HomeMy WebLinkAboutWALTER G PIPPEL ADDITION BLK 6 LT 5A
APPLICLj ~IT FILLS OUT UPPER HAL~ ONLY
Property Owner -'t~ ,~p-) /"J ~'/ J..'k' J~J' ~' /~-'; lq ~C) " Phone
Buyer
Address Zip Code
//~--~-~. ~ ' ~ I ~ ~ /~t~,~_~ Phone
Lending Institution "~'! ~.~,~-.- ~ ~ ~-~ ~
O~/CL~' ~/-~, J/3c~.-~ {~/' Zip Code
Phone
Realty Co. & Agent
Address Zip Code
L~g~, ~esoriptio. CT' ~A ~c ~ G to. G · 'P~ ~-~--- /~o-~ .
Type of Residence
[] Single Family
Multiple
[~Other FamBy NO. of Bedrooms
Water Supply
~ Individual ATTACH WELL LOG, A well log is required for all wells drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach log if available).
P.b,i ,ti,ity
Sewer Disposal ~, ,,~ ~ ~
[~ Individual ~h , ~ ~)l~'~ Q¢~' ~' Year Individual installed:
Public Utility ' When Connected to Public Utility:
~K Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
~uNIC~pALITY OF ANCHORAG~
E. NviRONN',Z N~AL pP, O~ECT[ON
{ .~zAPPROVEO BEO~OOMS *CONOmONS OF APPROVAL
( I OISAPPROVEO
I ) CONDmONALAPPROVAL'
Soils ~aling Date ,Sewer Installed Well To Absorption Area Well Log ~eceived
Well to Tank Septic Tank Size
72~23 (31~2)
APPLIC.. ,JT FILLS OUT UPPER HAL .·..ONLY
Phone
Buyer
Address ' Zip Code
Phone
Lending InsBtuBon i~'l ~::~ ~--T-
Address ' ~. ~ .~"'~i-- . ~ ~.~'¢~/',,J C ~ Zip Code
Phone
Realty Co. & Agent
Address Zip Code
LegalDescription ~/U. ~, ~1~1~/~.~. ~'~U~ ,
Street Location I"~ ~'~/'~ ~'~t ~IA'I g ~'~
Type of Residence
(~ Single Family
_ Muqiple Family NO. of Bedroorp~s
~I~ Other
Water Supply
[] Individual ATTACH WELL LOG. A wag Icg is required for all wells drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed:
When Connected to Public Utility: l~;~) ::~
Public
Utility
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector InspEctor
Field Notes:
( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE
BY:
Soils Rating Date Sewer ~nstalled Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 {3/~)
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION .
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of LO"r' &'CA /"il N
~C
by
public water system located
~' approved.0
Alaska, submitted in accordance with 18 AAC 80.]00
have been reviewed and are
[] conditionally approved (see attached conditions).
BY
If construction has 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 CHANGEORDERS
Change [contract order no. Approved by
or descriptive reference)
Date
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public,
APPROVAL TO OPERATE
The construction of the J_~T :s~A ~1 k (~ u.d., pub,,c
[
/
water system was completed on - y (date). The system is hereby
granted interim approval to operate for 90 days following the cpmpletion date.
By
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.
) ' :7
~.2 S "
LASKA,
~_, HEMICAL & GEOLOGICAL LABORATORIE O~'~dA ,INC.
5633 B Street
' ..
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Mailing ,~.ddr ess
City
Mo. Day Year
Zip Codt)
SAMPLE TYPE:
~-'Routlne
[] Check Sample (for routine sample
with lab rof. no..
O Special Purpoee
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
2 I I
4 I I
Tirne 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 via special delivery mail.
Oate aeoo~ved
Time Received //' ~ C,
Analytical Method:
[] Fermentation Tube
A Membrane Filter
Lab Re,ENo.
i'/~ ;'c. '5'71
.I
,1
I
I
Result* Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAM PLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
~ SCHEDULED COMPLETION DATE:, :
L T~~ BLOCK
SU~IVISION J _~): ' '" ''~ ~:' "
· i {N. SPECTION
·PERMIT
REIMBURSIBLE · ...
NUMBER
FEE
FEE $
DEPOSITS
TOTAL ":.$
REMARKS:
lease Print) MAIL ADDR.
"I HAVE REA~;~'C~NDITIONS AND REGULATIONS ON T~E REVERSE SlOE OF THIS PERMIT AN~AGREE TO
POST IN A CONSPIOUOUO¢PLACE AT THE aOB SITE
~2~ qm~ C~ER