HomeMy WebLinkAboutSUNSET HILLS WEST BLK 4 LT 22
December 29, 1978
t~780177
Bruce C~apbell
~tar ~)ute A Box 829
Anchorage, Alaska 99507
Subject.· Lot 22 BloCk 4 Sunset Itills West Subdivision
A permit issued by this department :for well and/or
sewer system has expired.
Permits are issued on a calendar year basis, as stated
on the permit, by authority of Municipal ordinance.
If you have drilled the well, a well log should be
sent te this department to document the installation
date°
If there are any further questions, pl(~,ase contact
this office at 264-4720.
Sincerely,
Les No Buchholz, RoS.
Senior Environmental Specialist
I~UI / 1 j w
enc~ copy of permit
d
MUNICIPALITY OF ANCHORAGE
DEP1 O,' zAL'[H &
FNV I~ONMf't~;[ L pKOIECTION
0 0 o 0 ¢
0 0 O 0 0 0
0 0 o 0 0 0
~ :: ~ ~ ::
CHEMICAL & Glo.LOGICAL LABORATORIES ~ ~; ALASKA, INC.
=-~-' TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER ~:
. 274-3364 5633 B Street
~ Dnnldng Water Analysis RePort for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
Mailing Address
City
State Zip Code
MO. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no. _j
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
2 L
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
[]' Membrane Filter
Lab Ref, No. Result* Analyst
L_ I
J
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev, Z978
BACTERIOLOGICAL WATER ANALYSIS RECORD
? 197?
MilV 10,:
Su)>iect: Lot 1'q, Block
there
b h
J t!r"t'"l V
INSPECTION APPOINTMENTS
~ME I-IME TIME
~UNICIPALITY OF ANCHO~GE
MUNICIPALITY OF ANCHORAGE DEPT,
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~EoN~ENT/~L ~,.¢[~CTJON
APR
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
FIEQUEST FOFI APPROVAL OF I~BIVlBUAL WATER AN SE I
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing,
~OPERTY RESIDENT (If 8ifferent from above)
~ BUYER PHONE'
LENDING INSTITUTION PHONE
~ "EALTOR/AGENT ~~ ] PHONE
~AI LING ADDRESS
~'. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS/
~ [] Orle ~ Four
INGLE FAMILY [] Two E] Five
[] MULTIPLE FAMILY [] Three [] Six
E~ Other
WATERiR SUP~E'SUP -Y
-E~'~- INDIVIDUAL* ' ATTACH WELL LOG, A well Icg is required for al wells drilled
[] COMMUNITY since June 1975. For wells drilled ~)rior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] IN~)IVIDUAL;ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED.
~ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUI--ST BEFORE PROCESSING CAN BE INITIATED.
72 010 (Rev, 6/79)
THIS SIDE FOR OFFICI,AL 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
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
9ive 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
~'A~FROVED FOR 4~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)
(84-68)F0
g88 I. O01.LQ