HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 1 LT 4B
.. _ APPLIC~,NT FILLS OUT UPPER HAI-C~ ONLY
Address ~ Zip
Phone
Lending Institution
Type of Resi~nce
ingle Family
~ultlple Family No. of
~ Other
n~ivld~l A~ACH ~LL LOG. A w~l log Is r~ulr~ for all wells drl~ since June 1975.
~ Public Utility
Sewer Disposal
~ Indlvld~l Year IndlvMual Installed:
olding Tank
NOTE: THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector(~ . ~
Field Notes: DEPT. OF H=J%TH
//../,3,~ ~ ENVIRO~'d~NT,~L I~ROIECTION
RECEIVED
(r~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DtSAPtW:~OVED
( ) CONDITIONAL APPR~V~J-°
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well lo Tank Septic Tank Size
CHEMICAL & Gt~OGIC~L L~BOR~TORIE$ · ? ~L~$K~, INC.
TELEPHONE (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
WATER SYSTEM:
Day year
SAMPLE TYPE:
/ri Routine
[3Check Sample (for routine sample
with I~b reg. no. )
[3 Special Purpose
[] Treated Water
[3 Untreated Water
SAMPLE
NO. LO~ATION
2 ~ ~ ' ~ ":'~ ~
~.~Collected ,... By ..,,
I
TO SE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
:~] Satisfactory
I'-i 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
Analytical Method:
[3 Fermentation Tube
· ~ Membrane Filter
Lab Reg. No. Result'
I-FI
I-I-I
FT-!
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220
BACTERIOLOGICAL WATER ANALYSIS RECORD