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MICA'S MEADOW LT 2
Micci's Mecidow Lot 2 #075 - 091 - 20 � LAV - 11-t W1111.JTA I t -r c)o= FA I- FACT���� ~ � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, •AK 99501 • 264-4720 ChIM_~E3 ~1- ILAX E. IF"FE:IF:4:101�~� PERMIT NO: 850703 DATE ISSUED: 10/31/85 APPLICANT: ADDRESS: • CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: / DAVE SEIFERT BOX 116 GIRDWOOD GIRDWOOD, AK 99587 /83-287O SUBDIVISION: MICAS MEADOW LOT: 2 SECTION: 18 TOWNSHIP: 10N RANGE: R2E 15004 (SQ"F1"" OR ACRES) BLOCK: NA I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA> and the State of Alaska. 2. I will install the system in accordance with all MOA cOdes and regulations, and in compliance with the design criteria of this permit" 3" I will adhere to all MOA and State ofAlaska requirements for the' set back distances from any existilg well, wastewater disposal system or public sewerage any adjacent or nearby lot" ��� SIGNED J DATE: �6�:�� ~K ��m�� ~~~�- _ APPLICANT: DAVE SEIFERT ISSUED BY DATE: M -W DRILLING, Inc. P ✓, P.O. Box 110378 • 10330 Old Seward Highw� (907) 349-8535 ANCHORAGE, ALASKA 99511 Well Owner Brooks Chandler DRILLING LOG tSb-24U Use of Well Domes tic Location (address of: Township, Range, Section, if known; or distance main road L2, Mica's Meadow Girdwood Size of casing 6" Depth of Ho1P 81' feet Cased to ` 81' feet Static water level 44' ft. (a73O ((below) land surface. Finish of well (check one) open end ( X ) ; Screen ( ) ; Perforated ( Describe screen or perforations: Well pumping test at 15 gallons per Pitfall (minute) for 1 hours with 100% . ft of drawdown from static level, ? t.",- Date J Date of completion 10/21/86 f ` .*q'L,D L (] %11)n(Ct° WELL LOG Depth in feet from f it ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 2 2 TO 3 3 TO 12 12 TO 36 36 TO 41 41 TO 69 69 TO 75 75 TO 81 TO TO TO TO TO TO TO (`;aqg Stick-up Gravel Fill Organic y Gravel. Gracie 1 N\C\"\\ �p MEP\�OZECj\O� MSp011 • 0,k- PR ttoOS\s0A 0(6( V. GYaVally Hardpan Gravel clay" Water gravel � t .-_ • :_ice- p/(1 77, a. i NV, i,A Certified Contract(: Certificate No's. 814 & 973 3 —CONTRACTOR h QJ N 3,5°,..56///" Z- 87. 1 Can E/7lrevie a N 4,74'56/46/' 04 /56, /0' /O'F/ec/. e€? r ' rWer; 71- Qo N U1 m � LEGEND J Primary monument recovered • /ran pipe and/or reibar recovered O 4/8".t 3O" rebor set this survey .9f'37'2/r'W.11 5117 Acce_31 a • 20rPrrrale Drive Acte-SY Paste/Yj E/) 71" �, 4- i Vi? &n 0 0000000 °�0 00 o n0 00000000 ® ° William S. Smith �� ®9�sj °o No. `, 4107-5 o -o. PREPARED FOR: /✓r0424-% (7714rV°L6a / hereby certify that an accurate survey of the following described property - Or , A4 CA Az' /f"11/ was mode on a'./76; „ /oeC and that the improvements situated thereon ore within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises /n question and that there are no roadways, transmission lines or other visible easements on said property except os indicated hereon. '�1 Gated_ at Anchorage, Alaska, lhisl'day, of p7.z// L.,£ No. 5r/i; 7S ORWN an 8JG CHCKD BY•' //e55 DATE; 8/2%,16G WO NO. 1r SCALE:/- SHEETNO./of/ F.B. NO. - GRID AS BUILT L rCA rr• CA &Oki/0 PREPARED BY CORW/N 8 ASSOCIATES 4790 BUSYNESS PARK BLVD. BLDG. 4 SU/TE / ANCHORAGE, ALASKA 99503 (907) 56/-6/5/ ainatea 1”) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 076 -091 - 20 1. GENERAL INFORMATION cosA # oqo Lica) Expiration Date: a - 9 - l O Complete legal description Lo 1- 2. he c.c 's M ec 0ec. w S /p Location (site address) 13 y M�ea'C 1'7<dtd6w Gt.o Current Property owner(s) A A rton J Canan, Pae Day phone 2 Liz - est, Mailing address 7331 So l pr r Lending agency Day phone Mailing address fJ ores. Dr Ane 0rms.° Real Estate Agent Mailing Address Ak 994-0 Sun. Daniel, cfoer.r C.hy R.r. Day phone 27-7 - '/ Unless otherwise requested, COSA will be held by DSD for pickup. P f ecv e to t / 2. NUMBER OF BEDROOMS: 2. token Cos if 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System .Brim bon,eIe22.7-Y(2,c ready. 4.r r, Gtr -40 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 ❑ Individual Holding Tank 0 ❑ Community On-site 0 ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. Name of Firm rid f/'s re. cAn1c.( Stevie v Phone 3Yr- 13Cs Address )'1t30 ScA, 6.7 on Rd., 14•.c\ ,4k 99.5 - Date Nov 7, 2-0°9 Engineer's Printed Name--p,.t./Jort rrcore 5. DSD SIGNATURE 1./ -.Approved for bedrooms. Disapproved. Conditional approval for By: C-71 *MIC1'17 bedrooms, with the following stipulations: �,cti 01- A 4P .....• • • ON SITE •'�c, ��• WATER AND • MI • 6. PROGRAM • •••...••• .44 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev 11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other cnt Original Certificate Date: / / — 9 -O 9 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lo I- 2„ M rea's N la da r„ Parcel ID: 07C-09/ -Zo A. WELL DATA Well type Piot' If A, B, or C provide PWSID # — Well Log (Y/N) Y Date completed 10/i1/96 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 8 ( ft. Cased to 21 ft. Casing height (above ground) 30 in. FROM WELL LOG AT INSPECTION Date of test to/zr/SC 913a /o9 Static water level Y Y ft. : W 7 ft, Well production If g.p.m. 6•`1St g.p.m. WATER SAMPLE RESULTS: Coliform /) colonies/100 mL Nitrate O•Y21 mg/L Other bacteria 4 colonies/100 mL Arsenic: Cr, ug/L date of sample: 9/ 3O/o9 Collected by: 7•flcosc B. SEPTIC/HOLDING TANK DATA N. A, (A w wK we w e� FI" Ftip T« see Tank Type/Material Date installed Tank size gal. Number of Compartments _ Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA W. ft. (Awwre Secoe'� Date installed • Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth _ ft. Eff. absorption area _ft2 Monitoring tube _ Depression over field _ Date of adequacy test Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (WN & type) If yes, give date D. LIFT STATION iv. A... Date installed Size in gallons 'Pump on' level at _ in. "Pump off level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N. A On adjacent Tots Absorption field on lot N • A On adjacent lots Manhole/Access (YIN) High water alarm level at In. Meets alarm & circuit requirements? Public sewer main ? 