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Home My WebLink AboutZODIAK MANOR ALASKA BLK 6 LT 5ZoD iA K .Lo TiME )ATE ~ISPECTOR INSPECTION APPOINTMENTS __ TiME TOR ~'AT~ECEiVED IME DATE INSPECTO ~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCNORAGE DEPT, OF %% & DEPARTMI-'-NT OF HEALTH & ENVIRONMENTAL PROTEC'FIO~viRONMEN fAL F,,,F, ECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION ,~LJ~ ~ il i~/i0 REQtJEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE I I )IRECTIGNS: ComF ere all parts on p~ee 1. Incomplete requests will not be processed. Please auow ten___(10) days for processing. 2, BUYER ~AILING A )DRESS ,,~P H O N [:' / STREET L IUYPE OF RESIDENCE ~ One ~ Four ~ SINGLE FAMILY ~ Two ~ Five ~ ~ULTIPLEFAMILY ~' Three ~ Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY PUBLIC UTI LITY Other__ ATTACH WELL L(bG. A welt log is reouired for all wens dri[lec s~ qce june 1975, For wells drilled prior to that date, .ti ye wen depth (attach log if available.) 8, SEWAGE DISPOSAl. SYSTEM [~ INDIVIDUAL/ON'SITE** YEAR ON-SITE SYSTEM WAS I~ISTALLED, -~ PUBLIC UTILITY "~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUESt' BEFORE PROCESSING CAN BE INITIATED, ~2-010 (~av. 6/79) 1, TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLy [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM E~INDIVlDUAL/ON -SITE []PUBLIC UTILITY THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTHER ~] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL WE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED -]NSTALL~ -- SOl LS RATING MANUFACTURER Connection Verified ~ []Septic Tank or []Holding Tank Size: _ If Tank is homemad~ give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: to nearest Lot Line 5, COMMENTS MATERIAL ~TE ~]~' APPROVED FOR ~ _ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-o10 (Bev, 6/79} RFQUFST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES ENVIRONMENTAL ENGINEERING DIVISION Telephone 264~4720 VIUNICIPALITY OF ANCH£)RAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 826 L Street - Anchorage, Al~sl(a 99§01 RRi':CTIONS: Comnlete all parts on o~9e 1. Incoelplate requests wlll not be processad. Please allow ten (10) davs for precessing. 344,.qo 2. pROPERTY RESIDENT (If ~f~m m~avel I PHONE ,~~: PHONE MAILING ADDRESS 3. LENDING INSTITUTIONc~o~,~i. MAILING ADDRESS 4. :~EALT~R/AGENT MAILING ADDRESS S. LEGAL DESCRIPTI N 6, TYPE OF RESIDENCE : O( ~ One ~ Four [] Other j~ SINGEE FAMILY ~ wo ~1 Fiw ~ MULTI ~E FAMILY ~hree ~] Six ~u~red for all wells dr ed 7. WATER ~LY ~ ~ ~ ~' /INDIVIDUAL' ~ ATTACH WELL ~OG. AwelL Io~ is [] COMMUNITY [] PUBLIC UTI LITY --~, SEWAGE DISPOSAL SYSTEM [] ~N DIVI DLJAL/ON-BI'r E [~ PUBLIC UTILITY ~;mce June 1975. For wells drilled orior to that date, give well det]tb (attach log if available,) , , **if individual/on-site, give installation date ,. f system is over two [2) vents om an adequacy test IS renuired by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, ~-010 (3'/7'8) THIS SIDE FOR OFFICIAL USE ONL, INSPECTION APPOINTMENTS 1, TYPE OF RESIDENCE _ NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2, WATER SUPPLY PERMIT NUMBER' "' E3 INDIVIDUAL DEPTH OF WELL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified __ []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: WELL TO: 5. COMMENTS [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED CHEMICAL & GEt,LOGICAL LABORATORIES t~F ALASKA, INC. TE LEPHON E (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street , Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I.D. NO. Water System Name Phone No. Mailing Address City State Zip Code Mo. Oay Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 'rime 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 I~ours old at examination to indicate reliable results. Please send new sample. Date Received Time Racelved Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst READ INSTRUCTIONS BF. FORE COLLECTING SAMPLE 06-1220(b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD