HomeMy WebLinkAboutBIRCH TREE ESTATES BLK 1 LT 8
MUNICIPALITY OF ANCHORAGE
I', ~.RTMENT OF HEALTH AND HUMAN SE[ .~ES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name/,t¢,¢~/.5 ....~--~ DISTANCES
Address % TA~K FIELD WELL
Phone(s) I Per~,t No. INo, of Bedrooms WELL
~?¢-/¢¢¢ J ~/¢~ 6 LOT LINE
Township. Range, Section
~*~, ~'J ~ ~¢ dr,vewa., water bcd,es, etc., AS-BUILT DIAGRAM tShow ,coat,ce o, well, septic system, property ,,nas, ,oundat,on.
TANKS i
Man%lacturer Capacity in gallons
Material No. of Compadments
TYPE OF SYSTE~
~TRENCH BED ~ W. DRAIN ~ OTHER
or,ginalDepth tOgradep,pe bottom from ~- ~ FT Total depth from orig,nal~grade/~
Fill added above origma, grade / Gravel depth beneath pipe FT
Total abs~rpbo, area /~ Distance between lines ~ ~'' i~'
Sg FT FT .... , ,
Number of hnes Pipe material
J Sod rating
Installer Date Installed
WELLS ~ ~
~ PRIVATE ~ OTHER {Identify) ~%
Classdicat,on (A,B,C} %oral Depth ~ Cased to
/__ / Scale:
· Inspections Pedormed by//
Municipal and State guidelines in effect on this datE:
72-013 (3/85)
ALASKA E FIUIROFImEFITAL COFITROL SERUICES, IFIC.
(~nqinecrinq ~- I~nuironmenlal Studies
Municipality of Anchorage
Department of Health & Human Services
825 L Street
Anchorage, AK. 99501
Attn: Dan Bolles
Re: Lot 8, Block 1, Birchtree Estates
Dear Dan:
December 11, 1987
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
RECEIVED
On 10/30/87, a testhole was dri]led on the subject lot to monitor for ground
water. See attached soil log. The testhole was drilled downslope of the
existing bed. Ground water was encoutered at 8 feet, which would be 9 feet
below the bottom of the bed. $otl was completely dry to 6 feet where it became
slightly moist. The hole filled with water quite rapidly indicating an artesian
pressure in the testhole. On 11/12/87 the water level was at 2.6 feet below
ground surface, or 3.6 feet below the bed. You were on the site on 11/30/87 and
found the water level at 2.8 feet below ground surface or 3 8 feet below the
bed. ' ·
I believe these water monitor readings are inaccurate due to the artesian
pressure showing a high static level. At worst case, I would say 6 feet below
the surface, or 7 feet below the bed, would be a more accurate groundwater level
which is where the soil showed some moisture content.
We request that you approve the septic system on the subject lot.
If you have any questions, please call.
Sincerely,
Alan C. Wien
Engineering Technician
1200 LUest 33rd Auenue. Suite B · Anchoraqe. Alaska 99503.(907) 561-5040
Municipality of Anchorage
Department of Health & Human Services
825 L Street
Anchorage, AK. 99501
Attn: Mr. Dan Bolles, E.T.
ALASKA erlUIROlqmellTAL COrlTROL $eRUICe$,
(~n§incerin§ 6, (~nuironm~nt~l $1uclies
Re: Lot 8, Block 1, Birchtree Estates Subdivision
Dear Mr. Bolles:
On December lOth, 1987, I visited the subject lot to look at the depression in
the snow that you had previously discussed with Mr. Alan C. Wien. Morris
Johnson showed me the area that you were talking about. I could see the area
which was near where you had walked. The snow pack is heavy. I dug through at
the locations shown on the attached sketch.
With the heavy snow pack and the relatively mild winter coupled with the fact
that the insulated shallow bed receives relatively warm water from the tank,
there was no frost in the ground at the site where the depression was shown.
The soils at that point were moist but not wet. From the measurements it would
appear that this depression was very close to the edge of the bed. See sketch
location 1. In the snow there are ice crystals from the ground surface to
approximately 4 to 5 inches. This would indicate that the moisture coming from
the ground is condensing and freezing in that range. At location 2 it is
slightly decreased and at location 3 the crystal limit is about 1 to 2 inches
from the ground surface. Also the ground at position 3 possibly had a frost
right at the ground surface. However, it was not so deep that I could pentrate
the ground surface just by taking my index finger and pushing it into the soil.
I do not know if you have had the experience but whenever you have a heavy snow
pack over a shallow bed you will get the 32 degree isotherm moving upward and
fluctuating between the ground surface as much as a foot into the snow. This is
evidenced by the evaporated water from the system moving up and then cooling to
32 degrees and crystalizing in the snow pack. As the winter goes on, if the
snow pack continues the ice crystals will increase in size and in depth. By
spring some of the crystals will be approximately 1/4 of an inch thick and may
be as long as 1/2 of an inch. This phenomenon is not new. I have experienced
it and reported it in the years since beds are being used in Anchorage. We know
that evapotransporation does occur in shallow beds. Particularly in the winter
there is evidence of evaporation of water and precipitating into the snow pack
over top. You will also notice that in the spring the snow will disappear
quicker over a bed than from the surrounding area.
Because the 32 degree isotherm is at or above ground surface, some slight
melting of snow will occur at the snow-soil interface. Therefore during the
winter, unless there is a heavy period of extremely low temperatures, the ground
over a bed will remain thawed. Since it is thawed and covered with a water
bearing substance the soils will be slightly damp.
1200 LUesl 33rcl Ptuenue. Suile B ·/~nchoroqe. ~loska 99503.(907) 561-50/-10
I do not believe water is coming out of the lower part of this bed. If anything
there might be less ground cover at that one point or the insulation did not
completely cover the edge of the rock. Therefore, heat is escaping from that
point faster than at other points. You might get one of the technical books on
arctic engineering and check what I am saying. This is a common phenomenon
which most engineers who work in cold climates have seen and experienced. It is
nothing to be alarmed about.
If you have any questions, please give me a call.
Sincerely,
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ,~ ~'~/-~'
LEGAL DESCRIPTION: ,~"' -~?J /
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
I'El 'TI
:E E't')
~./~)
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
s
IF YES, AT WHAT ~ O
DEPTH? o p
E
Depth to Water AIter__,a~.
Monitoring? ~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND FT
PERFORMED BY: '~'~-~'~'~ '~ I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: //~ ~ ~°~ 7
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO.
CALCULATED BY
CHECKED BY
SCALE
/ oF
DATE
DATE
....
AIX~CHORAGrz, ALASKA
r. 64-41 ! 1
TOH v a ,x,,C, WL ES
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 10, 1986
TO: Permit Applicant
Subject: Permit # 850148
Lot 8 Block 1 Birch Tree Estates Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be Obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspec.ted the installation of the on-site sewer system
the original as-built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
C E)N T A C'I" P H 0 N E: ::
M 0 R R :!: S J CIH N S 0 N
:1.200 :!: ST'I:~E:E::T :I:F~I. :l.'.:}
278'.." 1 {366
~'~' ...... ~" ... .tuv ~" ;'" ;~ '~ " ... '
....,I L '., by th,-"::, Municil::)at"'"',' ,::)F Anchc)r'a;.::.!,::.', (~..,~ , .::,.r"~d '.:h,:':, !::-', t .,,: t ;::., c;~. A'las~.:'.'::,,,
2, I w.:i.].t ins'La11 'Lhe sy.:H:..em :i.p. a,::::cc)r'dar'~c:e w:'Lh a].l MC)A c: ci d ,:::.! :::i ,::.:,.r"~d
ar'id :i.n comp 1 :i..:::nce :,,~:i.'k.l": the dEi'5:::i.m:::jn (:::P :i.t(:.TzP :i..;::i. O{:' th :i.:::: per'mit.
3, ].' J,,J:i.!]..::'J. dh(:.:.?r'e '{:.c) .:::,.] ]. MOA ...':..',. r'~ ,.'::l Stat,::.:, ,::::,.F :::::::::::::::::::::: r,,:.:.?ciu.:i.r, eh'¥iE!r':'l:.,..::: .For' tl"~,::.:-~ '..~,u::.::,'L i:::::~: k
d :i. '.;!:i-'L.:'..':I"iC::E.)E.."... {' I"'C:)YTi ,::).i"iy E:.:,F': :i. ::..:'J_'. :i. i'],:::j m.'.a':, ]. ], was'-:.'E:.E~i~.Ja'L.,::,r' (::~ i ::.'_: p c) .::h:: ]. syst,:.:.)A': oP F:,u.b ]. :i.
s ,:.:.::, w ,::::, r' .:::: {::j ,.':e :::::::::::::::::::::: ,::::,r": 'l.'..h:i.:::: c,r' any acl.:ja,:::E!r'.,t c)r' J'"i(.--'.:)apJ:)y :{. C:)'{:. ,,
...........................TF A ...... 1.1"' , <::,r:...: .t.[.]l,l :1: :rI,,IF;"I"AI I F::T} IN AN :..-...:" ' -" ,,:::. :..: r:- ,,'.i V F:r ::. !:::. i..) ::.,v MFIA /::,; .... t...)::)]:NE:i ........ bl.::., :.
T'HI:i:N (.1.) AN I:.L.J ..... ! r~ ., (.. (.d .... I:::' :::' :~1'~ '1' "1" AND :l:i'<"'r''' ........... ,,, ,. ...... r.,...,....,.,..~, ..., ... l ........
...... ::x... t:::.C ! :1: (::!i"-,l [ hJ.:::~ I BI::: ,..h.., I ~...: l.,h....L, :, fi:..'..t ) ,,:.:: !::: -.. F~ ~'1 .... <::-'
l,d TI mi .... N[)'I" 'E,'E::,-~ . ........ r-, .....r~ i:,t:::'i:::,r:m::,"", /'.,1~:',"~ ~ ":'
........ ' "' ,..'..., v :.,..~ W I 'T'HOLFI" Afl. ,....,_.,.......,:'~ :'~ ........, ~:, I C:At .... :I: NSF::'E:C::]" I ON .......... :, :...< ............. ) ]"HE!:
F'I. I:::'CTF:~ !' CAI .... ~ r'u::;'l.:' .,j..::" ..... ~.:'qi:!: :OE!I'.,IE BY A L...~.L,I:::.I,I.:::.,:::.~..,' ...., ,..,.'.. ,..: i:::, :::.~ ....... ::.. !:C:!: "':
...... :, ,E:: ..... : ...........................................................................................................................................................
,, .'. r.' M,.::) R R :I: .:::: ,.:! ::)H l~d) N '
...,I , L. :1: CANT,:
:1: SSL!I::::):) BY
ALASKA e LIIROFIm( FITAL COI'ITROL II'lC.
E,qi,ee~'inq g- (~nuironmental Studies
SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM -
Lot 8, Block 1, Subdivision: Birchtree Estates
1.0 GENERAL
1.1 THE DRAWINGS, SHEETS 1 THRU 5, SHALL BE PART OF THIS
SPECIFICATION.
1.2
ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE,
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
(DHEP), THE CONDITIONS OF THE PERMIT, AND ALL
APPLICABLE RULES AND REGULATIONS CURRENTLY IN EFFECT.
1.3
ALL EXCAVATIONS AND DEPTHS ARE ADVISORY, AND ARE TO BE
VERIFIED OR MODIFIED IN THE FIELD BY A DHEP APPROVED
INSPECTOR.
1.4
IT IS THE RESPONSIBILITY OF THE INSTALLER TO
ADHERE TO APPROVED DESIGNS FOR INSTALLATION, TO MAIN-
TAIN THE SPECIFIED SEPARATION DISTANCES, AND TO HAVE
THE APPROPRIATE INSPECTIONS.
1.5 IF THE INSTALLATION IS NOT INSPECTED BY AN AECS
ENGINEER, AECS WILL NOT BE RESPONSIBLE FOR THE
DESIGN. AN ENGINEER AT AECS SHOULD BE CONSULTED
PRIOR TO CONSTRUCTION, TO DETERMINE THE NUMBER OF
INSPECTIONS THAT WILL BE REQUIRED AND TO EXPLAIN ,,,,./~ ,~ ~/~ ~./.~._
WHAT THESE INSPECTIONS WILL INVOLVE. //?~L/~.f~.~~'~J_..
THE SEPTIC TANK SHALL BE A UPC-APPROVED TWO-CO ARTMENZ , --'
TANK, CONSTRUCTED OF 12-GAUGE STEEL WITH BITUMASTIC ,, ~--~> f /~
COATING, SET LEVEL ON UNDISTURBED SOIL, AND INSULATED
WITH AN OVERLYING LAYER OF 2 INCH BURIAL TYPE
POLYSTYRENE.
2.2
THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM THE
HOUSE FOUNDATION, AND A MINIMUM OF 5 FEET FROM THE
ABSORPTION AREA.
2.3
THE SEPTIC TANK AND BED SHALL BE A MINIMUM OF 100 FT.
FROM ANY PRIVATE WELL OR BODY OF WATER, 150 FEET FROM
CLASS C WELLS, AND 200 FEET FROM CLASS A OR B WELLS,
UNLESS OTHERWISE SPECIFIED. LESS THAN THE REQUIRED
SEPARATION DISTANCE MUST HAVE PRIOR APPROVAL OR WAIVER
BY ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
(ADEC).
1200 tUest 33rd Auenue. Suite [~ · Anchora§e. Alaska 99503 e(907) 561-5040
2.4
PIPING SHALL BE FITTED WITH A MECHANICAL WATERTIGHT
CALDER COUPLING ON THE OUTLET AND INLET OF THE
SEPTIC TANK. PIPING SHALL BE 4-INCH SOLID PVC ASTM
D3034 OR CAST IRON, SLOPED A MINIMUM OF 1/4" PER FOOT
WITH A MINIMUM OF 4 FEET OF COVER.
2.5
CLEANOUTS SHALL BE INSTALLED AS DESIGNATED AND CAPPED
WITH AIR-TIGHT RAIN CAPS (JIM CAPS OR EQUIVALENT), AND
EXTEND A MINIMUM OF 2 FEET ABOVE GROUND LEVEL.
3.0 SEEPAGE BED
3.1
THE GRAVEL FOR THE BED SHALL BE 0.5 TO 2.5 INCH,
SCREENED ROCK WITH LESS THAN 3% PASSING #200 SIEVE
RESIDUAL. ALL SUBSTITUTES MUST HAVE PRIOR DHEP
APPROVAL.
3.2
THE BOTTOM OF THE EXCAVATION SHALL BE LEVEL AND RAKED
WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT
BEEN COMPACTED DURING EXCAVATION.
3.3
THE DISTRIBUTION PIPE SHALL BE 4-INCH RIGID PVC WITH
A MINIMUM CRUSH STRENGTH OF 1500 LBS. ALL PIPES SHALL
BE LAID LEVEL, AND SPACED ACCORDING TO THE DRAWINGS.
3.4
TWO MONITOR STANDPIPES SHALL BE PLACED AS SHOWN IN THE
DRAWINGS. THEY SHALL BE RIGID PVC ASTM D-3034,
OR 4" DIAMETER CAST IRON. THE SECTION SHOWN WITH
HOLES MAY BE EITHER DRILLED 0.5" HOLES ON THE 6 INCH
CENTERS ON OPPOSITE SIDES OF THE PIPE, OR A SECTION OF
REGULAR PERFORATED SEWER PIPE MAY BE CLAMPED TO THE
SOLID SECTION WITH A NO-HUB COUPLING OR SOLVENT JOINT.
