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Home My WebLink AboutNEWLAND BLK B LT 2 · INSPECTION APPOINTMENTS .... ~.~ . TIME TIME TIME INSPECTO~ INSPECTOR ~-' INSPECTSf~ ~X MUNICIPALI~ OF ANCHO~GE MUNICIPALITY OF ANCHORAGe~ DEPT. OF H:ALTi~ & DEPARTMENT OF HEALTH & ENVIRONMENTAL RO EC~RONMENTAL F~OTECTJON P 825 L Street - Anchorage, Alaska 99501 .UWRO TA SAU TAT O mWS O JAN i981 Telephone 264-4720 DIRECTION~: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER PHONE MAILING ADDRESS ~bT~fY ~S~D.NT (~f ~ilferent from above .... ~ PHONE ~ PHONE 2, BUYER MAI LING ADDRESS 3. ~ENDING INSTITUTIO~ PHONE MAILINGADDR~SS ~ , ~ ' ~ .~ ~ ~ --~ /~ ~ M~/LING ADDRESS / ~ 5. LEGAL DESCRIPTION ~TREET LOCATION 6. TYPE OF RESIDENCE [:~SING LE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS -~.~. One [] Four ,~,'~Two [] Five [] VThree [] 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 a~/ailable.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE E~] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I NDIVI DUAL/ON -SITE [~] PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line OTHER INearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS DATE ,/ //~ONDITIONAL APPROVAL (letter mu~'/,~omp~jn.y certificate) ~,~ ~P ~S~O~V~)~' BY ~~~ 72-010 (Rev. 6/79) CHEMICAL & GI~,,~-LOGICAL LABORATORIES "~.J ALASKA, INC. TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B St re et Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water System Name I.D. NO. Phone No. , (-~ Mailing Address State City. MO. Day Year Zip Code SAMPLE TYPE: r-] Routine [] Check Sample (for routine sample with lab ref. no, [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. I LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analys~s shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory ~ Sample too long in transit; samDm should not De over 48 hours ol(~ a[ examination to ndicate reliable results. Please sene new sample. Date Received Time Received ' Analytical Method: [] Fermentation Tube C~ Membrane Filter Lab Ref. No. Result* Analyst I I *No Or colomes/lO0 m or NO. of Positive portions READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source Date Received Time Received p.m. Lab. No. Presumptive 10mi Z0ml 10mi /0mi ]0mi 1.0mi 0.1mi 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB, Broth 24 hours: Multiple Tube Report: Membrane Filter= Direct Count Final Membrane Filter Results ' Reborted By , ' ' Broth 48 hours: /0mi Tubes Positive/Total lOml Portloni Collform/lOOml BGB Collform/100ml Date CHEMICAL & GE. . 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: I.D. NO. Water System ~Jame Phone No. Mailing Address City State [ MO. Day Year Zip Code SAMPLE TYPE: [] Routine [] CheCkwlth labSampleref, no.(f°r routine sample ~ [] Special Purpose I- Treated Water [] Untreated Water SAMPLE NO, , I LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY 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 ndicate reliable ,esults. Please send new sample. Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst I I--C] I I *NO of colomes/100 m or NO. of Positive [~oroons READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source No, Presumptive 10mi 10mi 10mi 10mi 10mi /.0mi 0,1mi 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB Broth 24 hours; Broth 48 hours: Multiple Tube Report: 10mi Tubes Positive/Total 1Omi Portions Membrane Filter: Direct Count Collform/300ml verification: LTB BGB F[nal Membrane Filter Results - Collform/10Oml - GREATER ANCHOR~iGE ~--SA BO Tax Code** · I Date.. Owner: Mail~hq Address: User / Tenant: Property Address: DYE rEST: ~ Positive [] Negative ADDITION~t INFORMATION; 0 fHc e: Administered By: