HomeMy WebLinkAboutMCRAE LT 15C-1B (OF LT 15)
-'-- "MUNI~]P,~LITY OF
MUNICIPALITY OF ANCHORAGE DEPT. OF i'LV',LTH
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~NVIRONMENT,",L
825 L Street - Anchoraga, Alaska 99501
ENVIRONUENTAL ENGINEERING DIVISION FEB 2
Telephone 264-4720 R E C E i V E
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten H0) days for processing,
1. PROPERTY OWNER
~AILING ADDRESS
PROPERTY REStDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
~/~/ ..... ~c ~/~
3, LENDING INSTITUTION I PHONE
MAILING ADDRESS
4..~L~OR/~e~.T ......
MAI LING ADDRESS
STREET LOCATION ':.
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ One [] Four
[];;;~ SI NG LE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG, A well log is required for all wells drilled
since June 1975, For wells drilled prior to that date, give well
depth (attach log if available,)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
~ PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72.010{3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSP ECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified, LOG RECEIVED
3. SEWAGE 'DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
I--] PUBLIC UTILITY
Connection Verified
INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions;
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/HoJding Tank Absorption Area ISewer Line Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
0
_ APPROVED FOR
[] CONDITIONAL APPROVAL (Petter must accompan~ertificate)
[] DISAPPROVED
DATE By (T~.~t /
LEGAL DESCRIPTION
72-010 (Rev, 3/78)
C I'IEWCAL 80EOLOOICAL LAIK)RATORIE8 OF Ai.,ASKA lNG,.
P.O. FOX 4-1276 ANCHORAGE, ALASKA ~ 4640 BUSINESS PARK BLVD.
Drinkin§ Water Analysis Report for Total Coliform Bacteria
TELEPHONE
(9O7) 279-4014
TO BE COMPLETED BY WATER SUPPLIER
I.D. NO.
PUBLIC WATER SYSTEM:
Mailing Addresa :
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
1
2
3
4
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
LABORATORY:
NAME
ADDRESS
CITY
Date Received
Time Received / (/
Analytical Method:
[] Fermentation Tube
~!~ Membrane Filter
Lab Ref. No. Result*
J
~ '~, ?.
* No. of colonial 1100 mi. or No. el Positive portions.
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Form No. 18-310 {3.78)
o6-122o (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
a.m.
[.ab. No.
Presumptive 10mi 10mi 1Omi 1Omi 1omi 1.0mi 0.3. mi
48 Hours
24 Hours
48 Hours
EMB Broth 24 hours:
Multiple Tube Report=
Membrane Filter: Direct Count .
Verification: LTB //~_/~
Final Membrane FIIter,/~e~s
Reported By ~/~ , ')
Broth 48 hours=
lOml Tubes Positive/Total lOml Portions
Coliform/100rni
BGB
1977
C. D o Simon s
Star Route A ~/~ox 1555M
Anchorage, Alaska 99507
Subject ~ Permit Expiration
D~ar Mr. Simons
A pe~.m~it issued by t! ~.s ¢~epart~ent ~o]: well and/or on-s~te
sewer installation on Lot 1~ Block 2 Mc ~-~ahon Subdivision.
has expire~-1 stnc~ the issue ctat(~ eXc~edD °n~ (1) ye~.~.. ~:~'~ ....
In the event you still plan to install the welt and./or on-site
sewer syst~.~., a new permit is required. The original soil test
~'~ay be used. to obtain a current permit.
If the well has been d. rJ. 1]x-,-d, a well log should b*f~ s~ant to
%~'his departrlent to document the inshallation date.
If you have any questions re.qar6tinSj the abovo matter, please
(lo not hesitate to contact this office immediately a't 279-2511,
extension 224 or 225.
Sincerely,
Levi No Buchholz, R.So
San itarian
UNITED STATES DEPARTMENT OF THE INTERIOR
GEOLOGICAL SURVEY
WATER ANALYSIS
2OW
Location Well a'~ 2625 W. 34 st, - Spenard
drilled well
Source
Cased to (fi) Date drilled Point of coll.
Owner Stephel
Treatment
WBF
Temp (°F) ~ Appear. when colt.
Collected 8-8-72
Depth (ft)
County
400 Oiam (~n.)__
Use __dom~siic
WL Y,eld
__ By ........._C_h e_r~y._._and. R_u~_f e[_t
~emara5
Silica (SiO2) 23 Bic a~..bonate (HCO 3 ) 146 2.39
Aluminum (Al) ,.C,aTbonat. e (COs) 00 ~ 0___~00_
.Iron (Fe) (total) .23 I -
Manganese (Mn) .13 SuLfate (SO4) .8 0.~0_~2_ .
Chloride (C1) 1.8 , 0,05 _
FluoFi,de (F) I .2 i - 0.01_.
Calcium (Ca) 28 1.38
MaF. nesium (Md) 9.0 0.74 Nitrat~ (N, O3) i _1.6 i o.o.q
Sodium (Nm) 8.~ o.37 Nitrate as N -- I .... .3~
Potassium (K)
Total I 2o53 Total , 2.50
Specific co;nductance
{micromhos e't 350 ~) 224
Diaeolved eoltds: ~ 147 pH , 8.2
Colcu~ated , ,, ' '
............................. Color
H~dne~s ~ c~cO~ ,, .
Lab, No, Col 15860 Field NO, Project S~ate
UNITED STATES DEPARTMENT OF THE INTERIOR
GEOLOGICAL SURVEY
WATER ANALYSIS
2GW
Well at 2625 W,
34th St. - Spenard (drilled well) County __
Depth (ft) 400 Diam (~n)_
Location
Source collect~,~l,~u~hat~1,,,..,,~ ~.faucet after sufficient pumping to
Cased to (ft) ~D%'i:6-cff~leb~'l'k' Point of coll.
Owner Stephel
Treatment
WBF
Temp ('F) ~ Appear, when coil,
Collected 8~-23-,.72 a,m,
Remarks
WL ........ Yield
By ............... _R~m_i'~ t _
m~/1
, 2,41
Silica (SiO2) 21 . Bico.rbonate..(HCO3 ) 147 , ....
Aluminum(Al) Carbonate (CO3) oo, o.0o
.Iron (Fe) (t~tal) .29{{ _
Manganese (~n) .14: SuHate (S04).. .6J 0.0_1 .
Chloride (C1) 2.0 0.06
Fluoride (F) I .2 , 0.01
Calcium (Ca) 28 1.42 t .....
I
Magnesium (M~) 9,0 0.74 Nitrate (NO,3) i 1.4 ! 0.02~_
/
Sodium (Ns} 8, 7 ,38 Nitrate as N _ ] ,32
P otas s..i..um.
Total 2.51
Total
SpeeiffS conductance
..... (micromhos !~tr 250 (;) 226
Dissolved solids:
Colcula~ed 145 pH 8.2
,Cot,or .... 5
Hardness as CaC03 ,, lO8 ' ~
, Alkalinit~ as CaCo3 121
Lab, No, Cot 15861 Field No, : Proiect
State