A RUBBER RAINCAP (JIM CAP OR EQUIVALENT) SHALL BE PLACED
OVER THE TOP OF THE PIPE.
3.5
IF THE FINAL GRADE OVER THE BED IS LESS THAN 4 FEET
ABOVE THE GRAVEL, INSULATION IS REQUIRED, USING DOW
EXTRUDED BLUE STYROFOAM BOARD. THERE SHALL BE 1" OF
INSULATION FOR EVERY FOOT OF SOIL LESS THAN THE REQUIRED
4 FEET OF COVER, BUT THERE MUST BE AT LEAST 18" OF SOIL
EVEN THOUGH INSULATION IS USED. THE SOLID PIPE
EXTENDING FROM THE SEPTIC TANK TO THE DRAINFIELD SHALL
ALSO HAVE 4 FEET OF COVER OR AN EQUIVALENT LAYER OF
INSULATION COMBINED WITH SOIL TO PREVENT FREEZING OF
THE LINE.
3.6
IF INSULATION IS NOT NECESSARY, THEN THE GRAVEL MUST BE
COVERED WITH A LAYER OF A NONWOVEN FABRIC (SUCH AS
MIRAFAI, FIBRETEX 200 GRADE, POLY-FILTER X, OR
EQUIVALENT).
3.7 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A
WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS.
ALASKA ENVIRONr 'NTAL
CONTROL SERVICL , INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
JOB
SHEET NQ
CALCULATED BY
CHECKED BY
SCALE t"~
DATE
&,r. vv T~'~L ~?,~lt,.i P~V~IILJIg, OUI~ ~ ~ -'- '-~ DATE -.~/ ~' / ' ~
ANCHORAGE, A~SKA 99503 / / '
(907) ~1-~0 C,Ec~t~ e~ ~,
............... ; ............. ; ........... ~ ................. ~ .............. , .............. ~ ........... ~ ......................... ~ ............ ~ ........... ~~ i ,~ ............ ~ ............. ~ ............. ~ ...................... : .............................................
........... ~ .~ ............ ~.~ .......................... ~ ...... m~.~.~ ........... ~ .................................................................. ~ ............ ~
~ [ ' ~ ~ ..... ~ ............. ~ ............. i ...........................................
[ ~ ,~ .............. ,i ............. ~ .......................................... ~ .................................... : .......... ; .................... ; .~ ............. ~ .........~
............ ~' ............ i' ~ ~ ~ ~ ~ ~.
~ ~ ~ ~ ~ ...... ................
~ ~ ..... ~ ..... ~ ..................................................... _ ~': .............. ~ ~ .......... ~ .......................
~ ~ ......................... ~ ..................... ~ .......... .................................... ........................................ : ......
........ J .......... ~ ................. 1 ............ i ............ ~
~ ........... ~ ............ ~ .............. ~ .............. ~ ......................... ~ ..........
..................... ~ ........................................ ~ ............. ~ ........ ~'~ ....... ~ ............. ~
............ ~ ............. ~ ....................... [ .............. ~ ~ ~ .............................. : ........ ~...~.~, ............. ~ ..................................... : .............
~ ~ ~. ~ , : ~ ................ ~ ...........................
~ . ~ ~ ~ .....
~ ..... ~ ................. ~.j~;~,..: ............ ~ .....................
i ~ ~ ~ ~ ~ ......... r ............................... : ..........
.......... x ........... ; ............ 1 ........... ~ ....... ~ ............ ~ ...........
~ ~ i ...... ~ ....................... ~ ............ : ........... ~ .....................................................
............ ~ ............. ! ............. ~ .............. J .............. ~ ........ ~ ~ . ......... ~ ............ ~ ............. i ~
~ ~ i : -* ~ ........... ~ .............. ~ ......
. . , ......... , .................................
.................. ~ ............. ~ .......... ~ .............................. ~ .., ........... ~ ......... j ........ ~,. ~ : i ~ ~ - /;.
~ . ~ i ...... ~ ........................ ' ................. ~ .......... [ ................................ ; ............ ~ .....~ ........ ~ ............ : ....... ; ..............
..... :; ...................... ; : ........... , .................... ~ ........ , ..................~ .....................
: t .... ~ .... ~ .......... ? 't .......... t ..... ~'*' ~ .......................................................
.: ................................................................................................... , .l~g . . , ,
ALASKA ENVIRONr'*-~ITAL
CONTROL SERVIC INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
JOB ,0 ;~ ~-/'r~
SHEET NO
CALCULATED BY "~;~'~'~'7
CHECKED BY ~
SCALE ~ ~ [4:::)'
DATE
o 0
!.
_i' ~o . ,4
~/~ ,-,'%'W-~'""-'F eot
O~OG'Tgs (106)
£0§66 ¥~1SV9¥ '39¥~IOHC)N¥
B m,!ns 'enue^¥ p~$£ ~,seM 00~ !
