HomeMy WebLinkAboutWALTER G PIPPEL ADDITION BLK 5 LT 7A
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CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans fortheconstructionof ,/;I,.,, , ,~.~
' ~ ?f ~ : public water system located
Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
.[] approved.
;~ [] conditionally approv~,d (see attached conditions).
If construction nas not started within two years of the approval date. this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change {contract order no, Approved by
or descriptive reference)
Date
The "APPROVAL TO OPERATE" section must be corn pleted before any water is made available to
the public.
APPROVAL TO OPERATE
The construction of the - ~ublic
water system was corn pleted on "' ' ' Idate). The system is hereby
granted interim approval to operate for 90 days following the cpmpletion date.
As-built plans submitted during the interim appr~)val period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
final approval to operate.
~ A.,,~.T F~L,S OUT U,.E..^~ ::O.,¥
Property Ow~o~ ~'~ · ~ Y~ ~.: ~ ~ ~ : Phone
Lending Institution
"~' ' Z ?:, ..:~ ....
Address
RealtyCo.&A~nt ~.~ - ~ , ? .' ,. ~; ~: (.~'., . ,- I t ,'-
Address :
Sewer~ IndividuaIDisp°sal ~ ~ .. : ~ :: ~,, .
Time Time Time Time
Date Date Date, :~.. ~"_ ~) ~..~ Date
Inspector Inspector Inspector Inspector
'~'JO ~ Jig (~Y~A~'~'~(~J~J~= MUNICIPALITY OF ANCHORAGE
DEPT. OF HF/',LTI[
: ~(~Lb~: ~("~'~-~.'" ~_d~°~. ~J~__ E~v,~o,~:~:~ ~o~,,o.0c.r
RECEIVED
(~) APPROVED B£DBOOM8 'CONDITIONS OF APPBOVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
BY: C~,
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
L~ OR~TORIES~ F tL~SKA~ INC.
~'/~~ ..... ~' · ~"_ A~ . . '
~ ELEPHO~E (907) 562-2~3 CHORAGE INDUSTRIAL CENTER
Dnnkm~ Water ~nal~sis ~opo~ for ~otal Coliform Bacmria
TO BE COMPLETED BY 'WATER SUPPLIER
I"" I I I I J I ] (°) sea h on back
WATER SYSTEM: . / t
w. ler 5~tem Na~ · ~ ~o~ No. /
W~t~r
Purpo~
}eclal ~Untreated Water
AMPLE
NO.
4 I
'1
Time Collecled
Collected
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 via.special delivery mail ........
Date Received ~ >./~C ~_
TlmeRecelved ~ ~{~c)
Analytical Method:
r3 Fermentation Tube
~-Membrane Filter
Lab Ref. No. Result* A~.yst
I CF'_]
I
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE