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HomeMy WebLinkAboutGLACIER VIEW HEIGHTS #4 BLK 3 LT 7Glacier View 40 Heights #4 Block 3 Lot 7 #050-501-31 Municipality of Anchorage '° •, Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 www.cl.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW070059 PID Number: 050.501.31 Zabel fer RemillardWastewater System: ❑ New ® Upgrade And,ep for Loop Eagle River, AK 99577 ABSORPTION FIELD Pnaw NlnDer of BW roortr' 0 Deep rr«rcn o $Mllow rrwrar ®ew 0 Mood O ouwr: LEGAL DESCRIPTION Tool Devdhamongrnalgraa 0.3 GMT? 1 Ft. Block W aubdnr . Dapm It, pipe bdnera hon edgnal grade Gravel dspth beMedl F."I 3 7 Glacier View Heights Subdivision 3 Ft. 0.5 Ft TlowtV, Rerge: eeawn: FMaddedabovednpnYprude: Gravel LerjM 1.3 Ft. 10 Ft. Well: ❑ New ❑ Upgrade or..el.otl,. Nw et/Mea DnoVo. bnreen/nee 17 Ft. 3 5 Ft claovftalq jpmate. A a. D) Toot Depen: Goad u, TUW eworpoan vu Ppe Material ExistingPrivate n. fl. 170 Fe Perforated DnINr- One Dmtvi. .SW WI Water Level. InnnkM: Dns InotoW Ft. GLW Construction 611012007 Y*d "sn n u+w H"ht Aoove Grwne TANK GPM FL FL SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublWPrlvate Man" eaI I. ro From Tank Field Station Tank Sawar Una Existing 1250GnJ won 127.3 139.6 - 120 Mnnw w. a .r a ca y.n .nu. surl.wnn 100+ 100+ LIFT STATION ..::,, -r anu sa-ver Lw u» 36.5 .,•r, .,Ga 12.4 A -Pwnp on' Mrei n py(�pafr levN n •r,' Hph weIV &W. at. wad Fldn N � . I,72.�.. `•Jv in In. 50+ Pump M.ke a ModN EMct,"i lmpenm wp.norrrwl by. Cunnn Orrn1 Re co Reconfigured field, deleted 135 SF and added 170 SF due to BENCH MARK Lxalan end Dowriptkn house addition. Revised total area is 2045 SF Finish floor of new addition p..,,rh.d levetwn 100.0 FL Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1" 101612006 .•�� OF q� 2nd 611012007 �p ,..•••• .. �+ ♦i Development Services Department Approval : �?.•' '';♦i a: Conditional Approval Date: g, ... ........1.... ....... .. • ♦j .Steven R. Pannone: i J Reviewed and approved by: 1 Date:. ♦ 't ♦ No�C1E 8149 ♦♦i ce%... � ;��;...... • PERMIT NO: 070059 RECORD DRAWING P.I.D. NO: 050-50141 WASTEWATER DISPOSAL SYSTEM LOT 7 BLOCK 3 GLACIER VIEW HTS S/D, NO.4 6 \ \ SrJT4 Bq HO Exim \\ SEPTIC S&S ENG`/ ISTG BED SYS M / EXIST 50g \ \ T 3 x67'Lx0.5 j SEPTICT \\ , INSTALLED NEW .0. ' TO REMAIN \ \ \ ON LINES TO FACILIT TE M2 5 \ CLEANING OF LI ES \ FC . \ T1 , 7.3 \\ - INSTALLED N EADER LINE TO ALL DI RIBUTION 139.6 EXISTG \ \ LINES. WELL \ \ S&S OR SEPTICS .W DRAIN FIELD\ 17'Wx10LFx0.5 ED- 170SF TOTAL ADD'N TEND 3 LATERALS 8LF TO SOUTHEAST-/ APP'N RAT - BEDROOMS AREA REOU 30 -WIDE BE 67 LFx 30' Wx TOTALAREA REMOVE 135 ADD 170SF (1 0 iN RATE: 5-15 MPI 0.3 GPDSF 4 (600 gpd) RED: 2000 SF 0.5' EFF DEPTH 0.5 ED, 1.0' TD :)1010 SF Tx0.5 ED) Steven R. Pannone CE 8149 11-5-07 0 —1�NEW 12'X16' Cl ADDITION TO HOUSE -A EA /IN 10' OF PROPO D ADDITION APPROX 5 SF. REMOVE P ES 8 GRAVEL COMPLETELI',FILL W/ PIT -RUN GRAVEL 8 COMPACT. �—'_.__---.— ARE7UNDEVELOPED ` NO SEPTICS ` WAN 100 FEET 0 RECORD DRAWING SWING TIE TABLE: A B C1 17.1 14.3 C2 23.1 20.0 C3 288 25.6 AREA UNDEVELOPED NO WELLS OR SEPTIC W/IN 100 FEET NOTES: 3) Maintain 10' separation to all lot 5) Install expansion bed at the 1) All work shalt be performed In lines and water lines, unless noted same elevation of exisfg. accordance with AMC15.65. otherwise. 6) Install sand layer under 2) Materials used shall be In 4) Lots served by private water gravel to maintain 4'separation accordance with those specified In systems. No wells within 100' of to ground water and a level bed. AMC15.65, Wastewater Disposal. proposed system. trAHtU 1 -UH: PANNONE ENG. SVC, LLC Michael & Jentler Remillard P. O. BOX 102954 22830 Eagle Glacier Loop ANCHORAGE, ALASKA 99510 Eagle River, AK 99577 696-4232 227-3522 P, 272-8218 Fax DATE: 11.5.07 PLAN SCALE' 1•=5n• PERMIT NO: 070059 RECORD DRAWING DETAILS P.I.D. NO: 050-50131 WASTEWATER DISPOSAL SYSTEM LOT 7 BLOCK 3 GLACIER VIEW HTS S/D, NO.4 w-wm r3x c 33ru wewa aasrc� 1— U LJ U) m -x own =-Wn3 33 NO M313 eno lens ua wvm M011WNMe Air yy \ iI 7 ..... Z RECORD DRAWING • r PREPARED FOR: r....::....::••• none StevenCE 8149 Michael B Jenifer Remillard # 11.5-07j �� 22830 Eagle Glacier Loop •.,, ••' Eagle River. AK 99577 0 6964232 1— U LJ U) m -x own =-Wn3 33 NO M313 eno lens ua wvm M011WNMe Air yy \ �........ ..... Z RECORD DRAWING • r PREPARED FOR: r....::....::••• none StevenCE 8149 Michael B Jenifer Remillard # 11.5-07j �� 22830 Eagle Glacier Loop •.,, ••' Eagle River. AK 99577 ";rt P� �& 6964232 W _J Li 0 OL PANNONE ENG. SVC, LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P. 272-8218 Fax SATE: 11-5-07 DETAILS ;ALE: NTS MUNICIPALITY OFANCHORAGE I '1 Development Services Department On -Site Water & Wastewater Program 11 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 \b (907) 343-7904 1 �� ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 11, 2007 Expiration Date: May 10, 2008 Permit Number: SW070059 Parcel ID: 050-501-31 Legal Description: GLACIER VIEW HEIGHTS #4 BLK 3 LT 7 Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: 022830 EAGLE GLACIER LOOP Owner Name: MICHAEL & JENIFER REMILLARD Lot Size: 48503 SO. FT. Owner Address: 22830 EAGLE GLACIER LOOP Total Bedrooms: 4 Permit Bedrooms: 4 EAGLE RIVER . AK 99577-9527 This permit Is for the construction of. R Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with; 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by catling (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...Date: (??C5T Issued By. bc;0C 1yZ- --anti Date: / cq-% 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. 19.5-n- n l- SI t�� Property owner(s) �ehlLYC�bay phone I(n r' Mailing address Zip Code Site address 2215a iC,I E �n eLCtr php Zip Code 9 C16 Legal description (Sub'd, Block & Lot) Legal description (Township, Section & Range) Lot Size (IS X03 Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field 191 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ M Number of Bedrooms 4 THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5 Waiver Fees: Date of Payment: D Date of Payment: Receipt Number. Q Receipt Number: (Rev. 11105) Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (9071272-8218 (907) 272-8211 Fax May 6, 2007 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 7, Block 3 Glacier View Heights S/D, No. 4 Septic System Reconfiguration Permit Renewal Request Ladies and Gentlemen: I am writing in response to your Review Comments dated May 2, 2007. I will respond to your comments in the same order that they were presented. Please note, this work was started under Permit Number SW060072 and was terminated due to winter weather. Comment: Please identify the 4 standpipes after the tank and determine why the first two found after the tank are filled. Response: The first two stand pipes are the original double clean -outs installed in 1991. The second two stand pipes are clean -outs on sweep tees to clean the lines running west. There is obviously a blockage between the first set and the second set of clean -outs. The Owner has been notified and he will coordinate to have the lines cleaned. ctc- Comment: Please explain how pit run gravel will prevent effluent from migrating through the decommissioned section of the bed. Response: Gravity. Please note: This work was performed under the original permit and an inspection was called in on October 6, 2006. The material excavated from the footings of the new building (a silty sand to silty gravel) was placed in this area and compacted. Comment:Your profile does not show the 5 laterals of the original bed. Response: Revised Section to show the three pipes to be extended. Comment: Per AMC 15.65.060.H.5. "The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet". Response: Revised plan to extend field to southwest. Comment: The profile shows that the bottom of the system is within 4' of ground water. Response: Based on Record Drawing information, the bottom of the field is 4.2 feet above ground water. Added this information on Detail Sheet. Pagel of 2 Page 2 of If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, Steven R. Pannone, P.E. Civil Engineer Attachments: Q\Work\Letters\7-3 Glacier View Hts.002.doc PERMIT NO:SWO60072 DESIGN DRAWING P.I.D. NO: 050.50131 WASTEWATER DISPOSAL SYSTEM LOT 7 BLOCK 3 GLACIER VIEW HTS S/D, NO.4 101 EXISTG SEPTIC--" S&S ENG INSTALLED NE) ON LINES TO FACII. CLEANING OF INSTALLED N LINE TO ALL DI JES < 5. :ADER UTION LINES. '-,AREA VELOPED S&S EN NO, S OR SEPTICS TH PROPOSED DRAIN FIELD ADD'N I17'Wx10LF4.5 ED 170SF TOTAL ADD'N EXTEND 3 LATERALS 8LF TO SOUTHEAST J PERCOLATION RATE: 5-15 MPI APP'N RATE: 0.3 GPDSF BEDROOMS' 4 (600 gpd) AREA REQUIRED: 2000 SF 30 -WIDE BED: 0.5' EFF DEPTH 67 LFx 30' Wx 0.5 ED, 1.0' TD TOTAL AREA:I 010 SF REMOVE 135 $F ADD 170SF (10LFx17k0.5 ED) G � T`04 TG BED SYSTEM / EXIST 50g x 671 x O.SED SEPTIC T •, • TO REMAIN \FC T1 27.3 T I / \� / Crap✓ 139.6 EXIsrG WELL\� 'I 12 — PROPOSED 12'r16' ADDITION TO HOUSE 17.0 AREA WIIN 10' OF PROPOSADDITION APPROX VDI REMOVE P ES &GRAVEL COMPLETEL$:FILL W/ PIT -RUN GRAVEL & COMPACT. AREA UNDEVELOPED \ NO WELLS OR SEPTICS WIIN 100 FEET _ l01 DESIGN REVISIONICLARIFICATION AREA UNDEVELOPED NO WELLS OR SEPTIC WON 100 FEET , �� NOTES: 1) All work shall be performed in 3)Maintain 10'separation to all lot ur""""`"...... lines and water lines, unless noted same elevation of exlsrg. •.••�04 accordance with AMC75.65. otherwise. ) y 6 Install sand layer under `��P'(............., �•' �••• �� 2) Matedals used shall be in q) Lots served by pdvate water gravel to maintain 4'separation qg Tx ♦ accordance with (hose specified In to round water and a level bed. systems. No wells within 100' of 9 �.. ° .. . .... I... AMC15.65, Wastewater Disposal, proposed system. 0, Sievan R. Pannone --PREPARED FOR: PANNONEENG. SVC, LLC Michael 8 Jenlfer Remillard P. O. BOX 102954 BOX �j . CE 8149 5.7-07 • 22830 Eagle Glacier Loop Eagle River. AK 99577 ANCHORAGE, ALASKA 99510 g� ♦♦'• ...... -352 P. 72-8218 Fax '•�•� 696.4232 DATE: g3-0s a u PERMIT NO:SWO60072 N r v a O DESIGN DRAWING DETAILS P.I.D. NO: 050-501-31 WASTEWATER DISPOSAL SYSTEM LOT 7 BLOCK 3 GLACIER VIEW HTS S/D, NO.4 0 ,.i 101 1!W-NT] YJN ..L 38N WllM 0.SM) ? >' Z t< 2 p e LLI i„ 3Bnl BOLNOr, O.ISIN3LL J !n0-Nr3V OJLX3 8 o ++ ' uB-xvm 3ienW 'n o im etro b i1w wM R c ••�� O.. q���1� w1e0w"'m� ••�P .............'. lei i TH 49 w i• .......... .. Pannone REPARED FOR: PANNONE ENG. SVC, LLC a tSteven R. �l a '•. C-6 Michael & Jenifer Remillard P. O. BOX 102954 9 1#� 7 9 �� ♦�44��� 22830 Eagle Glacier loop River, AK 99577 ANCHORAGE, ALASKA 99510 o •� • Eagle 227-3522 P, 272-8218 Fax u Ott, ;'CF'��• DATE: 4.3-06 DETAILS is SCALE: NTS N MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 n (907) 343-7904 V ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT lo1D� Upgrade Date Issued: May 01, 2006 Expiration Date: May 01, 2007 Permit Number: SW060072 Parcel ID: 050-501-31 Legal Description: GLACIER VIEW HEIGHTS #4 BLK 3 LT 7 Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: 022830 EAGLE GLACIER LOOP Owner Name: MICHAEL & JENIFER REMILLARD Lot Size: 48503 SQ. FT. Owner Address: 22830 EAGLE GLACIER LOOP Total Bedrooms: 4 Permit Bedrooms: 4 EAGLE RIVER , AK 99577-9527 This permit is for the construction of: ❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, seated, and heated to prevent freezing. Received By: Y2:. L -_&0/VW Date: '5v2 oc, Issued By. { her Date: 5.11 /0 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 050.501.31 Property owner(s) Michael & Jenifer Remillard Day phone 6964232 Mailing address22830 Eagle Glacier Loop, ER AK Zip Code 99577 Site address 22830 Eagle Glacier Loop Zip Code 99577 Legal description (Sub'd., Block & Lot) Lot 7. Block 3 Glacier View Heights SID No. 4 Legal description (Township, Range & Section) Lot Size 48,503 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. Pannone Engineerinq Services, LLC (Signature of property owner or authorized agent) Permit/Rush Fees: 1160 Waiver Fees: Date of Payment: Ll - Z rJ = 0 & Date of Payment: Receipt Number: Receipt Number: (Rev. 11/05) Municipahiy of Anchorage 4.: Tyj1Y/w r CO. IAx 1!NfSll•.\nc6nrigc,.11uxkn!NASI!A(N:ill•Tchph�mc l!NIiI:14:1 hi111. 1',x4!N)7).14&82(N) C 47(N)lHmg:ncSl mo •.\na•hnmgc, .\laslm tk),illi s.•ci. a�a�c.numLorg Mayor Mark Begich Iluildina Safety Di%3sion 19 April 07 Michael R Jennifer Remillard 22830 Eagle Glacier Loop Eagle River, AK 99577 Subject: Expired On -Site Water and/or Wastewater Permit Permit Number: SW060072 Legal Description: Glacier View Heights #4 Block 3 Lot 7 Dear Mr. & Mrs. Remillard: An On -Site Water/Wastewater Permit, number SW060072 issued by this office for a single-family system, will expire on 01 May 07. Permits are valid for 365 calendar days from date of issue. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A one-time renewal fee for a second year may be issued for a $115.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are $460.00 for a wastewater permit and $175.00 for a well permit. eE_A.1rXAv If you have any questions, please call this office at 343-7904. 412(.107 Sincerely, 5�i;/p -- 0 93 7 72- Daniel 2Daniel J. Roth Program Manager On -Site Water and Wastewater Program Enc: Copy of permit Community, Security, Prosperity Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: PES Legal description: Glacier View Helghts #4, 1331_7 ®Permit ❑C.O.S.A. ❑Inspection Report The attached paperwork has been reviewed and is being returned for the following reasons: Please identify the 4 standpipes after the tank and determine why the first two found after the tank are filled. 2. Please explain how pit run gravel will prevent effluent from migrating through the decommissioned section of the bed. 3. Your profile does not show the 5 laterals of the original bed. 4. Per AMC 15.65.060.H.5. 'The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet'. 5. The profile shows that the bottom of the system is within 4' of groundwater. Name of reviewer: Deb Wockenfuss Date: May 2. 2007 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK Municipality of Anchorage Development Services Department Building Safety Division % On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Pes Legal description: Glacier View Heights 94, B3 L7 #2 ®Permit 0C.O.S.A. ❑Inspection Report SAI." The attached paperwork has been reviewed and Is being returned for the following reasons: 1. The profile shows the wrong width. 2. Please change your note from 4' of topsoil and seed to 60 . Name of reviewer: Debbie Date: May 9, 2007 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK PERMIT NO: SW06 DESIGN DRAWING P.I.D. NO: 050-501-31 A EXIST'G SEPTIC� // S&S ENG/ WASTEWATER DISPOSAL SYSTEM LOT 7 BLOCK 3 GLACIER VIEW HTS SID, NO.4 11.4 V c5C2 \� \ TG BED SYSTEM x 671. x 0.5ED 5%/ �FC / 1 TI � 'ROPOSED IELD ADD'N x67LFx0.5ED \�� /Z)"3 F TOTAL ADD'N \\ X /` \ SSS EN 5% \\M1i� E ST'To'4 BR , \ HO / EXIST 51 SEPTIC T TO REMAIN \ 7 \117.3 \\ 1139.6EXIST'G PROPOSED 12'x16' ADDITION TO HOUSE AREA WIIN10'OF PROPOSf D ADDITION APPROX 5 SF WELL REMOVE PliES 6 GRAVEL ` \ ` COMPLETEL'�'FILL W/ PIT -RUN AREA EVELOPED GRAVEL 8 COMAAC�T. NO WELLS OR SEPTICS WAN 100 FEET `-_' --_-- DESIGN CALCULATIONS: AREA UNDEVELOPED \ ` PERCOLATION RATE: 5.15 MPI NO WELLS OR SEPTICS APP'N RATE: 0.3 GPDSF BEDROOMS: 4 (600 gpd) AREA REQUIRED: 2000 SF 30 -WIDE BED: 0.5' EFF DEPTH 67 LFx 30' Wx 0.5 ED, 1.0' TO TOTAL AREA:2010 SF REMOVE 135 SF ADD 201 SF (67LFxTx0.5 ED) WAN 100 FEET u �! *R E D g AA REVELOPED /NO WELLS OR SEPTIC WAN 100 FEET ""' `�. 