'ONI '-'IOlAB=IS 90B.I. NO0
'IVJ. N_~NOBIAN;! VMSVqY
ALASKA ENVIRONMENTAL
CONTROL SERVICI' INC.
! 200 West 33rd Avenu, ,uite B
ANCHORAGE, ALASKA 99503
(907) 56[-5040
SHEET NO. OF
CALCULATED BY ~ A ' DATE
CHECKED BY ~ DATE
SCALE ~ f''
LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
z*~-----"P E R CO LATI O N
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERFORMED:
20
COMMENTS
PERFORMED
72-008 (6/79)
SLOPE
SITE PLAN
WAS GROUND WATER
E~COUNTERED?
IF YES, AT WHAT
DEPT.?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
~ )~ ~o .~.-~ ,o ~
4 lo~ F o 'Vq ,o s-
PER(~)LATION RATE '3 I ~C~'~'~ (minute~Ti~ch)
TEST RUN BETWEEN ~ FT AND ~" ~¢~'" FT
~o~~~ CE}TIFIED BY:' l ~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR: t~J~ 0 ~'r"'~ ~..Tc~n .~ 6/.7
DATE PEREORMED:
LEGAL DESCRIPTION: Bir--r_.h'f£¢~ ~----c~'~L°:~'~& B)o~/c I Lo1-e~
SLOPE
em.o
SITE PLAN
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
PERFORMED BY: '~ar~..~ )
WAS GROUND WATER S
ENCOUNTERED? ~ ~ L
O
P
IF YES, AT WHAT d''" S/t~/~'
DEPTH? ~'~517-4 ]~'~
Reading Date Gross Net Depth to Net
Time Time Water Drop
l o q z i o ,,5-3 .o~
2- io $" z ,)- ,::? · o .3
PERCOLATION RATE
TEST RUN BETWEEN ~'~ FT AND --2 a/7.-- FT
CERTIFIED BY: DATE:
(minutes/in~;h~ ~' · 0 ~
72-008 (6/79)
ALASKA ENVIRONNI. FNTAL
CONTROL SERVIC. INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 56].-5040
SHEET NO
CALCULATED BY
OF
CHECKED BY
SCALE //$ '~ 0
DATE
\
................. ; \
.: ........ ~...~"i;;~''''~ ................ : ' .... iiii'i"ii'iiii'iiiii"iiiiii'i"iii" i .................... /i. iiiii.'
.ALASKA ellUIROrlmt~rlTAL COKITROL $t~RUICI~S" IrlC.
J~nljine~rin~j [ J~nuJronm~ntaJ $11Jdi~s
PERCOLATION TEST DATA SHEET
CLIENT
ADDRESS
DATE
ZIP CODE
LEGAL LOCATION t~,r'~qc~
TOTAL DEPTH OF HOLE
ZONE TESTED
ft.
ft TO .2.,
ft
READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in)
DATUM
to'Il
l OJ.-t
FINAL PERCOLATION RATE
PERFORMED BY
2'/I
J
tc~ %~l -~ 2.06
{min/in)
t2oo JJU~st 3$rd Auenu¢. Sui,t,J~' Anc~raqe. Alaska gg~o3 · (907) 276-1361
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO. // OF ¢
CA'CUL*TEDSY tk ~i/~A DATE !1' :-- ~:'
CHECKED BY DATE
SCALE
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO.
CALCULATED BY
CHECKED BY,
OF
DATE
SCALE
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
! 200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) §6~.-§040
JOB
SHEET
CHECKED BY DATE
sCALE /; la
........... ~ ..... ~..¢....~ ~ ~.,,~r.~. ~
?
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
CHECKED BY
DATE
~p~ CN>1
(907) 243-2282
KEN JOHNSON
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
30 YEARS ALASKA DRILLING
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 99502
~or ~is Johnson
1200 I Street, ,~ 410
Anchorage, Ala~ka
RE~ BIRCH TREE E'~TA~ES LO£ 8 BLK. 1
( 278-1866 )
0 ft to 2 ft
2 ft to ~ ft
9 ft to 14 ft
14 ft to 32 ft
32 ft to 34 ft
34 ft to 36 ft
36 ft to 37 ft
37 ft to 39 ft
39 ft to 44 ft
44 ft to 51 ft
51 ft to 57 ft
57 ft to 59 ft
59 ft to 96 ft
96 ft to 101 ft
101 ft to 104 ft
104 ft to 107 ft
107 ft to 209 ft
TO~AL CASING
110 ft !0~ in.
