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Home My WebLink AboutSHEETS LT 3 PETERS CRK TERR TWNHMS PH 1HlEtT:5 CHEMICAL & GE_ LOGICAL LABORATORIES tt,.t' ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER q, 274.3364 5633 B Street W'�*2'w Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: I.D. NO. Water System Name Phone No. Mailing Address City State SAMPLE TE: Mo. Day Year Zip Code SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample El Treated Water with lab ref. ' ❑ Untreated Water ❑ Special Purposee SAMPLE Time Collected NO. LOCATION Collected By 2 3 4 5 Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result" Analyst i Ifl . i m .Noof colonies/ 100 ml. or No. of Positive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source READ INSTRUCTIONS a.m. Date Received Time Received p.m. Lab. No. pre.umotive loml loml I loan I loml I loan I 1.0mi BEFORE 24 EMB Broth 24 hours: Broth 48 hours: COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Posltive/Total 10ml Portions Membrane Filter: Direct Count Coliform/loom) Verification: LTB BGB Final Membrane Filter Results Collform/looml Reported By Date r _ Time: a.m. - - p.m. MUNICIPALITY OF ANCHORAGE i, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet - Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE - EW s0 AJ ❑ UPGRADE _ _ MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption area Dwelling PERMIT NO. U X DISTANCE TO: C�O t%& &A L __. O e f- Z Manufacturer Mat No. of compartments Liq. rapacity in gallons Inside length Width Liquid depth Z Sb IF HOMEMADE: Q _ DISTANCE TO: Well _� _ Dwelling m® PERMIT NO. � Z 2 z Manufacturer Material Liquid capacity in gallons p Well T Fou ation Nearest lot line PERM NO. ytT DISTANC:To �� o Z� , �D� tIt!b 2 No. of lines Length of each line Total leneth of lines Trench width Distance between lines t•, z LU _ �© __ _ _ � inches_ F_ Top of tile to finish grade Material beneath tile Total effective absorption area D ® — O inches `�- Length Width - Depth TA �T PERMIT NO. w --• C b Type of crib Crib diameter Crib depth --- Total effective absorption area A a LU _ y Well ___ Building foundation _ Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. Go L aD.aJL w S DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER LZ o PIPE MATERIALS 0 SOIL TEST RATING 0 0 � INSTALLER o 1 REMARKS L i CfTO qG — TEC710N :w i L'e vv .r soav+n •• r� — o a y ! 41 t t:f,``,*, , c c v ci° c i fq�a',. ti•` :4 q7t APPROV DATE_ LEGAL ZQ3la - /2-U1 3 lHev. 3/78) I- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 025 L Strout - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION C*) Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1, Incomplete requosts will not be processed. Please allow-ten "I'd Yy fpr processing,. ��-_-��-- -1 N - 1. PRO TY OWNER `, ---V--AL � MAILI GA RS� -- PROPER' E IDEN-I' If diffe Ls t�from above) PHONE 2. BUYER PHONE m MAILING 3. LENDINGIN ITU 10I�I„ PHONE C/J T� G l MAILING A RES 4. REALTOR/AGENTPHONE MAI LING ADDR ESS D JUN 2 71983 "Municipality of Anchorage" "Dept, of Health & Fnvironmental Protection" -V THIS SIDE FOR OFFICIAL USE ONLY .T DATE RECEIVED r INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR 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 ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY — — — DATE DRILLED ❑ PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE DATE INSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER ❑Septic Tank or ❑ Holding Tank Size: "Z•�bt, If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Linem WELL T0: Absorption Area to nearest Lot Line 5. COMMENTS [J' APPROVED FOR BEDROOMS�� • ❑ CONDITIONAL APPROVAL (letter must accompany certificate) 01 DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72.010 (Rev. 3/78) Co 10 / � 1-11,11,14� CHEMICAL & Gk,.)[.OGICAL LAIRATORIES F ALASKA INC. TELEPHONE (907)•2794014 ANCHORAGE INDUSTRIAL CENTER 274.3364 5633 B Street 4 :weonwronin Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER II TO BE COMPLETED BY LABORATORY WATER SYSTEM: ��I.D. NO. pAj4�,-) �/ SA77S' _A7 Water Systepr.jJam� Phone No. Mailing.dmfis City f State Zip ode SAMPLE DATE: Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected 10 1 4-3 LOCATION / ei s Collectedi�-�. /600 ce 2I 3 a 5 I� L I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Analysis shows this Water SAMPLE to be: Satisfactory IV ❑ Unsatisfactory ❑ Sample too long in transit: sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received 62- Time Received 1�60 Analytical Method: ❑ Fermentation Tube Kmembrane Filter Lab Ref. No. Result* Analyst /Abo -i i F7 I I LZ7 I I M *No. of colonies/ tl 0 ml01Noof PoW,s portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev, 1976 Date Cal acted Dab Recelved Time Recelvad Souris A.M. 0.0%. Lab. Nn. EMB Broth 24 hour[; Broth 48 hours: Multiple Tube Report: —10ml Tubes Positive/Total 10m1 Portlona Membrane Fater: Direct Count Collform/100ml Verification: LTO BGS Final Membrane Filter Res Jut/a /y/r---Cpllfo%rrn/100m1 RePurted By / Date a.m. P.M. DEPHRTMENT OF HEHLTH HHD P. 11.1 PROTECTION 825 'L' 'TREET, HNCHORHGEHK995� 264-4728 ... .~~.... �_�� PERMIT NO ( 810669 ) DHTE OF ISSUE 7028i HPPLICHNT NILEY D�NNISON ISSUED ~..... ..... �...... ..... ~^_.-~... .... .... .-.. INSPECTION HISTORY ~ SENER 1 0 SEWER 2 0 WELL INSP 0 WELL LOG DHTE 0 DRILLER GREATER ANCHOkAU. /ACS°+ L'OROUu., i)epartment of ❑ivirorunental Quality 3330 "C" Street Anchorage, Alaska 99V03 SOILS LOC PI;ROLATION Tl' "ST Performed for ._--___.P_RIN�---CRE£K.___��ccw--�n��--------------,;ate Pcrfori;, Legal Description--:----L.�T____ This form reports: Soils log x — _ Percolation test Dep th Feet }.. - 2- 3 - 4 I��l 5M 2-50 9- 10 - l�--t4 GW $5 s Was ground water encountered? -&10 -__ If yes, at what depth? — - Reading Date Gross Time Net Time Depth to Water Net Uroh hercoiation rate minute. Proposed installation: seepage Pit Drain Field Depth of Inlet Depth to lottom of pit or trend COMPIEPITS: So-i/s c�aS�Pc�_.Q�y_v�gVFl lyriS._---..-----_.___.__ -en� — Performed [3y: Certified '6-37 P,Q-040 (6/74)