HomeMy WebLinkAboutRIDGE VIEW LT 1416
000
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15
. APpLIc"NT FILLS OUT UPPER HAl. -' ONLY
Phone
' /) I ,; ~ z,~ ~o~ p~.~.,-~ / -~ /
Mailing Addre~ ~ '~ff~/ /~}. t~ .... r" /~fi//~' ~ /'(.'.'~ ."~2~"~' ?? /' .
Address. t. ,t~ /' (''/'')/'" .... ./:':~? )..~. Zip Code Phone/L
Realty Co. & Agent "-~ ~2 /2
Address Zip Code
Legal Description A~) 7 /~ ~/' ~O~- /x/ i'c~[~ j// ~ ,~ -~ ~c.t t ~/, .S t ':
Type of ,~esi~nce
~-,~ngle Family
~ Multiple Family No. of Bedrooms_
~ Other
Water Supply
~.,~dividual A~ACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Ulility
Sewer Disposal
Q Individual Year Individual Installed:
..blic Utility When Connected tO P.blio Utility:
Holding Tank ~t~ ~ L ~q k~c~a
NOTE: THE INSPECTION FEE MUST ACCOMP~Y EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
' ~ Time
Date Date Date / Date
Insp~tor ~ ~'
,~ ) tp:~:~Z~DROOMS 'CONDITIONS OF APPROVAL
( ) UlSAVPHUV~U
( ) CONDITIONAL APPROVAL'
Soils Rating Date ~wer Installed Well To Absorption A~ea Well Log Reeeived
Well 1o Tank Seplic T~k Size
72.023 (3182)
CHEMICAL & GI -LOGICAL LABORATORIES ? ALASKA, INC.
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM: ~
I.D. NO.
Phone No,
Water System Name
Mailing Address
State Zip Code
City
MO. Day Yeer
SAMPLE TYPE:
:[] Rou'tlne
[] Check Sample (for routine sample
with lab ref. no._
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
1
2
3
4
5
.~ Time Collected
Collected · By
LOCATION .~: . ~ ~ ,
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
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1978
Date Collected_ 6ource
3ate Received _Time Received .p,m, La~. mo.
24 Hours
48 Hour~
Confirmatory { t
24 Hours ~
Multiple Tube Report: .10mi Tubes pofltlve/Totat 1Omi Portions
Collform/lO0n31
Membrane Filter: Direct Count
_BGB
: . Collform/lOOml
4. 3 2 I
C H RISTIhJE
10
I1
20 ~