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HomeMy WebLinkAboutSOUTHFORK BLK 4 LT 5om") <\ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTALPROTF..CTION ENVIRONMFNTAI_ ENGINEERING oe DIVISION x25 1. Street - Anchorage, Alaska 99501 Telephone 2.64-47.2_0 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW ❑ UPGRADE MAI LING ADDRESS E cS / LEGAL DESCRIPTION n 4 Isr� l LOCATION NO. OF BEDROOMS DISTANCE TO: Well Q f.t Absorption area ! Dwelling / of -77 PERMIT NO. / 2C) v Y L) a Q Manufacturer Material r No. Qf compartments LU 1 N Liq. capacity in gallons Inside length Width Liquid depth D IF HOMEMADE: - DISTANCE TO: Well Dwelling PERMIT NO. J � Z 2 z F Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well ! T��d Foundatio .,�� i Nearest lot line �©Of PERMIT NO. 2� CY J Z w No. of lin Length of each lire Total length o�lin� Trench th Distance betwe�ines I --S C� / s Q Top rile to finish Material beneath rile Total F- of grade effective absorption area irk Length Width Depth PERMIT NO. LU QF- Type of crib Crib diameter Crib depth Total effective absorption area wLU a y Well Building foundation Nearest lot line DISTANCE TO: Cla� D9pth Dri I r Dis nce tot line PERMIT NO.� J GSL JK LU Buil ing undati n Sewer lineO ! Septic tank e Absorption area(s) DISTANCE TO: W OTHER t PIPE MATERIALS � 3©3 SOIL TEST RATING INSTALLER 6 FAvt" &-_" R- REMARKS bvL.24 fL� c✓t y U APPROVED DATE LEGAL X1 K CX 72-013 (Rev. 3/78) ( f HPPLICHNT DEHN­DELUCIH LOCHTION LEGHL L 5 B 4 �OUTHFOFK S/D BOS EHGLE RIVER 99577 LOT SIZE ]]]]]] SQUHRE FEET TYPE GF SOIL HBSORPTION SYSTEM IS: DRHINFIELD MHXIMUM NUMBER OF BEDROOMS = ] SOIL RHTING (SQ FT/BR)= 110 THE REQUIRED SIZE OF THE SOIL IS: �W 1=1 T- 1-4 ova qwj U ESH, e-12 -5 ... 1`1-1114 _=_1 �� ��3F7i1.1E17 L. �FEE K W F -1 =­ � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROU�41D AND THE BOTTOM OF THE (IN FEET). V H I -EE, �frr,- 044 W VR ��-T,, 9-A 1_1 �. c �-�EE�^ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE AND THE BOTTOM OF THE EXCHVHTION (IN FEET). �Q (A U 1 Fit E -E 9_:-,1 E_" F"' "T - 1 1:1 �M Im F-_ 1 2f FED— -L ICE- �������� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS QF ANY WELLS HDJHCENT TO THIS �ROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL WILL SE�VE. _�~ �fl, � - 0 1 C D 1r W!"W"EMM-1- M ITKIWAS 5"s FOE FEE Fit K Cis U 1 W EE: Ell ~ BACKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS, DEPHRTMENT WILL BE SUBJECT TO PROSECUTIO�� MINIMUM DISTHNCE BETWEEN H NELL HND HNY ON-SITE SEWAGE DISPOSAL SYSTEM ] 100 FEET FOR A PRIVHTE WELL OR 150 TO 200 FEET FROM A PUBLIC NELL DEPENDING UPON THE TYPE OF PUDLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET, OTHER REQUIREMENTS MAY AMPLY. SPECIFICATIONS AND CONSTRUCTIQN DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INST8LLHTION. F, FEE 1: W I F EEE!, Ey --,a LEE.- V? F`:HE IF,' E��� I CERTIFY THHT :W I HM FFIN ILIIf-IR WITH THE REQUIREMENTS FOR CM -SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPALITY OF HNCHORHGE 2: I NILL INSTALL THE SYSTEM IN HCCORDHNCE H1ITH THE CODES. ]� I UNDERSTHND Th IT THE ON^SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE RESIDENCE PS TO 11ORE: THAN 3 BEDROOMS SIGNED: .���~~�. .......... HPPLICHNT DEHN--DELUCIH ISSUED BY_ .DHTE_ Y4`0 1 'T" Cb'F-' �! H�,?