Loading...
HomeMy WebLinkAboutLINCOLN PARK BLK 3 LT 16Lincoln Pk. /,2-7 ~ " DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECT_Q~ INSPECTOR INSPECTOR MUJ~ICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. CE HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIJ~MJRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 jbN 6 I981 ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAC LI DIRECTIONS: Complete all parts ou page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE · , MAI LII~G AD~}~ ESS 3. LENDING INSTITUTION ~-~ · I PHONE MAI LING A D Dd.~R.~!~S S . 4. REALTOR/AGENT PHONE MAI LING ADD ~R~SS STREETLOCAT:ON /::.:_ 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OFtBEDROOMS [] One [] Four [] Two [] Five '~ Three [] Six [] Other 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 IV]UST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ~-oto mev. ~/~/_,],_.~ ?) 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 [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED E~]PUBLIC UTILITY Connection Verified. INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: 1 Absorption Area to nearest Lot Line 5, COMMENTS [~fAPPROV ED FOR ....-- BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street 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 State Zip Code- City - Mo. Day Year SAMPLE TYPE: [] Routine [3 Check Sample (for routine sample with lab ref. no. [3 Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 2 [ 3 l LOCATION Time Collected Collected By J TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] bnsatisfactory [] Sample too long in transiT; samole should not De 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 *No. of colonms/100 mi. or No. of Posilive DOt[iOnS READ INSTRUCTIONS BEFORE COLLECTING SAM PLE 06-1220 (b) Rev. 3978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source PresumPtive 10mi 10mi 10mi 10mi 10mi 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 FIter Result~ ,~ -' Reported By '~ :' "' '~ !" Broth 48 hours: 10mi Tubes Posltlve~Total 10mi Portions Collform/3.00ml BGB __ / : Collform/100ml