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Home My WebLink AboutSUMMIT ESTATES BLK 1 LT 13 ORA GREA,..;.~R ANCH of EnvironmentaIGE AREA BORL JGH Department Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ,ff'~'l~'~¢'~/ b~" LEGAL DESCR,PT,ON L. SEPTIC TANK:~.~ ,~--z MANDFACT,RER NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY__ GALLONS. TOTAL LEN H , DISTANCE FROM WELL/{~/ FOUNDATION NEAREST LOT LINE /L'~/ OF LINES NUMBER OF LINES / DISTANCE BETWEEN LINES ~ TRENCH WIDTH~ IN. TOTAL EFFECTIVE ABSORPTION AREA ~ ,~)/~ SQ. FT.., LENGTH OF EACH LINE ,~)-~,~CP? DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE ~/"/ MATERIAL BENEATH TILE__.~-),-~ IN. ABOVE TILE / IN. WELL: ~ TYPE_ /' ~ CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE__ SEWER LINE TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: REMARKS: G.A.A.B. Form LQ-032 PERMIT NO. DEF'F.:IRTME:N-F ".~.-" HE:F!I__TH R['.,iD ENV:IRONMENTRL..,~. ,tO-I'ECT!Of-4 2'.5:t.6 E. 'I-L!DOR 14.'.[)., FINCHOF.~'.FtGE., P-ti<. S~:DSEr;:' < 770:J:5 ) t::tPF'I. I' Z:RN-I" L..OE:FIT :i ON LEE'iFIL 7'4OOE~ :;._';(;!Ur:IRE FEET 'EOTt~ RFI'!'!I'-dG <S(;:! F'T,.-"E:f~'.)= -i P;i..] ....I.,..E. OF THE '::" :il FI[;':'q,'"I;'F:'TZCd'-,! :i.T,"CSTEH .i.':,: THE rdx:.;. J].BE_~ '::'"'=' :- ..... THE LENG TH I], l' .',iEI'.~'E.; I]N ): E; THE i..ENL"~TH ,' :i N FEET ) OF THE TREf.,!(:::H OR [:,F~:F:I I t'.,!F ]: E: .[:,. THE: .[:,F;F'TI-I OF F: 'f'!REN, E:FI ";F~' PI:" :iS THE [:, :I STf:Ii'.,iCE [,[EIIdb. Er.I 'f'!dE c; I:~'F'FICIE OF THE ]ROIJND FIN::, THE E -- TT ]l'i qF 'FHE E[:<Cla',,,'FiT Z ON < Z N FEET ::,. -'~ "- IS ....... ~ c.L.. E:E'i'I.,,IEiEN 'THE '" . '['F'Fq[ I. THE .,1: I-I,E:L [:,EPTH THE I',iIN:IML.IM [:,EP"I"H OF l~'' .... ., -. F~N[::, THE E:C, TTOPI C,F THE E::.,;CRV~TI ON ,:: '_r N FEET::,. _ _ ~-~_~ __ /{~ ~ 7' '- -;~t E ~,- :~ E' '" ...... i: r ............ := ...... ~" ....... : _ '""~ ~q- "'i' ~, I:' ER"'I','F'ZLL1;iqG 'IF FIN"r' .=,'r_ rE.,1 I.,.!:ITHOUT F'I!qFIL ]:I'.,]S;PEC:T]:Cd'-,i Rid::, MFI: I:~ .... .~L I:,.r TH!:..:.; L. LFifll..tlIE. t,lr 14]:L.L L,E '.:;.,UBJEC:T T" I [4. U_..,[..L..LII~. i"'! :i N ! MUM [) ]: S]"FINCE BETI.,-IEEN I':I, I.qEI..L Faf'dD RIg.r' L I,f-- :,_ I I: :"_'.4E!4FIGE D '[ C;F'F'r:-;RI :tC~O FLEE:' F-I~' I:i Fk]. ,:I~E. WELL OR ;=.'l..l~..i FEET F'OF:: I~ F' Et._~"Z: WEL. L. ~;I:'EC ][ I::' :i CFll' 1 Olds FII'.,i[:, Z:ON'/TR:' -' T I ]' I'.,I [:, Z I::IGRFIM'_:5 F:IF.:E FI',,,'R :i LRBLE 'i"(] J. i I_.. I_.1 ..... I- k ~ F I::1 i NSTRI_I_I:TI" ] ON Z CEi;:'I"ZF~r' THRT i.: I RI,1 Ffai','IIL. IRI~', I.,.!I;TH THE F,.EQI.JII;:',E:I,'IEN'['S.; FOR OI'4-SZTE SEIdERS RND idEI,._L!~; ,'::IS SET FORTH 8'¢ THE FIUI'.,I):CZPlaLI'f"-r' OF' FiNCHORRGE. ;E: Z WILl__ :INS-t'RI...L THE S'¢STEI,'I :iN FICCORDFINCE 14:i'!"id ]"lqE CODE:S. ]]:: I UNDE:];?.STFIN[::, THFiT TF/E ON-SITE SEI,.IER S'.r'S'!'El'l f'iR"r' REg!U:IRE Ei~,iLF:IRGEMENT :iF:' THE RES:(DENCE IS REMODEl_ED TO :INCLUDE MORE ]"HI:IN ]: BEDROOMS. F:IF:'PL :[ I::~ JOHi'.,I L. OI.,.IE , SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT grE/~,,.~r ANCHORAge AREA BOR~bgh DEPARTMENT OF ENVIRONMENTAL QUALITY INSTALLATION OF: SEPTIC TANK ~/~1~ /SEEPAGE PIT , DRAIN FIELD TYPE AND SIZE OF FACILITY TO BE SERVED , OTHER FINANCED THROUGH SOIL TEST RESULTS TO BE INSTALLED BY COMPLETION DATE ANTICIPATED FINAL iNSPECTION: 2/I HOUR NOTICE REQUIRED· BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY Will BE SUBJECT TO PROSECUTION. ! FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT , DR SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK wATER MAIN TO sePtIC TANK --/1~ DRAIN FIELD SEPTIC TANK, ' /~) / SEepaGe Pl~_ /~ / DRAIN Flel TO ~IVE~. LAKE. STREAM· CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES FITTED WITH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROUgh REGULATIONS REGARDING ~I~N. SEEPAGE AREA SIZE ~ .... TYPE I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE EQ-O16(3-75) GREx~'~ER ANCHORAGE AREA BOr~,UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: ~ L / ':~'> ~'-~?,~5/' DISTANCE FROM WE,L//~ M^NUFAC URER NUMBER OF / COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY//g~O'/~ GALLONS. SEEPAGE PIT: NUMBER OF PITS / . LINING MATERIAL~-- y BUILDING FOUNDATION ADDITIONAL ABSORPTION CRIB SIZE: DIAMETER__DEPTH /--/2 DISTANCE FROM: WELL NEAREST LOT LINE ,/~-/'~ I TOTAL EFFECTIVE · ABSORPTION AREA (WALL AREA) SQ. FT. WELL: T d r " ; /CCONStRUCT,ON BUILDING NEAREST FOUNDATION LOT LINE ~:~/~/~Y~ m/~/~'] DEPTH //~2 DISTANCE FROM: NEAREST SEPTIC )~//~" SEEPAGE SEWER LINE TANK .//~'' SYSTEM CESSPOOL APPROVED OTHER SOURCES DISAPPROVED DISTANCES: DIAGRAM Of SYSTEM INSTALLED BY: ~"~'~'~- LOT SLOPE: Form No, EQ-031 DATE ~----'/] -- ~'~/~ A p p R O V E~//2-//b-~ ~///~ G.~.A.B. ~ GREATER ANCHORAGE ArEA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C' STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM w APPLICATION AND PERMIT PERMIT NO. SEEPAGE PIT , DRAIN FIELD TYPE AND SIZE OF FACILITY TO BE SERVED ~--~ ~ OTHER FINANCED THROUGH COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTE= THIS PERMIT 15 NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPT[C TANK SIZE / '"~ ~'"'O TYPe MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK . SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK [00 SEEPAGE AREA SIZE TYPE DIAGRAM OF SYSTEM ~,.~) I' . DRAIN FIELD SEEPAGE PIT / (~ 0 r ALSO CONS[DER AREA WELLS. SEEPAGE PIT /~ r CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FeET [NTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT F[TTED W[TH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING I TALLATION. GREATER ANCHORAG UG ]NANC -68 AND DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAiD CODE. DATE : ICANT'S SIGNATURE V -- ~-.~ THAT THE ABOVE GREATER ANCHORAG[ ARIA BOROUGH DEPARTMENT OF ENVTRONMFNTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For ~'~m~ ~O~;NJ ~-~ Legal Description: Lot~___Olock_ ! _ This Form Reports Soils Log__ ~ Soil Test Must Be Logged To 4' Depth Feet Soil Characteristics 4-- 5-- 6~ 7-- 8~ l0 11-- 12-- 13~ Cas~ ~ Subd i vi s i on ~C.~ vt~ -~--~-~t~. Percolation Test Below Proposed Seepage System Was Ground If Yes, At Water Encountered ?._1~ Wha1~ Depth? Reading Date Gross Time Net Time Depth to H20 Net Dro~ Percolation Rate Minu~:e Pro,]osed Ins~]]~-t~on: Seepage Pi:t Del)th of Inlet Depth to COMMENTS: Drain Field Bottom or--Pit or Trench Test Performed 3Y '.~N~_. ~' ~/~-~-~(' Date Certified BY: Date: Type of Resi~nce ~ Single Family Water Supply ~ Individual A~ACH WELL LOG. A w~l Icg is required for all we~ls drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Individual ~ ~-~-~ ~'9 ~ Year Individual Installed: ~ Public Utility ~ 4~ ~ -- When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time LL~&,¢)~/~'C ~TLme /')L~ ~ Field Notes: MUNICIPALITY OF ANCHO~G~ RECEIVED ~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ALASKA v[UIROFlm{ IITAL COIITROL S idIC S, IIlC. ~ngin¢¢rin9 6 enuironment,~l $1uclics 1/5/83 1ST ALASKA MORTAGE 4609 BUSINESS PARK BLVD BUILDING L ANCHORAGE AK 99503 SELLER JERRY MILLER BUYER- SUBDIVISION-SUMMIT ESTATES BLOCK-1 LOT-13 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 480 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 700 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 1/5/83 SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME THIS 3 BEDROOM HOUSE. OF 1000 IS ADEQUATE FOR 1200 LUcst 33r~J ~oenus, SuOe ~ · ]~nc~oro§e, Alos o 99503 · (907) 276-1361 ALASKA 6 FiLIIROFIITlenTAL COFITF OL SeiWICe$, IFIC. ~n§in~rin~ 6 ~nui~onm~nld $ludi~s January 27, 1983 Municipality of Anchorage Department of Health & Environmental Protection 825 L. Street Anchorage, Ak. 99501 Re: Health Authority On January 27, 1983 our company collected a water sample from the house located on Lot 13, Block 1, Summit Estates Subdivision. The property owner is Jerry Miller. The water analysis was satifactory. The well has a seal and the casing stands approximately two foot above the ground. The electrial wires are not completely enclosed in metal conduit. There is a 4 inch gap between the ground level and the conduit. The well was located over 102 feet from the septic tank. All but one of the four standpipes had caps. - The results of the bacterial test for the water is attached. Sincerely, Leroy C. Reid Jr., PhD PE President 1200 IIJcsl 33rd Aucnu¢, $uii¢ ~ · Anchora§¢. Alasl<a 99503 · (907) 276-1361 ~ INSPECTION APPOINTMENTS T ME_ % TIME (~ /~v //./ TIME INSPECTOR I NSP ECTOR I NSPE~O~ MUNICIPALI~ OF ANCHORAGE ~UNICIPALITY OF ANCHORAGE DEPt. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~jRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION SEP ~ 0 ~980 Telephone 264-4720 .o.A...OVA. o. DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not b~ proce~ed, Please allow ten (10) days for processing. 1, pROPERTY OWNER PHONE MAI LING ADDR ESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE 1AILING ADDRESS 3, LENDINGINSTITUTIO~ ] PHONE MAI LING AD OR ESS Pb. gox ~-~oqo Jo~ ~, 3~~. ~' 4..EALTO./AGENT ] PHONE 5. LEGAL DESCRIPTION STREET LOOATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] Other__ ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six WATERRSU~PSU PLY [~ INDIVIDUAL* * ATTACH WELL LOG. A well [bg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS E~] SINGLE FAMILY E~ ONE E3 THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2, WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified . ! - INSTALLER []Septic Tank or []Holding Tank Size:__/~J3 If Tank is homemade SOILS RATING give dimensions; TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area~ Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS RQVEDFOR ._~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) E~] DISAPPROVED DATE BY /// 72-010 (Rev, 6/79) CHEMICAL & GEr~rLOGICAL LABORATORIES b~? ALASKA, INC. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: . Phone No. Water System Name ~! /~ , ~ Mailing Address ~ · City State MO. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sam with lab ref. no. [] Special Purpoee [] Treated Water [] Untreated Water SAMPLE NO. 4 LOCATION Time Collected Collected By TO' BE COMPLETED BY LABORATORY Analysm s 3ows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] SamD~etoo ong in transit: sample should not De over 48 hours old at examination [o ndicate reliable 'esu~[s. Please send new sample. Date Received Time Received Analytical Method: [] Fermentation Tube ~ Membrane Filter Lab Ref. No. Result* Analyst I~.~/ ':,,:~ ,' / ~i' I-~~ I ~ 06-:[220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD READINSTRUCTIONS BEFORE COLLECTING SAMPLE 24 Hours 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENTOF REALTHAND ENVIRONMENTAL PROTECTION Le Bar/Hessler Property October 7, 1980 Virginia Johnson % Dynamic Realty 501 West Northern Lights Boulevard Anchorage, Alaska 99503 Subject: Lot 13 Block 1 Summit Estates Subdivision (Caren Le Bar Property) Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report be delivered to this department from Chem Lab, 5633 B Street, for our review. (2) The top of the well casing sealed with a sanitary seal so that it is water tight. (3) The septic tank pumped with a receipt submitted to this department. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RcP/zjw cc: First National Bank of Anchorage Post Office Box 4-2090 99509 % Jenny Department of Environmental Quality . ~'33~0 "c" Street, An~ Alaska 99503 274'4561 .~ n. ~L~, Date Received Noverober 30, 1976 Approval requested by: Alaska Mutual Savings Bank Mailing Address: Post Office Box 1120 Phone: 274-3561 x 216 Property Owner: John R. & Phyllis Lowe Phone: 344 v, vl Mailing Address: 5408 summit Street o 4. 5. 6. Legal Description: Location: 5408 Surdmit Street Lot 13 Block 1 Summit Estates Type of facility to be inspected Single Family Well Data: No. of bedrooC~ A. Type Individual C. Construction Sewage Disposal System: On-site system A. Installed C. Septic Tank: 1. D. Seepage Pit: 1. B. Depth D. Bacterial Analysis B. Installer Size _~ 2. Manufacturer Absorption Area ~/f4~)3~ ~ 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank ///~' , Absorption area ~' , Sewer Lines __, Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to neares{ lot line EQ-034 (1/74) Page 1 of two pages m ~.:r & Water Facilities · P~e 2 of ,two pages - Re~_ st for Approval of Individual .~.~ Legal D~scription Lot 13 Block 1 Summit Estates Comments Approved Disapproved Date ~--~ Appr~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and ccurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: CMRO VA John R. and Phyllis Lowe FHA CONV. X Mailing Address 5408 Summit Street Day Phone: 3. Name of Buyer: Richard W. and Caren F. Lebaz' 344-8761 Mailing Address: P, O. Box 1144, Anchorage Day Phone:~ 4. Name of Lending Institution: Alaska Mutual Savings Bank Mailing Address: P. 0, Box 1120 Phone: 5. Name of Realtor or Agent: Ann Davidson 301 East Fireweed 265-4807 274-3561 ext. 216 Mailing Address: 6. Legal Description: Lot 13, Block 1 Summit Estates Location: Phone: 278-3541 5408 Summit Street~ Anchorage, Alaska 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Single Family Public Utility. No. Bdrms. 3 Individual If Individual, number of dwellings presently served 1 If Individual, depth of well ? Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) x 72-OO3(3/76) DATE ALA,~,. DEPARTMENT OF HEALTH AND SOCIAL S[~...P. ES DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS / .,l :> x? INDIVIDUAL[~ SEMI-PUBLIC ~ CHLORINE RESIDUAL PPM REPORT RESULTS TO / ADDRESS ZIP CODE " Lab No. OFFICE AnalysTs shows this Water SAMPLE to be: (~' Satisfaclory [- Unsalisfactory ~ Questionable [] Sample too long in transit; sample should ~ot be over 48 hours old at examination to inet[cafe reliable results. Please send new sample, ~ Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY ' DATE COLLECTED - -- TIME COLLECTED,4' ' Diameler of Well Depth Peet. Well Casing Material Diameter Depth Length of Waler Deplh Drop Pipe Prom Bolt~ Feet Offset in In Utility . PURPOSE OF EXAMINATION: Illness Suspected? [] Yes New Source of Suppry? [] Yes [] ~o Reparrs to System? READ INSTRUCTIONS ON REVERSE SIDE BEFORE .COLLECTING SAMPLE yes [] No Signature o6-122o bi BACTERIOLOGICAL WATER ANALYSIS RECORD Lactose Broth ~.,. 10cc 10cc 10cc 10cc 10c¢ 1.0cc 1.0cc EMB AGAR Lactose Broth, 24 hfs. 48 ~rs, Gram~s slain Coliform Densily IMost probable No. per MF Results Alaska ~utu&l ~avings ~n~ Mortgage Loans Post Of~iOe Bo~ 1120 Anchorage, Alagka 99510 are escrowed to upgrad~ the sewer absorption area. The a total depth Of approximately t~n to twelve feet. The upgrade must be oom~leto~bYJune iS, 1977. tho Ju~ 15th date, F~s shoul~ be allow~ ~or ~is aXso. If ~re are any ques~io~s, please ~untact thie office et 276-2221~ e.xten$io~ 286. Le~DR. Buohholz Sanitar~an Ann Davidson