ~W~ ~.,~/~ ~7
3. Name of Buyer: ~~ ·
Mailing Address:
4. Name
Mailing Address: _]~)~p~
5. Name of Realtor or Agent:
Mailing Address:
CONV X
Day Phone ~7~ ~ x,~'d>
Day Phone
Phone
Phone
Legal Description: ,?I~ ~-- / ~ /., _//~3~w- ~/.x~z~>W/~ ~ ~d,
Location: 0~~ ~</-- !~m~4/~L ~~
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings
If Individual, depth of well C~
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual
presentiy served
Individual (on-site) __~
!??I
~06-] 220(a) Rev. ]973
D~TE~
ALAg~'"'~DEPARTMENT OF HEALTH AND SOCIAL SE(-'~ES .
DIVISION OF PUBLIC HEALTH Lob No.
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS O E,CE
INDIVIDUAL
SEMi-PUBLIC [] CHLORINR RESIDUAL PPM
REPORT RESULTS TO
NAME
ADDRESS
CITY
ADDRESS
~OF SOURCE
ZiP CODE
COMPLETE THIS SECTION
ONLY IF WATER IS AN NDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED
Analysis shows this Water SAMPLE to be:
~ ~atTsfactory
[] Unsatisfactory
[] Questionable
~[] Sample too long in transit; sample should not be over 48
hours old'at examination to indicate reliable results. Please
send nev;'sample.
[] Boltle broken in transit, please send new sample.
SANITARIAN'S REMARKS
Diameter of Well Der~th Feet.
Well Casing
Material Diameter Depth
Length of Water Death
PURPOSE OF EXAMINATION: Illness Suspected?
New Source of Supply? [] Yes
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
[] Yes [] No
[]] No Repairs to System? [] Yes [] No Signature
0d-]22o (b BACTER OLOGICAL WATER ANALYSIS RECORD
Date Received . Time Received _
Lactose Broth lOcc 1Otc IOcc lOcc lOcc 1.0cc 1.0cc
24 Hours ,. ~
EMB AGAR
Lactose Broth, 24 hrs. 48 hrs. Gram's stain
Coliform Dens[t~ .Most probable No per 10Occ)
MF Results