HomeMy WebLinkAboutRANGEVIEW BLK 1 LT 13
DA. ~RECEIVED
~'~, I NSPECTIO~ APPOI NTM ENTS ~.~' 2
T ME TIME TIME
DATE DATE DATE
I NSP ECTO R INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing.
1. PR P RTYO~ER PHONE
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LEND ~G INSTITUTION PHONE
I
5. LEGAL DESCRIPTION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four
I~] SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
[] Other
7. WATER SUPPLY *
d for all wells drdled
[] INDIVIDUAL*
O&-~Y, Z/ ~".~T ~C,.~I WELL LOG. Is req ~u~re
~ COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED.
[~'PUBLIC UTILITY
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 NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE ~] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SiX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] iNDIVIDUAL/ON -SITE DATE INSTALLED
E~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, DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
I~APPROVED FOR _.~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
DATE BY
CHEMICAL & G~ LOGICAL LABORATORIES t,..'~-LA~A, INC.
TELEPHONE [907)-279-4014 ~- ~.,~[/.,~
274-3364
ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIEF
WATER SYSTEM: III I III
I.D. NO.
Water System Name Phone No
Mailing Address
City St@te
MO. Day Year
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
Coltected By
TO RE COMPLETED BY LABORATORY
Analysis shows tins Water SAMPLE to be:
~ Satisfactory
[] L r~satisfactory
[] Sample too long n transit; sam 31e should
~ot be over 48 hours old at examination
to ndicate re able results. Please send
~ew sample
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref. No. Result* Analyst
~'/ /': 71 CFTI .~=,',
[-[-I
FT-I
*No ol colonies/lO0 mi. or NO o] Pos~bve Portions
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (~)
Rev. le78
BACTERIOLOGICAL WATER ANALYSIS RECORD
Presumptive 10mi /0mi 10mi ]0mi 10mi /.0mi 0,1mi
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
Fna Membrane FI ter Re.Suits
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M, SUI LIVAN,
MAYOR
August 27, 1981
Vermeeda E. Current
8401 East 6th Avenue
Anchorage, Alaska 99504
Subject: Lot ~3 Rangeview Subdivision
The well serving the trailer is presently in a cement vault
with the well casing buried below ground level.
The well casing will need to be extended above the natural
ground surface prior to the department sending an approval
to the lending institution.
oThe water analysis report needs to be submitted to this
ffice from the Chem Lab, 5633 B Street, for our review.
Please notifty this office for a reinspection when the well
has been upgraded. If there are any further questions, please
call this office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Peoples Bank and Trust
Pouch 7-025 99510