HomeMy WebLinkAboutCOLLEGE PARK BLK 3 LT 200
L.
0
APPLI( NT FILLS OUT UPPER HAt ONLY
Property Owner ~1~ ~,,/j~,~O//(~ ~L~ 'J/~'> ~Phone
Address Zip Code
Lending Institution Phone
TyPe o~ Resi~nce
~ Single Family
.~ Multiple Family No. of Bedroo~
~ 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 Indlv~ual Installed:
Public ~ility 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
Inspector Inspector Inspector Inspector
Field Notes: ~
(L~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3182}
CHEMICAL· & G~,.~ LOGICAL LABORATORIES. ~ J'. ALASKA, INC. ~.
- TELEpH~iNE (907)-279.4014 ANCHORAGE INDUSTRIAL.~ENTER
~ Drinking~ater Analysis Report. for Total ColifOrm Bacteria
TO BE COMPLETED BY WATER
WATER SYSTEM: ~?
~-* ~.. I.D. NO.
Water System Name ...... PhoneNo.
Mailing Address ~ ~ ,
CIW Sm~
Mo. Day Year _ ~
SAMPLE ~PE: '~.~,~
D Routine
D Check Sample (for routlno~mple
with lab ref. no. . ~, -.t
D Spectal Purpose -~
Zip Code
ID Treated Water
[] Untreated:~Water
SAMPLE
NO. LOCATION
1
06-1220
Rev. 1978
ColleGtecL
TO !BE COMPLETED BY LABORATORY
A-~alvsis shows this Water SAMPLE to be:
~atisfactory
["1 ' U~satisfactory
[] Sample too long in transit; sample should
~t be over 48 hours old at examination
to indicate reliable results. Please send
new sample,
Date Received
'Ari~iytical ,Method:
D/' Fermentation Tube
~Membrane Filter
Result*
- · _ ~*No of co on es/100 m orNo pfPostve~ortons
Analyst
READ I'NSTRUCTIONS
BEFORE
COLLECTING SAM PLE
Date Collected Source
ii Rlcelv~l Time RIgIIvI<I )',m, Lib. No
PresumptiVe 10mi 1Omi 10mi :tOtal 1Omi 1.0mi 0.1mi
24 Hours : r
48 HOurs .... L ~
Confirmatory
24 Hours ' t
48 Hours ' '
EMB Broth 24 hours:
Multiple Tube Report:
Meml)rlr~ Filter: Direct Count -
Verification: LTB
Final Membrane Filter RIIults~ {~,,,)
Broth 48 houri;
10mi Tubes Positive/Total :10mi PMtlons
Collform/100ml
BGB.
f