HomeMy WebLinkAboutWALTER G PIPPEL BLK 9 LT 3 PARK TERRACE
APPLI( NT FILLS OUT UPPER HA[. ONLy
P'r~perty Ow~ne'r ~,~/~/~Z/-J~JJ~-~ j~---'~ ~-/~.~'~5) J ~hone
Address : Zip
Zip Code
Address
RealtyCo.&A~nt ' ~ .~ y~/ ~:~ Phone
~ddress. P- ~ ~d~ ~ 7~t ~ ~/~-~ Zip Code
Type of Resi~nce
~ Sing,e Family
MulBple Family NO. of Bedroo~
~Other
Wator 8uppl~
' ~al ~/~ rfC j/ AWACH WELL LOG. A w~l ~og is required for all wells drilled since June 1075.
For wells drilled prior to that date, give well depth (attach log if available).
Sewer Disposal
ndividua[ Year Indiv~ual Installed:
ublicoldingUtilitYTank When Connected to Public Ut [lity:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date
Inspector Inspector Inspector Inspector
( [1~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDmONAL ^PPR VAL'
Soils Rating Date Sewer Installed Well TO Absorption Area Well Log Received
Well to Tank Septic T~mk Size
CHEMICAL & ¢I~-LOGIC.4L LABORATORIES o../ALASKA, INC.
TELEPHONE (9071-279-4014 ANCHORAGE INDUSTRIAL CENTER ~'"~
274-3364 5633 B Street ~o
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
I.D. NO.
Mailing Address
City . State
MO, Day Year
zio Cede
SAMPLE TYPE:
Routine
Check Sample (for routine sample ,'
with lab ref. no. ! [] Treated Water
Special Purpoee [] Untreated Water
SAMPLE
NO.
, I
I
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Ahalys~s snows This Water SAMPLE to De:
?
~ Satisfactory
[] .Unsatisfactory
[] Sample too long in transit: samore should
not be over 48 hours old at exammauon
to indicate reliable *esults. =lease sene
new samole
o~te Received
Time Received
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref. No. Result* Analyst
I I
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev.]e78
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date ColleCted eburce
-ab. NO.
24 Hours