HomeMy WebLinkAboutBRUIN PARK FIRST ADDITION BLK 6 LT 2
,,Z ~ E~SOI LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERFORMED:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
DEPTH
SLOPE
WAS GROUND WATER
ENCOUNTERED? $
/ O
SITE PLAN
IF YES, AT WHAT
DEPTH?
P
E
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
COMMENTS
PERFORMED BY: ~'L~ 5 ~* ¢ CERTIFIED BY:
{minutes/inch)
72-008 (6/79)
APPLI ',NT FILLS OUT UPPER HA' ONLY
Lending Institution '-:
Phone
Realty
Co.
A~nt
Phone
Add ress~:~
Street Locati~
Type of Resi~nce
~ Single Family Bedroo~ _
~ultiple Family No. of
~ Other
Water Supply
~Jvidual A~ACH WELL LOG. A w~l 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 Utility
Sewer Disposal
~ Public Utility When Connected to Public Utility:
~lding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time
Inspector
Field Notes:
Date Date Date ~ Date
RE
( /~PPROVED BEDROOMS ~ *CONDITIONS OF APPROVAL
( ~ DISAPPROVED /
,' , CONDITIONALAPPRO~AL' '')/~//2 ~..~'~ ~
DATE 4-~~. ,~ /:
Soils Rating Date Sewer Installed Well To Absorption Area
Well to Tank
72-023 (3/82)
Well Log Received
Septic Tank Size
L!i.o.,..,xCHEMICAL & GL LOGICAL LABORATORIES ,~/ ALASKA, INC.
,
D ki tei~ ly i fo oal Ii rm aceri
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
Mailing Address
~:~, NO,
Phone Np~.
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
E3 Untreated Water
SAMPLE
NO.
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
ri:Membrane Filter
Lab Ref. No. Result*
*No of colonies/100 mi, or No of Positive portions.
Analyst
06-1220(b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Date Collected Source
a.m.
Date Received Time Received ,
Presumptive 10mi 10mi 10mi 10mi 10mi 1,0mi 0.1mi
24 Hours
48 Hours
Conflrn~tory
24 Hours
48 Hours
EMB
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: iTB
Final Membrane Filter Results_~
Reported By :' ' ~':'
Broth 24 hours: Broth 48 houri:
10mi Tubes Posltlve/l'otal 10mi Portions
Collform/100ml
BGB.
(- Collform/lOOml
· -, Date -
Time: , l.m,
