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Home My WebLink AboutROSALIND LT 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Well~-X¢-~ I Absorption area ~-2 Manufacturer ~,~,_ i /' ~ Liq. ca it~ i~gallons Inside len~ IF HOME,DE: Wa,] /_bl Foundatio?~ /..~ Dwelling W dth ~ NO. OF BEDROOMS PERMIT NO. No. of compartments Liquid depth Well Dwelling PERMIT NO. DISTANCE TO: Liquid capacity in gallons D~STANCE TO: Material Nearestlotl~,~ ,~_ T~h~inches ~ inches PERM,T NOT /O IDistance between lir~e~, Total effec~rption area PERM T NO. No. of lines / Length of each line Top of tile to finish grade Length Width DISTANCE TO: DISTANCE TO: Building foundation Total length of lines~ Material beneath tile Depth Cribdepth~ / Building foundation Driller Sewer line Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Absorpt on area(s) Septic tank OTHER PIPE MATERIALS SOIL TEST RATING ~.~5~ INSTALLER REMARKS DATE LEGAL PERM~'T' N0. E,I..I ,-'., - .-] '-"' -""> T F~F'F'L I CRNT STE',,,~E JUHN::,L.N SR LOCRTION ~::t80 SPRUCE RE:' LEGRL L:t F..U=,HLZN[. S,-"'[;' - ,,-- ,:, · .-:. ¥"r'F'E OF SOIL HE,=,UF..L,T ILN S'¢STEM TS: I '-" = 4 '=,:It RFtTING MFI::'::IHLtH NJMBER OF BEE)ROOMS ..... - ' ~ .... ' .... =T_-TEfl I.E;' THE REQJIF:E[' SIZE OF THE SOIL RBSORF'TION '-'"- E;:. EEZ F" 'T g--Il == E~.:.' IL E ~'-~g ~ T' IH == DEPRF.':TMEN'T' OF HERLTH RN[:, ENV~RONMENTFIL PROTEC:TION 825 'L"' S"f'REET., RNCFIORRC~E., RI<. 9950t 264-4720 I:::t~'-.ff--. d_:.; :E q-EZ SEIL,3EIFE: #JF:"i:.E~F~RE:.E F"EEF~.:F"I :ET ( 78:t046 ) LOT :,IaE ±Z::]:00 SQUFIRE FEET TNE LENGTH [:,IHENSION 12; THE LENGTH (IN FEET:) OF THE TRENCH OR [:,RFIINFIEL[:,. THE [:,EF'TH OF R TRENCH OR PIT IS TNE [:,ISTFINCE BETNEEN THE SURFFICE OF THE GROUND RN[:, THE BOTTOM OF THE Ei:.',C:FIVFITtON (IN ~ ]"I4E GRFI',,,'EL DEPTH IS TNE MINIMUM [:,EPTH OF 'GFrR'v'F~I_~ .,'--EETREEN THE OUTFFILL F'IPE FIND THE BOTTOM OF THE E,-.,L. H OMFIJN ,::IN FEET.'.',. F'ERMIT I-FFLI_.HNT HRS TIdE RESFONSIEILIT~ TO INFORM TNIS [.',EPFIRTMENT DLIF.:ING ]'HE INSTFtL. LB]"ION INSF'E:TICNS OF FINY NELLS R[:,J'RCENT TO TNIS PR]F'ERT'¢ FIN[:, ]'HE NUMBER OF RESIDENCES THBT ]"HE NELL WILL SEF.?,/E. .......... -E' l...g El ,:: :7.-: ::, ][ ~'-t :;~; F" E C: -IF' Z. hZ) f-.t ":_=.-; ~-a F.: E= ~: E 6:." L.~ ]: F-: [--: BFIC:KFILLING OF FIN'¢ SYSTEM NITHOUT FINFtL INSPECTION RND FIF'PRO',,,'RL B'.t THIS [:,EF'FIRTMENT N ILL BE SUBJECT TO PROSECUTION. MINIMUM DISTFINCE BETNEEN R NELl_ RND RN'¢ ON-SITE SENRGE DISPOSRL S"r'STEM IS :b-30 FEET FOR R PRIVFITE NELL.; OR i50 TO 200 FEET FROM FI PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC NELL OTHER REQUIREMENTS MR'¢ FIPPL'¢. SPEC!FICFITION':5 RND CONSTRUCTION E.',IRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. I C:ERTIF'.¢ THRT ±: I RM FFtMILIFtF.'. NITH TFIE REQUIREMENTS FOR ON-SITE SENERS RND NELLS RS SET FORTH B'T' ]'HE MUNIC IPFtLIT'T' OF FINCHORFIGE. 2: I NILL INSTFILL TFIE S'~.'STEM IN RCCORDRNCE NITH THE CODES. 3:: I UNDERSTRNE:, THRT THE ON-SITE SENER SYSTEM MFI'.r' REQUIRE ENLRRGEMENT IF' THE RESIDENCE IS REMODELED TO INCLLIDE MORE THRN 4 8E[:,ROOMS. S I GNED:. __.-2727_. ................. -: .'.D-' '='; E,= .... 'b~' i St::;UE[: .......... [)RTE ............ ¢. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2224 SOILS LOG- PERCOLATION TEST LEGAL DESCRIPTION: SOILS LOG [] PERCOLATION TEST 6 7 8 11 12 13- 14- 15- 16- 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER v 'Xx~.~A--' ENCOUNTERED? · IFYES, ATWHAT (~ ~,~'- DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE {minutes/inch) TEST RUN BETWEEN FT AND -- FT CERTI FlED GAAB HD ] GF~-ATER ANCHORAGE AREA BOROUxr.~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~ ,;" ~'~'~ ~///~'/~?~-~;/ LOCATION r.-~~7'--~'' f~'~ ~~ SEPTIC TANK: MAILING ~ A D D R E S S~'};~,,~j~ LEGAL D ESC RIPTIO Nzx~J ~-/. DISTANCE FROM WELL -~// '/ LIQUID CAPACITY ./-~Z-~..-~/-/]' GALLONS, NUMBER OF MATERIAL ~/~ ~/~--~/~~ ~ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH ~ ' LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER ' ' OR WIDTH LINING MATERIAl .~--- ~-' ¢~':~' DISTANCE FROM WELL ~/ .~/,~-~ /' NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH/.-~4''' , DEPTH BUILDING FOUNDATION SQ. PT. TILE DRAIN FIELD: DISTANCE FROM WELl. ~ATION , NEAREST LOT LINE ABSO. SQ. FT. L'~N~TH OF EACH .m = DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE _,, ~ . ~_~ · ~,~ / DISTANCE FROM WATER WELL: TYPE~.,~,~..//-~/...~ DEPTH BU LDING FOUNDATION, · . · SAMPLE _./'~"~ , NEAREST NEAREST SEPTIC .,~=. ~ SEEPAGE / OTHER LOT LINE ,'-"~'? ~ ~/ , SEWER LINE" , TANK ~-~' '~" , SYSTEM /"'.~',/~ , CESSPOOl DISTANCES: DATE DIAGRAM OF SYSTEM W_.~. ,~ - , . - " ~ " "~/~'~/~""~ APPROVED ' HEALTH AUTHORITY GREATE r'"ANCHORAGE AREA '-'OROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. ~¢/~' SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ,,~ ~4,~ ~.~,~.~¢.~/.,~., LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~'/'¢~ PERCOLATION TEST RESULTS MAILING ADDRESS~ ~°~29/ PHONE NO. LOCATION OF INSTALLATION 5;~.. SEEPAGE PIT ~ , DRAIN FIELD , OTHER TO BE INSTALLED BY_ .) .~,..3z.~ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS /'~'~z~~ '~<~'~'~ ,PERMIT TO INSTAL LA ~'~:~ /~&~ SIZE OF UNIT ~0 BE SERVED ~ ~/~' AS DESCRIBED BELOW. ~ ~.~ ~ ~ -~ . SEPTIC TANK SIZE J'Z-~O TYPE ~'~)~ SEEPAGE AREA /~ ~ /~ .TYPE , DIAGRAM OF SYSTEM DISTANCES: I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28~68 and that the above described system is in accordance with said code. DATE ~.~/~.4~/ /~. /¢ '/0 APPEl CANTS SIGNATURE ~ ~,~L,~../~.×-Lz~'~ ~'.'~,_~,~-.9 GAAB-HD-2 GREATEr' ANCHORAGE AREA 3OROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. -'-> Y'~ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT ~---------~7.~-/~ "~-'~-~"A/' MAILING ADDRESS ~-~ ~,~ PHONE NO. NAME OF APPLICANT~)/(~/Z; RESIDENCE ADDRESS ~~ ~-~/[~ LOCATION OF INSTALLATIO~(~Z~ LEGAL DESCmPnO APPLICATION TO INSTALL: SEPTIC TANK ~ ., SEEPAGE PiT. ~/ ,DRAIN FIELD ,OTHER. TOSERVETHE FOLLOWING FACILITY ~ ~Z~. FINANCED THROUGH ~ TO BE INSTALLED BY ~'~;/~- ~TEST RESULTS /~7 ~~ ANTICIPATED DATE OF COMPLETION BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT ~/~ /~/~gg THIS IS TO SERVE AS ~'//~¢' r . , ~ 2 ~,._~f t,J~/7///b/--~£~/Y~~ , PERMIT TO INSTALL A ;~7~(-7Z~'~ ~----'/'~'-'2~T-A:77"~" AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED .'¢Z-~C'~/2,~, /'(-7/~n-'~' t4¢'2-~ / · SEPTIC TANK SIZE ~ ~ ~-~? TYPE 'TZ?~-?./.