���������� �EPHRTMENT P, HEHLTH HN� ENVIRONMENTHL r?OTECTION '^ 825 '\ STREET, HNCHORAGE/ L`;1 ' ~ 26 20 E""; E -E. 15 W 1 - 1 Eon K K FEE Fit Ohl 1 7, PERMIT NOk ( 8206�2 ) HPPLICHNT DEHN­DELUCIH LOCHTION LEGHL L 5 B 4 �OUTHFOFK S/D BOS EHGLE RIVER 99577 LOT SIZE ]]]]]] SQUHRE FEET TYPE GF SOIL HBSORPTION SYSTEM IS: DRHINFIELD MHXIMUM NUMBER OF BEDROOMS = ] SOIL RHTING (SQ FT/BR)= 110 THE REQUIRED SIZE OF THE SOIL IS: �W 1=1 T- 1-4 ova qwj U ESH, e-12 -5 ... 1`1-1114 _=_1 �� ��3F7i1.1E17 L. �FEE K W F -1 =­ � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROU�41D AND THE BOTTOM OF THE (IN FEET). V H I -EE, �frr,- 044 W VR ��-T,, 9-A 1_1 �. c �-�EE�^ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE AND THE BOTTOM OF THE EXCHVHTION (IN FEET). �Q (A U 1 Fit E -E 9_:-,1 E_" F"' "T - 1 1:1 �M Im F-_ 1 2f FED— -L ICE- �������� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS QF ANY WELLS HDJHCENT TO THIS �ROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL WILL SE�VE. _�~ �fl, � - 0 1 C D 1r W!"W"EMM-1- M ITKIWAS 5"s FOE FEE Fit K Cis U 1 W EE: Ell ~ BACKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS, DEPHRTMENT WILL BE SUBJECT TO PROSECUTIO�� MINIMUM DISTHNCE BETWEEN H NELL HND HNY ON-SITE SEWAGE DISPOSAL SYSTEM ] 100 FEET FOR A PRIVHTE WELL OR 150 TO 200 FEET FROM A PUBLIC NELL DEPENDING UPON THE TYPE OF PUDLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET, OTHER REQUIREMENTS MAY AMPLY. SPECIFICATIONS AND CONSTRUCTIQN DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INST8LLHTION. F, FEE 1: W I F EEE!, Ey --,a LEE.- V? F`:HE IF,' E��� I CERTIFY THHT :W I HM FFIN ILIIf-IR WITH THE REQUIREMENTS FOR CM -SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPALITY OF HNCHORHGE 2: I NILL INSTALL THE SYSTEM IN HCCORDHNCE H1ITH THE CODES. ]� I UNDERSTHND Th IT THE ON^SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE RESIDENCE PS TO 11ORE: THAN 3 BEDROOMS SIGNED: .���~~�. .......... HPPLICHNT DEHN--DELUCIH ISSUED BY_ .DHTE_ Y4`0 MUNICIPALITY OF ANCHORAGE Department, Health and Environmental, `rotection 825 Ly/ Street, Anchorage, AK. 'Y4501 r 264-4720 Permit HANDWRITTEN PERMIT Wad;--"D/OR ON-SITE SEWER PERMIT Applicant: -2c Zu'e� 'cam Mailing Address:�'/ c��` Location: Phone Number: 6q Ila % Legal Description: L S Q V 46Y -k. Lot Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: Maximum Number of Bedrooms: Soil Rating(sq.f Size: Holding Tank: t/br) l"/d The Required Size of the Soil Absorption System Is: DEPTH LENGTH__ GRAVEL DEPTH a WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). ) * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ / Q 0 GALLONS # � Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ' * * TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 2 I certify that: (1.) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more tha\ t 3 .bedroo� L— !� Signed: y 6 _ Issued by: Applic nt Date: % 27 ' SWP/024(1/81) f f� SOILS LOG 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH APERCOLATION AND ENVIRONMENTAL PROTECTION • +.e TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �� 9a __ DATE PERFORMED: J-2,82— LEGAL "2,8G - LEGAL DESCRI 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMME 4 SITE PLAN (GM)-s►4y , 5d ndy c,�bb►Es c,ornmo c� Ity (GM�1%40_ 5i4,J lcav( 7 WAS GROUND WATER S ENCOUNTERED? Yi® OL P IF YES, AT WHAT E DEPTH? Reading Date v Gross Time Net Time Depth to Water Net Drop t ft/5- 2-e)- -e) .68 � 32. r 7/11 Z �!7 it: LI It; �. 