HomeMy WebLinkAboutSPRUCE ACRES LT 16014
APPLI(' NT FILLS OUT UPPER,HA[ ~ONLY
Address Z~p Code
Address Zip Code
Address ,~ Zip Code
~,~a, ~"~'~'~--6~-~ I~ ~'~'~"~'~"~'~--~"~'~'- ~-~ ~
Type of Resi~nce
~ Individual// A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
date
give
depth
(attach
log
~ Individual - Year Indiv~ual Installed:.
~.' Public Utility When Connected to Public Utility: ?~ ~-~ /
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Date
Inspector inspector In s p~tp~.~..~ Inspector ~/~,~ .
Field Notes: g~pT
:
RECEWED
( ~PPROVED BEDROOMg *GONDITION8 OF APPROVAL
( ) DIgAPPROVED
Soils Rating Dale ~wer Installed Well TO A~sorgiion Area Well Log Received
Well to Tank Septic T~k Si{e
CHEMICAL & G~ LOGICAL LABORATORIES
TELEPHONE {907)-279-4014
274-3364
· ; ALASKA, INC.~
ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
I.D. NO.
Water System Name
F~hone
CitY
Mo, Day
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref, no.
[] Special Purpose
State Zip Code
Year
[] Treated Water
[] Untreated Water
SAMPLE
NO.
1
2
3
4
LOCATION
.... /~-:
I
Time Collected
Cgllected By
/o..-~y'- it"/"
TO ~E COMPLETED BY LABORATORY
A.~alysls shows this Water SAMPLE to be:
.[~], Satisfactory
[] Unsatisfactory
[] Sample [oo Jong m transit; sample should
not be over 48 hours old at examination
[o indicate reliable results· ~lease send
new sample.
Date Received ' /-') ~'~ 5 ~
Time Received
Analytical Method:
[] Fermentation Tube
r~:Membrane Filter
Lab Ref. No.
I '.r'.r'?-' ~ fl
I
Result* Analyet
READINSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
48 Hours
Confirmatory
24 Hours
EMB Broth 24 hours:
Multiple Tut3e RePort;
Membrane FIItert Direct Courlt
Verlflcat Ion: LTB
Final Membrane Filter Results