HomeMy WebLinkAboutAUTUMN RIDGE LT 28Autu n Ridge
Lot 28
#015-054-31
' Municipality of Anchorage Page
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
P,O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904
'ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT
Permit Number: SW030138 PID Number: 015-054-31
tame: - Wastewater System: New
Crown Pointe, Inc.
Address:
P.O. Box 112313 Anch., AK 99511 ABSORPTION FIELD
Phone: Number of Bedrooms: 5' Wide Trench
345-6277 Five (5)
Sod Rating: Total Depth from onginal grade:
LEGAL DESCRIPTION 1.2
Block: Lot: Subdivision: Depth to ~pe bottom from original grade: Gravel depth beneath p~pe:
28 Autumn Ridge 2
Township: Range: Section: Fill added above o~ginal grade: Gravei Length:
2
Gravel w~dth: Number of lines: ~ D~stance between trees:
Well: New 5 Ft. 1[ .t.
Classification (Private. A, B, C): Total Depth: Cased to: Total absorption erea: P~pe Material:
Private 44 F~. 44 FI. 640 ,~' ASTM 3034 PVC
Driller:. Date Ddlled: Static Water Level: Installer: Date installed;
Alpine Drillin!] 5/1103 26 ,t. Sanders and Sanders 61312003
~e,d: 30 GP~, IPump Set at:FI. Icasingl'eightAb°veGr°und:>2"'. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
"'~_ To Septic Absorption Lift Holding ~ublic/PfivateManufacturer; ~apac~ty
From ~ Tank Field Station Tank Sewer Line Anchorage Tank 1,500
Matenah Number of Compartments:
w~, >100' >100' NIA N/A >25' Steel Two (2)
Sur~aceWater >100' >100' NIA N/A ~ / LIFT STATION - NONE ON LOT
Lot une >5' >10' N/A NIA
O'
N/A
N/A
In. in.I In.
Foundation
Cu,~,n Dra~n None Noted Pu~ ~e & ~ede, ~,e~,nca, ,nspa~ons,e,or~d ~:
reme~s: BENCH MARK
Garage Slab
100.0 ~t.
Engineer's Stamp
..........
~cv:...
Inspections performed by: A Harala Dates: 1s~ 613/03
2nd 6/3/03 ['~t.'"~;;';;'~E'~
Department of Health and Human Services approval
Reviewed and approved by: /~/..-//~-~ ~/O-e~ Date:~ '~'
ge
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bra le, )-6655 - 343-7904
On-Site Disposal Inspection Report
Permit Number: SW0301~
Page 2 of 3
PID No. 015-054-31
ABBO1-F ROAD
1
/
/
/
./
PLAN
/
/
/
/
/
/
/
/
/
( s2
Site
S2
AS-BUILT
SCALE 1' = 40'
z
N 89'59'00"E 75.00'
®
WELL
DRIVEWAY ESMT.
(BK 463, PG 254)
Five Bedroom
Home
I A B
S1 28.2 110'0
S2 29.6 120'0
C4 17.0 ~44.0
1,41 55.1 J39.8
C5 64,1 J45.2
N 89'53'31"E 87.90'
BUFFER
E ESMT.
LANDSCAPE ESMT.
LOT 28, AUTUMN RIDGE
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK, 99519-6655 - 343-7904
On-site Wastewater Disposal System or Well Inspection Report
Permit Number: SW030138
Page 3 of 3
PID No. 015-054-31
96,9
............ Geo._~.ex_.~![e F._(~brl__c. __.
I)r~InFletd Rock
~---BS,0
64' Trench Length (NTS)
PROFILE AS-BUILT
Scole: 1" = 10'
INE DRILLING FRX NO. : 907 345 0202 Jan. 26 2004 Oi:21PM P1
Municipality Of Anchorage
Department of Health and Human Services
\~'~1/ 825 'L' Street
~ P.O. Box 196650 anchorage, Alaska 99519-6650
l~ick Mysttorn' h~,J/vnvw, c~a n~horage.ak.us
Mayor
Permit Number: #SW ,030138 Date of Issue: ,5-'I-03 P~.rcel Identification Number: 015-054-31
Date Started: 8-21-03 ,Date Completed: 8"21'03. ls well located at approved permit loc~tion? [~ Yes ["-] No
Legal Description:
Property Owner Name & Address:
~'~orehole Datai
Autumn Ridge Lot 28
Crown Point Inc.
PO Box 112313
Anchorage, Alaska 99511
Depth (ft)
From To
Method ofDrilllng [S/] air ro~z.,'y ~'] cable tool
Casing type: stc~
Wall Th]6kn~ss: ,~$_@ inches
Diameter: _6 inches Depth: 44 feet
Liner Type:
Diameter: inches Depth: feet
Casing sficlmp above ground: _~ feet
Static water level (from ground level): 26.__feet
pnmping level:. 44 £c=t afar
_.2 hours pumping 30 gpm
Recovery Rate: 3_0. gpm
Method of Testing: .air I~
Well Intake Opening Type:
[~ Open End [~] Open Hole
]--] Screened Start feet Stopped _ feet
[] Perforations Start feet Stopped__ feet
Grout Type: bemoni~e ii 8 Volume: I bg
Depth: Stat 0 feet Stopped ~ feet
Pump: Intake Depth _. feet
.Pump size hp Brand Name
Well Disinfected Upon Completion? [~ Yes ~'] No
Method of Disinfection:
Comments:
Well Driller: Alpine Drilling & Enterprises
PO Box ~'i0496
Anchorage AJaske 9.951 f
S0il Type, Thickness & W~t~r Strata
stick-up 0 2
organics & silt 2 8
sandy silt 8 21
gravel 21 25
gra. velly silt 25 37
water sand & gravel 37 44
. 'owner ~4~- 30 ~s of completion and thc property
Atteuli0u: The well driller shall pw~id= a well log to thc property . ..... ,.,: .~ ~ ....~ ........ ,.
MUNICIPALITY OF ANCHORA GE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: May 19, 2003
Expiration Date: May 18, 2004
Permit Number; SW030138
Legal Description: ~Autumn Ridge E(St 28,
Design Engineer: 0014 Anderson Engineering
Owner Name: Crown Pointe, Inc.
Owner Address: P.O. Box 112313
Anchorage, AK 99511-
Parcel ID: 015-054-31
Site Address: P.O. Box 112313 Lot Size: 40074 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
[~ Disposal Field [~ Septic Tank
~-~ Holding Tank [] Privy
~-~ Private Well
Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Issued By:
Parcel I.D.
Municipality Of Anchorage
Development sei-vices Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number'SW
Property owner(s). Crown Pointe, Inc.
Mailing address (1) 'P.O. Box ~12313 Anchoraqe, AK 99511
Mailing address (2).
Legal description (Lot, Block & Sub'd.) Lot 28, Autumn Ridge Subdivision
Legal description (Section, Township & Range)
Lot Size 40,074 SF Acres/Sq. Ft.
Day phone 345.6277
.Zip Code
THIS APPLICATION IS FOR:
Sewer Only []
Sewer and'Well []
Sewer Upgrade []
THIS PROPERTY CONTAINS:
Hot Tub []
Swimming Pool : []
Therapy Pool []
Number of Bedrooms Five (5)
Well Only
Water Sto~age
Jacuzzi
Water Softening Unit'
[]
[]
[]
[]
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property Owner or authorized agent)
Permit Fees: ~-",_~) · O O
Date of Payment: ~..11~/~'~
Receipt Number: JS~)"~,~
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
· ANDERSON:,ENGINEERiNG.
ANCHORAGE, AK 99524
i,=-: 522-6779.:(FAX)
May 13, 2003
Municipality of Anchorage
Development Services Department
.On-Site Water and Wastewater Program
4700 South Bragaw Street
AnChorage, AK 99519-6650
Subject:
Lot 28, Autumn Ridge Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 28, Autumn Ridge Subdivision intends to construct a five-bedroom
home on the lot. We are therefore requesting a permit be issued for the construction of
a new well and septic system to serve the proposed home. The attached Site Plan and
backup documentation identify the location and configuration of the new well and septic
system and the parameters used in the design. Also identified on the plans are the
locations of neighboring wells and septic systems, alternate absorption site and the test
hole locations. Existing drainage patterns are shown and will not be altered by the
construction of the new system.
