HomeMy WebLinkAboutALPINE VILLAGE BLK 5 LT 15
EPCRAfS
MUNICIPALITY OF ANCHORAGE
rte._
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section \—� Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 014-132
1. GENERAL INFORMATION
Expiration Date: " 2 -
Complete legal description ALPINE VILLAGE BLOCK 5, LOT 15
Location (site address) 7437 BERN STREET, ANCHORAGE, AK 99507
Current property owner(s) CJM PROPERTIES LLC Day phone
Mailing address
Real estate agent
5300 CAPE SEVILLE, ANCHORAGE, AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
❑
Water Storage
❑
Holding Tank,
❑
Community Well
❑
Community `
❑
Public Water System
❑
Public Sewer,,
Waiver request for:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 47280
Date of Payment c3��J�a0;2 0
Receipt Number
COSA# 0,50 261019
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
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, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) 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 (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 3/12/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local
���
soil characteristics, groundwater levels that may fluctuate during the year, quality of
oF A4,- k
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
•' }
�(
these various and dynamic characteristics and are outside the control of the evaluator of the
well and Therefore,
���••
••,
septic system. any estimate of how long a system will function satisfactory
k TM
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be by First Water Consulting &
.. ......
given
FWPS .
6. DSD SIGNATURE/
Curtis Huffman 1d
�F� •., CE 128991
System #1 Approved for bedrooms
}}�sfF,pSoF!12�20
�P����
System #2 Approved for bedrooms
��j� ROFES$00'
Disapproved
Conditional approval for bedrooms, with the following stipulations:
VS
i()
u PIS/ tn�a`��� � ticccrr
cp�r�r
�\e VKNI -TV
O /rri
`- ON-SITE
WATER AND
WASMVIATER
01
Q�
SER����`°
Original Certificate' Date: 3 " ( Ci''c� o
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Sys'.ems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: ALPINE VILLAGE BLOCK 5, LOT 15
If more than 1 septic system on lot: COSA Checklist # _of
A. WELL DATA
Parcel ID: 014-132-24
Structure served by this system _
❑ Well log is filed with Onsite (or attached)
Water storage tank volume NA gallons
Date drilled CIRCA 1977
Well disinfected for coliform test? ❑ Yes ® No
Total depth 72'+ ft (Per acoustic readings).
® Coliform bacteria is Negative
Cased to tltLVV\ ,Jw
Nitrate mg/L Nitrate less than MRL (ND)
® Sanitary seal is functioning correctly
Arsenic ug/L ❑ Arsenic less than MRL (ND)
® Wires are properly protected
NES,.
Casing height (above ground) 12 in.
Collected by
Date of flow test for COSA 3/11/2020
Static water level at beginning of test 63 ft.
Date of Sample 3/11/2020
Well production at time of test 2.58 gpm
Comments Shared well located on adjacent Lot16
— see attached as -built.
B: ,TANK DATA - NA
Ageof tagk(s) _years
Tank type/`ma`t-tial
Measured operatingAuid level in septic tank
® Standpipes/fou ndation-cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA - NA
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from grade _ft (max)
Measured depth to pipe invert from grade _ft (miz
F1N/A — pressurized field
❑ Monitor tubes go to bottom of effecti e. If not, state
depth into effective
❑ Code -required soil cover o er field
El System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons, troduced gallons
Comments/Deficiencies:
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
�equacy test date
Results ❑ Pass For bedrooms
`Fluid depth prior to test in
Wal' added gal
New depV'n in
Elapsed time r, in
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 1 months)
If yes, enter date
ics
E. SEPARATION DISTANCES
From Private Well on ADJACENT Lot 16 to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes if No *15'+ ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes if No ft
® Yes
if No
—ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes if No ft
Frb-m Septic/Holding Tank on Lot to: (Please enter
distances
if less than required) /
Building Fondations > 10' ® Yes
if No
ft
Surface Water > 100' ® Ye No o/ ft
Property Line > 5 ®Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5' ` Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Ye
Water Main > 10' ®
if No
ft
Community 1l`v4dlls > 200' ® Yes if No ft
Water rvi Lin > 1' Y.