100' Sewer /septic service tine 'i Y Holding tank Animal containment areas 14/• A. M. 4 O. A, Public sewer manhole/cleanout > 400 ' N • A. Manure/animal excrete storage areas iv• A. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line _ Water main Water service line Wells on adjacent Tots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: N. A. W. A. (Aw wu S e 44"0") Absorption field Surface water Property line Water Service line Curtain drain • F. COMMENTS Building foundation Surface water Wells on adjacent lots ( Atrtum ceea.er) Water main Driveway, parkinglvehicle storage ."0.V 1 •a^•_ " h, G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name -rho afore 1'•ri0eIr Date avvero 1.r r 3 200 9 1• ,. ri •: • r n TFi:•: 4-' COSA Fee $ N9 -`-- Waiver Fee $ Date of Payment 1! — q — 09 Date of Payment I & Receipt Number 0 ' a L Receipt Number (Rev. 11/05) PRIVATE Wet ACCESS EASEMENT 10 SIg4 L07S 1, 2. AN0 3 LOT 68C LOT 1 cra-str15.ittiN 0 4911.1 %c ':-7;0, area•. G .Thomas H. Oreye OR L5-7625 Opp S4213-41441-4-4-4--1.4 SS -4 —4-4 �.�.Se EXCLUSION NOTES N u Me ens .e.pwebey le Orlvnwe tee •.alwu. of wy .mwn.M.. townenla co miner. .Iwcn rot M N With JACK Mh11TE CC4PANV mer no cocvn.lmc.. should any pewee heroes 0e used N. �i' 1 tmeVut4on a 1 N14DIitnn9 yppN1Y hN GEORGE MCCOY tepee en . a.to ameaw.an na NOT. LAND & CCNSIRU.TION SURVIVORS-PLANNERS-ENGINEFRS 140 Y&ST BENSCN BLVD. 1 103 ANCHORAGE. ALASKA 99503 (907) 562-5291 WAN 1•:[la N.yffe n Ixr.. DEC 22 1997 } 11.50' jI(lo.) 561-6626 93—L -867A ovn .. e•} e49 3 324\20 1 AS—E3LJILT OF: UCLA DESCO.NON MICA'S MEADOW $Wtl£Y CLR IhCAIbN LANILC.1 nos crewed 0 py.as many el he e•oprty as Mew on M•. deems we Mel le inye.e•n.nb elwl.e 1M. - en 0e ..IM tow ropely les rd ne w•neeen- n enls est ewe Inco Sole LOT 2 LEGEND: 5Ef {NO WA a/t-@ Sit w O 325• a woo • out"! $1 � & Mot [) 'Lucy. —.— . — OKeneL- eeCe MGs- CMCMR- Ayna 1- CSA.a- lima" A M PAYYpnY n. SGS SCS 140 Client Name Project Name/4 Client Sample ID Matrix 1095323001 Flattop Technical Srv. Lot 2 Mica's Mcadow S/D Lot 2 Mica's Meadow S/D Drinking Water Printed Date/l'ime Collected Date/Time Received Date/Time Technical Director 10/19/2009 16:22 09/30/2009 12:00 09/302009 15:30 Stephen C. fade Sample Rcmarks: Parameter Results Metals by ICP/MS Arsenic Waters Department Total NitratclNitritc-N Microbiology Colony Count Total Coliform Fecal Coliform Laboratory NI) 0.421 0 0 0 Allowable Prep Analysis PUL Units Method ContainerlD Limits Date Date Init 5.00 ug/L EP200.S C (<10) 10/12/09 10/15/09 NRB 0.100 mg/L SM204500NO3-F 13 (<10) coV100mL SM20 922213 col/I00mL SM20922213 co1/l00mL SM209222B A A A (<200) (<1) (<1) 10/09/09 LCE 09/30/09 DLC 09/30/09 DLC 09/30/09 DLC Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING r' HAA# 0q7›.5 Expiration Date: J l— O.. 7 - 0 3 Parcel I.D. 075-091-20 1. GENERAL INFORMATION Complete legal description MICA'S MEADOW SUBDIVISION; LOT 2 Location (site address or directions) ALYESKA HIGHWAY* GIRDW000, AK Current Property owner(s) MARGARET ROBBINS Day phone 274-6244 Mailing address P.O. BOX 1326 GIRDWOOD, AK 99587 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well III Individual On-site 0 Individual Water Storage 0 Individual Holding tank 0 Community Class Well 0 Community On-site 0 Public Water System 0 Public Sewer lIII The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority 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. 1 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 ali applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD� SIGNATURE V Approved for oZ bedrooms. Disapproved. Conditional approval for OF ....... „A VA O cAp ear'fofessio11°oc •J•fr: Gar E 953 bedrooms, with the fllowing stipulations: WI or A . ON-SITE • m �� • WAItRAND WASTEWATER PROGtlAM . . ff LL 1 Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By-; (Rev. 12/01) til Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: S —.2 7 - © 3 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.cLanchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MICA'S MEADOW S/D; LOT 2 Parcel ID: 075-091-20 A. WELL DATA Weil type PO/ATE If A, 8, or C provide PWSID# N/A. Well Log (Y/N) YES Date completed 10/2111988 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth . 81. ft. Cased to 81 ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 10/21/1986 8/23/2001 Static water level 44 ft. 46 ft. Well production 15 g p.m. 6.3 g.p.m. WATER SAMPLE RESULTS: Coliform 0 Arsenic N/A mgJL. 8. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size. .gal. Foundation cleanout (YIN) 12 in. colonies/100 ml. Nitrate 0.339 mgJL. Other bacteria 0 oolonies/100 ml. 8/14/03 Date of sample: 7/31/03 Collected by: AKWWC, INC. D PUBLIC SEWER Number of Compartments Date installed eanouts (YM) ss on over tank (Y/N) ____ High water alarm (YM) p ng Pumper C. ABSORPTION FIELD DATA Date installed Length Total depth Soll rating (g.p.dJftbrttTbdrm) ft Width _ ft. Gray = • - •w pipe ft. ft Eff. absorption area ft2 Monitort . • • e Depression over field Date of adequacy test Re • -ass/Fal) _ .. For. bedrooms Fluid depth in absorption field be • =st in Water added __gal. New depth ____in. Elapsed Time: m Final fluid depth _ in Absorption rate >= g p d uvenation treatment (past 12 mo.) (Y/N & type) If yes, give date System type D. LIFT STATION Date installed "Pump on" level at in Datu E. SEPARATION DISTANCES Size in gallons Manhole/A "Pump off in High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots On adjacent lots Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water main Water ots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation er Wells on adjacent lots Water service line C F. COMMENTS 100'+ 100'+ 100'+ N/A PUBLIC SEWER Absorption field Surface water G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed N me JEFFREY A. GARNESS Date 13/27.10?o? PUBLIC SEWER Driveway, parking/vehide storage HAA Fee $ 315- — Date of Payment Receipt Number (Rev. 12/01) 6'22.43 yo56(; Sc Waiver Fee $ Date of Payment Receipt Number Sent By: Alaska Water and Wastewater Con; 907 338 3246; Aug -27-03 12,08PM; ',if. I . f c ..1: 33q.. 3Zi A#. 4T( •%C. • by W Y / Jxa 44/ S•� 1,44.03 014 ACUSt f�. W Bert ialC L S. •Iq LOT?. N LOT 1..• sirs. awl 4'9L 71r 5„% "7-Fi:gellf.rereAt. 416 .♦ %. -1t2s r' l s Ar. d. Oi 66C 6' b7 67 reirECI:i�akik C(lIejl?al, M:R k 4 a al •«•.. nga.Ht4f 1/,�11. .M, i. Ing ^ 11..61 $0 a.. •i4 imitate •7 M• ..w....I,. a1'.w•alt. Y $644.fwaY CR't0 tvalvT U1' 1t O .i E: WRC: M C: C O Y ww N •at 001• w U• ,11we44 IASWNea 1111. 401(' Iu• 64,Mit d•wa11 ®. a'':1 J�.C`: Wr1iTC C'3 3i..NY .JN. a• Ir:......•••1 111•;:, NY Int•tIN• /• .qt I•. .161 4, IWt U3 is7t' ..11-1 V.. t *pi - wpm Qr far 4646006.41 ir40 1t10 fC•q. ....•"....... • K`% G\'t M1QA.ti6,G //NI(QJ1 ...• •MGYt IN / •Ka••°"" aiaraai a.••/ .' • .,.nn, .S •..•.... •.i .Ga• Kta 1. J.•.Yy an• i t R/ UM•a•1•aO.0 LK11aa Ihr /YG/t�•• 14 •••.• a.e.w 10. M•n t4 /N.• 01V 41446:'. .1u•1• • I% 11.`Mltl. t44. ■ '/ As—ie u.i.- c1', uoAL K;Grouo..• 1 ,vi -M JcI.l>... wrt•.wYQna.p,.r�RS-[NGNCCRf • V.)9J1• 652 217: LOT 2 LAM) calsfr, •40 NAST ONSON k1.1),I •.LMJ A $9.'/J7 Tuba• t°"`::•12.Iit\AICAIS MEADOW Page 1/2 •r 8- 8-03; 9:15AM; SGS Ref.# Client Name Project Name/U Client Sample ID Matrix 1034762001 AK Water & Wastewater Consultants Inc. L2 Mica's Meadow Mile 1.3 Alyeska Hwy Drinking Water :907 5815301 # 2/ 3 MI Dates/Times are Alaska Standard Time Printed Date/Time Collected Date/Time Received Date/rime Technical Director Released 08/07/2003 10:36 07/31/2003 11:10 07/31/2003 16:35 Step ye/C. Ede Sample Remarks: Parameter Waters Department Nitratc-N Qualifiers Results • 0.339 29 OB, No Coli Microbiology Laboratory Total Coliform PQL Allowable Prep Analysis Units Method Container ID • Limits pate Dau Inn 0.100 mgt EPA 300.0 B (<-10) 08/01/03 JJB co1/100mL SM189222B A (<=1) 07/31/03 JS 1 9 ( 1 1 1 1 .1 1 8- 6-03; 9:18AM; • ;907 5615301 8 A- 3 CT&E Environmental Services Inc. Laboratory Division ri►rcaroma iiiiiioiAivvminieirsiiiiiiiiiiiaiiimst 200 W. Potter Drive -inking Water Analysis Report for Total Coliform Bacteria Tei: (907) 5624343 -1606 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE . Fax: 907) 561.5301 • MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: jg • Satisfactory • O Unsatisfactory 0 Sample over 30 hours old, results may be unreliable O . Sample too long in transit; sample should not be over3Vhours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received 7- 3t it Time Received /63.5 Analysts Began In S Analytics! Method: ' Membrane Filter • 0 MMO-MUG • • m...4..r.nfeolonieaf100ml. Result Analyst .0347621 O Treated Water 11111� Lill 11 N�C.T ,Fbks Jun r•�00 • Faxed • O Untreated Water O PUBLIC WATER SYSTEM I.D. N PRIVATE WATER SYSTEM Send Irwin / Cone WNW • Sur SAMPLE DATE: Io171 Month . SAMPLE TYPE: •1f�( Routine • O' Repeat Sample (for routine sample with lab ref. no. ) 0 Special Purpose f•II Day D Year Date: Time: Time Collected •• Client notified of unsatisfactory results: SAMPLE LOCATION Collected By 0 0 k.)...2Phoned Spoke with Faxed % //i --fz�� k "/ Date: Time: 'Pe' 410/ Ir - ID ' PleasePleasePrim • I GBBAACT OGICAL WATER ANALYSIS RECORD.. MMO•MUG Result: Total Coliform E. COU n Meiabnne Filter. Direct Count 21 06, NO Gpr t • Colooles/100 mi Verification: LTB __ BGB COLIFIRM Fecal Coliform Confirmation Sia 1S -1Z16)( 1 Colitorm/100ml Final MembnnIe/Firlte�r� Results � J Reported By W `�'t.4. Date Ff/ I ! 0 Time 30 brs Comments: T71'TC 1.. Ni T• C..nt OS -ofA.ra.oew re SIM Mambo; of the SOS Group (Soci4t6 Gdnerale de Surveillance) nuan •ucer vinr;M A i i AUG -22-2003 10:56 AM O3.:1-03 11;OSAM cROU-CTIF. 5me(a/Cll. SPV gref IVD T -TIT P•0;41 :-517 LT &E Environmental Hermes Inc. 200 W. Potter Drive Anchorage, AK 99518.1605 I'elcphoae: (007) 561-2343 Facsimile: (907) K(1.5301 P. 01 200 W. Patter Drive )rinking Water Analysis Report for Total Coliform Bacteria AI;1 oU96ez z a 51".Taos YEdD.IN T ' UCT7ANS ON AVERSE SID2 UUFOJUL COLLEC71NG SAMPLE Fe:: " 7 6 :1.. • MUS BB OMPI ETEL) RV WATER SUPPI=RR 70 BE COMPL • u• B l I.AB • LATORY O PUBLIC WATER SYSTEM 7I1. N PIUVAT& WATER SYSTEM *awn! Mats Al flewIt ice e.re...+tta.. ed.�w c10' u1 F. Ale/ /. _ _ j4fiiir*--- rorairaw Ll._.1_1._.1 t.., ) O AmI JIaMR' p SmIlowl Ce Maw., L-- SAnMPLE DATE: SAMPLEIYPI;: apYdne la Repeat Sample (for routine iambi nit 'lab ref. -no. ) O Special Purpose SAMPLE LOCATION 'OLE Month 1711 rE3 1 Aa)• Year aero.. o Treated Water Q Untreated Water Time Collected RAA.'. 1 CoUoeted Ry vi� e• atte now hint Analyzes thorn this Water BAMPL1i to be: SetiiJhcmty lJmaucrsztoty Sample over.30 hours old. results may be unreliable SsmPlu0011111 IR truth; sample should not be uvos3Peoare old et exantinetrrm to indicate reliable melte. Please mid new Limpid via special delivery mail. Date Seethed • 15451t15 1141(5 Time Received Analysis, lman Analytical it whorl: eNt=.Membronc Pills o MMO-MUO • Number rd'colonies1100 tut. Lab Ref. No. Result* Analyst ob5(�P6 •�� Stet r.. Asea MI Jaa Date ..� Tinter Clleut notified of ant tandem oryrrsals: 0 Phoord Spoke with • Dilly �— . _._.._.. 