Test holes have placed on the lot during the subdivision phase indicate clean sandy
gravel with percolation rates less than 1 minute per inch. Mom than 50% of the
material encountered in the hole is less than %" in diameter. It is unnecessary to place
a sand filter in this material. Groundwater was noted during.our field testing at 10'
below the surface and has stayed at this level since the original placement of the holes
even during high groundwater Periods. We are proposing therefore to construct a 5'
wide absorption bed with 4' of gravel beneath the distribution pipe. The total depth of
the trench will be 6' to maintain 4' separation from groundwater. Additional fill will be
placed over the trench to provide 3' of cover.
The ground surface on the lot slopes as shown on the attached Site Plan with a shallow
slope near the proposed absorption trench. The new trench will be constructed on a
fairly fiat surface in conformance with Municipal requirements and parallel to ground
contours where possible. All components of the new septic system will be constructed
a minimum of 100' from all wells in the area.
Lot 28, Autumn Ridge
May 13, 2003
Page Two
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Michael E. Anderson, P.E.
Attachments
/ /
26
43,151 sq.ft. 40,262 sq.
Sept
I\
;q.f
'EAST'
AREA YST PLAN.,~~...., ................. ~...L,
AUTUMN RIDGE SUBDIVISION
LOT 28
ABBO'I'r'ROAD
N 89'59'00"E 75,00'
DRAINAGE
I / BUFFER LAN:
Proposed
Well
ESMT.
,/
/
/ DRP/EWAY
FOR LOT 27
63' LonQ x 5' ~de
x 4' E,ff~ctLye D.epth
Absorption /rencn __
1.500 Gollon
Septic Tcnk
~ 10' ,
II Ntem~te ~t~
Faq
SITE
RN. FLR.
EL -
F~ve Bedroom
Home
x
N 8g'55'51'£ 87.g0'
SCALE
PLAN
l' = 40'
LOT.28, AUTUMN RIDGE SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom House 5' Wide Trench System
Perc. Rate: LT 1 Min./Inch 1,500 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
5 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 625 SF Absorption Area
625 SF/5 LF (Width)* .5 (Red. Factor) = 62.5 LF Trench Length
THEREFORE: Construct a 63' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be
6' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench.
4'0"
Natural
Backfill
Geotextile
% O
Fabric
4" Perforated
PVC (Holes Down)
-- Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
(.o SCALE) ~,~ ............
_.- ~:....." _~.....~ ~o.
NOTE: Grade Area Over Trench to Drain Away. ~'.~/' .,,,~.
Minimum 6' Separation From Bedrock. ¢~,.':,..%,"~ ........
Minimum 4' Separation From Groundwater.
,/..E...................
Minimum 10' Separation From Water Service Line.
Minimum 100' Separation From Surface Water or Streams. ~-~.'... No.
~;.*'~;: .......... '.'- <~
Municipality of Anchorage
Depadment of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
performed For: Bob Klein
Legal Description: ,Lot 28. Autumn Ridge Subdivision
SLOPE.
I ' PTIOL
2 ..
" ' TEsTHoLE NO. 44
4 ..
' .
· 5 '
8 .
· · .Was Groundwater ..
9 Encountered? :Yes S
· If Yes, What Depth? 10' L
10 Ground ' Depth to Water" .. . . O
· -. Water· . After Monitoring '" 10' "' P '-
- tl Date: . 1122/00 E
Date performed: 12/7/99
SITE PLAN
Reading Date Gross Net' Depth 3-o Net
Time Time 'Water Drop
1 7-Dec 11:41 " 2.25",
2 11:43 2 8' ' 5.75" .
3 11:44 2"
4 '11:46 2 8" .'6" '
'5 ' 11:47 2"
6 11:49 2 7.75? · ' · 5.75"..
· B(~ttom of ~
Hole
.. . ~ ~ ¢, ,, ~ · ..
18
19 . "t.~~ . Perc. Rate: LT 1 MinJInch Perc. Hol~ D~ameter: 6"
.... ... ~ "' . Test Run Be~een 4 Ft. and 5' Ft.' ' ..
~,, -. Comments: ' Percolation Cavi~ Presoaked Prior to Testing:· '
Pedo~d I, Michael E: Anderson: Ced~ That ~is Test Was Pedorm~
By~
In Ac~rdance ~th All Stateand Municipal Guidelines In'Effect On This Date: ' 1120/00
Iff
II
II
II
II
Il
Ii
i1
Municipality Of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650'
SOILS LOG - PERCOLATION TEST
Performed For: Bob Klein
. Legal Description:. Lot 28. Autumn Ridge Subdivision
" SLOPE
Date Performed:
SITE PLAN
2
3
'4
5 -
7
8
9
'10
11
13
PTIOL
:rES'I'HOLE 'No: 45
Ground
water.
