HomeMy WebLinkAboutDEBORA BLK E LT 6L�1
PST"9 "OTO
\ t MUNICIPALITY OF ANCHORAGE I^,
� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
cif ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501
Telephone 2644720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
NAME
PHONE �1
GJ
ONEW
L.
PGRADE
MAILING ADDRESS �/(� ,�/
D. d.i� /�
(/ e
LEGAL DESCfl IPTI JV
yG-y it
� (1./3 Cl��
6'.
L'
LOCATION
Ju4All z—
NO. OF BEDROOMS r`
DISTANCE TO:
Well /�. f4
S . Z
Absorption area f
?��
Dwelling p �,
Z /
PERMIT NO.
G/n/- NU�1Bc,QE �'
O
_
EZ
Manufacturer A/1
Mate Q /
No. of compartments z
Liq. capac l/iin gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
IS Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
—10Z
_ FQ-
Manufacturer
Material
Liquid capacity in gallons
0
w=
DISTANCE TO:
WellAy. /
3Q .�
Foundation
2
Nearest t roof..
P R IT N
/, + at,,A£ .E40
LL Z
No. of lines
Length of each line ,�
Total length of lin*
Trent width
Distance between lines LO /,(,
2
Z
inches
Top finish
tepa�bfTeath til
IF'/Total
effective rption area
F¢-
of the to grade1, („�
L
y1
p
inches
Length Width
[ pth
PERMIT NO.
w
Q f-
Type of crib Crib diama r
Crib depth
Total effective absorption
area
W L
DISTANCE T0: Well
Building foundation
Nearest lot line
J
Class Depth
Driller
Distance to lot line
PERMIT NO.
w
i
DISTANCE TO: Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
i
PIPE MATERIALS
vG
s
f
SOIL TEST RATING
[J
INSTALLER
REMARKS
t
�
S 7
If
I
-e
Ao,
L 7 ��o;ssaioy,,M�
oe
Alt
I,
F%
APP( HOy D � \: ;�- DATE
LEGAL fG�/'(/ ., ...•�
S & S F.ngitla.,Hril�
jne-
72.013 iRev. 3178) / /
mur4 i c I F}nL- I TY cF= Fir4cHORRrE
DEPARTMENT J'�`, HEALTH AND ENVIRONMENTAL /�OTECTION
825 STREET, ANCHORAGE, AY,. 95_.;1
264-4720
WELL- Fir4E> Oro—SITE SEWER F}EFtt'1 I T
PERMIT 140. C 810776 )
APPLICANT RON SWAVELY PO BOX 114 99577 694-2544
LOCATION
LEGAL L 6 B E DEBORA S/D LOT SIZE 250000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER. OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
L`EF~TH= o L_Er413TH= :F--2 Gf;; nVEL_ OEF}TH= 4
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DP,AINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN 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 CIN FEET).
FZElJ I REDS SEF T I c TFirJF. S I LE= 1�� �FiL_LOt15
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 C 2 7 I rAn3F:D'ECT I Q" FIRE FZErv-U I REL7 ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A 14ELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE 14ELL 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 LIME IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER, INSTALLATION.
F� E:FZM I T EXF:�' I RES OFEE CEr'7BER T1s 1SL 1
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 THE CODES.
3: I UNDERSTAND THAT THE OM -SITE SEWER. SYSTEM MAY REQUIRE EFJLARGEMEFJT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED
APPLICANT RON 51-IAVELY
ISSUED BY
E 23_siZ_2J------
V4. 0
Y OF
Departmentt Health and Environmenta�rotection
825 b Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT
WELL ANDJW ON-SITE SEWER PERMIT
Applicant: F#Af SmpAYEtV Mailing Address: Rasir//y
Location: Tik..m?_a_ Phone Number:„►901:tSyy
Legal Description: LT 4 F k&A4 S_!21 Lot Size: %sf
Type of Soil Absorption System Is:7-geAtN oto oN 40*7 W 6 At&A9 $/A.
Trench: X._ Drainfield: _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: J.13_ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
1 � �
DEPTH �_ LENGTH . GRAVEL DEPTH V— 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 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. %IAN4k ipso ” b/all look.
* * ' * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
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 1
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 requite enlargement if
the residence is remo eled to include more that 33� be room
Signed: Issued by /J"IealeKt-
Applicant �1
Date: 2-A % — V
SWP/024(1/81) virtu N Loe.147o oN for g/,�E j7FdoAA s/O
1#7 7 8/E E DE10-A.9 j/b 114J ASS •EtwT ♦N Tks`we
FiR I sT 3* 8/k f P-6&^9 A/f..
1
by
A & L DRILLING COMPANY '
B0X 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE694.2589
/
OWNER OF LAND PAJt= S'ELC l % DEPTH OF WELL 71 /
ADDRESS : STATIC LEVEL OF WATER FT.
LEGAL DESCRIPTIO"' Zp7' G A tF Dcdal.9 [)RAW DOWN FT. c%0 '
DATE - Started Ended 7 GALS. PER IIR 3 C O
PERMIT NUMBER -7k 0 O 10 �L—T�J KIND OF CASING TS an
KIND OF FORMATION:
From (9 Ft. to-c2—Ft. From Ft.
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MISCL. INFORMATION:
271
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9 7Fq
x,95',", �. t3oTTown (G R
DRILLER'S NAME
?, <_i
MUNI iC I F!lf=ll I TY QF' nNCI "4--;ZFRRiGE
DEPARTMENT ( 'HEALTH AND ENVIRONMENTAL' ]TECTION
825 'L• STREET, ANCHORAGE, AK. 995wi
264-4720
WELL FaEFTM I T
PERMIT NO. ( 780010 )
APPLICANT DAVE SELLILS
LOCATION EAGLE RIVER
LEGAL LOT 6A BE DEBORA #2
PO BOX 197 EAGLE RIVER
694 2588
LOT SIZE 16800 SQUARE FEET
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR R PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F>EFZM I T E?XF" I FZESa L7E=CTEw E3EFZ NAL, 1&7EB
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 THE CODES.
SIGNED
APPLICANT DAVE SELLILS
ISSUED BY
V3. 0
1 RETURN T0: Division
o Porcupine Goollos Iccal I�i'e'1 21)SurveysJODI (OGGSI
' -6615)
Anchorage. Alaska 11501
YAT[R V 11 R[CORO
A .!r .. ..��•� rail"
'
Drilling Company
i
LOCATION Or WELL Please coarobu either la, Is. or Ic.
�s
'
is. mom"" Subdivision Lot [lock Ib. Fraction Sactlon 1b.
1
la Distance end Direction Ira. Road Interac00111
Street Address and Area of Well 1,4cstl0n
WELL LOG
Feet 601or
Material Type
,'C'. C1r, •,
LN
41 1
l.t t7
F'e.:. C'.•
1 li
t,cs:
t.`. , 1
t.. r,.•
x.11
STATE Of ALASKA
DEPARTMENT Of NATURAL RESOURCES
U.S.C.S. Local to.
Drilling Permit No,
A.O.L. No.
township Mo la len
WS EN
). OWNER Of VELLI s.... .. '
Address:
X11
A. WELL DEPTH: (CONT) fated) Surface [bvatlon Date of
CaNpl•tlon
ft. -- - l
5.
[]Cable tool "❑Rotary C)Drlven Dug
[I Roger ❑Jetted ❑bred ❑Others
6. USE: .QOon•stic 0Public Supply Industry
0I rr lgat ion ❑Recharge ❑Co'rerclal
„ F]Test WellOther:
T. CASING: E3 Threaded ;Q Wel sod•
/_i• In. to ft. Depth Weigh[ lbs/ft.
z` In. to ft. Depth
�. RIRISH DR WELL:
i,
TyMt plarteri
Slot/Mash Site: Length:
Sat between ft. and ft.
Fittings; '
1. STATIC UATIR L[y[Li ft.
0Above clIeler land surface
Type of Measur•Nentt
10. PUMPING LEYEL below land Surface
ft. alter nn. puping #.P.M.
ft. after* hrs. pooping O.P.M.
11. WELL HEAD COMPLETION: Ulm Approved pit
QPItI"eli AdsPtaf Inches above grade
J2: GROUTING: Well Grouted: UTas -UNO
t. Material: ❑Neat carnt [3 Other:
13. ►UN: (If available) MP 0-1
•. langeh of Drop PIM Et. upeelty q•p•r
Type: •QSubrrslblp ❑Ree lProcatirp
ft�--
❑Jet ❑OtMn
Ib. REMARKS: 'L'1 N r 1. :'� !: 1 ;,r• .. [ L.. i.l
15, WATER WELL CONTRACTOR'S C[ATIPICATION:
This roll rs drilled under My Jurisdiction and this report Is true to the best of my snowlCOge and belief:
Asillst-or.4, 1,
vf.MN .'e Contract License WIT)er
Address
Signed: �%-" s _. �i �1 -. Oates
utnar sed Representative /l r
Fare OI'YK Copy Distribution: WHITE ' State DOGS. PINK - Driller, CANARY - Custoeer
/
i
-a
APPLI('IT FILLS OUT UPPER HAI'ONLY
Time
Property Owne,TcwA) 9 Zx'vrf1/f! N n/S(£�
Phone
Mailing Address,-;!;)-,-) jU/l.rJ171-; �^� s/�l
X19 </l�f / II T2 Zip Code 95 7
�.//heap
Buyer �Sc&V-gx £. 1 1/OM.t/ 4 /2L160'e19•
Date
Address Zip Code
Date
Lending Institution Qr�C{JON/��� 7770.�TG fJ�£ e�SC.0//17JS
Phone
�j
Address %D / ` , v D01-2 �,v 9`��ICHM l96 £. Zip Code / �s
7
a / //—
Realty Co. & Agent14�(�j/7,—sro �ctyc ff�S .LA��, ,ifi!//�/9 �7/J/<Er/
Realty
Phone
Address /j/ () �' 1306�� 3nNCr,���AGL Zip Coded/ 0'5
/
Q7f—r oGVu
dorStLegal Description /01-
reet Locaunno i xe'-.
Street
L cl-r G
Type of Residence
Single Family -
Multiple Family No. of Bedrooms
( frXPPROVED BEDROOMS
O Other
( ) DISAPPROVED
Water SupplyI
�1 Individual �'
m"
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
[j CommunityFor
wells drilled prior to that date, give well depth (attach log
If available).
O Public Utility
Sewer Disposal '
IcIndividual Year Individual Installed: 1991
Public Utility When Connected to Public Utility:
Solis Rating
❑ Holding Tank
Well To Absorption Area
Well Log Received
Septic Tank Size
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOl1EST BEFORE PROCESSING CAN BE INITIATED.
("—Si
Time
Time
Time
Time
7 ` L
G
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
L cl-r G
( frXPPROVED BEDROOMS
'CONDITIONS OF APPROVAL ^
( ) DISAPPROVED
( ) CONDITIONAL APPROL: !�
C.—
DATE
BY: C
Solis Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
("—Si
Well to Tank
-
-
D. .RECEIVED
_
NSPECTION APPOINTMENTS
TIME
mac_ 1�
TIME
NU OMS
TIME
L7 l
�'Fwo ❑ Five
MULTIPLE FAMILY
❑ Three ❑ Six
DATE
W44��ATTACH WELL LOG. A well log is required for all wells drilled
DATE
DATE
r
OLit
2 - I
INSPECTOR
ONSITE SYSTEM WAS INSTnnAL/LED.
INSPEOR
INSPECTOR
INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITI7
1t
t f_. Yk C'L I. LIsA.
MUNICIPALITY OF ANCHORAGE Dem. Of w40H S
F2CTECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC- p4TAI
Sn L Strsat • Amborap, AW W 99601
1SB1
i
JUL 2 7
ENVIRONMENTAL SANITATION DIVISION
Telephone 26"720 IR E C E IV E`�
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incosnplew requests will not M proraed. Please allow ten (10) days for processing.