'llmrc 0 Gaend 0 Fa tied Comments: BACTERIOLOGICAL WATER ANALYSIS RECORD Mg0.MV0Itarks Tota) Coliform ( Membrane Filter: Direct Cont N. Cali Colonies/1110 int Verification: LTB -- ISOD .._ COLIWIRM_.____.__� Fecal C•Ilratm CnnI J enters /lest Metabases Filter Results Reported By Y 1 r A_ Cifltirmi100 mi Mine , kctA bre mwmonall rwrC- IAA Nrnen.f 1'. co. 0* -l;.Ar Ram YR 0E3E3 member el me X011 GrouptSoei/le G411era16 de SurvemAncel 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. # ((791 1 ao 1. GENERAL INFORMATION Complete legal description HAA # 11Z°I1 CXR Lot 2; M..ca&4 Meadow Subd.iv.L4&,n -56 Location (site address or directions) NUN Cnow Cneefz Road Gindwood, AK Property owner Bnoolu Chand2en Day phone Mailing address C/O Geroge McCoy JACK WHITE CO. 3201 "C" Street, Suite 100 Anchorage, AK 99503 Lending agency Day phone Mailing address Agent George McCoy/ JACK WHITE CO. Day phone 762-3118 on 783-2937 Address 3201 "C" Skeet, Su to 100 Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 v 3. TYPE OF WATER SUPPLY: Individual well Community well Public water xxx NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: 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 M21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo i Z MICA'S MEADOW S/D Parcel I.D. A. WeII Data Well type PK.1V A7 If A, B, or C, attach ADEC letter. ADEC water system number N/A Log presen (c - Total depth Sanitary seal Date of test Static water level Well flow Pump levell Date completed /o/2 / /867 Driller Al _IA -I 011-1LL-/w( Cased to FROM WELL LOG / Y6, c (� Casing height / 1-1- FROM + Wires properly protected ON) '7 \ z AT INSPECTION 1 o IZI� s O 44/ � ►�, Jh ca `� / S g.p.m. G • 3 g.p.m. } ¢ i ur oz W 32 ' ce w uK SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot "Mr -1 vi -J 17 1- SE6-,-,4/e-__; On adjacent lots /Jd ouLr- Absorption field on lot /UD.tie- ; On adjacent lots No,-' r Public sewer main %(-- Public sewer manhole/cleanout /60/ f - r Sewer service line as- WATER S WATER SAMPLE RESULTS:,. Coliform /7oa,t n Date of sample: / Z-(3// % 3 B. SEPTIC/HOLDING TANK DATA Petroleum tank N o'•- Nitrate Or 33 72417/,e- Other bacteria Collected by: „'G/NEER LIUC� v,v r TY SC(.J Lr_ stalled Tank size Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) larm tested (Y/N) Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On a•la To property line Absorption field Surface water/drainage Foundation rvice line 72-026 (3/93)' Front CONTINUED ON BACK PAGE 01/05/94 12:49 CTaE ENVIRONMENTAL LAE SERVICES COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES INNO.239 DE Chemlab Re..# Client Sample Matrix Client Name Ordered By Project Name Project* PWSID REPORT :93.6948 ••- 3 (e ID :LOT 2 MICA' MEADOW S/D :WATER :S & S ENGINEERING :SCOTT SWE N0R :UA of ANALYSIS Sample Remarks: ROUTINE SAMPLE COLLECTED BY: SS Parameter Nitrate -N rt = V;33 E STREET ANCHORAGE. AK 99.5+8 TEL. t907) .582-2343 FAX: I90?j E8";.s3O1 WORK Order :74583 Report Completed :01/05/94 Collected :12/31/93 @ 15:00 Received :01/01/94 @ 13:22 Technical Director:STEPHE . C. EIDE Released By : hi hi QC Allowable Ext. Results Qual Units Method Limits Date 0.33 nig/L FPA 353.2/300.0 10 See Special Instructions Above See Sample Remarks Above Undetected, Reported value is the Secondary dilution. Anal Date In! 01/03 LL. UA = Unavailable NA = Not Analyzed prrictiCal quantification .limit. LT = Less Than GT = Greater Than soSGS rye Member of the S35 OroLp (Saciu �ia 6± eraie e9 Surveiliar?Ce) ENVIRONMENTAL SERVICES IN ALASKA. COLORADO, UTAH. ILLINOIS. OHIO. MARYLAND "rST VIRGINIA, NEW JERSEY. SOUTH CAROLINA 01/05/94 12:48 CTE.E DAN I RONMENTAL LAB SER. -VICES COMMEFICIAL TESTING & ENGINEEFON`G CO- ENviRoNmENTAL. LABoRATopty suiviczs NO. 239 Di Drinking WaLcr Analysis Repon for Total ColiForm B ae t(5i a STFIEE: z.K READ Lys TR cc TIONS vERSE SID BEFoRi•-•; COL TING S.4.1-1.PI,,F 7a: (-,;r:•; iv.F.IST BE COMPLETED 3 WATER SUPPLITTR ---- 7 To SE COIVRLFf.:7:157-51YLADC)ILLATORY o PUBLIC WATER SYSTVel LD. o PRIVATE WATER SYSTEM o Send Result4 QSe7dThok. Ztr S Y'S%"71 o SeNd Rc,suLs 'DATE: SAM?' E TYPE: n Repeat Satupie (for rOUtirie JpiC with lab ref. rio. r. Special Purpose SAMPLE I.00ATIO L6T-1 aza, 's IJ 2 I Ycai. s'r(otvs tt:Js SAI'vcill1-.7 to be: Sal.:321ary LJESIiraCtOry old; reaas may ei.lretiable • Sarnpe too in tiar.zit; sample should LIDtrb over 43',.'.ors old at exan-dria:iori to ir.dzi.cat,:i....tijable 1 -es:!. ?ie 21t:":1 Sed new sarapic via soeciaLiri-y D ath Reecis ed (— Time Bei:en ed 1 Anal:tsis Began AitcaiAlethod: _ s re" i Lab Ref. No. 3 Trev.red `..-Vater Sem: 7') o Untr.:ated Wale: .-tna!st result•;: Time Collected elected Lz;•• Phcnve /E -LCX> PIC:3c BACTERIOLOGICAL, WATER ANALYSISECOR.T.t MMO.N.IliG Tot21 Coilfe,rm (701;,* :Membrane Dil'Lz: Vercniiet; LTB BGB C, LIE LTC,' Feel CGlifnrm Con.fir.:2aticq). Final Membrane.Fttr Royitt. Coliforn31100 trl Reported By ik V 1-7 ' . • Date - 9 -• rs ,41 COMM:nU: SGS ine SG'S ENVIAC,WEI.,I7AL SER.'ICES 1ALAEKA. COLORADO. / c rc . -03 PART ONE OF TWO: REMAINDER TO FOLLOW DALeo MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL. HEALTH , CERTIFICATE OF INSPECTION FOR Vg1- fid HEALTH AUTHORITY APPROI S F ON-SITE SEWER AND WATER FACILITY 264-4720 '=• Application Date 31 to -02 -1^0^1Q -9"r , j 98G 1. GENERAL INFORMATION ;, (a) Legal Description (include lot, block, subdivision, section, township, range) 1'1 ca`s'` M.pa.doo Location or directions) T f dac18 6e 'Ai (b) , Applicant Name 5 oCk3 Gland 1& Telephone: Home 183-2(0 13 Business 2�.t 810 Applicant Address ` RI). BOX 2(3 )' Crirdwood, ` AK. 44 587 (c) Applicant is (check one): Lending Institution 0 ; Owner/builder Mr: Buyer ❑ ; Other 0 (explain); (d) . Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) ; Mail the HAA to the following address: 2. _. TYPE OF RESIDENCE' Single -Family Multi -Family 0 Other Number of Bedrooms WATER SUPPL-Y/ +.' Individual Well I Community 0 Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ❑ Public Community ❑ ` Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status 72-025 (11/84) Municipa, }ty of Anchorage P.O. BC ,96650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES 0Q -1 -Doi December 3, 1987 Mr. Brooks Chandler P. 0. Box 263 Girdwood, Alaska 99587 Subject: Lot 2 Mica Meadow Subdivision Dear Mr. Chandler: This department has received notification from your engineer that the well on the subject property is now in compliance with municipal regulations. If you have any questions, please contact me at 343-4761. Sincerely, Daniel J. Roth Civil Engineer On -Site Services cc: Gus Andress, P.E. Manager, On -Site Services/Water Quality Programs • ..„„zwyr *44%*41 O QVC r Catzt ©0n ssociates,inc. �� 1987 Consulting Engineers :(" 12001 Industry Way • Bldg. B • Suite Eleven • Anchorage, Alaska 99515 • (907) 345--4 i / November 18, 1986 Municipality of Anchorage Department of Health & Human Services 825 "L" Street Anchorage, Alaska 99502-0650 SUBJECT: LOT 2, MICA MEADOW SUBDIVISION On October 21, 1986, Corwin & Associates, Inc. health authority approval on the subject property. time, the wires to the well were not buried and a approval was obtianed for the subject property until could be buried and reinspected. On November 16, 1987, Corwin & Associates, Inc. reinspected the subject property and found the wire buried and encased in conduit at the well as required. We recommend that a full approval now be issued on the subject property. Should you have any questions, please let us know. completed a At that conditional the wires V,T truly ours, CIATES, INC. uceCorwin, P.E. Presi:ext BJC/j MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL -'Q—) - i S OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION (a) Application Date 31 ttCP-r'JQ. r 198G Legal Description (include lot, block, subdivision, section, township, range) M l'ea's NUez do1J L +a Location (address or directions) �/�-1 hoc [ 8 6e t/q l (b) Applicant Name 5(04.5 lilaY I Ler-Telephone: //�� : Home 155-20143 Applicant Address 'f BOX 213 ) &6'-CiWOOd) p C(Q 567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer 0 ; Other 0 (explain); Business 271-64/of (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (f) 2. TYPE OF RESIDENCE Single -Family I Multi -Family 0 Other Number of Bedrooms a 3. WATER SUPPLY Individual Well Q/ Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL i Onsite 0 Public Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11184) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOr. HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHnou(KLIST - FEBRUARY 1984 DEPT, OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION JAN 131987 RECEIVED Edi wd.a0 Legal Description: Cit I LL 3 Mecdoo 3. La+ a Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) l 25 Date Completed c9/ OdO10 ( /Q8C, Yield Total Depth B 1 � Cased to 81' Depth of Grouting /1•A_ Static Water Level 3.5 Pump Set At SO Casing Height Above Ground ,P1 Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot TtA)1lC To Nearest Edge of Absorption Field on Lot 1Ltc1 Sanitary Seal on Casing (Y/N) L1QS Depression Around Wellhead (Y/N) 1\I0 ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole 145' 4 - Water Sample Collected by tba- Q� Water Sample Test Results 6au6jaC�r� "gF(o� Well Lag. * fro1'v Well 0.( 531 cicaw;nq 5.5 1,4, F�(I reCoVery 1NJE� tel' ax -J2 nOt byturizd,i1Vi-i5 a >MQ 9Qtl B. SEPTIC/HOLDING TANK DATA Tull (1.4^ L. TU la' PER 14udq To Nearest Sewer Service Line on Lot •06412 OF (ogw,r s< Assoc, Comments ; Date 30 . .eCDrm -C1 i Qa10 ',JELL( lQ U -d Q L.n, 1 hour. (s5 •-I-o x..,7 C1md 1� 5 r.o1- 69LA5©r,ct(l 5 �i a.sa 66-o bt,Uc' W 4%06. R tAQS= Date Installe• Size No. of Compartments Standpipes (Y/N Air -tight Caps (Y/N) oundation Cleanout (Y/N) Depression over Tank Y/N) to Last Pumped Pumping/Maintenance Con .ct on File (Y/N) ; for Holding Tank High -Water Alarm N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holdi Tank: To Water -Supply Well To Building Foundation To Property Line osal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) CHEMICAL & tOLOGICAL LABORATORIES_,F ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUB C WATER SYSTEM I.D.# PRIVATE WATER SYSTEM C Jmr' . Name 11-7 qo (pit a i Mailing Address City Sig/ —CI Si Phone No. P R d 61d,E � SAMPLE DATE: i Mo. 2 Day , IL State Year q gSG3 Zip Code SAMPLE TYPE: [Routine O Check Sample (for routine sample T. ated Water with lab ref. no. ) ❑ ,F O Special Purpose Liu SAMPLE NO. LOCATION 1 1M 0A`.5 NIPudoa) Ab. (/7-1-a Y:-kkor bink - 2 3 4 5 ntreated Water Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: t. Satisfactory El 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. Date Received Time Received Analytical Method: 1/ /G Membrane Filter No. of colonies/100 ml. Lab Ref. No. Result* III Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Verification: LTB BGB Final Membrane Filter Results rs Reported By TNTC = Too Numberous To Count OB = Other Bacteria 0 Coilform/100m1 Coilform/100m1 Date / Time: /�%� a m p.m. \ i 1 1-1-11T January 10, 1986 TO: Permit Applicant P.O. BOX 6650 ANCHORAGE, A! AKA 99502-0650 (907) 264-4111 TONY <P2'S^iLES. 1 4 O•R DEPARTMENT OF HEALTH & HUMAN SERVICES Subject: Permit # 850703 Lot 2 Micas Meadow Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as -built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit 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. # t71 f(79[ 1 aQ 1. GENERAL INFORMATION Complete legal description Lot 2; MLca'6 Meadow SubdA.v.izion HAA # 1 Q()I (7n 1 Location (site address or directions) NHN Crow Cnee a Road GJv.dwood, AK Property owner Brooks Chandten Day phone Mailing address C/0 Geroge McCoy JACK WHITE CO. 3201 "C" St'eet, State 100 Anchorage, AK 99503 Lending agency Day phone Mailing address Agent George McCoy/ JACK (tlHITE CO. Day phone 762-3118 on. 783-2937 Address 3201 "C" S.t'eet, Suite 100 Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 v 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: 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 5. STATEMENT OF INSPECTION BY ENGINEER J. 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/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone 67 "2-9 7 Address ag1e }Over, A Engineer's signature Date 6. DHHS SIGNATURE x Approved for 2 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: fr1,1;-/ Date/ -2 94 CAUTION 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 (Rev. 1/91) Beck MOA N21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Loi Z M ICA (S MEADOW SO Parcel I.D. A. Well Data Well type PrLiv ATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log presen') (c . Total depth g� Sanitary seal �YJV) % C= S Date of test Static water level Well flow Pump levels Date completed /072 1 /86, Driller M -1A) Dvt-ic.L/wC Cased to 8/ FROM WELL LOG 44' Casing height / �f Wires properly protected ON) 7( S Z AT INSPECTION j CO o zU\W S a O y Jh co ..., S / g.p.m. 3 g.p.m. I l` W) y W v D z 5 144 W uK SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot AMM ci/ J (7-1' 5Eh62; On adjacent Tots A-)6006.-5 Absorption field on lot /Uv.w5 ; On adjacent lots No/ -'r Public sewer main � Public sewer manhole/cleanout /0o/ r Sewer service line 2S Petroleum tank Not'—) l t/JUw N WATER SAMPLE RESULTS:,,.. Coliform //0t'A""�nn Date of sample: /?/31/ % 3 B. SEPTIC/HOLDING TANK DATA Nitrate Ur.33 /17 Collected by: --S4 el--)Cil/-)E6/2//UCS L Other bacteria AIL'A-) e stalled Tank size Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Iarm tested (Y/N) Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On a.ta To property line Absorption field Surface water/drainage Foundation rvice line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION G6,i,i v N \--6atinstarled Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) ` • •• , on level at "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots ABSORPTION FIELD DATA Surface water Date install-. Soil rating (GPD/Ft2) System type Length Wi.' Gravel thickness Total depth Total absorption area C ut present (Y/N) Depression over field (Y/N) Date of adequacy test Results •: s/fail) for Water level in absorption field before test After test Peroxide treatment (past 12 months) (Y/N) ARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation • : ' ting or abandoned system on lot On adjacent lots Cutbank Wats ain/service line Driveway, parking/vehicle storage area adjacent lots Bedrooms , give date Property line Surface water Curtain drain E. ENGINEERS CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HM guidelines in effect on thed of this. inspection. Signature Engineer's Nam7034 Eagle Riv Date HAA Fee $ JDD Date of Payment / —71/ Receipt Number oZ S J C/ 1/14/ 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF. HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ,Q,- CC) LS '', OF ON-SITE SEWER AND WATER FACILITY 264-4720 1.: GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Mi`ca`s M.ea.dotk (.a+a Location (address or directions) (b) : Applicant Name 5(0Ok5 ekunci Ler//a� Telephone: Home '183-2(0143 Business 272-SYo� Applicant Address R)• $OX 2(13 ) &irdWood, ` 4g587 (c) Applicant is (check one): Lending Institution 0 ; Owner/builder EK, Buyer 0 ; Other 0 (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: 2. TYPE OF RESIDENCE 1 Single -Family i Multi -Family 0 Other Number of Bedrooms 3. WATER SUPPLY Individual Well CT ,.Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite 0 Public lld Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. (b8/L l) 9ZO-ZL Z1o3e6ed �!aoM s,aaau!6ua leuo(ssaload eqj u! suo!ss!wo JO saoaaa ao; elq!suodsaa lou s! e6eaououy !o /(1!led!oiunlj aql •panss! s bleo!1!>aao a aaoleq elep azAleue .; JO suo!loadsu!;onpuoo iou op d3Ha to saaAoldw3 •sluawaa!nbaa aims pue impel u!elaao A1s!1es of aapao u! suo!lnl!lsu! 6u!pual Apia pue sawo4 to saasegoand o1 AsaJnoo a se s!4; scop d3Ha a4.L 'e>!se!v 10 aims aw u! paaa1s!6aa aaau!6ue leuo!ssa!oad luapuadapu! ue Aq anoge g 1dea6eaed u! uaA!6 suo!leluasaadaa a4; uodn AieIos paseq saleo!}!laao lenoaddV• il!aownV q eaH sanss! (d3Ha) uo!;oaload leluawuoa!nu3 pue 41leOH to luewuedea e6eaogouV 10 A1!led!ounvi a41.•'. NOIlfVO it/Ai1 SUyJI✓iroj1y 57-1.1-/sJ jenoaddV !euo!1!puo9 to swaa,L panoaddy .J0 panoaddV '1VAOHddV d3Ha '9 leuo!1!puo3 panoaddes!a Aq swooapaq leas s,aaau!6u3 1-21', ,yon1U'" +,bq /fib i �' l ') alea go5bb7I�1'D•b>,ao�uv ra g -pig 7/•(d s-e"?9PV06Gh sseappv 1319 ') 01.9 , euoyda!al '-o<,11�(5 1 L�OSSkj L (''I,} U on wa!d to aweN V - .`uo!load'sul s!41 to amp ow uo;oalpa u! suo fe!nfiai pue'saoueu!pao 'sapoo awls pue led!o!un!nl Ile 4j!M eoue!ldwoo u! s! wags (s lesods!p aaleMalseM ,p/pue Alddns aaleM ails-uo am 'uo!loadsul pue uo!1e6!lsanu! Aw wail pue sal!! a6eaogouy 10 Auled!o!unlnj a4; wail peu!elgo uo!lewaolu! a41 uo paseq 1e4; Ai!aan as wnl 1 •u!aaau pa1eo!pu! aanlonals 10 odic; pue swooapaq to aagwnu eql ao1 alenbape pue !euo!punl'ales s! walsAs lesods!p aaleMalseM ao/pue /tlddns aaTeM alts-uo a411e41 smogs lenoaddV /1!ao41nV 41IeaH slim() uo!1e6!lsanu! Aw;e41 X1!aan 1 'Molaq uMoys amp uo!;ep!len al!110 se pue o18a04 1:19x111V leas,(w Aq pa!llua° sv + NOIIVWHOJNI aK'" d1Va `H3HH3S 33Id `SIS31 `SNOI1O3dSP" "lNialAOHd WHIH ONI1:133NION3 .'9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 1Q--) S. OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date -3I �C-12n'"^`-" i / 98(0 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) M,'ca s M doo Lc+a Location (address or directions) T le) A5..ac 18 5e `/I brook3 lit nci Lor Telephone: Home 135-2G1-15 (b) Applicant Name Applicant Address RD. Box 2(a3) &'i>^dwooJ, NY- qq f_57 Business 27z_ 84/0 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder I Buyer ❑ ; Other 0 (explain) (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (f) 2. TYPE OF RESIDENCE Single -Family Multi -Family 0 Other Number of Bedrooms a 3. WATER SUPPLY/ Individual Well Q Community ❑ Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 0 Public 113 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DAiw AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm/ // O w� Y� �550'LICtSR.„Inc, Telephone 5101- � l Address 17 7Z 8o 6in.LSS Park 81i/a)Wl An(I),Oraq PI Ay- RR 503 Date I l��(�f1VYr� JLr 4 # Canc ,tio na-(� Approvo-( etm�C tw k 4vt� �a� q 41,„_ lie; ea( LJ. s 4-0 kJ2 @cpm b Engineer's Seal 1 6. DHEP APPROVAL _ /j r%�(�'l� /— Approved for bedrooms by G'�'��/� Date �'F _ F 7 Approved Disapproved / Conditional Terms of Conditional Approval P1-1./-1, 5- %iE<or4Ai/_295 Tw4T In/ii?-5 4k -- QtaieD tvREN Ca/vPiT/o4--5 AL1014r 414* dle CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11184) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOrri HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHCW KLIST - FEBRUARY 1984 DEPT, OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION nrt Legal Description: PIICCI 5 MeaL,3 5x,13. to+ a JAN 131987 d,RECEIVED Well Classification CJt If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) -e` Date Completed (9I OCJ01oer, /98(0 Yield Total Depth B 1 1 't Cased to 81' Depth of Grouting P4. P - Static Water Level 43.s' Pump Set At SOS W.A. Casing Height Above Ground off Sanitary Seal on Casing (Y/N) Ci/6 Electrical Wiring in Conduit (Y/N) Separation Distances from Well: p f To Septic/Holding Tank on Lot GbIkC tittLt2s Depression Around Wellhead (Y/N) 1\10 • On Adjoining Lots To Nearest Edge of Absorption Field on Lot 3.0 ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole /l/5) 4- i qSI To Nearest Public Sewer �u. ,u To Nearest Sewer Service Line on Lot Water Sample Collected by (Aida- 13Cpr•' Water SampleTestResults 6+2� `6 O . OY t4 FY"Oey‘ Coq Frory, w ell 0.4 53' dr4Win 5.5�NI. FtUI rPC0Ver\t WJld'� l}9•0 C,'(,2 not bk,iri.ecl.,5 a NW (l Comments B. SEPTIC/HOLDING TANK DATA Date Installe Standpipes (Y/N Depression over Tank /N) Pumping/Maintenance Con Size Air -tight Caps (Y/N) 401 PER lgarPA tity064A of CoRwtp { • Date Z. tgCOfm1QQ-C) I C�QI 4ssoc, 6 �Q I-257 yl.ld fit, wti,.I J-Qb:, l hour, ** (..Q 6 -I-o "- 0.Pn a 5 11 o 1- 69A5®r d i onch o'J� No. of Compartments oundation Cleanout (Y/N) e Last Pumped ;for N) Temporary Holding Tank Permit (Y/N) ct on File (Y/N) Holding Tank High -Water Alarm Separation Distances from Septic/Holdi . Tank: To Water -Supply Well To Property Line To Water Main/Service Line To Building Foundation osal Field To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in bsorption Strata Type of System Design Date Installed Length of F• ftf---- Width of Field D• .th of Field Gray = Bed Thickness Square Feet of bsorption Area Standpipes Present (Y/N) Depression over • eld (Y/N) Date of Last Adequacy Test Results of Last Ade. uacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation To Property Line To Existing or Aba- doned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major drainage Course To Driveway, Parking Area, o• Vehicle Storage Area Comments D. LIFT STAT N Date Install Size in a G II d on "Pump On" Level Dimensions Manhole/Access "P ff" Level at High Water Alarm Level at Vent (Y/N) Tested for _ Pumping Cycles durin Electrical Codes (Y/N) Comments equacy Test. Meets MOA ** Check Pe milled Icertify thlt1j: Signed Companly . C/ Be room Rating Against HAA Request ** c verified, or conformed t all MOA and HAA guidelines in effect o Date (JGC.VI< %, tet -237 f 0C ((AC MOA No. SC, div Receipt No. Date of Payment Amount: $ he 00/ up6f don o[f-40 46 -/ A p p r(Ud c(m ` Page 2 of 2 4_,2 ..e(XClIr( 1 w (r,o6 Glel f 00,11 (SLS hkY(.eu 72-026 (11/84) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AIC 99519-6850 www.d.anchorage.alcus (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 075-091-20 1. GENERAL INFORMATION HAA# /44- 0 /6 el 7 7 Expiration Date: 12 - % - O g Complete legal description MICA'S MEADOW SUBDIVISION: LOT 2 Location (site address or directions) ALYESKA HIGHWAY • GIRDWOOD, AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MICHAEL FLYNN Day phone — P.O. BOX 115 • GIRDWOOD, AK 99587 Day phone SCOTT KIRK w/ GIRDWOOD REALTY Day phone 783-2231 P.O. BOX 376 • GIRDWOOD. AK 99587 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: lis Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer • The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at, or prior to closing for the engineering seMces provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I yen& that my Investigation, based on procedures outlined In the Health AuthorityApproval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system ls(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 ofAnchorege 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. Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 . DEBARR ROAD, SUITE 28 * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AMC, Inc attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readiyWent/liable features. The operational We of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate duting the year, and Me water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are rro hidden defects or encroachments. AWWC, Inc can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or 1610A DSD. The content of Nes report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Ls not authorized, nor W At confer any legal right whatsoever. 5. DSD SIGNATURE Approved for r2 Disapproved. Conditional approval for Phone 337-6179 Date X40 • 0ft r1:14:4.;, si O fcQ�4Lp_• Pr°ar � g.• •ketsei OF hyo. bedrooms. • • ON-SITE •�1;GC. _` WATER AND ; m bedrooms, with the fllowing stipulations ` = WASTEWATER : PROGRAM : z Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By Q fJ Cil !'-' c,—e- (Rev. 12/00) Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date' (-7- 0 / Municipality of Anchorage Development Services Department Building Safety Oivbbn Onsite Water & Wastewater Program 4700 South Brapaw St. P.O. Bar 196650 Anchorage, AK 995196650 www.cLanchorage.ek.us (907) 943.7904 P HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MICA'S MEADOW SUBDIVISION: LOT 2 Parcel ID: 075-091-20 A. WELL DATA Wen type PRIVATE If A. B. or C provide PWSID# N A Wen Log (YM) YES Date completed 10/21/1986 Sanitary seal (WN) YES Total depth 81 R Cased to 81 t Wires properly protected (YM) Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 10/21/1986 8/23/2001 Static water level 44 {i, 46 {i Wen production 15 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.5 mgJL. Date of sample: 8/16/2001 Collected by: B. SEPTIC/HOLDING TANK DATA 6.3 g.p m. YES 12+ in. 11541 GALLONS IN 245 MINUTES.' Other bacteria 0 colonies/100 mi. AWWC. INC. (PUBLIC SEWER Tank Type/Material Tank size gaL Number of Compartments Foundation cleanout (Y Date Installed (YIN) Ion over tank (YIN) _ High water alarm (Y/N) mping Pumper C. ABSORPTION FIELD DATA Date Installed Son rating .p.d + • ft'/bdrm) Length tt Width ft. G r:, • =low pipe 1L Total depth _ft. Et absorption area_ R' Mone • r ' be Depression over field_ Date of adequacy test (Pass/Fan) For bedrooms Fluid depth In absorption fie • • , • , test_ In. Water added _gal. New depth _In. Elapsed _ min. Final Auld depth_ In. Absorption rate m g.p.d. rejuvenation treatment (past 12 mo.) (YIN & type) If yes. give date D. LIFT STATION Date installed Size In gallons Manhole/ 'Pump on' level atin. 'Pump ' n High water alarm levet at lo Cycles tested_ Meets alarm & dreult requirements2..._ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WEU. ON LOT TO: Septic tankNR station on lot N/A On adjacent lots Absorption field on lot N/A On adjacent Tots Public sewer main 75'+ 100p+ 100'+ Public sewer manhole/deanout Sewer /septic service line 25'+ Holding tank 100'+ N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property fine Water main PUBLIC SEWER SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property fine Building foundation Water Water service fine S It:.. Driveway, parldngNehlde storage PUBLIC SEWER F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots I certify that 1 have determined through field inspections and review of MUNdpa/ records that the above systems are in conformance with MOA HAA guidelines kr effect on this date. Engineers Print7 N7ns JEFFREY A. GARNESS Date S D / HAA Fees 300 O" Date of Payment 0j/ /o/o/ Receipt Number 9 7a` Pm 1?AO) Waterer Fee $ Date of Payment Receipt Number AOC -22-01 08:02 FROM -CUE ENVIRONMENTAL SRV 9075615301 T-150 P.02/03 F-976 CT&E Environmental Services Inc. ANWAIWINUIN CT&E ReLN 1015419001 Client PO4 Client Name AK Water & Wastewater Consultants Inc. Printed Date/Time 08/21/2001 16:07 Project Name1N Mica's Mcadow, Lot 2 Collected Date/time 08/16/2001 14:45 Client Sample ID Mica's Mcadow, Lot 2 Received Date/Time 08/16/2001 17:40 Matrix Drinking Water Technical Director Stephen C. Ede Ordered By Released By 4 PWSID 0 Sample Remarks: Allowable Prep Analysis bitParameter Results PQL Units Methal Limns Date Date Waters Department Nitrate -N 0.500 U 0.500 mg/I. EPA 300.0 (<10) 08/16/01 SCE. Microbiology Laboratory Total Coliform 0 0 col/100mL SMIB 92228 (<1) 08/16/01 SKW AO§ -22-01 08:02 FROM -CUE ENVIRONLENTAL SRV L1E 9075615301 7-150 P.03/03 F-976 CT&E Environmental Services Inc. 'y����������� Laboratory Division rine /r��rArarsant��a�a' 200 W. Potter Drive Water Analysis Re•port for Total Coliform Bacteria Tei'90 ,'?86A2,239493518-1606 Drinking ESIDEBEFORECOLLECTINGSAMPLE Fax (907 661-6301 READ /MMUST BE COS ON REVERS TO BE COMPLETED BY LABORATORY BE COMPLETED BY WATER SUPPLIER Analysis shows this Water SAMPLE to be: Satisfactory O Unsatisfactory O Sample over 30 hours old. results may be unreliable le should O Sample too Ione in transit; same not be aver 48 hours old at examination nnindicate ample via especial delivltase send Data Received d/6 of Time lux. end 42e. Analysis Began /3SZ) Analytical Metb04 D MeMMOmbTMUG°ne Filter • Number ofeoloniesll00nal.• Analyst Lew 11•1.r Wa . Result* Month ' Day Ye r 1015419 i tit FDW Jun Fuel o PUBLIC WATER SYSTEMLB•N 7PC PRIVATE WATER SYSTEM SAMPLE DATE: SAMPLE TYPE: O Treated Water ,X�/ Routine ,(• untreated Water Dau: /p\ with la Sample (for routine sample /- ' Date: notified of unsatisfactory results: with lab Perp no. �� O Special Purpose Time Collected 0 Collected By Peened SpafuwKa SAMPLE LOCATION o %�. 1 WM _ Time' '' /bl� �� Date -.M �� Mew him 1 BACTERIOLOGICAL WATER ANALYSIS RECORDE. MMO-MUGRaolt Tau* Conform D Caloaldl00 Tal Mearns PUter: Direct Coat Verification: LTD �—� BGB--COLIMA_ Fecal Coiltorm CooBraAd•a ID Cslitorm/100 ml Final Membrane Filter Ranla a /9 -v, Time �� Drs Date &_ 1 Reported By a. Time: Comments: Fated TNTC -no Ns.n•a Ts Cowl 011 Ode lonow OPEIGS Maribor of the SGS Grout/ (Societe Genitals( do Surveillant eu.nenuusMTat. FACILITIES IN ALASKA, UUFORNIA. FLORIDA, IWNOIS. MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA