HomeMy WebLinkAboutO H FAST BLK 1 LT 12
V - DATE RECEIVED
INSPECTION APPOINTMENTS
~ ',&Cb ~n~
DATE DATE DATE
~UNIClPALITY OF ANCHORAGE MuNICIPALI~ OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT, OF V:~/.LTi~ &
825 L Street - Anchorage, Alaska 99501 ~NVIRO~MEiRT?,L
(~~ ENVIRONMENTAL SANITATIONTelephone 264-4720 DIVISION
.o.A...OVA o. AT..
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PRQPER~Y OWNER ~, PHONE
PROPE~TY~ESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
~'LENDINGINSTITUTION ] PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT PHONE
MAILING ADDRESS
5. LI~GAL~DESCRIP'rlO~
STR E ET~LOCATION
6, TYPE OF RESIDENCE
~ SINGLE FAMILY
[] MULTIPLE FAMILY
NDMBER OF~BEDRQQMS D~O~
One [] Four v,~ Other
Two [] Five
Three E~ Six
7, WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8, SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
~ PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010 (Rev, 6/79) ~'1 ~',,_~
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [~] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified iNSTALLER
[]Septic Tank or E~Holding Tank
Size:. If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
~;~'~A"~-~OVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
I~]-~--DISAPPROV ED
274-3364 5633 B Str0et
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM [-II I I I I
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 reft no,
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
1 I
I
LOCATION
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 sample.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref. No. Result* Analyst
J
I [-~
*No olcolonles/lOOml or No ol Po$1[lvepoHions
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev, 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collecte~ Source
elved ---- Lab. No.
24 Houri
~onflrmatory
EMB
Multiple Tube Report:
Membrane Filter: Olrect Count
Verification: LTB
Final Membrafle Filter Results
Reported By
Broth 24 houri:
__Broth 48 hours:
[Omi Tubes Positive/Total 10mi Portions
Collform/100ml
BGB
Collform/lO0~nl
Date
pom,
TUDOR
GENERAL NOTES
I. Source of record dato is P-~56
unless ofherwise noted.
2. No direct occess to Tudor Rood.
3. Access to the Old Seword H[ghwoy is per-
mitted only within the 45' north of the
SW property corner.
ROAD ~
820.16 Meos. 820,~.O0()Rec.)
32
~oo,oo L )
SURVEYOR'S CERT/FICATE
PLA T APP RO VA L
LSA -
NOTARYACKNOWLEDGEMENT
HIS LATI~,~ I
i
tOT SA, BLOCK I
0. fl FAST"S SUBDIVISION
LOT Z ,9 TH£ SOUTH ~0' OF £OT 2, BLK. / (BK...~GS D P$ )
0.~ FAST'S SUBDIVISION (PLAT No. P-15E)
TECTONICS, INC.
P. O. BOX
ANCHORA6E~ ALASKA 99509
PLAT A,°PROVAL
LINE SCHEDULE
LEGENO
::::: I I°'1
~. 45th Ct.
5 6
o
E. 46th Ct,
UNSU3DIVI[d.£D
NOTES
LOT :5-iA
O' UT[L.
O.H. FAST SUBDIVISION ADDITION*t]:.
LOTS 5A ~ 5-lA