0rga,nic peat .~.o~
Course gravel & gray silt .,,~
~ed. Erav & ~ray silt ~'
Boulder ~ ~ \~
CourBe gray & ~ray silt i, ~.~
Boulder
Cobbles & course gray
Course gray & gray silt
aame with finer gray
Med gray & light Brown silt
Boulder
Course gray & gray silt
Brown silt & fine gray
Same (weeps) 11 ft. head bails down
Same ( dry )
Med gray & sand.. Water bearing
Test bailed at 10 GPM
21 ft head
4 ft drawdown..., good recovery
Bottom stable ...very clean
TEST PUM~ DATA. July 16, 1985
Static Water Level 90.5 ft ( TOC )
T I~E G.Pi~I DRA~'~DO WN RE~qKS
1900 9 94 light dirty
192 0 14 97 · 5 cloudy
1945 14 98 Clean & clear
2000 14 98 "
Good recovery
Pump set at 105 ft 10 in from top of casing ( TOC )
~'~,~s ~o ~o TODAY
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
91-009(3/76)
urdcip . tYof
Anchorage
P.O ')X 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
March 25, 1987
Dr. Leroy C. Reid
1200 West 33 Ave., Suite B
Anchorage, Ak. 99503
Dr. Reid,
On November 25, 1987 a letter was sent to your office
concerning the disapproval of a septic system on Lot 8 Blk
1 Birchtree Est. On that same day I discussed the matter
with the owner, Mr. Morris Johnson. It was agreed, at that
time, to hold the as-built and HAA until a meeting could be
arranged with your office. However, to date Mr. Johnson
has not contacted this office for such a meeting. I am,
therefore, returning both the as-built and HAA to your
office along with a copy of the previous letter.
Should Mr. Johnson or your office wish to give further
consideration to the matter please don't hesitate to
contact me at 343-4744.
Sincerely,
Daniel N. Bolles
Eng. Tech. III DHHS
MUNICIPALITY OF ANCHORAGE
DEPARTI~, ,T OF HEALTH AND ENVIRONMENTAL I, ,,TECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SiTE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range) .
(b)
Location (address or directions)
Applicant"Name
Telephone: Home
Business
(c)
Applicant Address /,Z¢-~ .~ ~'7~ .~*'/~ ~/~ ,/~/~./ /~'
Applicant is (check one): Lending Institution [] · Owner/builder~'; Buyer []; Other [] (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
Telephone
TYPE OF RESIDENCE
Single-Family'S' Multi-Family []
Number of Bedrooms -~
Other
WATER SUPPLY
Individual Well,~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~, Public [] Community [] Holding Tank
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11,84)
5. ENGINEERING FIRM PROVIDI, INSPECTIONS, TESTS, FILE SEARCH, C ,A 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 ~~ Telephone
Address /~'0 /~ ~]~
Date
App~uvud ;'u., ------'---' bedrooms by
~ Disapproved ~ ...........
Terms of Conditional Approval
Date
CAUTION
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.
Page 2 of 2
72-025 (11/84)
MunicipalitYo
Anchorage
P.O. BC,, 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264'~k1~txx 4744
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
On-site Services, Room 502
November 21, 1986
Mr. Jeff Kaitchuck
1200 West 33 Avenue Suite B
Anchorage, Alaska 99503
Subject: Morris Jo~nsen Property
Lot 8 Block 1 Birch Tree Estates Subdivision
Dear Mr. Kaitchuck:
The Health Authority and as-built received by this office, concerntngf:
the subject lot, have been disapproved for the following reasons:
There exists, downslope of the septic system and between Lots 8, 9
and 11 a drainage ditch. This drainage serves to transport both
surface and ground water encountered due to the excavation. Per
Alaska Stature 18 ACC 72 and AMC 15.65.040 I; and .060 B this would
require a minimum 100 foot separation from the septic system. The
possibility of a waiver in such an instance could not be issued
without suitable precautions being taken (AMC 15.65.020 A-C and
.150 A-C).
e
The presence of a small stream of water between Lots 8 and 7 which
is glaciating across the driveway and around the well, raised the
possibility of contamination of the water supply by surface runoff.
e
The presence of numerous outbreaks of water around the residence and
septic system indicates possibly that the seasonally high water table
is less then the -5 foot which was noted in March and June of 1985.
Per AMC 15.65.020 C 6; 040 F; and .060 A3 this would have to be
determined.
As these facts were not considered in the design and permit process for
the subject lot we cannot authorize the use of the on-site system installed,
Mr. Jeff Kaitchuck, A.~E.C.S, Inc.
November 21, 1986
Page Two
Whereas your office designed and inspected the installation we would
like to have your input, so as to solve this problem as quickly as
possible. Please feel free to contact my office at any time for further
clarification.
S in c~.r ely ,,~
Daniel N. Bolles
Engineering Tech
On-site Services
DNB/lJw
5&unicipality
P.O. dOX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-,t:td~ 4744
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
On-site Services, Room 502
November 21, 1986
Mr. Morris Johnson
1200 I Street, Suite 410
Anchorage, Alaska 99501
Subject: Lot 8 Block 1 Birch Tree Estates Subdivision
Dear Mr. Johnson:
After careful examination of all available information and following an
in-field investigation, I regret to inform you that in the opinion of this
department the septic system constructed on your property is not in compliance
with existing State and Municipal Codes. Per Alaska Statute 18 AAC 72
and AMC 15.65.060 B1, the existance of an on-site septic system within 100
feet of surface water is not permitted. The existance of water bearing
ditches constructed along the western and southern boundaries of your property
would preclude the site selected for on-site disposal. There also exists
concern over possible encroachment on the four foot separation required by
AMC 15.65.020 C between the base of the seepage bed and ground water, as well
as the possible contamination of your well by surface water runoff.
I would like to discuss this matter as soon as possible and would suggest
both you and your engineer be present to go over our findings. Please call
me for any further clarification you might need at 264-4744.