Service e _ 0 ® es
o �
ft
If ;otic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distanpe� rf ess than required)
Building Foundation > 10' ® Yes if N ft l&orption field is under driveway comment below
Property Line > 10'1-
Yes if No _ ft Wells on Adjacent Lots:
Water Main > 10' Yes if No ft Private Wells Yes if No _ ft
Water Service Line�0' ® Yes if No ft Community Wells %200' ® Yes if No
Surface_ ter > 100' ® Yes if No ft
F. ENGINEER'S COMMENTS
Shared well on adjacent Lot 16. *Met separation requirements at time of drilling and shared use (1977).
G. ENGINEER'S CERTIFICATION
•� 1
I certify that / have determined through field inspections and review ���Q•:•' .����
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date. '•
• . '.
• Curtis Huffman . • '
CE 128991 .• i�w i
,ten MRm�r
Wim
17
130.00' NB9° 59'00"E
uj
WELL , c
uJ ° 37.0`
zz
u* Y"-b EXISTING o $
t--
�g HOUSE N Ito
9
ZFGd I.. 0,cv 28.(Y I Lu
Lu
IJJJ
uj GRAVEL ORNE b O
co
O
30, 130.00` N8V 59 00"E
a Ta
UNDER NO aRCUMSTANCBS SHO(LD AN AS-8%T BE USED FCR OaNB RuCT1CN. lR. ESTA tSFil+if,' Bdt ibAtiY ORFENCE LINES.
THE
SiJRY£YOti TAKES f 1TY FOR
THE JNJI%k . MANSACRON ONLY ANQ A&9.k $'0'tA'NOK UA WTY'-OKY fbR *W C'MT OF THE SLR%tY.
ilMM DISTANCES PREVAIL O`V SCAUNB. RWeOWOTION VAY CRUS$ iN SCALE"
LOT SwRWY SURVEY TYPE sw S
T4tat&IT AS-IftY �r}
AVfAL E11tifamac A4'#li.T SET MM
ORA81,r46E t :i::! ASPHALT
PLOT x , .. AS- M'r . . LOT svr;vry , . , TaAo +riY �� E Ot#ti� RE�,tR � . YADOP Fp4gE } eDNt F7E
`�.: Ami Xb' �V. .R•-�1t--* t�fOiA�,-F� M
, Lt�F.l i .yil?Op.pEf�C:
PLOT PLANS Vic. L N{�
IT FH T}fE RTWIQ S{IJ9.TiY't W THE RV&jf EA OR OWNER, RRdOR TD ONL'I T41 O$E IMPROVEMENTS #t�i5V>c 81tCUh[a. AND YtS18t K MAL( 8E
GOAiSTT2kJCi3QPf. PRl3POS£U (t t] 7G SR#t7E ft£tI�TlV£ 9S1D�1at. P;'PtOES; V, t Sc .$lA (i OicS`1WO- f'3, Sp 6WAlK4, 'DRt VAIN
TO F'i1GF$HED L SOS VTUTY CONNECTIONS ANCI TO 0000 WE ETC., ARE SRQYAV tit TNfE1R "I t°Pki4JfflYK3E' Lt3L`hit�l. GN1 Y. SNOW
TIi$ iXiSil�IVCL` OF A#'Y EASEiOM COVENANTS OR' kSTRICTfONS MAY PA£'ElT r.OwE'*PRIOVEMENT4S'f![6A.}-�£t1tlY� ) APJ� tt�Ch�i1
14HfCH DC5 1lOT APPE-AR f1N TN! �f:4f7DED SUSOINASICIN PLAT. ALL. DNST4N.CM A tE t'4`ET dkb UNL ZISS..OTMERVASIE. NOTECI;
I SURVEY CER71CA AW � Prepared by
PLOT ptANOF IS,R o b e r �t E . J o.h rt s, Jr. & Asso.c..
'
+sR�aiProfessional gond Surveyors
� � f'rn �!� _ Wit' " `')-�..,/t7tSA. Ds't+iv;
7
�I d.�R. MIIAfIi1 W,;�
uu .eyaarw.M.
LoES E;. ?fot Pis Wo
tWCATM AS-AtlS:T i4,... ",W .•k .r.dNni `� �Ji1
L. i Dake it
«'�,�7�!' �u•F
rs 0-7/31.115
M wd w +bo mLV.Ginb .W[�e(k" +� Datb '.w
t 41.21—S .'�a71 ( 2 Tl -
FKAL �STIUC1tl1�. AS-aMT , r ,.
