HomeMy WebLinkAboutHAMANN LT 6BHarnann
Lot
OEM
#050�61 1 �32
Municipality of Anchorage
Development Services Department
BVilding Safety Division
On -Site Water and wastewater Program. 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 9951 M650 Pa e
www.ci.anchorage.ak.us (907)343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PID Number: (3 261-L 1— 3
PermitNumber:
t System: []New Uf Upgrade
N. - Wastewater
6 ( CU� Ro <e,- —
�rl�w dw2�WD
ABSORPTION FIELD
I
P,,_ 2 q, te"oer of ewv�s
Deep Twlh 0 Sl,afiOw Trwxh D BSKJ 13 MOSO 0011W
Sod Raling TON D*PM ftV, org" Walle
10
LEGAL DESCRIPTION
26po,Ft" Ft.
LO�R S� On 0
A Fl�
Gxa,oel OWh 06IOSM 1XII0 7Ft
r4eq
T�Mlqp Ranp sallam
FM S� "l`l41 7010 Ft.
G,� LVxFh Pill.
Gr" S,Mn
Nu"W
Ims
Well: New Upgrade
Fi.
A
A, C), I ON o"M ca
TON WUWM NOS
935l'?
P M
0
e Ft
15Z
DINO, D
Vale mv. ,
Ft
YWd
P,ail,,setaa
cs" 1,109" 0 Gr�
TANK
ISM
Ft.
Ft
SEPARATION
DISTANCES
14 septic [I Holding [j S.T.E.P. [I Other.
To septic Absorption
Lift
Holding ubliCjPnvate
M �&Sr T41, I k- �'y '.-
/Sbo Gal
From "-,, Tank Field
Wait 55' 57'
Station
Tank Sewer Line
rq4tiw
E/='PL_
I
I
LIFT STATION
S.dace watia
ae
LOU"
6q
3 1
IV ON. a
-P,,W W, at
C~ Drain
tie
yvw
R~s I We4
4-a a k
BENCH MARK
4
D.�P�
4y'u<tl'00( C116arl
Ft.
a a a ....... f -2--c-6
Inspections performed by:17034 Eaglo Rlvw Loop Road, NO-Mes: let
Fogle River, Alaska 9957JF 2 nd �57-
Development Services Department Approval
Conditional Approval Date:
Reviewed and approved by: Date:
llt� N%t -OF-
�; qE
1. . I ,
ROBERT C. COWAN
PERMIT No. SW060087
PACE 2 OF 3
Municipali _'_ t 0 f Mc ' ?f A
DEPARTMENT OF HEA TH A D AeN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D. Box 196650 0 Anchorage Alaska 99519-6650 0 Tele hone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR RIELL INSPECTION REPORT
LEGAL LOT 68, HAMANN S/D P.I.D. NO. 050-611-32
ALPEIVGLOW
DRIV
0
SATELLITE DISH
OLD
WELL
ct
>
IA
IBM
FC
CO2 SCALE 40'
MT2 STI NEW 1500 GALLON 11I
LOT 6A ST2 SEPTIC TANK
10. MIN. DBLI & OBL2 C7
8 \\,f, TH *J f)
\%k. I,- A
7,ZV
ROBERT N
MTI cc
COI
%
PERMIT NO-SWO60087
PACE 3 OF 3
Municipali _'t of Anchora e
DEPARTMENT OF HEA TH AND HURAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage AlaSka 99519-6650 e Tele hone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR RIELL INSPECTION REPORT
LEGAL LOT 68, HAMANN S/D
ST1
FINAL GRADE
NEW 1500
87.7'// GALLON
I SEPTIC TANK
FINAL GRA
MT1 =79.3'
MT2=79.2'
2
P.I.D. NO. 050-611 -32 _
92.2'
2" INSULATION
87.4'
COI=89.2'
CO2=89.5'
" INSULATION
C01=86.2'
CO2=86.2
A
NO WATER FOUND
73.2' B.O.H.
N. T. S.
ItOBIRT C_ COWAN 12�
MUNICIPALITY OFANCHORAGE
Development Services Department
Ori -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: May 10, 2006
Expiration Date: May 10, 2007
Permit Number: SW060087 Parcel ID: 050-611-32
Legal Description: HAMANN LT 6B
Design Engineer: 0003 S & S Engineering Site Address: 024206 ALPENGLOW DR
Owner Name: CRAIG ROSE Lot Size: 69626 SQ. FT.
Owner Address: 24206 ALPENGLOW DRIVE Total Bedrooms: 5 Permit Bedrooms: 5
EAGLE RIVER. AK 99577 -
This permit Is for the construction of.
M Disposal Field [?] Septic Tank E] Holding Tank El Privy E] 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 ( I BAAC72 ) 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.
Received By.
Issued By:
Date:
Date: :':2 X 0/0&
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0,16-4c I I- -3��L
Property owner(s) 6ralci 6:5 Day phone
Mailing address ZipCode
Site address
Legal description (Sub'd, Block & Lot)
Legal description (Township, Section & Range)
Lot Size t-4rl te,9�2 Sq. Ft.
THIS APPLICATION IS FOR (JEall that apply):
Absorption Field
9
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
El
Code
Number of Bedrooms
THIS APPLICATION IS AN:
Initial
El
Upgrade
Renewal
I certify that the above information Is correct. I further certify that this application Is being made for a
Single Family Dwe Ili nga'ndD%_\in-ZrccQrdance with-aWicable Municipal Codes.
of property owner or authorized agent)
Permil/Rush Fees:
Date of Payment:
CD Waiver Fees:
Date of Payment:
Receipt Number: -j L) 1 10 Receipt Number:
(Rev. 11/05)
HE-ALTHAL914DRITY
APPROVA1.3
SEWER&WATER
MAINEXTENSONS
SEWER&WATER
MPECTICN
ENOWERINGSTUMS
ANDREPORTS
WELLINSPECTION
&FLOWYEST
SITE PLANS
WILTEST
PEADOLATION
TEST
STRUCTLIRALIL
MECHANICAL
INSPECTMNS
ONSME
WASTEWATER
DtSPOSALSYSTEM
DESIGN
FIOBERTC. COWAN. PE.
ROBERTA. SHAFER PE.
CIVIL ENGINEERS
(907)694-2979
FAX (907) 694-1211
April 25, 2006
MUNICIPAI= OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 613, Hamann Subdivision
It is requested that you issue a permit to install a new septic system to upgrade the
existing three bedroom dwelling on the referenced property to five bedrooms.
Two test holes were excavated and percolation tests performed. The approximate locations
of the test holes are located on the attached site plan. At the time of excavation (4-18-06),
no water was found. After monitoring, ground water was not IMind.
We do not anticipate any adverse effects on neighboring %% cl Is. septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require
Enclosure
Shafer, P.E.
information, please contact us.
17034 NORTH EAGLE RIVER LOOP - SUrTE204 -EAGLE RIVER ALASKA 99577
9
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Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage. AK 99510,6650
www.clanchoracie.aka!
(907) 343-7904
Soils Log - Percolation Test
Performed For: Date.
Legal Description: LCrC (,E)) Njqrnfqfjk) -�, _Township. Range. Section:
SIMA
3-
Depth
— 0(L&q"(C'S
---I J
�- - ML
5.
6
7-1
9-
0
to-
14.1- ' - �:l
15
18-
19 -
— 60 /6k?T-
WAS GROUND WATER
Date
ENCOUNTERED?
Net Time
IF YES, AT WHAT DEPTH?
0
Depth to Water Aller
Monitoring?
P
a
—494—
Dale:
**0
Site Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
ON&
-pe
4%
P.O
15 q'
;Z
0
0
*5 0
7- Vz"
0
it
a
--�) 0
V/Z!,
PERCOLATION RATE I Z_ (.-AnAnch) PERCHOLEDIAMETER
TEST RUN BETWEEN q FT &w �15 FT
COMMENTS
PERFORMED BY: ),-�/�CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND M NI P GU NES IN EFFECT ON THIS DATE. DATE:
�16'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
to'0
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
NAME
____TP
H _0N E I /,KNEW
D,4&v_o 5t) t 6 4t + v 09-
j447Z1;'_ �;D'Syt EJ'UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
6
LOCATION
NO. OF BEDROOMS
DISTANCE TO:
Well -7f--
Absorption argo
Dwelling
PER
6,5
L) x
l-- 2
CL <
—
Manufacturer
No. of comp6rtment
21
LU
L i q.7g on,
IF HOMEMADE:
=n,,,
Width
Liquid depth
DISTANCE TO:
Well
Dwelling
PERMIT NO.
0
Manufacturer
Material
Liquid capacity in gallons
Well j
13
Foundationq,
Nearestlotl
/0
PER27
DISTANCE TO:
5
W
_j
No. of lines
Length of paah line
Total le f linf4,
Id
Trench
Distance bet linos
W
Lu
.1/0
inches
//+
Top of til- ty f i grade
eL a] benV)h Qle 1Y
92, S112—
Total epti ab or area
4 I
Fle
- Y I- 060Y
inches
_ I
Length
Width
/Depth
FIT NO.
LU
0
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
w
W
0 1
Wei I
Building foundation
Nearest lot line
DISTANCE TO:
_j
I
Class C__1
Dep h
>T/
Driller
Distance to lot line
I
PERMIT NO.
_j
Z_�
Lu
IDISTANCE
TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
r
PIPE MATERIALS
/PC/- C'
'N
11
SOIL TEST
RAT0\IG
t
INSTALLER
1`�)
r__I_
--A
I
1 1.
REMARKS
'o
H
-to
0 t'
el)
f4_4
41W
r
J'4
NO- 145
% XE e
L 0
It,- 49 "o
% t?0F 91 �A
"4"
AP PIKOW
EE DATE LECrAL
NOW Alma
Nt RIVER, ALASM '0577
72-01) (Rev. 3/78) '1/, F" - _- rn* W
` V11x|nt N| ' � I'RaML!H PINV 1:00"i 1AVNw.P4!on '4U!1:1 L:|1UN �(
' 825 STREET/ HNCHORHGE, HK
264~4720 `
� oil 149 ]l "'T, -Em': E":E: ��K 15: in! 1: -Y,
� PERMIT N8. ( 820658 )
/ RPPLICHNT DHVID SLENKHMP %S&S SRB296X E. R. 99577 694-9055
LOCHTION
1EGHL L6 HHMMHN LOT SIZE 999999 SQUHRE FEET
TYPE OF SOIL IS: TRENCH
MHXIMUM NUMBER OF SOIL RHTING 250
/
. THE REQUIRED SIZE OF THE SOIL HBSORPTIO� SYSTEM IS�
/
/
� 1-1 IFE1 Fo, W 04 11, MoN �W In! 1011- WKII NEYS CAI Q Not V FEE L. ED, ERE W -11�� �
'
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELS
THE DEPTH OF H TIENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE OF THE
GROUND AND THE BOTTOM OF THE EXCHYHTION (IN FEET).
� THERE IS NO SET WIDTH FOR' TRENCHES.
THE GRHYEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE
' HND THE BOTTOM OF THE E�CHVHTION (IN FEET).
�-Cy,0_9 X 100=710w �����C_-:: ��1 21 EE L Z, 9 tz-Ed ��Q ing KE.-,
PERMIT HPPLIC8NT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE
INSTHLLHTION INSPECTIONS OF HNY WELLS HDJ8CENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THHT THE WELL WILL SERVE.
�~~ �R_�q N 4, ?C- 12: in 1: IwASMIMICY11- X K0011-0 f=2 v RE' M W Cyr. �__R I: LEE.�
BHCKFILLING OF Hl -4Y WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN H WELL fiND HNY DISPOSHL IS
100 FEET FOR H PRIVHTE NELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTHNCE FROM H PRIVHTE WELL T8 H PRIVHTE SEWER LINE IS 25 FEET HND
TO H COMMUNITY SEWER LINE IS 75 FEEK
OTHER REQUIREMENTS MHY HPPI SPECIFICHTIONS HHD HRE
HVHILHBLE TO INSURE PROPER INSTHLL�TION
103 EE F&C M 1: W 1=:: ".1 IEE So �Q 1:1 EzE IV! W EE, F, ��' ����
I CERTIFY THIAT
1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE 5E1,.IERS HND WELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE
2: I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES.
]THHT THE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE
RESIDENCE IS REMODELED TO MORE THAN ] BEDROOMS.
�
ISSUED ~�BY���-�� ~����°~^�/*'� _~D�T�~--�.��� ~ 8
- 9 --- 3 _q _L R--- JL f—do JL I 'Ir B-0 W_ F-9 a -4 a, ff__ I F�_ r-1 5-3 r -
DEPARTMENT �,,,,,HEALTH AND ENV I RONMENTAL'),,,'.-OTECT ION
825 'L" STREET., ANCHORAGE, AK. 9_9501
264-4720
L4 r=_ I I F='oE=F.'r-1 I -r
PERMIT NO. 820851 )
APPLICANT DAVID St-ENKAMP 1584 E.R. RD E.R. 99577 694-9055
LOCATION
LEGAL LG HAMANN LOT SIZE 999999 SQUARE FEET
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 THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F:!'[—= R.0 I -q I -Ir E: X F=13 I F;? [—= '—S 0a E* C_� F= M E� I—E F;?. ::-� -1 _. -1 _=-A oz_� ��
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED: ----------------------------------------
APPLICANT DAVID S ENKAMP
ISSUED BY— DATE --- 4� V4. 0
7 -----------
264-4720
"if T
ON
p LS MAW& LOT SIZE -A-q-q-q" SaL*N;E FEET
v.AM V11-5-TRMCE REINFEN A WELL WD fW M -SM SZkMHOEE DjSPQ5fkL SYS EM
MET FoR 8 miVATE MLL OR :15*6 TO 200 FEET FROM A PUBLIC NELL DEPENDIRG
YHE TVFE OF PUBLIC WELL.
