HomeMy WebLinkAboutALPINE VILLAGE BLK 4 LT 15
APPLIC FILLSOUT UPPER HAl ONLY
Prooerty Owner t ~ \ '\ ~ ~ Phone
Mailing Address I /-~
Lending Institution
- - ~ ' ~ - '~' ' Phone
Realty
Co.
&
Address~' ~( ~' d~.~. ~ ~ v~ Zip Code ~ ~'~ '-2, -~,
Legal Descrlpt~n L
Type of Resi~nce
Single Family
Multiple Family No. of Bedroo~
~ Other
W~ Supply
~lndividual A~ACH ~LL LOG. A wal 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 Indiv~ual Installed:
~ Public ~iltty 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 ,
Date Date[ (~) i~._ ~ ~..~ Date Da~::,_
Inspector Inspector Inspector Inspector
DFPT C,~
"T N"T'~-~_. ] o - / 3 - .oC'' 7,,.,_ ENVIR .,i ,l/',",,
i, U3 2 O i982
RECEIVED
( ~OVED BEDROOMS,~ *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROV/I¢,.*~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Rece{ved
Well to Tank Septic Tank Size
72-023 (3/82)
.. CHEMICAL & G'~ LOGICAL LABORATORIES ? ALASKA, INC.~
AX '
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:
I,D. NO,
/; Phone No.
Water System Name
Mailing Address
City State
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Zip Code
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
, I
I
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 sampe.
Date Received ·
Time Received '
Analytical Method:
[] Fermentation Tube
[]~Membrane Filter
Lab Ref. No. Result* Analyst
I I-q-'!
I [-r"-I
I r-F1
I FT""I
*No. of colonies/lO0 mi. or No, of Positive oort~ons.
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Ray. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Data Collected Source
a.m,
Data Received Time Recolvesl __ p.m. Lab. No,
Presumptive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
EMB Broth 24 hours: Broth 48 hours:
Multiple Tuba Report; 10mi Tubes Positive/Total 10mi Portloni
Membrane Filter: Direct Count ~* r' Collform/100ml
Verification; I.TB BGB~
Final Membrane Filter Results , ,.- Collform/100ml
Reported BY ~':: · ' Data
Tlma~ ' a,m.