:* t&t t" `�r+' 41* ad s o ....,..•+•••r• R�
11 1 K
s
2 11 11 1
DEVELOPMENT SERVICES DEPARTMENT
On -Site water and wastewater Section
www.muni.org/onsite
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC201089
Subdivision: Alpine Village BLK 5 Lot 15
907-343-7904
Fax: 343-7997
A water sample revealed an arsenic concentration of 14.5 micrograms per liter
(ug/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Information on arsenic is available from the On -Site Water and
Wastewater Program website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Madmg Address P O Box 196650 * Anchorage, Alaska 99519 6650 *www mum org
a
N y
LO
Cl) 44
C-2
4 H r-1 td r-4 N 0 tv to tit 4141 r4 , in � O •r4
w m m O b to ro r-4 41 .-4
H�i V .0 r.•' til �+ 'r'f •r4 .Q r-4
A•
4�J w U?
• t", -P u J) to O 41 -P to Ri C
z v e4 44 ° 0 0 H ro O 4 14 �' o rA >Qa ' a° , a a 4J
41 44 � 4?U) 0 43 - 41 t4 41 41 >r 'C1 �-�I H N u
m b O 41 1 rq 0 � a A 14 0 � w� v ar
w w o •o o u a0 too z r4 rd w O,
n w ui a1 A �° H m I; o 41 a ro o cn
3 H.L' 41 y E-4 10 b >1 b O } tQ Id 41 A
th O -r1 Ln 41 V•S %a 4 C' •O rt 'd
• �-+ r•1 0 > of rti QJ Z A
rA 2 O •r4 PG ++ ri 4.4 iJ
U z o 0 b FA +1 U xS 41 a rn r4 0 �S ° +� a uas o
.� u rr � ro 4s u a� ro O a
H ��°, w `zn o %o 14 tT C" $4 o � A ° ° u u � 44 � to u N
r. •Q 4,-f La to 9 41 O H 44 Gl
Z W A b la H .-f 1p to > 4J sr -•i 41 0 H 4) V N
W
E-4 z O E-0 %w ii I ri U 14 'O O •.-4 m O uJ�+ w of k z O
z Q ro ° cn o �+ a o m •� a 4J o �Q a' �. to m w G.
Q a cn M u ro z •.4 w V: to$4 w ;h41 4; D., A 04
° I~ (az rl uo w O Ai .61
O
a Id W .0 Ri 4.4 •••r 4: ,-4 Q .�
x w c 2 4 to w 4� 0 q? w O � O !ri r•4 G1 � r-•1 4 4
w o H ro tv ot-4 =1 ca r-4 O rd 0 0 -4 O r4 41
F C -r va 4 1••1 W h 'ti 1.4 41 4 OO A Cf' I'. i4
T a 94 d•4 �i ++ tq r1 C: 14 vH 01 r.4 • 4A t0 �+ oi � to N r N O 4.04 of
a LM 0-4 ji
W -� 0 w r O a a aa r-1 U r'4 Z ro %a a 0. .0 w ,n 0,
a u w w H b -A m a A to o -4 ra r+1 0 0 a Lf) cr
° a H con o a 3 4 w N crop 4.) x m cn H� V�
O h H a o V a 41 4J 3 a► >41 1: }s
.14
#•t V 0 •04 td H 'Cf •1J r•4 F 4 Aj 4} ft ro m
PQ >4 ro w r+ ° �a 13 44 aJ r► to N 4J b N -14 41 .° 'o cn
E4 A .0 41 V Z: .L" rt 4 4j H r4 A 4i H 'O H -A Z O A
E-4 41 H 0 w k E4 'O I C .,4 a.1 w E-4 Q a >, 4 H 0 O ° 4 0 41
pc] 14 -r4 + ; -0 41 N 4) + -1 ►'Li G w N (d U) .-1
?. Q! 4J w3 • Vl O P 4 P4 ri W V � it r4
O :3 H 44 •r4 'C! 43 r -i t' • 9: t,3 4-t IV 41 r-)
ri 0 } O A N W 'O •r4 4i 4J r•, 0 .9 N .>~ a In .0 ,d tv �
