HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 6 LT 13Zoo iA K ..
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APPLIq NT FILLS ()UT UPPER HAl. ONLY
Lendinglnstitution J... O/~/t D "~. AId-~'-I{(,: L).11 ) Phone
Type of Residedce
for
drilled
June
1975.
~'~'~ Community For wells ddlled prior to that date, give well depth (attach Icg If available).
~ Individual Year Individual Installed:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
~ , , ~ ENVIRONMEN1 AL PRO [ECP~ON
MAR i! 8 1983
RECEIVED
( k(_) APPROVED BEDROOM8 'CONDITION8 OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE L~ _ ('~_^_ ~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size~
CHEMICAL & GF~ ,OGICAL LABORATORIES ~ ALASKA, INC.
TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER ~//~
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
I.D. NO.
Water System Name Phone No.
Mailing Address
City State Zip Coda
MO. Day Year
SAMPLE TYPE:
£3 Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE Time Collected
NO. LOCA'FION Collected . By ..
J
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
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref, No. Result* Analyet
I J
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 tb)
flev. lg78
BACTERIOLOGICAL WATI"R ANALYSIS RECORD
Date Collected Source
Prosumpt lye 1Omi 3. Omi 1emi 10mi ]emi ~ ,Ornl O,1ml
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received_~~-~__~2)~.
Time of Inspection .......
Date of Insoection
REQUEST FOP. APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Address:~~ ~0~ ~ Phone:
Pro~or~g ~nor ~ bono
Number of Bedrooms:
Well Data:
C. Constructio ~ _ D. Bacteria] Analysis
Sewags Disoosa~ System, .~¢~kl~
A. Installed B. Installer
C. Septic Tank: 1, Size 2. Manufacturer
D. Seepage Pit: 1. Size 2. Materiel
E. Disposal Field: Total Length of Lines
8. Distances:
A. Well To~ Septic Tank
, Nearest Lot Line
B. Foundation to Septic Tank
Absorption Area
Sewer Line~
Other Contamination
Absorption Area
C. Absorption Ares to Nearest Lot Line ........... .
Request for Approval of Individual ,Sewer & Water
Page Two
~roval Valid for One Yaar From D~[O SSgned
Gro~or Anc~ora~o Aro~ Borouoh, Da~ar[men~ of Hnvlronmon[al Quali~y
DIAGRAM OF SYSTE~
~ certify that the information contained in this request for appreval to be a true
and accurate reprnr;entatton of -the subiect sewer and water facilities located at:
Date
DATE
I]EF "MEflT OF HEALTH AND SOCIAL
DItlISION OF PUBLIC IIEAL'rH
BP, CTFRIOLOGICJ~,[ WATER
NAME
ADDRESS
OF SOURCE
Atmlysis~hows this Wate~SAMPLE o be
[] Satisfactory [] QuesEonable [] UnsaSsfac~ory,
SAMPLE COLLECTED BY,
,,,,,,.,,.,,.,,..-...~..,,.,,.,,,,~.,:~.,~;,,..,~,~..~~ ..
· ,. ~ lm~p~ovo your [] spring [] duq well [] driven well
SANITARIAN'S RIE:MARK~
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
06-1220 (b)
BACTERIOLOGICAL WATER ANALYSIS RECORD
DEPARTUEflT OF HEALTH AND SOCgAL SERVICES
Dll/ISIO[t 01: PUBLIC HEALTH
BACTERIOLOG CAL WA'lrER AflJIkY$ S
ADDRESS
SAMPLE COLLECTED BY. ~ ~- .
MAT~qlAL: Building Sewer - E] C~a[ [] Weod [] Tilo F~ Fible [] Cement
PUMP LOCATION~ L-] In Wl~ll D R(z~oment ~] In B~m~nt [] Room
[] OlWoll FI Other
...... 41 If ahem' chacldng eq~Ipment a dlsinfecdng ;~aslducfl is not obtaJnad, please
~yslem, [] see encl~um
....... Division of Public Health, sanitation oEica for bulledn~, ConnuhaSon and
~ANITARIAN'S REtaARKS
IlEAl) INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
08-1220 (b)
BAcTERIoLOGICAL WATER ANALYSIS RECORD
Lot J_3~ ~locK'i "ii, Zodiak Manor
top of! the wo, l.[ c;aF;Jn ~;hould be' scaled go bhaL ib ~.~:;
uater tight,
,!: incere ,i y,
Jim
S pe c i a 1 i ,{~ t
0 P,i 9 4/c j/i: 1