HomeMy WebLinkAboutBERNARD BLK 2 LT 17 t[UNICIPALITY OF ANCHORAGE Hea~ and Environmental Prote¢ ~n Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 INSPECTION REPORT ON-SITE SEWAOE DISPOSmA/ SEPTIC TANK: DISTANCE FO / NUMBER OF IN~,IDE L.E~GTH .................... INStL)E WIDI~ ._ I t(~f) [:)t P[H ....... ~ I(~UID CAPACI1' .......... GALLONS. / W ~_~ / TOTAL LENGT~ ~ O~ ~i,es ~ ....... DISTANCE BETWE:N LINES ................. ~/~ inENC,~ WIDI~_~... IN. TOTAL EFFECl ABSORPTION AREA ..... ~_..~_ ............ SQ. Fl'. LEITH OF EACH LINE t~Z I SEEPAGE PIT: DIAMETER ~.~ OR WIDTH ....... LENGTH~, DEPTH Log Crib Rings .... BUILDING FOUNDATION ........ Crib Size: DIAMETEF~. ._L)EPIt~.._ DISTANCE FROM: WELL '10TAL. EFFECTIVE NEAREST LOT LINE ...... AI~,SORPTION ARFA (WALL AREA) ............ SQ. I:T. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: # of Bedrooms: ~r~ V Installer: Remarks: _ ~..~. F:II:::' F: L I L I:l (.".: I::1 T :[ ('.)1",t Li, IL:: r2i 1:::1L. 'I""r'F'E CiF:' i:~;1:.~1 :[ L.. I:IE~SOF. tEFT I L')N :'Z'.,.'S'I-EI"I I :E; · "FF.:E1'.,iCH 1"t]: N :[ I"'ti..Jl"l D I Ei;'I'1::11",tCE [.:.':[.z"r'HEEN FI HELl._ FI1'.,I [.':, F:1N'.r' ON-S :[ I"E SEI.,.IFIGE [::, I S.:F'OSR[... :E;"r'E;T'E:M I'.!::'; :1. OO F'E:E:"r' F'OI:~: F:1 F' FR :[ 'v' FI "I" [:Z I.,.IIrZLI .... OF.: ;~9E1(:":1 FEE:T FOF.: FI I::'I. JBL. IC: I.,.IEI....I .... E.~;F'EC I F' .'[ CI::1T I O1'.,1:i5 FINE:, C(:)I'.,I'i:;TF.:UC'T' I ON E:, I FtC. iF.:I::1H:E; FIF.'.E la ',,,' l:::t I L. FtBL[C TO I I'.,ISLItRE F:'rf.'.CIF:'Ei:I:R 11'.,1:!!!; T' I::1 I.... L 1::1 'T' :1: O I'.,I. ]: CEI:~:T I F"~" "t"Hf:IT :1. ' :1: f:11'"l FI:It'"I I I.... I FIF:: I.,.I I "I"H THE: F;.:E(..:!IJ :I: REI"'IEI"ITL'-:.: F'OD.: [:d'.,I-5; ]: TIE E;EI.,JE:I'E:~; 1::11'.,t[::, I.,.lti.~:l....L..Si;H"'.::, .... :~;Ei:'l" FOFRTH I:.:.Y'r' THE: HUN I C t F'FIL. I T'?' OF' FII",ICHt'.)F:FICiiE. :t: I.,.I ILL. I NSi;TF:tLI .... THE: ..~.:.';"r'tF.;'TEH I N FIC::COF.:[:,f:II",ICE 141 '1'1-1 'I'HE~ C:OI::'E:iS. 3: IJ N [:, E F.'Y.".:;'T' FI N [) 'I"HFI'I~/~'HE OI'.,I-~5]:~.'/:!.::';E:HEF-.': 'J.:.';"r'L:;I"E::H I"'lf:1"r' F4:E:LZ..!LIII;.:E EI",tL_RF::C'.'iI.:.'.':HIE:I",I'T' :[1:::' THE: RE!:::.z.';]:I:::'I!.:.':I",IC:I~i :l:'.:ii~:l'"l~:.'~::~.,. ,~':E:, 'l"O ]:t'.,I,:.'~,~::,IE:~I"IOF":F'~';'Iq"~11'"I ~!; :: ..... :.., .............................. ; ........................ //:..: ......... ............ ,.~.F,.~'L.. I CFII'.,IT F.: I C:H1::II:~.[::, I-::: I.,.IE.'t: St.-.-.., .I :..'