HomeMy WebLinkAboutMURRAY BLK D LT 8O l (L. t)
Property Owner
Mailing Address
Buyer
Address
Lending Instit.uti°n /
Realty Co. & A~nt
Address
APPLIC~ NT FILLS OUT UPPER HAL'- 3NLY
Zip Code
.1~ / '¢' ,~ Zip Code
Zip Code
Phone
_F
Phone
Phone
Type of Residence
[] Single Family
[] Mulliple Family No. of Bedrooms
~,'~ Other
Water Supply
/~lndlvldual
Community
[] Public Utility
A'FrACH WELL LOG. A well log Is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
Sewer Disposal
[] Individual
,,~Public Utility
'U ~lolding Tank
Year Individual Installed:
When Connected to Public Utility: ~/¢~ ~ Z-.' ~'- ~ '.t,'¢'
NOTE: THE INSPEC'rlON FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
~:?.,' O~ ~
Time Time Time ~-~(..f/~ T i m~e} /7
~_ ,. ', (~_b o_~
Date Date Date ' Date
Insp~tor ,~
Insp,tor Insp~tor , Insp~tor 0~,~. '
Field Notes: ~ ~ %~ . /. __ ~ , MUNICIPALIT70F. ~NCH~RAGE
--/72- ¢)/';~ - P¢oL Z ~/ ~ ,/~ ~, 5 /982
?_,,, ,.. RECEIVED
) DISAPPROVED
) CONBITIONAL APPROVAL*
*CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank
Well t.og Received
Septic Tank Size
72-023 (3182)
CHEMICAL & GE ~OGICAL LABORATORIES, 'ALASKA, INC.
TELEPHONE (g07)-27g,4014 ANCHORAGE INDUSTRIAL CENTER
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
I.D. NO.
Water System Name
Phone,No.
Mailing Address
City State Zip Code
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref, no,
['3 Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO, LOCATION
3[ I
.I I
L
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysm shows this Water SAMPLE to De:
[] Satisfactory
[] Unsat sfactory
[] Sample Too Iorg in transit: samole should
qot De over 48 hours old at examination
to ~ne~cate reliable results. Please send
new samgle.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
.~ Membrane Filter
Lab Ref, No. Result* Analyst
I
I
*'No of colonies/100 mi or No DJ Po$1[ive portions
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06.1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Data Collected Source_
Data Received Time Recelvec~ p,m. Lab, No,
Presumptive lOml 1Omi 1Omi 1Omi 1Omi 3..Omi O,lml
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
EMB
Multlpre Tube Report=
Membrane Filter: Direct Count__
Verification= LTB
Final Membra.ne:Filter Rasults
Reported By ~
Broth 24 hours=
.Broth 48 hotlrs=
10mi Tubes Posltl~t/Total 10mi Portions
Collform/100ml
.BGB
Collform/lOOml
Date