HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 5 LT 100
iriS'no
10
ruER ANC. IIORAf;g AI,'J;A BOROUGH
32'/ EAGI,F, STREET
ANCHORAGE, ALASKA' 99501
Depth ~~~'
F~et Soil Cha2'acte~i~tics Location S~etch
//
____APPLIC ,iT FILLS OUT UPPER HAL ONLY
: Yoperty Owner
Mailing Addrqss
Bdyer
Address
Zip Code
Lending InslituHon
Phone
Address
Zip Code
Address
Zip Code
Legal DescripHon ~ /~ ~ ~ / .
Type of Resi~nce
~ Single Family
~ Multiple Family NO. of Bedrooms
~ Other
Water Supply
Pbono
Community
Public Utility
Sewer Disposal
L] Individual
Public Utility
Holding Tank
AI~ACH WELL LOG. A well Icg is required for alt wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attacb Jog if available).
Year Individual Installed:
When Connected to Public Utility:
NOTE: THE INSPEC'rlON FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
rime Time[ /
Time
Date Date Date
Inspector inspector Inspector
Field Notes:
Insp r
RAG~,
Df_PT. OF I ~!-'¢ bt
BEDROOMS
'CONDITIONS OF APPROVAL
) DISAPPROVED
) CONDITIONAL APPROVAL"
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
Drinking Water Analysis Report' for 5633 B StTot'al Coliformreet Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM
Water System Name
I.D. NO.
Phone No.
Mailing Address
City State
SAMP'E DATE: F-T:] FT--1 5"T:1
Mo Day Year
Code
SAMPLE TYPE:
· [] Routine
- Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
- Treated Water
[] Untreated Water
SAMPLE
NO.
1
3
LOCATION
. : j
Time Collected
Collected By
TO BE COMI~LETED BY LASORATORY
Ana ,/s~s snows this Water SAMPLE to be:
/'~Satisfactory
[] Unsatisfactory
[] Samole too long in transit; sample should
nol De over 48 hours old at examination
to mcucate reliable results. Please send
. new sample, ~
Date Received _ ( ( -~ : .': Y
Time Received .' ~.~-)
Analytical Method:
[] Fermentation Tube
.Fl Membrane Filter
Lab Ref. No. Result* Analyst
J
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06.1220
Rev.]978
BACTERIOLOGICAL WATER ANALYSIS RI[cORID
NoveJ.lber 24, 1972
Mr. Melvin Couture
!lox 4-1[)65
Anchorage, Alaska 99503
Subject:: On.-site sewage disposal serving Lot 10,
Zodiac Hanor Subdivision.
iS1 ock 5,
Dear Mr, Couture:
I1; [las COhle tO our attention tha~ the subject system has been
recently installed on said lot. tIowewn', we. have no record o'F
ever inspecting subjec~ sys~e',a. P'tease contact tilis Department
within seven days froi~ the receipt of Chis letter concernin~i
the approval. Failure to do so iiay result iu 1 :gal acbion
being brought against you.
If you ilavo any questions re(ar(ling the above, please hesitate
to con~ac'c ~nis office.
Si nce rel y,
Til, Rumfelt, R.S.
Sanitarian I
;ECFJPT FOt~ CER¥IFIED N1AIL-z-30_ <_(plus
~.o., s~ ~ND Zm CO~[
~'~ PS Forr,~ 31~00 NO INSU~tANCE COVEflAG[ P~OVtD[rJ-
Apr, 1971 NOT ~'011 I~iTEI1NATIONA~ MA~L ~ a~o, ,~oo.~-~