RUM DISTRWE FMI F1 PRIVATE MLL TO R FRJVRTE E-EMER LIM IS 2S MET FM-)
-GEMMITY SF-14ER LINE IS ?S FEET�
A085 WE REQUIUD M4D flWT BE RETLRWD TO THE MPMtMNT MI -MIN 30 wv--�
El NELL CWV�LEIION-
REDUMEMENTS MY FIPFLY� 51RECIFICRTIONS AM CONSTRM-710N DIF46WIS RIRE
q,M4 FAMLIRR HIT" IME gEQLQREnENTl., FOR M -SITE -SEWERS FP& WELLS FV� SET
oillow *FNE nut4lelpfuly OF W14ORME,
�,VLL IWSTRLL IM SYSTEM IN RVVRM4M HITH THE MM
-------------------
RPFLICFKT NIVID Lr/FWJWV
PERFORMED
LEGAL DESCRIPTION:
F67P75F7H
I (5-rif-T) I /
COMMENTS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
'Ore-
. S E-W-1110r-Enif
PERFORMED B�". ank) 19331C
V;rdot��' ilIv ALASKA
72-006 (6179)
DATE PERFORMED:
El SOILS LOG
E-1 PERCOLATION
TEST
SITE PLAN
WAS GROUND WATER S
ENCOUNTERED? L
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
2
Depth to
Water
Net
Drop
1Y
Ae,
It
5
6'-
7
8'-
9-
10-
11
j
12 -
13-
14 �
15-
16-
17 -
18-
19-
20-4
COMMENTS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
'Ore-
. S E-W-1110r-Enif
PERFORMED B�". ank) 19331C
V;rdot��' ilIv ALASKA
72-006 (6179)
DATE PERFORMED:
El SOILS LOG
E-1 PERCOLATION
TEST
SITE PLAN
WAS GROUND WATER S
ENCOUNTERED? L
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1Y
Ae,
It
j
PERCOLATION RATE �—o (minutes/inch)
TEST RUN BETWEEN FT AND —,�— FT
- If
CERTIFI
DATE
C1 SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720 TEST
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION: 6
SLOPE SITE PLAN
DEPTH
IFFFT) z
I 11�lk 7y el
2
3-
4-
5-
6-
7- 51Z 7
8-
47
9-
10-
ILI L
WAS GROUND WATER S
ENCOUNTERED?
12- P
p E
( I IF YES, AT WHAT
13 ; DEPTH?
14-
:!t OF 4
... 44%
16-
1 7-
18- Robert A. Shafer
0
No. 1�57-E
ReadingF
oat.
Gross
Time
Net
Time
Depth to
Water
2,
p
it
/pl/q',
-31y 1,
3 3o
17
7�, q�)'
lo
17
20 v
L---.�
COMMENTS_
PERFORMED BY:
72-008 (6/79)
PERCOLATION RATE 1 0 (�i-wcshnch)
TEST RUN BETWEEN — FT AND 6 FT
CERTIFIED
PATE
a
t
0 SOILS LOG
MUNICIPALITY OF ANCHORAGE PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
(6-6 SOILS LOG - PERCOLATION TEST
PERFORMED FOR: DATE PERFORMED:
LEGAL DESCRIPTION: /01 In
DEPTH
fFEET)
---, r
_7
-S'IZ- 7-e 61
2-�
3-
4-
5- ILI
6
7
8
Z L5 0
9-
10 -
WAS GROUND WATER
ENCOUNTERED?
12–
IFYES,ATWHAT
13 j DEPTH?
L9 hL)
L
14 Readi
15-
17- 0
S
berf A. r
No. 145
19–
Mumm- MEMO
MENMEMEEMN
20-
PERCOLATIONRA E —lminutes/inchl
TEST RUN BETWEEN Z� FT AND FT -
COMMENTS
DATE:
PERFORMED BY; C E R T I F I E D B
L
72-008 (6/79)
Gross
Time
Net
Time
Depth to
Water
Net
Drop
21 ) 304
'N Y6
-3
-vo /y/
1/
3)10 P
/e it
/,K Ig
31Y
3 z
12,0,P
/0 1/
/� ' Z'/
311y
7/�-30'r� 1
/0 /1
/6 yy It
'�/y
20-
PERCOLATIONRA E —lminutes/inchl
TEST RUN BETWEEN Z� FT AND FT -
COMMENTS
DATE:
PERFORMED BY; C E R T I F I E D B
L
72-008 (6/79)
PERFORMED
LEGAL DESCRIPTI
Date
DEPTH
S
(FEET)
OF 4 it
ENCOUNTERED?
hM L
0
17 -
2
-
k4
IF YES, AT WHAT
E
3
DEPTH?
-;j�% No. 1457�t
0"A '0
m AO
4
N P -V V
6-
7
/y
I zl�l
9
10-
11
12
-
�13
-::I--
r
MUNICIPALITY OF ANCHORAGE
DEPARTIVjENTOF HEALTH AMD ENVInOMMENTAL PROTECTION X PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
X k DATE PERFORMED:
A 4,
// 'X/1
SLOPE
cz
15 -
Date
WASGROUNDWATER
S
Depth to
Water
OF 4 it
ENCOUNTERED?
hM L
0
17 -
P
-
k4
IF YES, AT WHAT
E
Robert A. W2 er
DEPTH?
-;j�% No. 1457�t
0"A '0
m AO
15 -
Date
Gross
Time
Net
Time
Depth to
Water
OF 4 it
16-
17 -
-
k4
�7
18
Robert A. W2 er
-;j�% No. 1457�t
0"A '0
m AO
20
N P -V V
COMMENTS
SITk PLAN
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
/y
I zl�l
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN ��—AND FT
PERFORMED CERTIFIED BY,,
72-008 (6179)
DATE:.�/
63 4 7 JUN 2-1 1982
" A.
�,�'CONSTRUCTION TEST L7\B \�/
"One Test is worth a Thousand Opinions"
2204 Cleveland Anchorage, Alaska 99503 277-0231
1
s-rformed for—
.:�gal Description
'-iis For -a reports
Bob Hamann
Lot 6 Block
SOILS TEST Yes
.)epth Soil Characteristics
-.-Ieet
I Peat
Brown Sandy Gravel (GP)
wl trace of Silt
12' Bedrock
s Ground 'Nater Encountered No
YES, What depth?_
Bedrock encountered @ 12'
Date Perfor.medl2/29/79
Subdivision Tract A Hamann Subd.
PERCOLATION TEST
ad ing
Gross Time Net TL-ne Depth to 11 2 0 Net Drainage
rcolation Rate
Pro%-)osed Installation
I
Depth of Inlet
4MENTS:_ 15 _ zq_j.La.re f-ee,
st Perlor-ned by
Paul
Minute
SEEPAGE PIT DRAIN FIELD
Depth to Bottom of Pit or Trench
Data Certified B ' v: Const. Test Lab.Inc.
Date : IlAlon
4
00
qf
CD
00
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00
Go
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I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # -3'2- HAA # V � A 614 0 b9cl
1. GENERAL INFORMATION
Complete legal description Lot 6B; Hamann Subdivi6ion
Location (site address or directions) NHN Schkoedek Dkive
Eaate Rivek, AK
Property owner Daniet and Satty HuiLtbeitt Day phone 696-4114
Mailing address HC83 Box 1628 Eaqte RivejL, AK 99577
Lending agency Day phone
Mailing address
Agent —
Address
Nationat P)tope'Lty I"pections Inc. Dav Phone 800-333-9807
236 South 108th Ave. Suite 3 Omaha, Neb)Laska 68154
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE: if community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rov.1/91) Front MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
S & S ENGINEERING 6'q q 7 61
Name of Firm 7034 Eagle Rivet, Loop Road Phone
900 Ri or, �leska 99577
Address jV V
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
py:,
I
Disapproved.
Conditional approval for
Additional Comments
WTIC
Date / -)- / ?,-g / q �
1� ROZERT C. COVIAN
bedrooms, with the following stipulations:
Date 4&,� �--, N—
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in theStateof Alaska.The DHHS does this asa courtesy to purchasers of homes
andtheirlending institutions in orderto satisfy certain federal and state requirements. Employeesof DHHSdo not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineers work.
72-025(Rev.1/91) Back MOA#21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: "s, Lee, Parcel I.D.
0
A. Well Data
Well type Ls!a -If A, B, or C, attach ADEC letter. ADEC water system number
— \J Date completed
Log present &J) -7,2-4 G -z_ Driller 1;11� L W -1 ,V"t 5
% 112 kk �_
Total depth - �2- 'A Q Cased to � 1�2_ —Casing HeigHL
Sanitary seal &J)
Date of test
Static water level
Well flow
Pump levell
FROM WELL LOG
-7 � 1, 4 -5 1?, -
-7 0 J
/ J
,�2 3
SEPARATION DISTANCES FROM WELL TO:
Septic/be" tank on lot J06 I
Wires properly protectediiSN)
, On adjacent lots /00 _'�
Absorption field on lot ./&?o I �_ ; On adjacent lots Inn , +
Public sewer main tjlA- -Public sewer manhole/cleanout
Sewer service line 1-15- 1+ Petroleum tank �25_ 1+
WATER SAMPLE RESULTS:
Coliform
Nitrate
Ole)
AT INSPECTION
Date of sample:
12
4
Z
M
en 0
M. g.p.m.
M �
�! >
r) Z
M
M
2 0
<
Z
, On adjacent lots /00 _'�
Absorption field on lot ./&?o I �_ ; On adjacent lots Inn , +
Public sewer main tjlA- -Public sewer manhole/cleanout
Sewer service line 1-15- 1+ Petroleum tank �25_ 1+
WATER SAMPLE RESULTS:
Coliform
Nitrate
Ole)
Other bacteria
Date of sample:
12
Collected by:
B. SEPTIC/HG6DtNGTANK DATA
Date installed -7-92- Tank size 125-0 Compartments
Cleanouts&N) Foundation cleanout (Y/N) Depression (Y
High water alarm (Y& Alarm tested (Y/N) "(14
Date of pumping Pumper _rx , C_,0_,5s-,e 0
SEPARATION DISTANCES FROM SEPTIC/HGLOZIG TANK TO:
Well(s) on lot 106, On adjacent lots
To property line 16 / 74- Absorption field
Surface water/drainage /00,
1&0 1 �- Foundation
Water main/service line
2-
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons—
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
tested
Level at
Surface water
Date installed I - �) 2-- —Soil rating (GPD/Ft2) A. System type
Length ;�b ; —Width 1;Z I S_ Gravel thickness �7 / Total depth
Total absorption area 99016 Cleanout present 6* - V Depression over field (YLW
Date of adequacy test 1c2 -1V_ '�/ Results traiMall) -_ 1��_s for 3, Bedrooms
Water level in absorption field before test 3 Iq -Aftertest— Z 1/0 �
Peroxide treatment (past 12 months) (YtV _�� �-e�,,16 �i_l if yes, give date — "i
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot / o C,) /
To building foundation
On adjacent lots—
Surface water
Curtain drain
On adjacent lots
)01 _k
E. ENGINEER'S CERTIFICATION
Cutbank
&
X
Property line /0
To existing or abandoned system on lot
Amer main/service line
Driveway, parking/vehicle storage area J-0 7'
certify that have checked, verified, or conformed to aH MOA and HAA guidelihes in eh�4 of this inspection.
.11 �%
Signature
Engineer's Name t 03 47- C6 ir/�) COWAR
CE - 860
Date
HAA Fee$ ;?) 00 - 60
Date of Payment d2)
Receipt Number P2 7 & 4 Zx
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
,a F-\
R"� Commercial Testing & Engineering Co.
'&Mfln, Environmental Laboratory Services
SINCE 1908
CT&E Ref.# 94.6095-1 LABORATORY ANALYSIS REPORT
Client Sample ID L6B HAMANN SID
Matrix WATER
Client Name
S & S ENGINEERING
WORK Order 11363
Ordered By
RAY
Printed Date 12/IS/94 @ 16:00 hrs.
Project Name
Collected Date 12/13/94 @ 10:00 hrs.
Project#
Received Date 12/13/94 @ 13:00 hrs.
PWSID
UA
Technical Director STEPHEN C. EDE
Released By 25—
Sample Remarks:
ROUTINE SAMPLE COLLECTED BY:
RAY.
QC
Allowable Ext. Anal
Parameter
--------------------------------------------------------------------------------------------------------------------
Results Qual
Units
Method Limits Date Date Init
Nitrate-N
0.10 U
mg/L
EPA 300.0 ION 12/14/94 MCE
See Special Instructions Above UA = Unavailable
See Sample Remarks Above NA = Not Analyzed
MU = Undetected, Reported value is the practical quantification limit.
Z� LT = Less Than
�D = Secondary dilution.
Z�� GT = Greater Than
iz
LL 5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
Cornmercial'Testing & Engineering Co.
Environmental Laboratory Services
5633 B Street
Anchorage, AK 99518-1600
Drinking Water Analysis Report for Total Coliforin Bacteria Tel: (907) 562-2343
Fax: (907) 561-5301
READ 11VSTRUCTIONS ON REVERYE Sr))EBEFORE COLLECTfiVO SAMPLE
BY
ci PUBLIC WATER SYSTEM LD. #
jo PRIVATE WATER SYSTEM
Send 0 Scmdrnyolce
Vf sy� Wwwn.""
e!
�RE
psont Nvmger
.- er
ciry
—7�pCwt
C) SendResulu o Sendln�oice
ccWWyNW0
MUW4 AM"
City �W- Zip Cod,
SAIVIPLP DATE' Ffl�]
Month
SAMPLE TYPE:
6- Routine
a Repeat $ample (for routine sarople
with lab ref. no,
11 SpecialPtirpose
S,kMPLE LOCATION
1-.0 r /-, 15 wa-LVA-41,1 -JX
Comments:
FA T 7-� [ U
Day Year
0 Treated Water
a Untreated Water
Time CoUected
CoUected By
Vaue Print
Analysis shows this Water SAWLE to be*.
Satisfactory
o Unsatisfactory
0 Sample ovcr 30 hours old, results mkv
be unreliable
0 Sample too long in transit; sample 5bould
not be over 48 hours Qld at exurtinatiQn
to indicate reliable results. Please send
new sample via 3peoia) delivery mail.
Date Reeeived a W
Time Receiyt:d I I ". CC) --
.Aoialyiis Began [DEC 2-8 1924
Analytical Method, # Membranc Filter
13 MMO-MUG
Number of colonies/100ral.
Lab Rtf. No. Result* Analvst
&AW
ScnttoAj).E. Anch FbIj Jun
't to f
Date; _ Time:
Client notified of unsatisfactory reiults-.
Phoned Spo).c yvith FAXed
Daw — Time: —
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result, Total Coliforni E C49U _
Nernbrarie Viltgr: Direct Count W Colonies,100 InI
Verification: LTB _-- DGE _COLIVMM� 77VTC - 7-,. pum�.uj 7-# C,..t
05 -orh�gdaaia
Feqal Coliform CoulitrMatiOn
Final Nitmbrave Filter Results W— Coliform/100 w
Reported By'l. �M-�A ���-ate I�EC 2 9 1954 Time I.,5C6— hrs
memt)er of the SGS Group (Soci6t6 Un#rale de Surveillance)
ENVIRONMENTAL FACILMES IN ALASKA. COLORADO, FLORIDA, ILLINOIS, MARYLAND. Nc-W JERSEY, OHIO, VTAH. VVEST VIRGINIA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date , &Zz
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
hk_311
Location (address or directions)
(b) Applicant Telephone: Home Business
Applicant Address
(c) Applicant is (check one): Lending Institution 11 Owner/builde Buyer El Other El (explain);
(d) Lending Institution //14_9XPz zi4ft�q Telephone
a
Address
(e) Real Estate Company and Agent
Address
�lephone
Ithe HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family# Multi -Family 11 Other
Number of Bedrooms
3. WATER SUPPLY
Individual WeIIX Community[] PublicD
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. or
4. SEWAGE DISPOSAL
OnsiteX PublicEl CommunityEl Holding Tank 0
Note: If community well system, must have written confirmation from the State Departmentof Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11184)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm 3 & % FJO.W"14 Telephone
Address ARR I Wy
Date Eagle 41tiver, AYa*kn 995W
6. DHEP APPROVAL
7 -
Approved for Z 11�9 bedrooms by
i
Approved )10� Disapprove
/ I
Terms of Conditional Approval
CAUTION
— 12-- �P 6
fof A k
OAT
4
4-1) P n
kA t, f %
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers' of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Paqe 2 of 2
To Nearest Edge of Absorption Field on % ots
txot k 0 Z) On Adjoining L
I
To Nearest Public Sewer Line To Nearest Public Sewer
Nk
Cleanout/Man hole To Nearest Sewer Service Line on Lot 440"
Water Sample Collected by S4S Date n - 8 (�a
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed -
Stand pi pesow-
- C9 Z�_ Size / No. of Compartments
Depression over Tank ffa
7 -
Air -tight Caps64W_ Foundation Cieanout PO
Date Last Pumped
,il, I
Pumping/Maintenance Contract on File (Y/N) — ; for
Holding Tank High -Water Alarm (Y/N) �C7_ - Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well /6b
To Property Line
To Water Mi4iR Service Line
Course
Comments
Page 1 of 2
72-026(11/84)
To Building Foundation
To Disposal Field — I ZI!