07 2- . E 11:5,3111—�l ,5 '49- �\�- g I 7—:03:4 S 39 1 PERCOLATION RATE '3 a (minutes/inch) TEST RUN BETWEEN FT AND � FT r PERFORMED BY: Mac,,FrAfkM Q, //t,�b nso CERTIFIED BY: 72-008 (6/79) DATE: " 6 2- E I MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES j 343-4744 CERTIFICATE OF INSPECTION FOR AEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. #O % 5 of I 0 7 HAA # 0 55 - L`_� 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 5; Block 4; South Fork Subdivision Location (address or directions) Drive (b) Property owner Nark Kudla Telephone: (home) 694-5393 Business 265-6998 Mailing Address Sp q2 -?3 (c) Lending Institution Mailing Address VE Telephone (.d) Real Estate Company and Agent HERITAGE REAL ESTATE/Dale Price Address 8550 Eagle River Road, Eagle River, Alaska 99577 Telephone (e) Mail the HAA to the following address: (or check here U if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 34 Eagle i Loop Roadi'suite 204 2. TYPE OF RESIDENCE Single -Family KK Number of bedrooms 3 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site El Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. riee) Page 1 of 2 Z to Z abed aOeB (891t Aad) SZO-ZL •>Iaom s,aaaui6ua leuoissaload ay; ui suoissiwo ao saojaa aol alglsuodsaa;ou si a6eaogouy to Aj!IediolunW ay1-pan ssi si aleolllliao e aaoloq e;ep azAleue ao suolload sui lonpuoo lou op SHH(] to saE)Aoldw3 • slue waiinbaa alels pue Iviapal ulelaao llsiles of aapao ui suol;nlllsui 6u.Pual iiayl pue sawoy to saasegoand of Aselinoo e se slyl saop SHHO ayl •e�sely to ale;s ayl ul paaa;s160.1 aaaul6ua Ieuoissaloid luopuadapul ue Aq anoge g ydea6eaed ul uanlb suoileluasaadaa aql uodn Aluo paseq paleoiluao lenoaddV A;laoylny y;leaH sonssi (SHH(]) saolnaas uewnH pue ylleaH to luawlaeda(] a6eaoyouylo AlljedioiunVq aye. lenoiddy leuolllpuo(] to swial leuolllpuoO panoaddesl(] X, panoaddy ale(] !q swooapaq <C- aol panoaddy lb'AOHddV SHHO '9 ale(] ZZ966 eMseltl ae . ssaippy bOZ'ON peon doo�l "KI -8 016123 bEOZI ` auoydalal ONI2133NIO wal.I to aweN -uolloodsul slyl to alep aql uo;oalla ui suollelnbej pue 'saoueulpio 'sopoo alelS pus ledlolunW !le yl!m eouelldwoo ui si walsAs lesodslp aaleMalseM ao/pue Alddns jalem alls-uo ay; 'uolloadsul Pup uo1le61lsanul Aw woal pue salll 96eaogouy ;o /llledlolunlnl ayl woal paulelgo uollewaolul ayl uo paseq ley; /luaA aaylanl ! -ulaaay poleolpul ainlonals to adAj pue swooapeq to aagwnu aql ao; alenbape pue leuolloun; 'ales si walsAs lesodslp as;emalsem ao/pue Alddns aalem @;!s-uo aql ;eyl smogs lenoaddy L(;uoylny 1411e0H sly; to LIol;e6l;sanul Aw leyl AllaaA I 'molaq unnogs a>,ep uolleplleA ay; lose pue o;aaay paxl;le Ines !w Aq pallllaao sy N011b'WEIOdNI ON`d V.LV(3 `HOHV3S 3l1d `S1S31 `SNO11O3dSN1 !DNIOIAOHd Wdld ONIa33NION3 '9 OWNER OF LAND H4,jSTODEPTH OF WELL Pd r� ,1DDRESS I_9A _moi- STATIC LEVEL OF WATER FT. Sy LEGAL DESCRIPTION _—/0 J �L—�3L /C �� J n % �'3'<'eDIZAW DOWN FT. DATE - Started 1 Ended GALS. PER HR _0 0 0 PERMIT NUMBER Ft. to KIND OF FORMATION: From_ From Ft. to 2 Ft.