HomeMy WebLinkAboutSPENARD ACRES BLK E LT 3A OF LT 3
0
Sp~nar el, Alasl~a~
W'e':-~dv[se:you t~'record, this certificate with your'
Warranty deed
APPLIC..NT FILLS OUT UPPER HAL. ONLY
Type of Residence
~ Single Family
Water Supply
'~lndividusI ATTAOH WELL LOG. A ~eli log is required for ~il wells drilled since ~une 1975.
. Community (/',)~ $ [ l-¢ ~t L C For wells drilled prior to lhat date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed:
Public Utility When Connected to Public Utility:
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Insp~tor Insp~tor Insp~
Field Notes: DEPT, OF HEALTH
/~[~. ~ ~ ENVIRONMENTAl. PROTECTION
..~.~.., .... ~ MAR
RECEIVED
~) ~APP~OVED BEDflOOM8 *GONDITION8 OF APPROVAL
(
( ) DISAPPflOVED
( ) CONDITIONAL APP~QV~~
~') C ILL . ~ /
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
72.023 (3182)
· CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~.
--~" TELEPHONE (907)-279,4014 R
~,~,,~t,~ Drinking W~ilf3,~nalysis Report forS~itilSt~itliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
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,
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
1
2
3
4
5
LOCATION
I
Time Collected
Collectea By
I
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
[o ~na~ca[e reliable results. Please send
new sam Die,
Date Received
Time RecelveC
Anal ytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref. No.
I
I
Result* Analyst
*No. oi colomes/100 mi. o~ No. of POSlhVe portions
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Received Time Received Lab. No.
~resumptlve 10mi 10mi ].Omi ].0mi 10mi 1,0mi
24 Hours
48 Hours
:onflrmatory
24 Hours
48 Hours
EMB Broth 24 hours~ Broth 48 houri..
Multiple Tube ReDorb Z0ml Tubes Positive/Total Z0ml Portlonl
Membrane Filter= Dlre~t Count Collform/Z00ml
Verification= LTB . .;r BGB
Final Membrane Filter Results .': ,' Collform/100ml
Reported By :' '~ ' , t Date
A}l;p}:ova~ foF f:he individual sewer and water J:aci].ities cannot
top f).~ %he </oli casiRg ¢~Jloi_tid ]){: s()a_].ed so {:hat i't :i.s
O~J~iC() ~:UOifi '[:1}i(.: (JhOl[L il,al), 5(}33 }3 S'hr:~eJ_~ J:.or ot~r ;fovJ0w.
r~o/: ',d ~l:Lsc~fep;iltcids have been cor~fooLed, ii'!: t:]~ere are ;.lily
ful:hhol: qUc:stio~s, please call k}!is oJ{l:J, ce <th 264~.,!720,
Sincerely,