~ TYPE SEEPAGE AREA DIAGRAM OF SYSTEM HEALTH AUTHORITY ] certify that [ am familiar with the regu~ements of Greate~ above described system is in accordance with said code. . / DATE ( APPLICANTSSlGNATURE~. APPLIF NT 'FILLS OUT UPPER HAL. iONLY Buyer Address ' Zip Code Lending Institution Phone Address Zip Code Phone Address Zip Code Street Locatian Type of Residence ~[~ Single Family [] Multiple Family No. of Bedrooms [] Other Water Supply .~. Individual ATTACH WELL LOG. A we~l 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 Utility Sewer Disposal ~ ~,~ Individual 'fear Individual Installed: Public Utility Whsn Connscted to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RECUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date 7-1 _ Inspector Inspector Inspector Inspector ( L.~PPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* 7~/3~- ~-~ BY: Soils Rating Date Sewer Installed Welt To Absorption Area Well Log Received ii_~'') ~ Well to Tank Septic Tank Size { -- .. CHEMICAL & G,.JLOGICAL LABORATORIES OF ALASKA, INC~ ~ ,~ TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER /~k 274-3364 5633 B St re et &,~ .......... ~ Drinking water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water System Name ~ Phone No. ,'~ i ?"~ ¢ - ~.-~ . ~.L-"~ ........ ; .... 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. 1 2 LOCATION · Time Collected Collected By TOBE COMPLETED BY LABORATORY Ana ~,sis snows this Water SAMPLE to be: E~]~'Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not De over 48 hours old at examination tO indicate reliable results· Please send ~ew samole. Date Received Time Received Analytical Method: E Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst F1-1 FTq READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source No. Presumptive 1Omi 10mi 10mi 10mi ]0mi 1.0mi 0olml 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours I EMB Broth 24 hours: Broth 48 hours: Multiple Tube Re0ort: 10mi Tubes Positive/Total 10mi Portloos Membrane Filter: Direct Count Collform/100ml Verification: LTB BGB ~ Collform/100ml Final Membrane Filter Results Reported By ~,, ~ ~.'~ -~ Date 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 Parcel I.D. Cf CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~)~L\ - ;:~;-~.~(~:~ HAA # ~ 1. GENERAL INFORMATION complete legal description Lot 1;.~*,,~---z-, ...... Rosalind Subdivision Location (site address or directions) 8180 Spruce; Anchorage; Alaska Property owner Mailing address Timothy and Deena Gobbi 8180 Spruce, Anchorage, Alaska Day phone 349-8805 house Lending agency Mailing address Agent Ad dress Day phone Day phone Unless otherwise requested, HAA Will be hel'd for pickup. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: NOTE: Individual well ¥~X Community well Public water 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: xxx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by myseal 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/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms and typeofstructureindicated herein. I furtherverifythatbasedontheinformationobtained 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 $ & S ENGINEERING 17034 Eagle R~ver Loop Road No. 21~ Eagle River, Alaska 9~2577 Phone Date Sm DHHS SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~/:J~/~ _~--~~ Date 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 th is 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 engineeCs work. 72-025 (Rev, 1/91) 8ack MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: !"z~-I-I;~.