1. PREI!RTV NER
1lrQ�
PHONE
6f(/.>
MAI LAG AD KESS
'rj2 &T_/j L/
fiAz� .� /t.✓4t— A 94 "77
PROPERTY RESIDENT lit
clotemm from above) PHONE
2. BUYER
PHONE
MAILING ADDRESS
3. L NDI Q INSTITUTION �. t
PHONE
MAILING ADDRESS
8.S ^ O
4. REALTOR/AGENT
PHONE
'PAUL_
MAILING ADDRESS
S. LEGAL DESCRIPTION
L,p i rL
STREET LOCATION
—J c®o
mac_ 1�
SIDENCE
NU OMS
INGLE FAMILY
❑ One ❑ Four ❑ Other
�'Fwo ❑ Five
MULTIPLE FAMILY
❑ Three ❑ Six
P{LY��/)DIVIDUAL* NT0
W44��ATTACH WELL LOG. A well log is required for all wells drilled
COMMUNITY
since June 1975. For wells drilled prior to that date, give well
PUBLIC UTILITY
LSEWAGE
depth (attach log if available.)
POSAL SYSTEM
INDIVIDUAL/ON-SITE"
ONSITE SYSTEM WAS INSTnnAL/LED.
PUBLIC UTILITY
/nYEAR
YlRLt) ! fP1,Itn^(o f�. (t�fL]LchC
INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITI7
1S
n of o (R«. 6/79) rY �l St•t ♦. , I ,-+ _4 T � �d -itc ti c � �W � T G Wu, J1.�%/
�% 7 ,tZ'o5.z,....ad LIQ 3rY ,N1//or_ o,v �.w�.�_ r�*T s�.uw, Iv0r
oN Zi G c% �N ,Z4 ? 7z47-tS S1gR�� 'I!'�- ('�
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic! olding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
LJKAPPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE !�J }(�• /
8 i/
BV
¢1 tit �2.,✓ ASL U�--��1A.�,fA c�ism 1pd-0
,v. 6/79) I f `,m,4,
MUNICIPALITY OF ANCHORAGE
OF HEALTH & ENVIRONMENTAL PROTECTION
Environmental Sanitation Division
0DEPARTMENT
•
825 L Street - Anchorage, Alaska 99501 Telephone 264.4T20
J' CERTIFICATE OF INSPECTION
SEWER AND WATER FACILITIES
1. PROPERTY OWNER
Ron Swavely
MAILING ADDRESS
Post Office.Box 114 99577
2. LEGAL DESCRIPTION
Lot 6'Block E Debora Subdivision
3. TYPE DWELLING
X9 SINGLE FAMILY RESIDENCE O OTHER (Describe)
O MULTIPLE FAMILY RESIDENCE
4. WATER SUPPLY
fXc INDIVIDUAL
O COMMUNITY/PUBLIC
5. SEWAGE DISPOSAL
X9x INDIVIDUAL/ON-SITE
0 PUBLICUTILITY
O HOLDING TANK (Maintenance Required)
XX APPROVED FOR two BEDROOMS
J': r
El CONDITIONAL APPROVAL (See Attached)°-
SEE NOTE ON THE REVERSE OF
O DISAPPROVED APPROVAL. -
DATE
BY (TITLE)
August 14,
961
72-014 lanai
8-14-s1
This residence(Lot 6 Block E) and a neighboring residence
(Lot 3 Block E) both have separate sewer systems located on
the neighboring lot(Lot 7 Block E). The major portion of the
absorption trench for Lot 6 Block E is located on Lot 7 Block E.
9LASKA, INC.
CHEMICAL & GI )GICAL LABORATORIES '
TELEPHONE 19071-2794014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
/A\\
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER II TO BE COMPLETED BY LABORATORY
WATER SYSTEM:
N I I.D. NO.
Water System Name _ Ono" No.
Mailing Addreu
rr.t. .� -A
city State I zip Code
SAMPLE DATE: C1 I Z
Mo. Day Year
SAMPLE TYPE:
❑ Routine
❑ Check Sample (for routine sample
With lab ref. no. t p TreUntated WWater
ed ater
❑ Special Purpose
SAMPLE Time - Collected
NO. LOCATION Collected By
2
3 L
4
5
READ INSTRUCTIONS
BEFORE ;
Analysis shows this Water SAMPLE to be:
l[" 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 J '%
Time Received
Analytical Method:
❑ Fermentation Tube
.❑'Membrane Filter
Lab Ref. No. Result, Analyst
.n-� j m
I I m
I I m
m
- •No of co omos/ 100 ml o, No of Povr..s ooroom
06.1220 IN BACTERIOLOGICAL WATER ANALYSIS RECORD
R". 1976 Z
Date Collected Souris
a.m.
