HomeMy WebLinkAboutSWISS AIRE LT 10
APPLIC' ~IT FILLS OUT UPPER HAL, ONLY
Address Zip Code
Lending Institution /~_~ {~ ~. ~ ~ ~ ~'~ Phone
Address Zip Code
Street Locati~
Type of Residence
Single Family
~ultiple Family No. of Bed[oo~
Water Supply
~ Individual A~AOH WELL LOG. A well log is required for all wells drilled since June 1975.
Comunity For wells drilled prior lo that date, give well depth (altach log if available).
Sewer Disposal
~.,~lding Tank When Connected to Public Utility: /~' el --
, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector inspector Inspector Inspector
A, UNICIPALITY OF ANCHORAGE
DEPT. OF H~t~L/il E~ ·
Field Notes: ENVIRONMENTAL PROTECTION
NiAY ~ 5 1383
gECEIVED
(-
( ~.,-~PPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) OISAPPROVED
( ) CONDIT}ONAL APPROVAL*
DATE
Soils Rating Date Sewer Installed Well TO Absorption Area Well Log Received
Well to Tank Septic Tank Size
HEMICAL & GE~JLOGICAL LABORATORIES OF AL~ ASKA, INC.
TELEPHON~E (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER
! 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
(*) See h on back
WATER SYSTEM: ~, ~O. NO..,
Phone NO.
Water System Name
c~'
MO. Day Year
Zip Code
SAMPLE TYPE:
:~ Routine
Check Sample (for routine
with lab ref. no.
[] Special Purpose
sample
[] Treated Water
~ Untreated Water
SAMPLE
NO.
I
I
I
I
I
LOCATION
1
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
XSati~factory
[] Unsatisfactory
¢
[] Sample too long in transit; sample should
not be over 48 hours old at examination to
indicate reliable results. Please send new
sample via special delivery mail,
Time Received /
Analytical Method:
[] Fermentation Tube
~Membrane Filter
Lab Ret No, Result* Analyst
I
I F1-]
I
*No of colonies/100 mi or NO of Positive portions.
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
o6-1z2o (~} BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 197~