~--II ~'(~%~Ll~b ~'~) ParcelI.D. A. WELL DATA Well type Log present (Y/~ Total depth Sanitary seal (~/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ['~FOP. E [0~(2 Driller ~8' Cased to ~0 Casing height ¥'~--'(~ -'~ Wires properly protected ((~N) Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION g.p.m. ~'~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~(~ t Absorption field on lot l~ ' Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots I(~O'+ Public sewer manhole/cieanout L~t,r~ ~Fo cc~,~o~ Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: Other bacteria Collected by:-~ '~ ~L_p.~r~.p_fZfru(~ B. SEPTIC/~ TANK DATA Date installed -~-~- Cleanouts (~N) High water alarm (Y/~ Date of pumping /0-'~ . /'~ ~-~-~ ~ Tank size I~:/~ ~-~~L't'', 1-4~: .~;ompartments Foundation cleanout (~N) ~ Depression (Y/~- Alarm tested (Y/~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot__ 60:¢ / On adjacent lots To property line oQ'C) '~- AbsorPtion field 'Water main/service line Surface water/drainage lOO~ + ~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION ~led Manufacturer Size in gall~ Manhole/Access (Y/N) Vent (Y/N) ~evel at "Pump off" level at High water alarm level~~ Cycles tested Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANCE FROM LIFT STATION ~0: Well on lot On adjacent lots Surface wa~ D. ABSORPTION FIELD DATA .C- Date installed ~')r-~O / ''](' I1-}~-~ S0il rating ~-~P-o ~Yz~/t System type ¢- , ~/ff~Width¢ll' 'f'~;'-~ . ~¢ , ~ Length I~t J ' ,~_ ~L/~ ¢4~/ (;..TG~avelthlckness ~, / Total absorption area ~'~:b'O ~- ~)~ ~- ~(~%F: Cleanouts present Depression over field (Y,~ /%30 Results (pass/fail) ~% Date of adequacy test Peroxide treatment (past 12 months) (Y/~ ~JCyT Total depth ~'~' .¢ '~.~ / '- for L~ ~.. bedrooms /~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I(~ To building foundation On adjacent lots Surface water lO© Curtain drain ~%~o~ On adjacent lots /00 '~- Property line /0 / ~ ~ To existing or abandoned system on lot ~j'/~4 Cutbank 1©0 '~ Water main/service line -~© "¢ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 17034 Eagle Eiver Loop Roacl No. 20~ . Signature Engineer's Name HAA Fee $ Date of Payment ~--i~\ S~ ~ Receipt Number ~).. ?~ i.o©q / \ (,¢ 5~ Waiver Fee: $ Date of Payment Receipt Number DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~II~vIRONMENTAL PROTECTION 825 L Street-Anchorage, Alaska 99501 sEP 0 1978 ENVIRONMENTAL ENGINEERING DIVISION Telephone 254-4720 RECF. I_V .D REOUEST FOFf APPROVAL OF INDIVIDUAL ~ATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPERTY OWNER ] PHONE MAILING ADDRESS PROPERTY RESIDENT (If differen{ fro ) PHONE 2, BUYER PHONE MAiLiNG ADDRESS 3. LENDING INSTITUTION ] PHONE MAILING ADDRESS ~'/~ 2_07 ?, 0, 4. REALTOR/AGENT I PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One I~ Four ~ SINGLE FAMILY [] Two ,.~7~. Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date j ~ ~ 0 If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010{3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR ' : INSPECTOR iNSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDI VI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY '/- ICi Connection Verified INSTALLER []Septic Tank or L-~ Holding Tank Size: /¢),.S'° If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4: DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [] APPROVED FOR BEDROOMS [[iJv'~UONDITIONAL APPROVAL (letter must accompany certificate) F~[~-~-DiSAPP ROV ED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev, 3/78) Anch©ra(~e, Alaska 99!502 se~er and water appreval~ you will nee,i to have In the event, the ~,rcolation test ~}'~o~s ,.h~ syste!n i-~ not ada~?uate for a four(a) bed~:oo~a sin,~le family Prior to tho u¥~grade a per~tt must b~ issued from of ~ ~c~ o og - i~ ther~ ar%~ any qu~-~t~o~-;s, p!ea~e con%act this ~ ~ 264-4720. Associate Specialist RCP/ljw cc~ Alaska Pacific Bank ~ort~f;e Loan Division Post Office BOX 420 99510 P.O. BOX 4-1276 ANCHORAGE, ALASKA 9°°509 4849 BUSINESS PARK BLVD. Drinking Water Analysis Report for Total Coliform Bacteria TL: LEPHONE (~07) 27g-4014 TO BECOF¢IPLETED BY WATER SUPPLIER .... o City State Mo. Day Year Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. ii~--Special Purpose ~ ~, [] Treated Water [] Untreated Water SAMPLE NO. , 5 LOCATION Time Collected Collected By TO BE COrClPLETED BY IJ~BORATORY LABORATORY: NAME ADDRESS CITY °ate ~eceived ~ - z 2~ 7/ Time Received Analytical Method: [] Fermentation Tube ;3~M embrane Filter Lab Ref. No. Result* Analyst I I II] J Steven A. Johnson & Associates ~,U. ~OX [o~ l{rlcJlora~u, Test Performed--for _~c~ ~. ~ ~~_ Date Started Legal Description L~ I ~~~.g Number of Bedrooms~ ~ Tank Pumped_ (1) Test Volume (TV) = ~ _Bedrooms x 1~0 gal/Bedroom = pa~,.[ 2 x TV = 2 x , ~gal = Table 1 T~me at beginning of pumping (Tp)~ t'~'~o~ I <~> ~;¢~ ..... Nm-["--'e~ .... ~~'~ I ~~~0 l_~ 8~.o I1- 600 800 , ' ' ' , 1600~ ' ~ ~ ....... ~800z ....... (2) SysZs~ capacit (SC) = 12~O~alkons. = ~--¢al/in-- SP (3) Su~e volu~e (SV) = 0,4 TV = 0,4 ~6¢06al = %~. gal (4) Fluid level 8top (FL) = ~_~T (m:i~:)' ' s? (.i~) I. ~ SP (in)l~S~P- (in) ,0 II T24 = i( 6)~. Lost' (FL .... ~umm_a~y Percolation Ra )=scx( SP24 = $P24 -~SP drms I 'Ij..... te (.PR) = Is~'2,_~--gal/day/bd~m P.O. BOX 4-1276 ANCHORAGE, ALASKA 99-509 4049 BUSINESS PARK BLVD. I=ELEPHONE (907) 279~O14 Water A{~alysis Report for Total Co}~form Eader{a TO BE CO[~PLE'FED BY WATER SUPPLIER PUBLIC WATER SYSTEI~,~I: I.D. NO. Public W~tor $yulc~m Nc-me M~lllng Addroue City State SAMPLE DATE: Mo. Day Year Zip L;ode SA~PLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no._ .) ~--Special Purpose L_O~{l~ [] Treated Water [] Untreated Water SAMPLE NO. I I . I LOCATION oT I Time Collected Collected By TO BE COMPLETED BY LABORATORY LABORATORY: CHEH & GE0 LABS CF AK. ,;[NC. NAME 4649 BUSINESS PARK BLVD. ADDRESS JCHORAG~KA C~TY Date Received Time Received Analytical Method: [] Fermentation Tube · ~ Membrane Filter Lab Ref. No. Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected 9-29-78 Source__ Date Received 9-29-78 Time Re~e,~ed 3:3C ~aLab, NO. 8757-30 presumptive lOml lOml lOml ]Omi ]Omi__ 1.Omi O.lm{ Multiple Tube Report: Membrane Filter: Direct Count Final Membrane Filter suits Reported B~ .lOmf Tubes Positive/Total lOml Portions _ Date o '2 -J