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Home My WebLink AboutGORDON LT 3A LEGFIL F: ]: C:HFIF;;:E:, C:. E. ~B,::I.'I"H .:::!?i:? 13 3F'r':,r'L I'.. L2:Fi G 'Z F'D :: N :-:;,.."D L "YT :5 Zl: ZE C!F' THE :1: C:E::F:'T]: F'"r' ::L: :[ FII'"I FOF:-I'H !!iir'-¢ "!'HE HU 2: :!: H'!:LL Time Depth , ~,,; and Remarks : ....... ~, Leng,..~th . Total '~,3,.["~. k, afll g,-s,:;;/',~;~ /,'~ --"/' ......... ANCHORAGE, ALASKA 99502 '/'- 20'~)~;.H~..- SUBSURFACE EXPLORATION ~ " ~ Shift Report 0f Operations ? o · 7/ ~;~c,-*-~ Size Static Level OPB-YIELD ~ ~ ~ ' Depth-Begin Shift"~U'~ L~6"[0¢t P p~I~L ID~;5 'TIme D~STRIBUTION HOURS g , (~.' ~:~L P ~ Surging LABOR EQUIPMENT ~' Name Hours Item Size Hours Drill-Rig .... Flatbed Pickup Boom Truck Welder Pump No. Depth Sample Description INSPECTOR APPLIC fiT FILLS OUT UPPER HAl ")NLY Buyer C / 'IL- / .(' ~(' Lending Inslitution Address Realty Co. & Agent Address !')/-)< /'t, /? ,Ki. Zip Code Zip Code Phone I-:-; v'/ Phone Phone Type of Residence ~gle Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply i: q.J.,,'lndividual !~ ~ , 'r? ATTACH WELL LOG. A well Icg is required for ali wells drilled since June 1975. [] Community For wells drilled prior to that date, give well depth (attach Icg if available). [] Public Utility Sewer Disposal [] Individual [~,"15 u b IIc Utility L-J Holding Tank Year Individual Installed: When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector ,~, Field Notes: J~J 0 MUiNICIPALI'r¥ OF ANCHORAGI~ DEPT. OF HCALTH '~ ENVIRONMEt~TAL PROTECTION ~,IAY RECEIVED ( ~ ) 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 (3~82) CHEMICAL & GL LOGICAL LABORATORIES ,~' ALASKA, INC. ~a;~;:~,;;~ Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I,D. NO. Water System Name Phone No. Mailing Address City State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref, no, ) [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPI_E 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 J ,~No of coIomes/tO0 mi or No of Positive pot[~ons 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 10mi 10mi 10mi 10mi 1,0mi 0.1mi 24 Hours 48 Hours I Confirmatory 24 Hours 48 H o u r.~._~....._,~_~ ~~~ EMB. Broth 24 hours= Multiple Tuba Report: Membrane Filter= Direct Count Verification: LTB Final Membrane Filter Results Reported By _Broth 4S hours: 10mi Tubes Positive/Total 30mi Portions Coliform/100mi BGB Collform/100ml , DATE RECEIVED DATE DATE DATE INSPECTOR INSPECTOR INSPECTO~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTil & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~NMEN.[AL I-';:.OTECTION 825 L Street - Anchorage, Alaske 99501 ENVIRONMENTAL SANITATION DIVISION i 1981 Telephone 264-4720 REQUEST' FOR APPROVAL OF INDIVIDUAL WATER AND DIRECTIONS: Complete all ~on pagB 1, Incomplete requests will not~ processed, Please allow ten (10) days for processing. 1, PROPERTY OWNER PROPERTY RESIDENT (If different from above) ' PHONE 2. BUYER PHONE MAILING ADDRESS 3, L~NDINGINSTITUTION [ PHONE MAILING ADDRESS 4, R~ALTOR/AGENT ] PHONE MAI LING ADDRESS 5. LEGAL DESCRIPTION/~,~ ~,~'~ STREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four r~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG, A well log s required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM E~] I N DIVI D[JAL/ON-SITE** PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE'.' THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PFIOCESSING 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 UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVi DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTAL, LER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~:],~"~PP R OV E D FOR ~.~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY CHEMICAL & Glo_LOGICAL LABORATORIES ~.F ALASKA, INC./~ TELEPHONE (907)-27g.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-II I I t I Water System Name Phone No. Mailing Address City State Zip Code Mo, Day Year SAMPLE TYPE: [] 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 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 Recetved Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. J Result* Analyst I *No of colonies/I00 mi or No. et Positive porlions. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev, 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source a.m. Date Received I'lme Received ---- p.m. Lab. No. Presumptive 10mi 10mi 10mi 10mi ],0mi l.Oml 0,1mi 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB Broth 24 hours.* Multiple Tube Ra~3orb____ Membrane FIIter~ Direct Count Verification: L. TB Final Membrane Filter Results Reported By _Broth 48 hours= , 10mi Tubal Positive/Total 10mi Portions Collform/100ml .BGB Collform/100ml Date