4CD O N a z R9 Ri CC 4J 4-4 f+ GA 41 r} O
b x W H 0% 3`� H Sd t• 1 w of r 4 Iii 4 w w 4•'� Q1
�4
41 z a1 O i+ Y r4 1 4)
N I-4 x a] r1 m a s~ a) a► O 9 h4 O O .O CD
V (D w 41 'o 4D w -r, >1 3 t~ •rd H A v 0
H Z k '� O +1 r-4 O k 4-4 r I tl: L4 -4
41 41 O i4 b 04 to 04 'G W 4► V4 H 4? V ++
go V •4 .14 r144 Id
O 111
O dl Sb ix 4J m 4j •ri m to to h to 0 4.1 w u O to w �►
r 1
OD iitf'4iit iROR►
t• i (7
}y� � � 1►04�i Y}4!Y lY '��7+1►>r10}fDNr
OA! SAJtW 'OVOY O.LF400H AbOdWV bOxi
M r•1 � M01111Y0��/0� 1YM 0}ff■/O:i Y
\°D rS 88Y7fl Np�N�l�IMNO 'N4511zNMOr
1 0} E a
rti `
U) a) 41 0 l tj r,ti
c +� is S 1 a+ w rd �3 +s✓.1 H
Q Z 4 40 to c+ w c+ynr
Iv (1) 4-)
+-
0 r-4 oa4w '" a
1 a,
' mo Ad `
6flj x wJ a) NuH b ub ++++ rr yrW4
. N t to Id p
Q +1 Jf O +
++ ns r!1 l4 •.a N to d to O to 4J Id P4 O
14 "J:5 U1
4) Na 0 Q
ww°
�.yr
10
o w +s c A ad 41 rd m a) a) f 41 *r H
4+ >•r o al r o s; m to U H a) '�' `.= # '
Q} s~ X w +1 jy ,y r 1 A W O O L" 1r
zz �r r#, o:
0 � Af rd al r 1 Oi N w .�! �? r0 � n 3 � � r -t • 'd`^I �i. = r W
r� tiro 1.1 to
.t~ 4' m IA A Q a3 A >`I �, W a 10 0 0
!a rd Id G r -I r•t Id 41o
1"� a � � � G"
+1 1d 4 3
++ P. at rd 41 w A A s1 m ++ O r -i *1 ]7-\
o �v 0 to N iY a+ A O d/•r•1toM� s3 0 0 i'Ci'.' a L+1
0 z a) > v u its a > �
4•+ >4 � r) O t3+ r♦ rQ In 0 0 � � on R p iii � 0 ro �
a t)+ 4J 41 0 0 O d •r♦ 14 „ •• w N 0 0 to b
v 4-3+3 4 0 44w abw0Ordr. C: IA ab
43 w Q. 0 CL o R3 >a O W Qa Ar rd O rd w E+ W 0
w A w ro aJ w w 01 ri 1i 0 to C9 Qy
rn U) a t~ 4 0 br .0 4.1 4) OG V 0) V4 >+ pQ
(a 41 w b to +3 al al W H .0 to 4.1 a 0 O 01 E+ e`
0 w b at w�y +) 9 w k al 0 +;o 41 .34 w O 41sn �►
N a9 0 9 W � r•1 1 J tQ 01 Q) +1 LO H V] (A qq1� 44 cA(0
•) a.A H
•r) tb O is 4) rd A "� 9 9 ❑ H- 0 A C Cn U
4 >4 r O to •11 tQ ri � 0) r-1 w W rI WW 4
dJ is FI toi3 .0 ! i w 1.1 w to to M H 0 tw
M rd id E�
p :1is U @ N 0 id O H 0
r.1 v L" is Aj ad 4 •r; -A H H m 044 0 0) W
m w r� O 0 W 4J�+ 10 H 41 M tJ E+ to O � •r•1 s.' � X% � t.[ U E H
ra 0I Q3 w w 0 w 0 H 0 r� 4) 41
� A 0
v a a) 0 0 ar ar a w 13QJ 17+�J
•r1 ra $4 w w r-, to ?4 ar o W a A 41 O 0 41 to G4 ❑ to
w
> a+ •rt , •r•+ a to o P7 to �► m v W O h .0
p. + W d to A a) a) 41 V N PG r w 0 tZ
In + 4J
�1i t 1 rl 'L1 t) V �.' t•1 t+ d O �1
mw
O d) 0J14 V. w a •11 �, r m a►
4J a 41 41 •r1 4 to O O O to to �+ ri 43 ae w 0 Oa •a to r4
ssr+lacs ua>
tows vatg"V •avvisom v
f a 00s fAWW -avow f1MOraM "soaYrw 0001
44QI1WM41$d 107'lV"DIS*XAO%J t
lsvlll o NO9NVl2lHH0 'No9NHor
raal.t�a �v�
M.