3) Maintain 10'separation to all lot of m5mu expansion mu at me 1) All work shall be performed In lines and waterlines, unless noted same elevation of exist'g. accordance with AMC15.65. otherwise Eagle River, AK 99577 696.4232 6) Install sand layer under 2) Materials used shall be in 4) Lots served by private water gravel to maintain 4* separation accordance with those specified in systems. No wells within 100' of to ground water and a level bed. AMC15.65, Wastewater Disposal. proposed system. tVAKtU I-IJK: PANNONE ENG. SVC, LLC Michael & Jenifer Remillard P. O. BOX 102954 22630 Eagle Glacier Loop ANCHORAGE, ALASKA 99510 Eagle River, AK 99577 696.4232 227-3522 P, 272-8218 Fax DATE: 4-3-06 1 PLAN SCAT F• 1-=,,n- PERMIT NO: SW06 DESIGN DRAWING DETAILS P.I.D. NO: 050-501-31 WASTEWATER DISPOSAL SYSTEM LOT 7 BLOCK 3 GLACIER VIEW HTS S/D, NO. 4 38r1 HOBNOn J 0 �o Ld 3QrU bovRon Ld —j SIX ' F•'C t. X x". r 0 ino-w3io Lm-wfm 31er100 W SUPE7741i%EDED Ino ofmD mw= OF T�v, m Rem Co N011VONMJ a r4q TH froo 0 o ...... .. ..... .................. • R. Pannone PREPARED FOR: Michael & Jenifer Remillard PANNONE ENG. SVC, LLC .pteve P. O. BOX 102954 E 8 49 I.. . . ........... 22830 Eagle Glacier Loop Eagle River, AK 99577 ANCHORAGE, ALASKA 99510 227-3522 P, 272-8218 Fax I 6964232 11 %saks DATE: 41111 DETAILS' SCALE: NTS Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8211 Fax Apri13, 2006 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 SUPERSEDED Subject: Lot 7, Block 3 Glacier View Heights S/D, No. 4 Septic System Reconfiguration Permit Request Ladies and Gentlemen: I am writing to request a permit to reconfigure the existing septic system at the above referenced property be issued for this property. The existing system serves a four- bedroom house. The Owners are wishing to expand the living room with an addition that will encroach upon the existing septic system. I am proposing the removal of the existing system within ten feet of the proposed addition, and adding the lost area (approximately 135 so along the south side of the field by adding a three-foot wide addition to the length of the existing field at the same elevation of the existing field (an addition of 201 so. I performed a recent investigation of this system. The system had approximately one inch of standing water in the field on March 27, 2006. The Owners live and work out of their house and they were in the process of doing laundry during my visit, which would account for the standing water. The lot is 48,503 square in size. There is adequate room on this lot for the reserve system as proposed by S&S Engineers in 1991. If during the course of the reconfiguration it is found that the existing bed is in failure, we will perform test holes and develop a design to upgrade the septic system. A request will be made to your department to modify the permit to an upgrade. 1. Soils. See the soils logs on file with your department. Ground water was monitored at a depth of 3.5 feet on June 27, 1991. Bedrock was not encountered in the test hole. It is my opinion that the overall soils appearance of the soils, an application rate of 0.3 gallons/day/square feet should be used. 2. Trench Design. a. Percolation Rate: b. Application Rate: c. Number of Bedrooms: d. Design Flow: e. Min. Absorption Area: f. Total depth: C:\Work\Letters\7-3 Glacier View Hts.001.doc 15-30 Min Per Inch 0.30 gpdpsf (500 sf/br) 4 600 gallons per day 2000 sf 0 feet g. Area Removed h. Replacement Area i. Effective Depth: j. Width: k. Reduction Factor: 1. Minimum Length: m. Design Length: n. Effective Absorption Area: 13SVpE RIGEDED 0.5 feet 3 feet 0.0 67 feet 67 feet 201 sf 3. Surface Water: There are no surface waters within 200 feet of the proposed septic system. 4. Topography: The average topography in the area of the proposed septic system is approximately 5%. The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, •����aaaa�l • i 49 it /\ Steven R. Pannone, P.E. Civil Engineer • ...... .......... ...., C.Steven R. Ponm Attachments: ,, •., No. CE 8149 )'NaESSva3y �aaaaa���• C:\WORK\LETTERS\7-3 GLACIER VIEW HTS.001.DOC rA PERMIT NO:SW060072 DESIGN DRAWING DETAILS P.I.D. NO: 050.501-31 WASTEWATER DISPOSAL SYSTEM LOT 7 BLOCK 3 GLACIER VIEW HTS SID, NO.4 f e S I y TM Nnnone•.