HomeMy WebLinkAboutALDERWOOD BLK 2 LT 10A I
TOTAL CASIi,~G 224'
APPLIr- NT FILLS OUT UPPER HAl--' ONLY
Lending
Institution
Phone
Realty Co. & A~nt ~ -- Phone
Address Zip Code
Street Locatim
Type of Resi~nce
Single Family
~ 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 IndivMual Installed:
~ Public Utility When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Dat~
Inspirer Insp~tor Inspirer Insp~or
Field Notes: (~ ~UNICIPALI~ OF ANCHO~GE DEPT. OF HEALTH &
ENVIEONM3NTAL P~OTECTION
REEEIVED
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
72-023 (3/82)
CI(EMICAL & G~'-LOGICAL LABORATORIES
TELEP~0NE (907)562-2343 ANCHORAGE INDUSTRIA~ 'CENTER
· 5633 B Street
Drinking W~ter Analysis Report for Total ColifOrm Bacteria
TO BE COMPLETED I~Y WATER SUPPLIER
WATER SYSTEM:
I.D. NO.
Water System Name Phom~ No.
Mailing Address
Sta~o
City
SAMPLE DATE:
Mo. Day
SAMPLE TYPE:
[3 Routine
[3 Check Sample (for routine ~l~le
with lab ref. no. ' )
[] Special Purpose
Year
iter
Zip Code
SAMPLE
NO.
1
2
3
4
5
LOCATION
/._
t
,t
Time
T~E COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
j~atisfactory
[] ~nsatisfactory
[] Sample too long in transit; sample should
~ot be over 48 hours old at examination
to indicate reliable results. Please send
qew sample.
Received
'ime Received //
I~lernbrane Filter
Lab Ref. Result*
Analyst
Rev. 1978
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Date CMlectad Sourc~
EMB Broth 24 ho.ri: , ~ Broth 48 ho.ri:
Multiple Tube Res)oft:
Membrane FIItar: Direct Count
Verification: LTB
Final Membrane Filter Results
1Omi Tubes Positive/Total 1Omi P~tlonl
Collform/100ml
BGB
Time,
Collform/lOOml
a.m.