71M
N
►': a:
>4
u-
x
1e
x�
41 rd
V
H b 4 0
�
O�
£ (0
ro
4.) 4J
W a) � �
_►
H34
r -I
ro q W
s
^1,
M as rl
ro 4
G� 14
U
4J
w3
>4 (0
v>
��
9O -C
tn
C
cto
O
ro $4
sx'
�
'� w
a) . �
�
41
IA Qi 44
IA t0
W
d 0 4J (L)
4J to > 4
w
H
p,4a�
jai
a� a+
u
.Jaa4Ju)
ro 4J.4 a,
&0
a) 4
A
�
v! Cvi
3 C► r. R.
4.►
N
o•�'�
q
094-4 w [L
Cl.
•04
M.
71M
Vstis•s" ttwI
t04it "BVIIV '30vm*dmw
009 3UAnS '4vOY ai1401214•wtv "St
hatAvubdboo "No1sommoad v
8#YIQ 4 NO2NEISRONO 'NOONNOr
6201,§Ao Anv•r
q�
►': a:
•
� 1
Vstis•s" ttwI
t04it "BVIIV '30vm*dmw
009 3UAnS '4vOY ai1401214•wtv "St
hatAvubdboo "No1sommoad v
8#YIQ 4 NO2NEISRONO 'NOONNOr
6201,§Ao Anv•r
APPLr .NT FILLS OUT UPPER HA : ONLY
Property ~wner ~'"'~..~.j ~ ,_.~/..,C~ ~¢.~(.~. ~.~.._.~+)' ~z~)~O ~ Phone
M~iling Addre~ ~)~"~ ~_~'f[I ~' I~c''/~ t~'~ Zip Code
Type of R~sl~nc~
)Single Family
~ Multiple Family No. of Bedroom.
~ Other
Water Supply
~lndividual ~.~ A~ACH ~LL LOG. A wall log is required for all wells drilled since June 1975.
~'Community~ ~~~ For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utilit~
Sewer Disposal ; ~, , .:-2
~dividual Year Individual Installed:
~z Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Insp Inspector Inspector
F,eldNotes 4~..~ ~.~/ ~ ~
· : JI~'0 ' MUNICIPALITY OF ANCHORAGE
(~"~ "" -- --~ "'-~ ' * I ~ .._ DEPT. OF H~:/',LTH
( ) DISAP~OVED
co~ ~ a
DATE
BY:
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
72-023 (3182)
CHEMICAL
~LOGICAL LABORATORIES .F ALASKA, INC.
TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name Phone No.
Mailing Address
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
I
I
3 I
I
t
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Sample too long in transit: sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
[]~ Membrane Filter
Lab Ref. No. Result' Analyst
l-I-I
F'T'q
r-r-q
*No. of colonies/100 rn or No. of Positive Portions.
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
a.m.
Date Received , Time Received __ 0.m, Lab. No.
Presumptive 1Omi 1Omi 1Omi lOml 1Omi 1.0mi 0.1mi
24 Hours
48 Hours
Confirmatory
24 Hours
,4~ Hours
EMB
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Filter Results
Reported By
Broth 24 hours:. Broth 48 hours:
10mi Tubes Positive/Total 1Omi Portlonl
Collform/100ml
BGB
Collform/lOOml
Dire
p.m.
ALASKA u IUIROFIITI6FITAL cOrlTROL SP dlCe$, IFIC.
I~nqi~eerinq 8- I~nuironmentcd Studies
APRIL 1 1983
GENERAL ELECTRIC MORGAGE/PATTIE
401 E NORTHERN LIGHTS BLVD.
ANCHORAGE AK 99503
SELLER - CINTHIA CHRISTENSEN BUYER-DON DABLEMONT
SUBDIVISION-ALPINE VILLAGE BLOCK-5 LOT-15
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 680 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 4/1/83 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF
THIS 3 BEDROOM HOUSE.
OF AL
.
1000
IS ADEQUATE FOR
1200 U Jest 33rd Auenu¢, Suile E~ · Anchorct§¢, Alaska 99503 · (907) 276-1361