- n JC '��419I IJ From 3 Ft. to__7—rFt. From --Ft. to Ft._ From_ From_��Ft. to,,S_/_Ft. Ft. From Ft. to Ft. Ft` -'t From Ft. to _Ft. _ From Ft. to Ft. FL From Ft. to Ft. From .Ft. to Ft. Ft. From Ft. to Ft. Ft. to From Ft. to Ft. From From Ft. to Ft. From Ft. to Ft. Ft. From Ft. to Ft. _ Ft. to From Ft. to Ft. From From Ft. to Ft. From From Ft. to Ft. From MISCL. INFORMATION: KIND OF CASING 6 :� O From_ Ft. to Ft. From_ Ft. to Ft.6€ From Ft. MUNIC PALITxw Y��— to to ENVIk;:Ur.Sp,�A From_ Ft. to Ft. From Ft. to Ft` -'t From---- Ft. to r r E: �, �, �• e From Ft. to FL From___Ft. to--Ft.--- o__Ft._FromFt. Froin-Ft. to Ft. From Ft. to - Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. _ From Ft. to Ft. From Ft. to Ft. From—Ft. to Ft— DRILLER'S NAME jJU��IC1iA1-I l,i �� Fu'/ r� UIV I�Ii)I1 ENVIitON�E�`(AI. SFRVI..�� MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 i 1 _u b CV Legal R Legal Description: ��� ¢✓L �`` �J-r►-I i�� G' 1 � A. WELL DATA Well Classification t�PN\h POA -l-, If A, B, C, D.E.C. Approved (Y/N) Well Log Present ffQN) __Date Completed �� Yield :7.5 U1't-i + Total Depth00 142 to laz IQ Depth of Grouting Static Water Level �'� t Pump Set At — Lt Casing Height Above Ground y Sanitary Seal on Casingd�RN) `y Electrical Wiring in ConduitT N) — Depression Around Wellhead (Y/d9T a L SEPARATION DISTANCES FROM WELL: I tX To Septic/HQ44frg Tank on Lot I—; On Adjoining Lots l I l To Nearest Edge of Absorption Field on Lot "I- ; On Adjoining Lots coo To Nearest Public Sewer Line - PJ _ To Nearest Public Sewer Cleanout/Manhole ps. To Nearest Sewer Service Line on Lot S25 14 - Water Sample Collected by � _ l I .Ze ; Date !n Water Sample Test Results Comments (� B. SEPTIC/HOLDING TANK DATA Date Installed 7--2±2- Size I to�� No. of Compartments StandpipesON) Air -tight Caps¢9/N) Foundation Cleanout (Y(jVD � Depression over Tank (Y/dP r" g%ate Last Pumped Pumping/Maintenance Contact on File (Y/N i/1. ;for —'--- Holding Tank High -Water Alarm (Y/N) �/�' Temporary Holding Tank Permit (Y/N) p SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: 1 To Water -Supply Well epi i To Building Foundation t� To Property Line C> "�_ To Disposal Field To Water Main/Service.Line o I+ k To Stream, Pond, Lake or Major Drainage Course Ot�t Comments TSS C IaS �G�OI- 72-026 (Rev. 7/88) Front Page.1 of 2 - C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata —�/>3(2_— Type of System Design Date Installed % "L Length of Field SS Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area X1 202 Statndpipes Present 67N) Depression over Field (Y/0' Date of Last Adequacy Test f 14 g3� Results of Last Adequacy Test`�� SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well ��� I To Property Line � 4=>, 4 - To To Building Foundatjor � t To Existing or Abandoned System on Lot P ; On Adjoining Lots 3b I r To Water Main/Service Line o I-4- To Cutback (if present) A To Stream, Pond, Lake, or Major Drainage Course I oto t 4- i'k.