ll
To Stream, Pond, Lake, or Major Drainage
MUNICIPALITY OF ANCHORAGE (MOAT
DEFT. 0 _' �'�Ut"OPAGE
ENVIRONMEt�F HEALTH &
TAL
PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
MAR 121986
CHECKLIST - FEBRUARY 1984
264-4720
/_07�
Legal Descri tion: w1d
4D
A. WELL DATA
Well Classification
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present&�r__
Date Completed '7 -Z4 -8Z- Yield
-1
Total Depth 4-1401 Cased
to \ � _Z2 Depth of Grouting
Static Water Level I'D I
Pump Set At
Casing Height Above Ground —
I _Z 0 �- — Sanitary Seal on Casing(G�w
Electrical Wiring in Conduit"r—
Depression Around Wellhead F(�q
Separation Distances from Well:
To Septic/Holding Tank on Lot
On Adjoining Lots
To Nearest Edge of Absorption Field on % ots
txot k 0 Z) On Adjoining L
I
To Nearest Public Sewer Line To Nearest Public Sewer
Nk
Cleanout/Man hole To Nearest Sewer Service Line on Lot 440"
Water Sample Collected by S4S Date n - 8 (�a
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed -
Stand pi pesow-
- C9 Z�_ Size / No. of Compartments
Depression over Tank ffa
7 -
Air -tight Caps64W_ Foundation Cieanout PO
Date Last Pumped
,il, I
Pumping/Maintenance Contract on File (Y/N) — ; for
Holding Tank High -Water Alarm (Y/N) �C7_ - Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well /6b
To Property Line
To Water Mi4iR Service Line
Course
Comments
Page 1 of 2
72-026(11/84)
To Building Foundation
To Disposal Field — I ZI!
ll
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installed 17- 33 - 9 ?1 Length of Field 76)
Width of Field �300 — Depth of Field
Square Feet of Absorption Area %alIV Gravel Bed Thickness
— Standpipes Present ��/K
Depression over Fielcilwa)
Date of Last Adequacy Test 3 'Id 96
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well /0-D I �- To Property Line
To Building Foundation
Lot
To Water Ma4WService Line ,? e) 11`
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments —
D. LIFT STATION
Date Installed
Size in Gallons
To Existing or Abandoned Systom on
�_ 1�
On Adjoining Lots
To Cutbank (if present)
t-/,/
qZ)
Dimensions
Manhole/Access (Y/N)
"Pump On" Level at "Pumn Off" Level at
High Water Alarm Level at / / Vent (Y/N)
Tested for I/V Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have chocked, verified, or conformed to all MOA and HAAguidelines in effect onthedate of this inspection.
Signed Date /7Z --ef-
CompaAskir�_.L - MOA No. S�� -5 , ,
14449M 993�O
Receipt No.
Date of Payment 73 -- I -D- -��
Amount: $
Page 2 of 2
72-026 (11/84)
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA INC.
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
0 PUBLIC WATER SYSTEM LIDS . I I I I M
P61PRIVATE WATER SYSTEM -7-
Name Phone No.
154-92 1
mailing Address
12
City Slate Zip Code
SAMPLEDATE: F4F-71 F23T;j
Mo. Day Year
SAMPLE TYPE:
Routine
Check Sample (for routine sample
with lab ref. no. El Treated Water
El Special Purpose Eir Untreated Water
SAMPLE Time Collected
NO. L LOCATION Collected By
1 —tz,� �2 6. ��6 I/ " aio 41—S
2
MUNICIPALITY OF ANCH
3
DEPT. OF—ff-ALIH
ENVIRONMENTAL PROTE
MATT TO
RECEIVE
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TO BE COM PLETED BY LABORA I Uri T
Analysis shows this Water SAMPLE to be:
Satisfactory
Unsatisfactory
El Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received
Analytical Method: Membrane Filter
No. of colonies/100 MI.
