HomeMy WebLinkAboutNEWLAND BLK B LT 1
APPLIC , IT FILLS OUT UPPER HAl.-' ONLY
Pre~perty Owner ~',~ ~"~5 /,.. . C, ~_F~.-~ ~"/'~y _ Phone
Buyer .
Address //-~-/' n" ~ , t ~ Zip Code
Lending Institution /t~ W'~ )~P' C~, ~, Phone
Realty Co. & A~nt Phone
Address Zip Code
Street Locat,~
~ Multiple Family ~o, or ~earoo~
~ Other
Water Supply.
~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed:
Public Utility When Connected to Public Utility:
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED,
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: ~__~ [.~<~).._ ~:) ~ ~ ~'
~ "~" ~ ~ 3 O~ *CONDITIONS OF APPROVAL
(.~) APPROVED BEDROOM8
( ) DISAPPROVED
( ) O0~DITIONAL APPROVAL*
DATE
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
72-023 (3182)
October 28, 1982
Cheryl C. Larry
1333 E. 26th Ave.
Anchorage, Alt 9950A
Subject: Lot 1 Block B Newland Sub.
Approval for the individual sewer and water facilities cannot
be granted until the following items have been corapleted:
The depression or pit around the well casing needs to be
filled with impervious type soil so that it slopes away
from the well casing.
v~{ ~e water analysis report nee~ to be submitted t° this
office from the Chem Lab, 5~33 B Street, for our review.
Please notify this DePartment for a reinspection when the
noted discrepancies have been corrected. If there are any
fur~er questions, please call this office at 264-~720.
Sincerely,
RP212/p/EH
Robert C. Pratt
Associate Environmental Specialist
CHEMICAL & G~.._,~OGICAL LABORATORIES ~:' ALASKA, INC.
TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
Mailing Address
kD. NO.
Phone No.
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,
2
3
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~: ,.,.~., Satisfactory
~ Unsatisfactory
[] Sample too long ~n transit; sample should
not be over 48 hours old al examination
~o indicate reliable results. Please send
new sample.
Dante Received
Time Received
Analytical Method:
[] Fermentation Tube
~;~ Membrane Filter
Lab Ref. No. Result* Analyst.
I
]
I ICI
*No. of colonies/lO0 mi. or NO. o! Positive port~ons
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAl- WATER ANALYSIS RECORD
Date Collected. Source
a.m.
NO.
presumptive 10mi 10mi 10mi 10mi 10mi 1,0mi 0.1m!
24 Hours
48 HOurs
Confirmatory
24 Hours
48 Hours
EMB. Broth 24 hours: Broth 48 hours:
Membrane Filter: Direct Count
Final Membrane Filter ReSults
10mi Tubes Positive/Total 10mi Portlona
Coliform/],00ml
BGB --
Collform/3.00ml
Date