- To Driveway, Parking Area, or Vehicle Storage Area L-olc�) Comments D. LIFT STATION Size in "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. ""Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on inspection. S D 5 ENGINEERING Signed 17034 Eagle River Loop Road No 04 Company Eagle River, Alaska 99577 Date zd llglffr, MOA No. Receipt No. 0 ✓ Receipt No. Date of Payment / o-- L{ , Waiver Fee: $ — Amount: $ !7 ox- Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 of this is 'i( V 11 YTA CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA,- INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99515 Drinking Water Analysis Report for Total Coliform Bacteria SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 1 11 �s 17 4 2 I� I 3 4 61 READ INSTRUCTIONS BEFORE COLLECTING SAMPL Analytical Method: Membrane Filter ' No. of colonies/100 ml. TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.# ETTT Analysis shows this Water SAMPLE to be: PRIVATE WATER SYSTEM 4 Satisfactory _ ❑ Unsatisfactory ❑ Sample too long in transit; sample should Name Phone No. S & S ENGINEERING 1 034 Eagle River Loop Road No. 204 not be over 30 hours old at examination Mailing A66% River, Alaska 99577 - to indicate reliable results. Please send new sample via special delivery mail. City State Zip Code SAMPLE DATE: TR ® Date Received i d tel—H] - Time Received Mo. Day Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 1 11 �s 17 4 2 I� I 3 4 61 READ INSTRUCTIONS BEFORE COLLECTING SAMPL Analytical Method: Membrane Filter ' No. of colonies/100 ml. Lab Ref. No. Result* Analyst 1 I Imo/ V m U m BACTERIOLOGICAL WATERFANIALYSIS RECORD Membrane Filter: Direct Count Verification: LTB Final Membrane Fil is Reported By TNTC = Too Numberous To Cour e Time: OB = Other Facieria PART t of z RF.MAINDF.F -C FCLJ.CW Coilforml100ml Coilform/100ml a. M. p.m. CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ^ % 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 LABORATORIES ANALYSIS REPORT BY SAMPLE for Woxk Order # 9238 Date Report Printed: SEP 19 88 @ 1.5:38 Client Sample ID:L5, B4 SOUTH FORK Client dame a t': 3 UU114r INu PWSID :UA Client Acct SNSENGP Collected SEP 14 88 @ 14:00 hes. P.O.# NONE REC D Received SEP 15 88 @ 14:00 hrs. Req # Preserved with :4 DEG C Ordered By : RJS Analysis Completed Send Reports to: Laboratory Supervisor _:STEPHEN C. EDE 1)3 & S ENGINEERING Released By 2) ................,.............................................. .....................�........n...._................=a.._.=._:,._... Special Instruct: Chemlab Ref #: 2625 Lab Smpl ID: 2 Matrix: WATER Parameter Tested Result/Unita ------------------------------------------------------------------- TOTAL COLIFORM col/100m1 Sample ROUTINE SAMPLE Remaxks: SAMPLE COLLECTED BY RJS, Allowable Method Limits -------------------------- . .................. ..........a......... _.......... -...... 1 Tests Performed Sae Special instructions Above UA -Unavailable ND- None Detected "" See Sample Remarks Above NA. tdot Analyzed LT -Less Than, GT-Greatex Than o � F V C LABORATORIES t 5 ;MICAL- &; GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE fox Work Cider # 9238 Date Re ort Printed: SEP 19 88 @ 15:37 p Client Sample ID:LS, B4 SOUTH FORK, Client Name S & S ENGINEERING PWSID :UA Client Acct SNSENGP Collected SEP ].4 88 @ 14:00 hrs. P.O.# NONE REC D Received SEP 15 88 @ 14:00 his. Req # Preserved with :4 DEG C Ordered By : RJS Analysis Completed :SEP 16 86 Send Reports to: Laboratory Super isox;:STEPHEN C. EDE 1)S & S ENGINEERING Released By �Ir/T —C 2) Special_ Instruct: Chemlab Rof #: 2625 Lab Smpl ID: i 64Rtrix: WATER Allocable Paxametar. Tested Result/Unita Method Limits ----------- ----------------------- .