Bottom of.
H01e
-was Groundwater
Enc~)untere(J? Yes .'
!f Yes, What DePth?. ' 11'
Depth to Water '-
After Monitoring 11~ .
Date: 1122100
S
'L
0
/.!
'Residing Date Gross ',let: . DepthTo Net
'Time Time' . Water Drop'
1 7-Dec 1:41 2"
2 '1:43 2~ .8" 6"
· 3 .1:44 2"
4 1:46. 2 · 8" 6"
5 , 1:47, 2" ': ,..
6 1:49 '2 8" 6".
.Perc. Rate: LT 1 Min./Inch ' Perc. H01e Diameter: 6" .
· Test R[Jn Between 4 Ft; and 5 Ft. "
'-' ' Comments: P(~rcolation Cavity Presoaked Prior to Testing.' .... : ' ' ·'
·, Performed By: A.' Harala. I, Michael E. Anderson'. Certify That This Test Was Performed
In Accordanc~ .With All State and Municipal Guidelines· In Effect On This Date: 1120/00
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 28, AUTUMN RIDGE SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,500-gallon septic tank at the location shown on the site plan.
Work also includes the construction of.a new absorption trench 63'
long by 5' wide by' 4' effective depth als0 at the location shown on the
Site Plan. The total depth of the trench will be 6' below existing
ground and the distribution pipe will be placed at 2' below the surface.
All components of the new absorption trench and septic tank must be
constructed a minimum of 100' from any surface water and 100' from
wells in the area. A minimum of 4' of cover is required over the septic
tank and 3' over the absorption trench. In lieu of cover 2" of direct bury
insulation and 2' of cover may be placed.
Construction shall be in accordance with the approved site plan,
design drawings, 'Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
DispoSal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,500-gallon septic tank must be procured from a certified
septic tank manufacturer if the existing tank is found to be defective.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
Lot 28, Autumn Ridge
· May 13, 2003
Page 2 of 3
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
o
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between'the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in' diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
Contractor shall verify the septic tank and drainfield are a minimUm
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
o
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
Lot 28, Autumn Ridge
May 13, 2003
Page 3 Of 3
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing..
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under'the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted'after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile 'fabric, gravel, distribution, piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as-built of the completed system.
Parcel I.D. 015-054-31
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
p.O. Box 1'96650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORIT:Y APP"R'~-,g,i- ........ ~ .............. i ..................
FOR A SINGLE FAMILY DWELLING.
HAA#, ~-~ L~'~
Expiration Date: ,~- 3' O ~7~
GENERAL INFORMATION
Complete legal description Lot 28, Autumn Rid.qe Subdivision
Location (site address or direCtions)= ~A"~l~ott Road
Current Prop(#ty owner(s). Crown Polnte, Inc.
Mailing address P.O. Box 112313 Anchora.qe, AK 995tJ
Lending agency
Day phone 345.6277
Day phone, .
Mailing address
Real Estate Agent
.....'..Mailing Address
::Unless otherwise re'quested, HAA will be held by •SD for pickup.
NUMBER OF BEDROOMS:
TYpE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
- Public Water System
Five (5) ,,
Well
Day phone.
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
[] Community On-site ~
[] Public Sewer []
The Municipality of Anchorage Development serVi(~es Depadment (DSD) Issues certificates of Health Authority
Approval (HAA) based only upon the representatio, ns given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply §ystem. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days'from the date of issue for properties served by a private or Class C well and may be reissued with
new water Sampl~ results less than 30 days old. (Cedificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Static water leVel - ~ * 26 .
":;* ,:~ { '~ ; .... I;'~' *: * ' "~;'1' ~ i ;: ........ t' , ,
I' ~-odUction*' ' "30, , ' ,t~P.m. ' ' ;i.;.!' ........ .'--'r' g.p.m.
We p ..- _ .......