Sinc~erely,, ~
Daniel N. Bolles
Engineering Tech
On-site Services
DNB/lJw
unicip ityof
nchor ¢
P.O. BOX 196650 ~--'~ ....
ANCHORAGE, ALASKA 99519-6650
(907) 264=¢k1~o~1x× 4744
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
On-site Services, Room 502
November 21, 1986
Mr. Jeff Kaitchuck
A.E.C.S., Inc.
1200 West 33 Avenue Suite B
Anchorage, Alaska 99503
Subject: Morris JoWnmem Property
Lot 8 Block 1 Birch Tree Estates Subdivision
Dear Mr. Kaitchuck:
The Health Authority and as-built received by this office, concerning.:
the subject lot, have been disapproved for the following reasons:
There exists, downslope of the septic system and between Lots 8, 9
and 11 a drainage ditch. This drainage serves to transport both
surface and ground water encountered due to the excavation. Per
Alaska Stature 18 ACC 72 and AMC 15.65.040 I; and .060 B this would
require a minimum 100 foot separation from the septic system. The
possibility of a waiver in such an instance could not be issued
without suitable precautions being taken (AMC 15.65.020 A-C and
· 150 A-C).
me
The presence of a small stream of water between Lots 8 and 7 which
is glaciating across the driveway and around the well, raised the
possibility of contamination of the water supply by surface runoff.
The presence of numerous outbreaks of water around the residence and
septic system indicates possibly that the seasonally high water table
is less then the -5 foot which was noted in March and June of 1985.
Per AMC 15.65.020 C 6; 040 F; and .060 A3 this would have to be
determined.
As these facts were not considered in the design and permit process for
the subject lot we cannot authorize the use of the on-site system installed¢
P 1,26 633 041
RECEIPT FOR CERTIFIED MAIL
/-NSq~SURANCE COVERAGE PROVIDED
( N0~R INTERNATIONAL MAIL
\ '~eeReverse)
S et d No
Mr. Jeff Kaitchuck, A.E.C.S, Inc.
November 21, 1986
Page Two
Whereas your office designed and inspected the installation we would
like to have your input, so as to solve this problem as quickly as
possible. Please feel free to contact my office at any time for further
clarification.
Sinc e_.r ely ,~ ~,~,,
Daniel N. Bolles
Engineering Tech
On-site Services
DNB/ljw
f
(907) 243-2282
KEN JOHNSON
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
30 YEARS ALASKA DRILLING
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 99502
JULY 16, 1985
Morris Johnmon
1200 .IS.treet # 410
Anchorage, Alaska
99501
RE, BIROH TREE .ESTATES LOT 8 BLK. I
( 278- 866 )
0 ft to 2 ft
2 ft to) ft
9 ft to 14 ft
14 ft to 32 ft
32 ft to 34 ft
34 ft to 36 ft
36 ft to 37 ft
37 ft to 39 ft
39 ft to 44 ft
ft to 51 ft
5i ft to 57 ft
57 ft to 59 ft
59 ft to 96 ft
96 ft to 101 ft
101 ft to 104 ft
104 ft to 107 ft
i07 ft to 109 ft
TO~AL CASING
110 ft 10½ in.
Fill
Organic peat
Courme gravel & gray silt
Med, gray & gray silt
Boulder
Course grav& gray silt
Boulder
~bbles & course'grav
Course grav& gray silt
~ame with finer gray
Med grav& light Brown silt
Boulder
Course grav & gray silt
Brown silt & fine grav
Same (weeps) 11 ft. head bails down
Same ( dry )
Med grav& sand.. Water bearing
Test bailed at 10 GPM
21 ft head
4 ft drawdown..., good recovery
Bottom stable ...very clean
TEST PUMP DATA, July 16, 1985
Static Water Level 90.5 ft ( T0C )
TIME GPM DRAWDOWN REMARKS
1900 9 94 light dirty
1920 14 97.5 cloudy
1945 14 98 Clean & clear
2000 14 98 " "
Good recovery
Pump set at 105 ft 10 in from top of casing ( T0C )
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PhuTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range) .
Location (address or directions)
(b)' Appl;can(Name ~J'~¢~/~'$ ~)~',~t''v/ Telephone:Home ~-/r~¢ Business
(c) ApPlicant is'(check one~: Lending Institution D' Owner/builder~; Buyer B' Other D (explain);
(d) Lending Institution ~ Telephone
Address
(e) Real Estate Company and Agent
· Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
single-Family~j~ Multi-Family []
Number of Bedrooms -~
Other
WATER SUPPLY
Individual Well,~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (11/84)
Page 1 of 2
ENGINEERING FIRM PROVIDIN~ ~NSPECTIONS, TESTS, FILE SEARCH, DA,., 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
Address /~'~'~ ~J
Date
Telephone
Apl~,uvud [u, "'-'"----- bedrooms by
,,¢~FprO~"8 Disapproved ~ -Cond:,t:,o,'~', ~
Date
Terms of Conditional Approval
CAUTION
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.
Page 2 of 2
72-025 (11/84)
WELL DATA
Well Classification ,
Well Log PresentON)
Total Depth
Static Water Level
Casing Height Above Ground
ElectriCa Wiring in Conduit (~'~)
Separation Distances from Well:
To.Septic/Holding Tank on Lot
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
DL=Pr. O~ Nr~N. TN &
NOV !-~ 1986
If A, B, C, D.E.C. Approved (Y/N)
"/"16' $~" Yield
Date Com/pleted
Cased to /~ Depth of Grouting
~'0, ~ · Pump Set At
/,.<" g~
Sanitary Seal on Casin )
Depression Around Wellhead (Y~)
..~To Nearest Edge of Absorption Field on Lot /j7.~¢ /
To Nearest Public Sewer Line ~.J,/~', .,,'~ To Nearest Public Sewer
Clean out/Manhole ~,/'//~ To Nearest Sewer Service Line on Lot
Water Sample Collected by ,~"~-~ (,.~, K~'~ 'rc~oC...~ ) 'Date
Water SamCe Test Results _ ,5/)* 7'/% F AC,~O~' ~'
· On Adjoining Lots
On Adjoining Lots
Comments
B. SEPTIC/HOLDING TANK DA'rA
Date Installed
StandpipeON) ,~. Air-tight Caps(~N)
Depression over Tank (Y/N))
Pumping/Maintenance Contract on File (Y/N),/.
Holding Tank High-Water Alarm (Y/N) ,~//,,"'¢
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /O13
To Property Line ~
To Water Main/Service Line _
Course
Size ,/~"~ff ~ No. of Compartments ~
Foundation Cteanout("~N)
Date Last Pumped ,~,~
; for ,~,,'~
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Type of System Design ~"~
Length of Field ~O /
Depth of Field
Gravel Bed Thickness ¢~" ''~
Standpipes Present(~)
Date of Last Adequacy Test
Square Feet of Absorption Area
Depression over Field (YN~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot ~///,~
To Water Main/Service Line
!
/,7--'~/ To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
LIFT STATION / /
Dat'~eln t ,
)ate~ Dimensions
S_ize in ?aliens ~ Manhole/Access(Y/N) _
"Purn.p On'' Level at ~ "Pump Off" Level at _
High Water Alarm Level at -"'-~~Vent (Y/N) _
Test_ ed for __ P~ during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that,~_______.~/,~,/,~.~conformed to all MOA and HAA guidelines in e f fo ct on the date of this inspection.
Signed Date
Company /'~'~ MOA No.
Receipt
Date of Payment-'
Amount: $
Page 2 of 2
72-026 (11/84)
JML INC.
LAB0~ )RV 1.0. #
7127 OLD SEWARD HIGH%,,,~' .....
ANCHORAGE, ALASKA 99518
(907)344-8551
BACTERIOLOGICAL WATER ANALYSIS
TO BE COMPLETED BY WATER SUPPLIER ....
TIME COLLECTED I TYPE OF SYSTEM
AMJ [~ PUBLIC. INDIVIDUAL []
r. TRCLE CLASS
TELEPHONE NUMBER
II)ATE COLLECTED ' I
mNTH ~Y YEA~
! I.D. NO. (pUBLIC SYSTEMS)
I,' ' . , I I ,I
NAME OF SYSTEM
SYSTEM ADDRESS
CITY STATE
'LOCATION WHERE SAMPLE WAS COLLECTED
COLLECTED BY:(SIGNATURE) /% z:/?~-~ ~.! //
L] / ~'/.-','..-~..L .... 1"';
..... - i,~',/ ~,
ZIP CODE
TYPE OF SAMPLE
(CHECK ONLY ONE THIS COLUMN)
rI~DRINKING WATER
v~'CHECK TREATMENT
[] RAW SOURCE WATER
[] NEW CONSTRUCTION OR REPAIRS
[] OTHER(Specify)
[~CHLORINATED
[:]FILTERED
~tJNTREATED OR OTHER
IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE?
[:]YES ~NO PREVIOUS COLLECTION DATE
ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM)
"'~'~D REPORT TO:(PRINT FULL NAME,ADDRESS AND ZIP CODE
, _~. ~ I,J~/~-
,i~OR LAB USE ONlY L
RESUBMIT SAMPLE
Sanq)le! rejected because:
CHECK ONE OR HORE
r-1Sa~le too long in transit.
Sanmle should not be over 30 hours.
['l Sanq)le received too late in week
[] Not in proper container
[:3Leaked: out
[] Insufficient information provided.
Please read instructions on form.
[]Other (Specify)
RECEIVED FROM ,l?
RECEIVED ~Y t ~l':( p[ m
ANALYTICAL METHOD:
~EMB~NE FILTER
[] FERMENTATION TUBE
Date & Time Started
Date & Time Completed 1~-'~?
LABORATORY RESULTS
Analyst ,,._J~77'2 £'~. ,-~ ~r...,x~
[] Other Bacteria
~3 Test unsuitable because:
[] Confluent Growth
[] TNTC
SATISFACTORY []
UNSATISFACT(N~Y []
BACTERIOLOGICAL WATER ANALYSIS RECORD
FOR LAB USE ONLY
OTHER
Membrane Filter: Direct Count ....
Verification: LTB
Final Membrane Filter Results
Reported By
BGB
Date
Coliform/lOOml
Coliform/1OOml
Time
A.M,
READ SAMPLE COLLECTION INSTRUCTIONS ON BACK OF FORM