Lab Ref. No. Result* Analyst
0-3
I i M
I GE ET -1
fN
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter Direct Count
Verification: LTB
8GEl
Coilform/100mi
Final Membrane Filter Resu / llform/1100ml
"s —Zz —
Reported By Date
I
Date
Time: a.m.
p.m.
TNTC = Too Numberous To Count
OB = Other Bacteria
3616V
Time
APPLK NT FILLS OUT UPPER Hk ONLY
Time
Property Owner
Date
Date
Phone
Mailing Ad ress
4�zip Code
Inspector
Buyer
�MN
Inspector
Address
Inspector
xL Zip Code
Lending Institu Ion
#01411e�
Phone
Address
Zip Code
ENVIR
Really Co. & Agent
A�1��7r
15V'0��elll
Phone
Address
IZECEIVED
Zip Code
*CONDITIONS OF APPROVAL
Legal Description 107-01
I DISAPPROVED
Street Location
I CONDITIONAL APPBOVAL-
Type of Residence
�Y,Single Family
0 Multiple Family
No. of Bedrooms—
DATE
E] Other
BY:
Water Supply
Individual
-Cornrnunity
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Soils Ratin
Date wer Installed
For wells drilled prior to that date, give well depth (attach log if available).
Ll Public Utility
5D Allf I-
it� k'g�-
Well to Tank
Sewer Disposal
P Individual
Year Individual Installed:
D Public Utility
When Connected to Public Utility:
El Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
MUNICIPALITY OF ANCHORAGE
[)FPT C'
ENVIR
IZECEIVED
5e I APPROVED BEDROOMS
*CONDITIONS OF APPROVAL
I DISAPPROVED
I CONDITIONAL APPBOVAL-
DATE
BY:
Soils Ratin
Date wer Installed
Well To Absorption Area 4—
wait Log Received
5D Allf I-
it� k'g�-
Well to Tank
Septic Tank Size
72 023 (182) /
CHEMICAL & GEG,,,_,)GICAL LABORATORIES C..,ALASKA9 INC.
TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Z6 9- 44ewra
Drinking Water Analysis Report for Total Colifor rn Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM: T=
I.D. NO.
WfeterS:y��stem Name Phone No.
7
Mailin ass
�Y-) 72
Zip Code
city state
SAMPLE DATE: F7171 i FOWI
Day Yew
Mo.
SAMPLE TYPE:
0 Routine
0 Check Sample (for routine sample
Xwith lab ref. no.—
special Purpose
,,fI Treated Water
K�Untreated Water
ColLectep
IHO-
4
5
TO BE COMPLETED BY LABORATORY
G
Arlakysis shows this Water SAMPLE to be:
atisfactory
�S 1
El Un4�atisfactory
i
EJ saTple 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
Anal tical Method:
Fermentation Tube
ElMlembrane Filter
Lab' Ref. No. Resultd,
FT -1
Analyst
I ET -1
No. of colonies/ 100 ml. or No. of Pos,t,w pOroons.
i -
66-1220 (b) BACTERIOLOGICAL WATER AN�`LYSIS RECORD
Rev. 1978
bate Collected
READ INSTRUCTIONS _,_ Received
BEFORE
24
24 Hours
—source
In.
Time Received - :1.m. Lab. No.
Dml 1 20ml 1 20ml I 10ml 1 2
0.2mI
EMS Brafth 24 hours: -Broth 48 hours:
COLLECTING SAMPLE MultlPle Tube RePort: 10ml Tub" POSIUVRITOUI 10ml Portion$
Membrane Flitert Direct Count Coliform/200mi
Viefificallon: LTO EG13
Final Membrano Filter Results Cc9lform/100mI
'Reported By -�, P Date
Time,
P.M.
SAMPLE 4
TI29
No. L,
C0111 ted
2
3
4
5
TO BE COMPLETED BY LABORATORY
G
Arlakysis shows this Water SAMPLE to be:
atisfactory
�S 1
El Un4�atisfactory
i
EJ saTple 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
Anal tical Method:
Fermentation Tube
ElMlembrane Filter
Lab' Ref. No. Resultd,
FT -1
Analyst
I ET -1
No. of colonies/ 100 ml. or No. of Pos,t,w pOroons.
i -
66-1220 (b) BACTERIOLOGICAL WATER AN�`LYSIS RECORD
Rev. 1978
bate Collected
READ INSTRUCTIONS _,_ Received
BEFORE
24
24 Hours
—source
In.
Time Received - :1.m. Lab. No.
Dml 1 20ml 1 20ml I 10ml 1 2
0.2mI
EMS Brafth 24 hours: -Broth 48 hours:
COLLECTING SAMPLE MultlPle Tube RePort: 10ml Tub" POSIUVRITOUI 10ml Portion$
Membrane Flitert Direct Count Coliform/200mi
Viefificallon: LTO EG13
Final Membrano Filter Results Cc9lform/100mI
'Reported By -�, P Date
Time,
P.M.