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'~,~,lr]r~).)~/ ' GREATER ANCHORAGE AREA BOROUGH
im Department of Environmental Quality
~~ 3330 "C" Street, Anchorage, Alaska 99503 274-4561
~]'~ ~ ' Date Received January 23, 1976
, ~.~'~P~F%/~ Time of Inspection ~
l. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location: 3212
voa.
First National Bank of
Post Office Box 720
Alfred E. Mead
3300 Doris Street, 99503
Anchorage
Phone: 279-4481 x 237
Phone: 277-8240
Lot 7 Block C Woodland Park Subdivision
Doris Street, 99503
Single Family No. of bedrooms 5
.5. Type of facility to be inspected
6. Well Data: Individual
A. Type
o
C. Construction
Sewage Disposal System: Public
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal
Distances:
A. Well to:
(Serves 3 dwellings)
1. Size
1. Absorption Area
Field: Total length of lines
B, Depth 157' w/sub, pump @ 40'
D. Bacterial Analysis
Utility
B. Installer
2. Manufacturer
2. Material
Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
, Other contamination
, Absorption area
C. Absorption area to nearest lot line
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re~-~st for Approval of Individual .~"'"er & Water Facilities
Legal D6scription T,ot ? Block C ~ooclland ?a~k Subdivision
Comments
'~a-l( Valid for one year from date signed
Greater Anch~e 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 (!/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO
2. Property Owner: Alfred E. Mead
VA KX FHA CONV__
Mailing Address: 3300 Doris Street
Name of Buyer: William D. Tracy
Day Phone 277-8240
P. O. Box 4-814 99509
Day Phone 278-2305
The First National Bank of Anchorage
Phone
Mailing Address:
4. Name of Lending Institution:
Mailing Address: P.O. Box 720 99510
5. Name of Realtor or Agent: Kenneth Bell
Mailing Address: 903 W. Northern Lights 99503
Phone
279-4481 Ext 237
272-2334
6. Legal Description:
Location:
Lot 7, Blk C, Woodland Park S/D
3212 Doris Street 99503
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply:
Home - Single Family No. 8drms. 5
Public Utility Individual Y'~
If Individual, number of dwellings presently served
If Ir~d4~ft~U*al, depth of well
Sewage Disposal System
Type of System: Public Utility ICXXXXX
If Individual, date of installation
3 dwellings
157' deep with subm. pump 40'
Individual (on-site)
EQ-037 (1/74)
06-1220(a} Rev. 1973
DATE
ALAI DEPARTMENT OF HEALTH AND .SOCIAL SE'~-'~,ES
DIVISION OF PUBLIC HEALTH
INDIVIDUAL ANI~_SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
INDIVIDUAL[~ SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
ZIP CODE
ADDRESS
OF SOURCE
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
Lab No.
OFFICE
~nalysis shows lhJs Water SAMPLE to ae:
[~-~atisfactory
3 Unsatisfactory
~ Questionable
~ Sample too long in transiU sample should not be over 48
~ours old at.examination to indicate reliable results. Please
~end new sample.
[] BbltJe broken ~n transit, please send new sample.
SANITARIAN'S REMARKS
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED
[] Other (List)
Building Sewer
DISTANCE TO: or Other Drainage Pipe Feet
Tile Seepage Cess-
Field Feel Pit Feet. Pool
Olher Possible
Sources of Contamination _
MATERIAL: Building Sewer- [] Cast Iron ~ Wood [] Tile
[] Plastic Joint Material - Type
GENERAL: Does Water Become Muddy or Discolored?
When?
Diameter of Well Depth
Well Casing
Material Diamezer Depth
Length ol Water Depth
Drop Pipe From Boltom
Offset Jn
PUMP LOCATION: [] In Well [] Basement ~ n Basement
On Top
[] Of Well [] Olher
PURPOSE OF EXAMINATION: Illness Suspected? [] Yes
New Source of Supply? ~ Yes J~ No ~eoairs lo System?
[] Yes [] No
[] No
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
ON ~-
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
06-1220
Lactose Brolh 10cc 10cc · 10cc 10cc 10cc 1.0cc t.0cc
24 Hours '- i
--48 Hours
EMB ~? ( ' AGAR
Lactose Broth, 24 hrs. 48 hfs, Gram'$ slain
Coliform Densit~ ~ost arobable No ~er 100cc)
MF ResuUs
DIRECTIONS FOR COLLECTING SAMPLES OE WATER FOR BACTERIOLOGICAL EXAMINATION
Read Carefully and Follow Instructlons Exactly
Bear in mind that water analysis deals with materials present in very minule quantities. The least care-
lessness in collecting and handling may give rise to results which are misleading.
Samples are accepted at the regional laboratories in the early part of the week (Monday-Wednesday)
unless there is an emergency or prior arrangepnents have been made. Arrangements should be made to
have the water samples reach the laboratory as quicldy as possible and within 48 hours after collection.
After 48 hours, the significance of the bacteriological analysis is irnpalred,
In collecting samples from TAPS or PUMPS proceed as follows:
(a) Thoroughly flush tap or pump by allowing waler to run freely for five minutes.
(b) Shut off water and flame the outlet with torch or burning paper. The flame should not be
merely passed over the outlet but should be applied until fixture ~h0ws indication of being
hot. Flame should be directed against inside edge.
(c) Open fixture so that a small stream flows.
(d) Remove bottle from mailing tube, Hold bottle by the lower half in one hand and with the other
remove the screw cap with the fingers, leaving foll protecting cover in place. Fill the bottle to
the shoulder. Replace cai) with foil cover, screwing firmly into place but do not apply pres-
sure which v/ill split cap.
(e) Pack botffe carefully in mailing tube enclosing this completed information sheet.
DO NOT COLLECT SAMPLES FROM FIRE HYDRANTS, YARD
HYDRANTS, DRINKING FOUNTAINS OR SIMILAR OUTLETS
WHICH ARE DIFFICULT TO DISINFECT PROPERLY.
STERILE WATI:'R SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST FROM:
Dept. ofHeaJlh & Social Services
Southeastern Regional Sanltarian
Pouch J
Dept. of Health & Socia[ Services
Soulhcentral Reg[onaJ Sanitar~an
338 Denali Street, MacKay Bldg.
Anchorage, Alasl~a 99501
Dept. of Health & Sodal Services
4.1