HomeMy WebLinkAboutVALLEYWOOD LT 3
Date ,,r,. Date Date \ /
Inspector inspector Inspector
Comments Conditional Approval
E~V~RONM~NTAL PRO~ECTION
RECEIVED
D~te 8ewer Inst~lled Permit No. 8eptio T~nk Size
Holding Tank Size
8oils R~ting Well To Absorption Are~ Well Log Received
Well to Tank
APPLICANT ~ILL8 OUT LOWE~ HAL~ ONLY
Buyer
Address . -
Lending institution A' ~ .-~ - r~r,~, i ~'/~c z/v zc /~/T~r Phone
Address ~ :~1/ Z'?> ~ 3&IX' /1~ e /)~sy // 9~>bz -
Street Location 2¢d0 V~ //e./ ¢~"~;c~ /~ rUC
Type of Residence "~, /'
~ Single Family ._~
Multiple Family No. of Bedrooms
~ Other
Wat~Supply
~ Individual ~_. ' ~ A~ACH WELL LOG. A well Icg is required for all wells drilled since Jun~-
~ Community~- ~' ' 1975. For wells dr lied_prior to,that date, giv6 well depth (sttach Icg if
~lndividual Year Individual Installed:
~Public Utility When Connected to Public Utility:. '
~ Holding Tank
NOTE: THE INSPECTION FEE MUST?C~OMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Name of Applicant
Mailing Address
DEPARTMENT O[~!EALTH AND ENVIRONMENTAL PZ--~TECTION
Pouch 6-650
Anchorage, Alaska 99502-0650
Phone 264-4721
RAT PERMIT APPLICATION
Phone:
Requested Number of Rats
.Location where rat(s) will be kept (Street address or legal description):
Requested Period of Time for this permit:
Describe precautions to be used to prevent escape or release of the rat(s):
How will the rat(s) be disposed of at the expiration date of this permit?
Other relevant informati.on you wish considered:
Signature of Applicant Date
FOR DEPARTMENT USE ONLY
************************** NOT WRITE BELOW THIS *****************************
Permit is ~__1 DENIED. See Explanation Below.
[__1 GRANTED, SUBJECT TO THE FOLLOWING CONDITIONS:
I certify I am familiar with Anchorage Municipal Code Chapter 16.90 and that
the above described activity will be operated in accordance with the provi-
sions of the law. I agree to the above terms and conditions. I further
agree to report the escape or release of any rats immediately, to 264-4721.
Applicant Date Rat Control Officer Date
NON-COMPLIANCE WITH ANY TERM OR CONDITION OF THIS PERMIT WILL IMME*IATELY
REVOKE THE PERMIT AND SUBJECT THE HOLDER TO THE APPLICABLE PROVISIONS OF
ANCHORAGE MUNICIPAL CODE CHAPTER 16.90.
SB4/p/D7
'CHEMICAL & GE~r%~oGICAL LABORATORIES ~-~'~ ALASKA, INC.
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
I.D. NO.
Phone No.
Mailing Address
City
SAMPLE DATE: ~'~
MO,
Cay Year
SAMPLE TYPE:
,~Routine
Check Sample (for routine sam ale
with lab ref. no.
[:3 Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
2I I
Time Collected
Collected By
t~-~
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to De:
~;tisfact%ry
[] Unsatisfactory ..,
[] Samole too long in transit: samole should
. not be over 48 hours old au exammauon
Io indmate reliable results Please send
Tim, .ecB ve
Analytical Method:
[] Fermentation Tube
J~Membrane Filter
Lab Ref. No. Result* Analyst
II ~-~
II ~-~
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
O6-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Co]leCt ee Source
Presumptive 10mi 10mi 10mi 10mi 10mi /,0mi 0.1mi
24 Hours
48 Hours
confirmatory
Final Membrane Filter ReSUltS
BGB
CHEMICAL &-GI~-'~OGICAL LABORATORIES ~ ALASKA, INC.
- TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL iCENTER
/~~ Drinking~Water Analysis Report for Total Coliform Bacteria
TC BE COMPLET. ED BY WATER SUPPLIER
WATER SYSTEM: ~?/ ~
.... -' I,D. NO.
Water System N~me ~' ' ....... Phone No.
Mailing Address
City ' ~. '~ State
Mo. Day Year
SAMPLE TYPE:
EY'Routine
[] Check Sump · (for routine sample
with lab ref. no. .
[] Special Purpose
Zip Code
[] Treated Water
[] Untreated Water
SAMPLE
NO LOCATION .
Time Collected
Collected By
t,-/:/,,;~, ~../..
TO BE COMPLETED BY LABORATORY
Aha ys~s snows tins Water SAMPLE to De:
'~ r ~
[j~[Satisfacto ¥
[] Unsatisfactory
[:~J~Sample too long in transit: sample should
not De over 48 hours cio at exa'nlnat~on
~,~to inamate reliable 'esults. Please send
new sample
:Date Received ~*'
.,~Time Received :' ~ ~ ~'~
Analytical Method:
[] Fermentation Tube
,El Membrane Filter
Lab_ .-,~ ,~,0Ref' ~o. Result* Analyst
r" -)Pr-~. I~ ·
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (~)
Rev. 1978
BACTERIOLOG CAL WATI~R ANALY, SIS RECORD
Date Collected eource
~e~umbtlve ]0mi 10mi 10mi 10mi 1Omi /.Omi 0,/mi
24 Hours
Final Membrane Filter ReSults [.r-)
,o!~EATER ~$NCHOg6GE AREA BOROUGH
D~Jpartme~t of Environmental Quality
3500 Tudor Road Anchorage, Atask~ 99507 279-868~
Time of Inspection ~-'~-~-~ /~
Date of I.soec~ien ~- 3/-Z25_
RF:QUEST FOR APPROVAL OF
INDIVIDUAl .... L., & WATEP. FACILITIES
FOR
Locetlon: ~-~-,/v//~z~P v
Type of Facility to be I~spected:
Number of Bedrooms: C~
3. Legal Description:
4.
Well Data:
A. Type
-- -7P-,,,_
C. Construction ,~ ·
A. Installed B.
Deoth ~ /
Bacterial Analysis
Installer
C. Septic Tank: ].. Size
2. ~anufacturer
D. Seepage Pit: 1. Size
2, Material
E. Disposal .:eld: Total Length of Lines
8. Distances:
A. Well To: Septic Tank ........... , AbsorDtton Area
· Sewer Lines
, Nearest Lot Line
Other Contamination
B, Foundation to Septic Tank
'~ Ab~orotion Area
C. Absorption Area to Nearest Lot Line
~equest for Approval of
Sewer & Water Facflitie~-~.
Ap~lid for une Year F%4o~ Date o~.~ned
Greater Anchora~'~, Area Borough, Decartment ~f Env!rnu~enta] Quality
D?AGR/~M OF
I certify that the information ' ~ in this approval to be ~ true
and accurate representation of the su~iect sewer and w~ter faci!tt~es located at:
Signed Date
06-1220 (aL'~
STATE OF ALASKA
DEPA~UEflT OF HEALTH AriD SOCIAL SE~CES ~..o.
~- DIVISION OF PUBLIC HEALTH
ACTERIOLOG CAE wATER:AflALYSIS
NAME
SAMPLE COLLECTED BY
DATE COLLECTED ' ''
Top - [] '.Vcod [] Concrete [] Melol [] OicenTo~
LOCATION: [] In Bosemeat [] Ik~,emeat OILset [] Under Ho~
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
drilled well [] cistern
SANITARIAN'S REMARKS
Relocate yom: well to cz scale location in relationship to ¥ou~ sewage
BACTERIOLOGICAL WATER ANALYSIS RECORD