HomeMy WebLinkAboutANDERSON MILLER Lot 11 & 12
' :-2 ~- · P~OpertY Owner: -_Jay>_~R-._;_M~'e~vil-l-'e - ' ' -phone:
_-.---'.':/Mailing Adaress~_35_0-0,1_i. OWa., 995Q3~ - ~, , '. , ' , - ,. - ,..
:-'- ' 3,-_ .Legal -Descr. fption: Lot_l:!a~a =.1._2 .-An.__derson Miller smbaiVision
-~' i.. _ _' . . , "3~0O-:-i~wa- DriVe ........ ' .....
?._ -i4:-_ s~ngle Family; Re.ei:.aenoe: =- .;(X) - . amber of sedrooms= Four
.~: '~.- - ~-~Mu-ltEple Family-Residence; ( ) Number of Bearooms;.
'-: - :--~5'. -We'll System:-'-in 1 well (x) cOmmunity/Public system
~--'- ~. ~ermit-~ - - -~'- ~' De~th of.Well ~6°' ~e~l-ao~°n
.'-' /: : - -" _ ' - -- ~ ' ' - -
~- - -~ _ - Cons~c~on - ::. - Bac~e~ial 'AnalYsis
. :6-'.' Sewage DisPosal System: .O~.Site-System ( ) Public ~Utility
~-- ~- ] permit.9 '. . ~ ._, -. _;.-ins~l_ied_ installe~ .
.'- ~ -' ~ _ : Septic .Tank. Size' __- - - . Manufacturer - -
-'-- - -.:' .Absorption Area - - ? Soils Rate - Material
' '- 7. / Distances: Well-to Septic Tank- _ to-AbsOrption Area
.-_: _.-l_: to:Nea~es~ Lo.t.-LSne_~-: -' __-- - _ _' -. - . _ - _ . -- .
-.. __. __.-._ . ~ - _- ._:~_..-~. _ _ _-~ . _- - ...-
MUNICIPALITY OF ANCHORAGE
~..~ Department of Health and Environmental Protection ' ~
//'~ld~"~ ~ S~,,~chorage, Alaska 99501
~'~quest for Approval~al Sewer and Water Facilities
1. Property Owner: ~ /~~a~
Mailing Address:
2. Name of Buyer: ~~C~-~ ~. ~4(5~3~
Mailing Address:
Lending Institution: '~~r-~._~' ~_-~)_rr ~(3~6(~,;
Mailing Address: t~O0 ~~O~r ~6.~~. Phone:
4. Realtor/Agent:
Mailing Address:
Phone:
w
Legal Description:
Street Location:
6.
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply: *Individual Well X) Public/Community System ( )
If Individual Well, well depth /~ ~3 ~'.;~
If Community System, name of system
Sewage Disposal System: On-site System ( )
If On-site System, date of installation:
Public System
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
ADHW- LAB
PUBLIC
ADDRES.
ICITY
mADDRES.~
~,, OF SO,UF
SAMPLE CO
DATE COLLE~
Sample Co
[] Other
SOURCE:
' Dug Well
Walls
Top -
LO CATION:
W
DATE
SEMI-PUBLIC
~lAIb U f r ALASKA.
[' 'ARTMENT OF HI: [LTH AND
rDIVISION OF 'UBLIC HEALTH.
BACTERIOLOGICAL' NATER ANALYSIS·
NDIVIDUAL ~THER
REPORT RESULTS TO
Lab. No,
, ' '
rED ~ · TIME COLLECTED
~cted From ~Kitchen Tap ~ ~throom Tap ~ ~sement Tap~
List)
Well. [] Dug [] Driven [] Drilled
[] Spring [] Cister, [] Other
r Cistern Construction:
r~1' Wood [] Con~rete [] Metal
r'' ~ Wo~ ~ Concrele [] Metal
[] In Basement [] Basement Offset
-[~ In Yard [] Other
Building Sewer
DISTANCE T( Or Other Draina~Lq, Plpe , , Feet.
Tile '-'~"~'"-~ '
· Seepage Cess-
Fi~ld-,~.~- Feet. Pit Feet. Pool
.Other Pos.~ ~
Sources of onta~nination
MATERIAb B Idlng Sewer -
Plastlc ii Joint Material -- Type
GENERAL:ItD~es Water Become Muddy or Discolored? [] Yes [] No
When? ~ , , _~r.
Diametermc~Well Depth
Well Casinl~
Material JJ Diameter , ,Depth
Length o1~ Water Depth
Drop Plpe~J From Botlom
Asbestos
[] Castlron [] Wood [] Tile [] Fibre '[] Cement
PUMP I
PURI~)SE OF
New S6urc
OFFICE
Records in this office indicate this WATER SUPPLY to be of:
~J'~factory [] Questionnble [] Unsatisfactory Sanitary St.atu$.
Analysis shows this Water SAMPLE to be: :
~.Satlsfactory [] Questionable [] Unsatisfacto?y.
If an "Unsatisfactory" or "Questionable'.' sfafuSs is indicated above
you should take immediate action as recommended below.
i~'~*~'~'~'"' ' i treat this water as outlined in the enclosed leaflet
· - 2.,Increase chlorination sufficiently to meet recommended residual standdrds.
D'etermine source of contamination and take action necessary to maintain
a safe water supply at all times,
--3;~Check chlorination and other mechanical equipmenLMake certain it. is
-' functionln~ properly,
~' 4. If;aft~r checki~ff'equJpment a disinfecting residual is not o~tained, please
~_ wire this office for emergency assistance or advisory service&,
[~] Bored .~:. This is a surface water source and subject to pollution by ma'n and anthills',
An approved water supply source should be developed..
~ Brick or ' "6, Improve your [] spring [] dug well []~d.riven'well
[] Tile LJ Concrete.
[] Open Top r~ ~ ~ drilled well' ~ [] cistern.
[] Jnder House '~ ' 7. Relocate ¥ou~ well to a safe location in, relationship to .your _sewage
disposal system. F'I ~see enclosure
Septic
rank . 'Feeh . 8.- Sample too Iong,ln transit; sample should not be over 48 hours' olc~ at
- Feet. Privy Fee~t~, examinations, to indicate reliable results, please'send new sample.
~ [] B~flle'Broken in transit, please send new sample.
· 9. Contact your nearest [] Local Health Department or [] Alaska
., '-- Division of Public Health, sanitation office for bulletins, consultation and
' *l assistance.
r ~NITARIAN'S 'RE~'RKS
Feet.-[
Fee
REI
CATION: [] In Well [] Offset In [] In Basement [] In Utility
Basement Ro~.m
~ wT°el~l [] Other.
~XAMINATION: Illness Suspected? []Yes r-]No
~f Supply? [] Yes ' [] No Repairs to System? []' Yes [] No
· ~ .Signature
) INSTRU CTIO,NS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
.- _ BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Received ' 1~'''~ 1/'~t~' '~'' Time Received
'i'1¥~
Lactose Broth '~/~',. ~ 10cc f- 10cc I 10cc 10cc 10cc 1.0cc 0.1cc
24 hours ' " f' ':I
48 hours
Brilliant Green ~,:
24 hours .'
48 hours
EMB - -'
. [~ ~ AGAR
Lactose Broth. 24 hrs. F -. 48 hrs. Gram's stain
Coliform Density (Most probable No. per 100cc.]
MF results '"
Reporfedby Z'~ ' Dote ~)[(~ lq~ '""~'-'L~
This analysis indicates Coliform Organisms to be: ~
, Present