(; S I...1E:I], S(III,S 1,()(1 I~I';II()I,A'I'I(JN 'I I.;S'I' Pc rfo rmud fo r Mr. Bernard Stewart i)a te f'e rfo nj,.~ J...J.u..n_e__2.3.,._.1971 Lc'ga I tlc:; Uep th Feet ) - _-E-%:7-?-c~¥ 2 3 4 9- i::,,' 10 - ::,',: ( ~ ;:o) 11 - '.r.,.' 12- 13- 14 - Was ground water encountered? :,'~o_ ......... If yes, at wilat (h':i~th? '1 '"/~? "~7" /' " '/' ,( adlll~ , , , : Y t)ate Gross Tlmc Net Time Uel)bl Lo Water lief Urop Percol a ti on rate Iai rill -Proposed i lis La 1 l d't-l~d'n'; .... -S'e-['i~a--(]e P i t Lira i n F ic Id 1. TYPEOF RESIDENCE " ~ SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER sUpPLY ~ INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY .... Connection Verified . . 3. SEWAGEDISpOSAL SYSTEM E~I~DIVI D~JAL/ON -SITE []PUBLIC UTILITY ConnectiOn Verified t'-]Septi'c T;¥~E Or Y-]'Holding Tank '" · Size: ],~'~ If Tank is homemade give dimensions: TYPE OF TANK ' :I'OTAL' ABSORPTION AR EA WELL TO: NUMBER OF BEDROOMS [] ONE REE [] FIVE [] OTHER [] TWO [] FOUR [] SiX PERMIT NUMBER DEPTH OF WELL -- . DATE RECEIVED '-INSPECTION APPOINTMENTS' DATE IINSPECTOR D~ R ECTIONS~ DATE DRI L.LED 'LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl L$ RATING · MAN U F~~..~ MATERIAL MENTS ion Area '[~ AppRovED FOR [] CONDITIONALAPPROVAL (lettermust accompany certificate) ~:"-d}_~ [] DISAPPROVED J~- 72-010 (Rev. 3/78) ( EOLO( I OF ALASKA, P.O. BOX 4-1276 4649 BUSINESS PARK BLVD. ANCHORAGE, ALASKA 99509 TELEPHONE (gO7) 2794O14 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM: Publl~Water System Name Mailing Address L I.D. NO. State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. ~LSpecial Purpose LOCATION [] Treated Water ~__U_~t reated Water SAMPLE NO. 1 § TO BE COMPLETED BY LABORATORY LABORATORY: CHEM & GEO LABS OF AK., INC. NAME 4649 BUSINESS PARK BLVD. ADDRESS ANCHORAGE, ALASKA CITY Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst * NO. o! colonies 1100 mi. or No. of Positive portions. Time Collected _ Collected 1 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) o6.z220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev, ].978 Date Collectecl ~ "J'~'7 ~ 7~ Source h"-~-/''X~ Date Received '-) -/ 0 - ? S/ Time Received ¢1~"' %:-'- p.m. Lab. No. . · Presumptive lOml 1Omi 1Omi lOml lOml 1.0mi 0.1mi 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB; Broth 24 hours: Multiple Tube Report: Membrane Filter: Direct Count Verification: LTB Final Membrane F~ter~Result. Reported By Broth 48 hours: 1Omi Tubes Po~,~tlve/Total 1Omi Portions Collform/100ml __BGB__ Date ¢~' ' j~ '~ ? ~/~o,lform/100ml T,..e, !