•� CE 8149 1no-wn'o N3N C wn3 uovN 0.39%3 3en1 eoiwon OASix3 3 o.3SIx3 C Michael & Jenifer Remillard 22830 Eagle Glacier Loop Eagle River, AK 99577 6964232 IM-NV313 33enoo NO NY= u+o NV33J Ino NvTo NOe30NnOJ a PANNONE ENG. SVC, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P, 272-8218 Fax TATE: 4'3.06 IDETAILS Municipality of Anchorage Page I of. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: __~'_~"'~"'~"~-J~ 16'~_[~/~') PID Number: ~~ [~ t ~ ame: ~~ ~,~F~ ~ ~ ~~ Wastewater System: ~New D Upgrade Address: ~,~ ~ ~, ~~_ ABSORPTION FIELD Phone: -- No:of Be~-- ~ Deep Trench ~ Shallow Trench ~ Bed ~ound ~ Other Total Depth from original grade: LEGAL DESCRIPTION ~ ~ soi,,~i.~: 0.~ ~/sq.~,. Lot: ~_ Block: ~ ~ Subdivision: ~Depth to pipe bottom from original grade:f Gravel depth beneath pipe Township: ~Range: ]S.c,iZn: ~"FiU added above original grade:~ ' --*' Ft. Gravel length: WELL: ~ew [3 Upgrade ~~~ Numbe~lines: IOistancebelweenlines: 8,c): ] Tota~ Depth: Cased To: ITota~ absorption area: Pipe material:~t~ Driller: I Date Drilled: Static Water Leveh ~lnstaller: ~ate insla~led:- Yield: Set at: t Cas' g Height Above Ground:/ T~ ~ 1~ GPM[ ~ Ft. ~ ~ --~' ~ s~ SEPARATION DISTANCES ~)~Septic ~ Holding From / Tank I Field Station Surface [ ~ z'~-.~~ ~ I I ~'7'-,' , Water · Lot I , ~',_1 ,,~,~ 1 .und t,o. Curtain I . $.T.E.P. anufacturer: [Capacity in LIFT STATION Size in gallons: [ Manufactur(~,.~__~~ -- '"'~u~m~rr," le"~;I ~~'7~;' I~vel at.,~h water alar~"~ at: BENCH MARK Inspections perforrned by: ~,' L Department of Heal~um~ices approval Reviewed and approved ?.___.¢¢JX.. ._ Location and Description: Assumed [--levation: _. ,OD ' ~,, "~' .. 72-013 (1/91)MOA 25 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · 'l"elephone: 343-4744 On-Site Waslewater Disposal System and/or Well Inspection Report 72-013 A (2/91) MOA 25 C��e ti iced Drilling lKog me co. "A SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK. ALASKA 99567 • TELEPHONE 6882759 OWNER OF LANDt- i ADDRESS LEGAL DESCRIPTIOy C t' (�i -"'F 1� DATE. Started Ended / r PERMIT NUMBER DEPTH OF HELL r�? 9. C . STATIC LEVEL OF WATER FF. a DRAW DOWN FT. GALS. PER HR 7r,.c KIND OF CASING 17)� KIND OF FORMATION: 4 t, C`f{1•i�i.��t STif.C�10 From `� Ft. to � From Ft. to Ft. ; 'K2e � 6 "/ Ft. Ft. Fromto From `� FL toFt. x"Ir= 1 '2e2`` - —l— _ From �� -Ft. to l L ` Ft. rl4 7"i `�AtrJO 6Q.4JEG From / - Ft. to Ft. From I Fl. t0 ��Ft• `St L .Y {'/Q /!i Qh�CG From Ft. to Ft ' From Ft. to Ft. C7 Frnm_�t. to Ft r --77 �� Ft. to�Ft. "f /C i `�� _ �P E GFrum Ft. to Ft. From From_20 Ft. to //O Ft.yC/t%i CPA✓'[ i lE,�� From Ft. Ft. , From Ft. to Ft. .S S From Ft. to Ft. -- Froml/ 1 FLYo2.?J_J._Ftt�L 4__ t 9e l L `i , From Ft. to Ft. e, �'✓ QJf)rillR)E C�4 4 From Ft. to Ft. ' From /J�Ft.to-Ft. !,-c 4 From Ft. to Ft. FromFt. to Fl. 7 it. to Fl. s1 Q 6R AJ c Z t F - From Ft. to Ft. pAof From „ r �� ' 4 % c 2 From WOT�a' From-176o—Ft.' I+r_+�,ppogf M+tO From Ft. to Ft. _ Fro I. A f X99 t t From Ft. to Ft. From Ft. to Ft. From Fi. to Fromj. tC[ 1�© L ` t From Ft. to Ft. iF From to Ft GE MUNICIP DM MISCL. INFORMATION: � ERV DIVISION EIJVIRONM APR 14 1992 RECEIVED DRILLER'S NAME PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910190 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:REMILLARD MICHAEL WAYNE OWNER ADDRESS:P.O. HC 83 BOX 1559 EAGLE RIVER, AK 99577 DATE ISSUED: 7/11/91 EXPIRATION DATE: 7/11/92 PARCEL ID:05050131 LEGAL DESCRIPTION: GLACIER VIEW HEIGHTS #4 BLK 3 LT 7 LOT SIZE: 48503 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY: v~g--~'-'~~~--~- DATE: ?