WATER SAMPLE RESULTS: '" '
· _ ..;,i ~:~, ,i2 "'"'"';~'--'*' '~" Nitr~t~' 405 'm"/!~'';I~" :'"': '~Otherb'acteria u co~onles/1uuml.
L;ollTorm u COlOnles/luU m~. · ,
Date'ofsample: 11912004 ', ,,. Collec!'.d Y. , ,
sEPTIc/HOLDING TANK DATA '. '
...... t t ' i , f .....
Tan~ TvP~/Material '; septic/steel ,,.: ' ,' ,'
.,~,T°n,k s ze''~', ~,500 ..oal. . ,: Number. of Co,mPa~tmepts
~,.,~;~,~,tio~ cleanout ~/N~ Y ' Depress on over tank (,Y/N) N :~ i" H gh w,@t,er ,a.,I,a,r~ (Y/N) N ,,
.._,.~ x, _;~.~,~,t,,',, ' · . -. , , Pumoer .New Construction.,
' ' ' ' Il ~ ' ; ' ''' ~ ~'' I ' ' '
ABSORP, TION FIELD DATA: ," ~"'
"'-;~' '-"--'~ ~-' ='3~2003" ~' Soil ratinn In ln~/fit orftt/bdrm) '1.2 GPDISF I I !, i Sys,te,m, ,typ~ .5 W~de Trench
SGS Ref.#
Client Name
Project Name///
Client Sample ID
Matrix
1040255001
Anderson Engineering
Lot 28, Autumn Ridge
Lot 28, Autumn Ridge
Drinking Water
All Dates/Times are Alaska Standard Time
Printed Date/Time 01/16/2004 15:09
Collected Date/Time 01/09/2004 10:45
Received Date/Time 01/09/2004 11:05
Technical Director ~.. Step~ C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date Init
Waters Department
Total Nitrate/Nitrite
4.05 1.00 mg/L EPA 300.0 C 01/13/04
Microbiology Laboratory
Total Coliform
3 OB, W/Fecal Coli col/100mL SMI8 9222B A (<=D 01/09/04 DKC
~~01119-04 06:29P~
1
FROI, I--CT&E ESI, SGS ENV SERVICES
9075615301
:;
SGS/C'rE .ENVIRONMENTAL SERVICES
T-114 P.Ol/01 F-035
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE '
-MUST BE COMPLETED BY WATER SUPI~IER - '
[~ PUBLIC WATER SYSTEM ID# - .
[~IVATE WATER SYSTEM
[] Send Results [] Send Invoice
'200 W. POTTER DRIVE
ANCHORAGE, ALASKA 99518
Tel: 907-562-2343
Fax: 907-561-5301 "
, 1040301
,:llru ~ N.m~ar
SAMPLE COLLECTION:
Mon~ Day Year
Transpo~
to ~] ~y= ~ Same as colle~or O~er:
TO BE COMPLETED BY ~BORATORY
~ample Receivin~Date: ,(X~I 4
'1 Z. tpCm~e ....- .o
SAMPLE TYPE:
" [] Routine
Repeat Sample
(refer to lab no.
[] Special Purpose
[] Sample over 30 hours old;
Results may be unreliable ·
[] Treated Water
[] Untreated Water
[] RUSH SAMPLE
Time:
Temp: ~ \~' 4~ [] 48 Hour Waiver Phone #;
Delivery Method: ¥'~.~ ~----' , For~
~ PriSma Hame ~e
comments:
..... ,iSent ~ ^DEC: !
Baclerioloqical Water Analysis Record_: I ANC FBK JUN
MMO-MUG {P/A) RESULTS:
IDate/Time: ....
Anaty$1s BeD_an: ' i/Iq/Oq t~. tD __ Totm conform:
I . L
Analyst: ~ .. E. Coli:
Analytical Method:
[] Membrane Filter
[~ MMO-MUG (P/A)
Reported By:.s~t~
MEMBRANE FILTER RESULTS:
Direct Count:
VelSficatic~l:
LBGB:
\\pelt a\p ublic\DOCUMENT~FORM S~licr°\C°li Form.xls
I Sent to Client:
lPhoned
Colooies/lo0ml ~Daterrime:
lSpoke with: ...
I~ Saiisfact~ry
[~ Unsatisfactory
Faxed r"-]
TNTC re'Tea Numerous
Oil · Other Bacteria
Form # FW- 0053 1D/24/03