HomeMy WebLinkAboutWALTER G PIPPEL ADDITION BLK 6 LT 5B
APPLIC..~NT FILLS OUT UPPER HA[._.,,ONLY
Buyer
Address Zip Code
Realty Co, & Agent Phone
Address Zip Code
Type of Residence
~ Single Family
Water Supply
~ Individual A~ACH WELL LOG, A w~l log is required for all wells drilled since June 1975.
Sewer Disposam ~6~
~ Individual ~ ~ ~ ~{~ndividual ns a ed ~ ~
ublic Utility ~ ~ ~ ~L When Connected to Public Utility: / ~'~ ~
olding Tank '
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspe:;tor Inspector Inspector
MUNICIPALITY OF ANCHORAGE
Field Notes: DEPT. OF H:A,LTH 8:
ENVIRON,'.A~N1 AL PROTECFtON
j, o
.RECEIVED
( ,,~.),.-.Aff~PROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ~ COND,T,ONAL ARP"OVAL'
DATE ""~. ~-- ) ~'~-~- ~ '~
sY: ~ Y
So]is Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tan~ Septic T~k Size
APPLI . NT FILLS OUT UPPER HAL.jONLY
Prope~y Own~er '~. ]~ , ~) /~(2t~2~-.. Phone
Mailing Addre~ ~ ~ ' '
Buyer
Address Zip Code
Lending Institution ~ ~' / ~m~A~, ~ ~ Phone
Realty Co. & Agent Phone
Address Zip Code
Street Locati~ M P~ ~,~
Type of Residence
~ Multiple Family No. of Bedroo~
Water Supply
~ Individual A~ACH WELL LOG. A well log is required for all wells drilled since June ~975.
~Community For wells drilled prior to that date, give well dept~ (attac~ log if available).
~ Public Utility When Connected to Public Utility; f ~ ~
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSIN8 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 Installed Well TO Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (31~)
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION.
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of
by
fi l k. '6,
public water system located
, Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
[] conditionally approved (see attached conditions).
B TITLE DATE
If construction has not starte, d 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 Date
or descriptive relerence)
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE
The construction of theLf T lk,, 6 k',C, '?,tfb pub,c
water system was completed on I 1 c~ ~. ~,./ (date). The system is hereby
granted interim approval to operate for 90 days following the cpmpletion date.
I~Y TITLE 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.
Drinking Water Analysis R~po~ [or To~al Coliform Ba¢'mda
~'~..lc~ A?/~/~ TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM:
/ ~,. ~ ~ ~ '~ I.~ - ~'"
Water ~tem Name phone N~.
City
Mo. Day Year
SAMPLE TYPE:
I~ Routine
~ Check Sample (for routine sample
with lab ref. no.
E] Special Purpoee
Zip
SAMPLE
NO.
1
4
5
[] Treated Water
[] Untreated Water
LOCATION
Time Collected
Collecled 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.
Da,e Reoelvo. I 2.:/~/ /,~ r
/ /
Time Received ///-("~ C
Analytical Method:
[] Fermentation Tube
,1~' Membrane Filter
Lab Ref, No. Result' Analyst
FT-]
~
Ki-1
K-K-I
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
J WATER&W~EWATER~U~fl~ ........ h~I~eE~IZY'¢: d.,
~ · .., ~ .... . . . · · .~.
~~ ~~~ .... Ass~ssa~N~,~ /~,'
~P~ER~.ON~~ Q Main ex ension*agf~menb.~,~;~
~?:~IN TAP &.ON PROPERTY CONNECT ~ Pending--AMOUNTS
· REIMBURSIBLE ... '-'
NUMBER DEPOSIT $
REMARKS:
' I HAVE ~E~'~bNDITIONS AND REGULATIONS ON T~E REVEaSE S~DE Of THIS ;ERMIT AN~AGREE TO
, POST IN A cONsPICUOU~PLACE AT THE JOB SITE
[~.. ~ ~m~ C~ER
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