///,/~/ _ ROBERTSHAFER, P.E. ROGER SHAFER July 5, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERfNG STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 7; Block 3; Glacier View Heights; Request you issue a permit to drill a well and install a septic system per our ¢~ached site plan dated July 4, 1991. As can be seen from the attached soil logs the groundwater levels on the property fluctuate. The high~st level found was at 3.5 ft. below the ground surface. We have proposed an elevated bed system with the receiving soils to be just under the organics. A sand filter leveling course is specified with a thickness varying between 2.5 ft. and 4 ft. due to the slight slope on the property (SEE SHT. 2 of 2) Due to the large lot sizes in the area, we do not anticipate any adverse effects on neighboring properties by the insta~ation of the proposed we~ and septic systems. If you have any questions or require any additional information for your review~, please contact us. E~T A. SHAFER, P.E. PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: I-EGA[. DESCRIPTION: b"~ ~'~'~ 2 3 4 7 8 10 ~2 ~3 ~4 17 ~8 Township, Range, Section: {~,,1~~ SLOPE SITE PLAN WAS GROUNDWATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? ~ oL P E Depth to Water Readin9 Date Gross Net Depth to Net Time Time Water Drop 2O PERCOLATION RATE _~ {minutes/inch) PERC HOLE DIAMETER _(-~2'~ FT PERFORMED BY: ~, ~, ~ ~-i~i£:~ '~,~:4:~-!-:.[!')(:' I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCO"DANCE W*~¢~t~¢ ~,¢~PAL GUIDELINEF~gFECT ON THIS DATE DATE: 72-008 (Rev. 4/85) ~gle gNor, Alasks *'~ v / Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'TEST PERFORMED FOR: '~--~'~ ~,-,---~'~-~"~ LEGAL DESCRIPTION: ~.-'"~ ~.~'~ ~ ['"'/~-~'1 I~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? / Depth to Waler After,~:LI/o ~ monitoring? -- 17-- Oate: ~-'~"'~-~ I SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop /:45 \ '/. TM PERCOLATION RATE '~-[ (mmutes/~nch) PERC FIOLE DIAMETER 17034 F.a~k~ Rive? Loop i~o; o; ,~ ,)~ I~ __ __ _ CEI. ACCORDANCE V~,T~I~I~,I~i~i&?~I~.~.,~b~I,,G)PAL ~'~ID~I'~,/E T ON TI'tiS DATE. DATE: COMMENTS PERFORMED BY: 72-008 (Rev. 4t85) CER'flFY THAT THIS TEST WAS PERFORMED IN DEPARTMENT OF HEALTH & HUMAN SFRV CES .... - .... 825 L Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLAT ON TEST ~' LEGAL DESCRIPTION: L T ~ 3~Z~C?~ ~/~¢Township, Range, Section: SLOPE SiTE PLAN S / L IF YES, ATWHAT ~ O 12 DEPTH? ~ p E Deplh to Watrlr Alter ~' t Gross Net Depth to Net Reading Date Time Time Water Drop z ? ~a 6 l~f~ q -- 7 Yz " I ~ I,' ~o~. ~ P" ~ ~ -~ z..' zo p~) ~ 9/~" /~" 14 15 16 17 18 Jo ~j?sP Loop Road No. 204 PERCOLATION RATE ~ (m~nutes/mch) PERC HOLE DIAMETER __ 72-008 {~ev. 4/g51 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.# ,t"~..~[~) -~23t-~\ -- '~' 1, GENERAL INFORMA'rlON Complete legal description Lot 7; Block 3; Gla~ier View H~ight~ -:Subdivision Location (site address or directions) Eagle Gla~i~r Loop Property owner Mailing address Michael R emillard Day phone HC 83 Box 1559 Eagl6 River, Alaska 99577 Lending agency Mailing address_ Day phone Agent PEPPERS CONSTRUCTION Day phone Address P.O.Box 771064 Eagle River, Alaska 99577 694-9681 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ,¢ TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. XX 72-025 (Rev. 1191) Front MOAII21 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/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and typeofstructureindicated herein. I furtherverifythat 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 Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional 17034 EagJe River Loop Road No. 204 bedrooms. approval for Phone Date bedrooms, with the following stipulations: Additional Comments 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 the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025 (Bev. 1/91) Back MOA ~I Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ A. WELL DATA Well type"'~'~'\J~¢-,' If A, B, or C, attach ADEC letter. Log presentd~N) Y ~ Date completed Total depth '~"~2 z~ Cased to Sanitary seaf~) FROM WELL LOG Date of test Static water level Well flow Pump level Parcel I.D. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ / ¢;~ Absorption field on lot ~.4 Public sewer main ADEC water system number \\//~ \ I::)riller '¢'-"¢-'~'~ Casing height Wires properly protected (~N) ""/ g.p.m. Sewer service line AT INSPECTION ; On adjacent lots _ ; On adjacent lot,,; Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed \~ ~\~-P" Cleanouts<~N) High water alarm (Y/N) Date of pumping Tank size Foundation cleanout ~N) Compartments '/ Depression (Y/~ Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot L/~-~ On adjacent lots To property line \ ~ '~' Absorption field Surface water/drainage \ c;~ I '~' Foundation_ Water main/service line_ 72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length Total absorption area Depression over field (Y/d~ Results (pass/fail) Width Peroxide treatment (past 12 months) (Y~ Soil rating ~:;~, '~ ~ ¢'~%ystem type Gravel thickness ~,~' Total depth Cleanouts present~-1GN) Date of adequacy test for z¢¢-- bedrooms If yes, give date On adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~.~1 I Property line To building foundation To existing or abandoned system on lot On adjacent lots ~ 14'' Cutbank ~D I~ Water main/service line Surface water \ ~~'k~ Driveway, parking/vehicle storage area Curtain drain ['~0~ E. ENGINEER'S CERTIFICATION Signature Engineer's Name I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ):]NGINEEI?ING ';~'~' .... ~ :~ ":" '''~ '"" ~' & $ 17034 Eagle River Loop Road No. ~04 Eagle Rivet', AlasI{a 99577 Date HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUM3d~ SERVICES ENVIRONMENTAL SERVICES DIVISION ON-SITE WASTEWATER DISPOSAL SYSTEM INSPECTION ENGINEER FIELD AUDIT TIME: LEGAL DESCRIPTION: ENGINEER: EXCAVATOR: AUDITOR: COMMENTS: SIGNATURE AUDITOR: CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMr-'RCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA99518 TELEPHONE (907) 562-2343 FAX:(907) 56%5301 ANALYSIS RESULTS for INVOICE # 52611 Chemlab Ref.# 92.1439 Sample ~ 4 ~at~lx: WATER Client Sample ID PWSID Collected Preserved with L7 B3 GLACIER VIEW HTS. UA APR ? 92 ~ 17:10 h~s. APR 8 92 ~ 14:00 hrs. AM REQUIRED Analysis Completed : APR 10 92 Client Name :S & S ENGINEERING Client Acer :SNSENGP BPO# : Req# : Ordered By :ROGER S}~FER Send Reports to: i)S a S ENGINEERING 2) PO# :NONE RECEIVED Parameter Results Units Method Allowable Limits NITRATE-N ND(O,IO) mE/1 EPA 353,2 10 Sample ROUTINE SAMPLE COLLECTED BY: R.J.S. Remarks: 1 Teat~ Performed ' See Special Instructions Above UA~Unavailable ND~ None Detected '" See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Groatet Than ~'~ S~S Member of the SGS Group (Soci~t~ GCn~rale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIViSiON OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY LABORATORY TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D. fi ~ ,,,¢~PRIVATE WATER SYSTEM !/d3., ...t e i::iver Loop Road No, 204 Mailing AOO,~9lc R;vur, Ala5ka ~2 City Mo. Day SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ret. no. ) [] Special Purpose Slalo Zip Code Year [] Treated Water [] Untreated Water SAMPLE No. LOCATION 1 41 Collected READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Collected By Analysis shows this Water SAMPLE to be: /1~. Satisfactory [] Unsatisfactory [] 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. T me Received Analytical Method: Membrane Filter No. of colonies/100 mi. Lab Ret. No. Result* Analvs/ BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LSB Coliform/100 mi Fecal Coliform Confirmation BGB Final Membrane Filter Results Rel, orled By ~',"~ ~;/ TNTC = Too Numerous To Count OB = Other Bacteria Date PAR]- ONE OF TWO REMAINDER TO FOLLOW Coliform/100 mi L,~ a.m. p.m.