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Home My WebLink AboutSPRUCE ACRES LT 12Ot4-Z3l O0 0 APPLI('-~:NT FILLS OUT UPPER HA~ '~ ONLY Buyer Address Phone Phone Realty Co: & A~nt Address Zip Code LegalDescription ~T/~ , ~U~ ~ Single Family Multiple Family ~Other No. of Bedroom, Water Supply ~lndividual ~ A~ACH WELL LOG A wall log is required for all wells drilled s~nce June 1975. ~ Community For wells drilled prior lo that date. give well depth (attach log if available). ~ Public Utility · · ~- ~ When Connected to Public~ility: Date Date Date Date Inspector Inspe:tor Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE ~ APPROVED a~OROOMS ~t 'CONBITIONSOF APPROVAL ( (( ) BISAPPROVEB Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Ta~k Size 72-023 (31~) CHEMICAL & G£ .LOGICAL LABORATORIES ~F ALASKA, INC.~ 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 WATE~ SYSTEM: Water System Name I.D. NO. Phone No, Mailing Address Ciiy State Zip Co~e MO. Day Year SAMPLE TYPE: []. Routine [] Check Sample (for with lab ref. no. [] Special Purpose routine sample [] Treated Water [] Untreated Water SAMPLE NO. LOCATION I I / ~ ~ ~:~ -~:" ~ ¢~: /.,.. ~ ~2 .;~ ...'?r' ~/~ Time Collected Collected By TO BE COMPLETED BY LABORATORY Analvs~s snows this Water SAMPLE to be: ~' Satisfactory [] Unsatisfactory --I SamPle too Ion§ n transit; samole should not be over 48 hours old at examination to indicate reliable results. Please send Date Received Time Received Analytical Method: Fa Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst t~i "7'?,. "''-~ I I-T-] I FT-I I I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 Rev, 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date ColleCte<[ Source a.m. Lab. Presumptive lOml lOml 1omi lOml lOml 1.0mi 0.1mi 24 Hours 4S HOUrs Confirmatory DATE DATE ~ ? Co ~ ,'~,-~ ~ATE MUNICIPALITY OF ANCHORAG~ MUNICIPALITY OF ANCHORAGE DEPT. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RONMENTAL P~OTECT[ON 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION ~0V 1 9 1980 Telephone 264-4720 PP.OV OF DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be p~oce~ed. Please allow ten (10) days for processing. MAILING ADDRESS PROPERTY RESIDENT (If differen{ fro ab } / PHONE PHONE MAILING ADDRESS 4. REALTOR/AG~ PHONE MAI LING ADDRESS 5. LEGAL DESCRIPTION TREET LOCATION A ~K¢. c~ :~ ~ '77 ?~' '~ ?~ s'p~.~ ~ ~__ ~-'~ 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One ~ Four [] Other [] SINGLE FAMILY [] Two ~1~ Five ..~ MULTIPLE FAMILY [] Three Six 7. WATER SUPPLY ~ * ATTACH WELL LOG. A we[I log is required for all wells drilled INDIVIDUAL* [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 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 DRI LLL=D [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE INSTALLED [~]PU BLIC 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 WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~AP~ROVEDFOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must acco.~a~y certificate) [] DISAPPROVED / / 72 010 (Rev, 6/79) CHEMICAL & GL~£OGICAL LABORATORIES t..~ ALASKA, INC.~ TELEPHONE (g07)-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 Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ret. no. [] Special Purpose [] Treated Water [] Untreate(~ Water SAMPLE NO. LOCATION Time Collected Collected ey~.~ TO SE COMPLETED BY LABORATORY Analysis shows tins Water SAMPLE to ce: ~ Satisfactory [] Unsatisfactory [] San' p~e too long m transit; samole should not oe over 48 hours old au examination to nama[e reliable results. Please sen(] new sample. Date Received Time Received Analytical Method: - Fermentation Tube ~ Membrane Filter Lab Ret. No. Result* Analyst *NO. of co[ome$/100 mi. or No. of Positive ~orlrons. READINSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Data C el[act act Source No, EMS Multiple Tube Report: Membrarte Filter= Direct Count Verlecatlon: LTe - Final Membrane Filter Results Broth 24 hours: Oate GREATER ANCHORAG~ AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 DATE RECEIVED: /~) -/~-~_./ INSPECT: / d~ -q~Y/ TIME: ~, REQUEST FOR APPROVAL OF INDIVI'DUAL SEWER AND WATER FACILITIES FOR APPROVAL REQUESTED BY: ADDRESS: PHONE: PROPERTY LEGAL DESCRIPTION: OWNER: ~d_..-~./~ ~' / PHONE: TYPE FACILITY TO BE INSPECTED: NUMBER OF BEDROOMS: WELL DATA: B. DEPTH E. BACTERIAL ANALYSIS DISPOSAL SYSTEM: SEWAGE A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK) 1. SIZE AGE 3. MANUFACTUREB 4. INSTALLER APPROVAL REQUEST FOR PAGE TWO SEWER & WATER FACILITIES B, SEEPAGE PIT 1. SIZE 2. LINING C. DISPOSAL FIELD 1. NUMBER OF LINES 2. TOTAL LENGTH REQUIRED MEASUREMENTS A. WELL B. WELL C. WELL TO SEPTIC TANK TO SEEPAGE PIT ~ - TO SEWER LINE D. WELL TO PROPERTY LINE E. WELL TO OTHER POSSIBLE CONTAMINATION P. FOUNDATION~EPTIC TANK G. FOUNDATION TO SE.F~AGE PIT H. SEEPAGE PIT TO PROPE'R.TY LINE 8. COMMENTS: A PPROVED.A~ ~/~x~/~--~q~/ DISAPPROVED: DATE: /[k*~ ~-._7 . I¢ 7[ DATE: __. APPROVTL ~ALID ~O--t ;N~ ~EAR PROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY ADHW-~B-2W DATE STATE OF ALASKA ~'RTMENT OF HEALTH AND WELF: DIVISION OF PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS Lab. No. OFFICE PUBLIC I~J SEMI-PUBLIC ~[ INDIVIDUAL ~] OTHER REPORT RESULTS TO' NAM E AODRES$ - CI3Y ADDRESS Of SOURCE SAMPLE COLLECTED BY. DATE COLLECTED TIME COLLECTED Dm ~] Olher Records in this office indlcole this WATER SUPPLY to be of: Satisfactory [] Questionable E] Unsatisfactory Sanitary Stalu$. Diameter of Well Oepth Feel, Well Casing Ma · al Diameter Deplh_ PUMP LOCATION: [~ [n Well [~ Ogsef jn [] In Basemenl [] Room If an "Unsatisfactory" or "Queslianahte" stalus 15 indicated above you should take immedlale acllon as recommended below. I. Nofffy consumers waler is polluted. Boil or chemically treat this wafer as oullined in lhe enclosed leaUel "Drink ff Pure." SANITARIAN'S REMARKS READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Laclose Broth 10¢c 10cc 10cc 10cc I 10cc 1.0cc 0.1cc I 24 hours 48 hour; . BrJlhonl Green 24 hours 48 hours EMB AGAR Lactose Broth, 24 hrs. 48 hrs.. Groin's slain Coliform Denslfy .{Most probable No. per 100cc.) MF results om pm Reported by ~ ' Dole This analysis indicates Coliform Organisms to be: Absent Present