EMp prom 24 houraf Bfetn as noun,
COLLECTING SAMPLE Multlo's Tube Reponf 10ml Tubes PoeltM/TOW 10ml Ponlone
Membrane FMerr Direct Count Colirorm/10am1
Verification, LTO BOB
Pinel Membrane Filter Results - 1 Coilform/160m1
�� 1 I �. w
Resorted By Das 1 - — ..
Time f n'•� ; a.m.
P.m.
n
1�
JAju licipality
of
. nchoraecsia�
n
POUCH 6-650
ANCHORAGE, ALASKA 99502-0650
(907)26-1-4111
TONY nNn„tc S.
VA Y014
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
December 7, 1982
T0: Whom It May Concern
Subject: Lot 6 Block E Debora Subdivision
222 Juanita Loop
Bacterial analysis of drinking water is affected by the
use of an iodizer. The water source may be contaminated
from the well, however, an iodizer placed between the well
head and the residence could result in the contaminating
bacteria not being detected by analysis.
If there are any further questions, please call this office
at 264-4720.
Sincerely, � g-
0�
Les N. Buchholz, R.S.
Program Supervisor
LNII/ljw X
J � v
Q
CHEMICAL & GLe LOGICAL LABORATORIES k.e, ALASKA, INC.
TELEPHONE (907)-2784014 ANCHORAGE IBUSTRIALCENTER
274.3364
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name Phone No.
Mailing Addreu
City State 2iP Code
SAMPLE DATE: = =
Mo. Day Year
SAMPLE TYPE:
❑ Routine
❑ Check Sample (for routine sample I ❑Treated Water 1
with tab ref. ❑ Untreated Water'
❑ Special Purpose
SAMPLE
Time
Collected
NO.
LOCATION
Collected
By
3
4
5
II
L
1
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
0 Satisfactory
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
17,17��7i
Time Received i =1117 n
Analytical Method:
❑ Fermentation Tube
❑ Membrane Filter
Lab Ref. jN�ol. Result- Analyst
M
I I m
U m
.No co cd mes/ 100 mi. Or No of ftV1 . POb Wu
06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rw. 197e
Dale Collected sour"
• a.m.
EMB arum-
MultIPMTube RWGrtr 10ml Tubes Paeltt"rrOtal 10ml Porth"'
Membrane Pater. Direct Count collform/looml
Verification, LTB - eoe
final Membrane Pala Results Callormnoaml
RaPwted CY Date
CHEMICAL & GLuLOGICAL LABORATORIES ALASKA, INC.
TELEPHONE 4907)•2794014 ANCHORAGE INDUSTRIAL CENTER
$74.3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER II TO BE COMPLETED BY LABORATORY
WATER SYSTEM: F7 I D' J
_— .. I.D. NO.
Water System Name ' \ ,t Phone No.
— t l C SI ri1 a ,_G,. �
Mailing Address
CS42� V _63&
City State
SAMPLE DATE: i1 f
M0. Day Year
SAMPLE TYPE:
Zip Code
❑ Routine
❑ Check Sample (for routine sample 1 ❑Treated Water
with lab ref. ❑ Untreated Water
❑ Special Purposee 'r�,;
SAMPLE
NO. LOCATION
3
4
5
It
READ INSTRUCTIONS
BEFORE
Time Collacled
Collected By
Analysis shows this Water SAMPLE to be:
❑ Satisfactory„
`�713_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
I� G. G f
Time Received
Analytical Method:
❑ Fermentation Tube
(3 Membrane Filter
Lab Ref. No. Result' Analyst
t
l I m
� m
u� m
•No Of cobra../100 m, W NO. of Povt" lwmum
06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1976
Date collected source
a.m.
EMB Broth 24 hourstBran w noum
Multiple Tube RePortt 10ml Tub" Poslllw/Tatel 10011 Portlo
COLLECTING SAMPLE Mu
Wbnne Fater: Direct Count Conform/100mi
verification: LT e Sao
Final Membrane Filter R"ults f 1 collform/100011
I\ (� ate i1?iI` 1
RpMted By r
/..,..�, 1i.•�.}'�•
Time Y •--^ a.m.
1...1 W P.M.