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.
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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.
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: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.
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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, !