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,='=". I Nil. J_ ;IN-ItlI..L. THE ._,~_'l'LJ'l IN FICCOI~:I]:q:INCE NITI. I THE CEI]:,FS
December 31, ].979
Kenneth G./Barbara 1;. ',,lartJ.n
8621 d'upite~: i)rive
Anchorage, Alaska 99507
Permit ~ 790449
Subject: Lot 23 Block 4 ZodJak ?.lanor Subdivision
A permit issued by this department for well and/or sewer
system has expired.
Pemuits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal ordinance.
If you have drilled the well, a well log should be sent
to this department to document the installation date.
if an engineer has inspected the installation of the
on-site sewer system, please have them send us ti~e as-builts
for our files.
If there are any further cR~estions, please contact this
office at 2~4-4720.
',:; i ncc ~:~ ] '/ ,
:!:es N. h -
LNB/].jw
eric: Copy of Permiu
DATE R ECE'IVED I
INSPECTION APPOINTMENTS,~,/ ~Z~_~~, ~.~ .~ __
DATE ~3ATE DATE
INSPECTOB~
~UI~clVAL Y ~k ANCHO~GE
GE DEPT OF J"' J~Ir &
MUNIC PALITY OF ANCHORA . ' · ~'.
DEPARTMENT OF HEALTH & ENVIRONMENTAL P~O~~ENl''d-
MAR 2
k ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 g[CEI. [[B
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND-SEWER FACILITIES
DIRECTIONS: Complete all parts o~l page 1, Incomplete requests will not he processed. Please allow ten (10) days for processing,
~PROPERTY OWNER PHONE
~AILING ADDRESS
~OPERTY RES DENT (if different from above PHONE
~ BUYER PHONE
MAILING ADDRESS
~ LENDING INSTITUTION I PHONE
I
5, LEGAL DESCRII;TION
STREET LOCATION
E] On. ~' Four ~ Omm__
'~ SINGLE FAMILY E3 Two [~ Five
~ MULTIPLE FAMILY ~ ::rea ~ Six
~ iNDiViDUAL' " ATTACH WELL LOG, Awellloa s raqu red for all walls drilled
CO ~MUNITY since June 197B. For wells drilled ~rior to that date, ~ive w~ll
: PUBLIC UTI LITY de~th (attach Ioa if availablm)
~ INDIVIDUAL/ON-SITE*" YEAR ON-SITE SYSTEM WAS INSTALLED,
~ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ,,1 /
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBEROFBEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTI LITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or []Holding Tank
Size: If Tank is homemad,
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATEINSTALLED
INSTALLER
Absorption Area
Sewer Line
Nearest Lot Line
SOl LS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
~'"~ APP ROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
72-O10 (Rev, 6/79)
CHEMICAL & GI~oLOGICAL LABORATORIES ~,t: ALASKA, INC.
TELEPHONE (007)-270,4014 ANCHORA(~E INDUSTRIAL (;ENTER
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM: L I I I I-T
I,D, NO,
Water System Name Phone No.
City State Zip Code
SAMPLE DATE:
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no, )
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
I
Time 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.
Date Received
Time Received r '
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref. No. Result* Analyst
':' '-'~J IF']
J
J FI--]
J FFq
READ INSTRUCTIONS
BEFORE
COL. LECTIN(-~ SAMPLE
06-1220 (bi
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