------------------------------- NITRATE-N 0,47 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. ..................... ........... ..................... .....<........... ........_............ ............... 1 Tests Performed See Special Instructions Above UA=Unavailable ND. None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than Time Time Date Date Date Inspector Inspector Inspectors Comments Conditional Approval MUNICIPAI-11Y UV i FAT. 0° H ' N(- '. ENVIC 1 it. -1. A. S :0 "EC".TI: RECEIVED Date Sewer Installed Permit No. Septic Tank Size /fib Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank 4( APPLICANT FILL_ S OUT LOWER HALF ONLY Property Owner William E. Johnston P. 0. Box 334, Eagle River, AK 99577 Phone 94-9766 Mailing Address Buyer Mark Kudl a c/o P. 0. Box 249, Eagle River, AK 99577 Address Lending lnstitutionFi.rst National Bank of Anchorage, Parkway Branch achy Jones P. 0. Box 8-9066, Anchorage, AK 99508 65-3892 Address Realty Co. & AgentCommonwealth AREA, Inc. , Myrna Johnston Phone P. 0. Box 249, Eagle River, AK 99577 94-9555 Address Legal Description Southfork Subdivision Block 4, Lot 5 NHN South Creek Road, Mile 7.0 Hiland Drive Street Location Type of Residence Single Family 3 [I Multiple Family No. of Bedrooms ❑ Other Water Supply 3�7 Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Community ❑ Public Utility available. Sewa�gge Disposal 1g 8 V Individual Year Individual Installed: Public Utility: — ❑ Public Utility When Connected to ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. W CHEMICAL & GEI.,OGICAL LABORATORIES ii,,% ALASKA, INC. EPEN TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street ° � > o —�, P e°e.,�aae Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO ,BE COMPLETED BY LABORATORY WATER SYSTEM: Analysis shows this Water SAMPLE to be: I.D. ND., ;AA D.,Sati factory rr ff ❑ Unsatisfactory Water System NamePhone No. .. f , , ,1 - ❑ Sample too long in transit; sample should ',I'f not be over 48 hours old at examination Mailing Address ! r; to indicate reliable results. Please send E /F gt. s! v?,. new sample. City State Zip Code - Date Received SAMPLE DATE: "€ Mo. Day Year Time Received` SAMPLE TYPE: Analytical Method: ❑ Routine ❑ Check Sample (for routine sample ❑ Fermentation Tube With lab ref. no. ) ❑ Treated Water O Membrane Filter ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected Lab -Ref. No. Result' Analyst NO. LOCATION Collected By i t E -- -- I l ED 3 4 5 - - -*No.. of colonies/ 100 ml. or No. of Positive portions, 06-1220. (b) Rev. 1978 Date Collected _ BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Date Received Time Received— Presumptive - - 10ml I 10ml 24 Hours 48 "ours BEFORE Confirmatory - 24 Hours - - source a.m. p.m. Lab. No. 0.lml 90 null,* - I 1 1 1 I -.EMB - Broth 24 hours: - Broth 48 hours: COLLECTING SAMPLE _ Multiple Tube Report:. - 10ml Tubes Pmltive/Tctal 10ml POrtiona Membrane Filter: Direct Count - - Coliform/100m1 Verification: LTB - - - BGS Final Membrane Filter Results - Collform/100ml - Reported By Date f - -... - ! i`-.. Time• � y � - - Lm. p.m.