The URL can be used to link to this page

Home My WebLink AboutBOB WELLS BLK 1 LT 3 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: '~~0~ PID Number: 0~7-0c{ ~, Name: ~/~ii~'~ D[60~jl Wastewater System: '~New ~ Upgrade Address: ~ ~o~lO E~J~,u~r ~ q%~'7 ABSORPTION FIELD Phone: ~. ~ No. of Be cms: ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION soi, Rating: I.~ GPD/Sq. Ft. Total , , Depth from o~i~al grade: Lot: .~ Block: ~ Subdiv~ion:~o~ ~' Depth to pipe boffo~o~ original grade: Ft. Gravel depth beneath~./pipe Ft. Township: -- I -- Isec''°n: --Fill added ab°vr~i2al grade: Ft,Gravellength:~OI Ft. WELL: ~New ~ Upgrade Gravel width: ~, ~t Number of lines: I Distance between lines: Et. / J '~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Date Ddlled: Static Water Lev~l: Installer: . Dateinstalle,: I Pump Set at: I Casing Height Above Ground: Yield: ~0 GPM a~O~ Ft. I ~ i Ft. TANK SEPARATION DISTANCES ~Sep~ic ~ .o~Uing ~ S.T.E.P. To Septic Absorption Li. Holding Public/Private Manu,acturer: Capacity in g~ From Tank Field Station Tank Sewer Lines ~0r ~,~~ '~ Material: _j i v Number of Comp~ments: Surface W.ter 100'+ I~ -- -- ~ LIFT STATION Lot ,+ 1+ Size in gallons: I Manufacturer: Line JO JO ~ '-- ~ "Pump on" level a~l at: High water alarm at: Foundation ~0 "~ J01+ '~ Cu~ainDrain _ ~ ~(,~_ _ ~ J Electricallnspectionspedormedby: Remarks: BENCH MARK Location and Description: Assumed Elevation: 72-013 (Rev. 9/91) MOA 25 Permit No. SW960208 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT .3, BLOCK 1, BOB WELLS SUBDIVISION PID No..'067-042-03 A B C FCO 4.5' - 12.0' ST1 54.5' - 64.5' ~T2 50.0' - 61.5' NEW )BL1 48.0' - 60.0' 1250 G::L. ,-NFW TRENCH ..... )BL2 46.0' - 59.5' SEPTIC Ti,NK--~,,.,,o ~ :01 23.0' - 28.0' 302 55.0' - 65.5' .~03 45.5' 80.5' - f ------ ~ ~ ;04 56.0' 51.5' - % ST 1 STg /~5.7' /FII[~ GRADE MT1 COg~C03 = 83.9' C04 = 82.7' _ .....~. '~$~ 8 · 1~5) GAL , C04 = 79.0' S.T. · · ~ r' = 40, ~o wz~. ~ou~ 72-013 A (Rev. 9/91) MOA 25 DEC-- 15--96 FR I 14 : 25 ~ I $OTELL. CONST. 02 E. R. REAL P CO. SULLIVAN WATER From , Fl, Io-,,,,..-,~ FI..:-.'..' : . , :.. i ,' ',.:,, ',':':'i' :Y: ,' ._Ft. tO ' ,.Ft.; :, , :'i. Ft. lo _si_; .... ......... to F From. , Ft. to ' :.'FI-~'-":..' ' '.. '~'~:"..' '.:'i..'. ,. ,,;.,,, ,..,' to .... F¢,__ Z..O~., .t~_/~.4"/' .......... From.___...Ft. to~F!,,,' ~ ". ........ '""" ":" ",, ,'.,.'" ,, .,,,' ,,,,.:_ .... $ ' '..: ..-'(. ',. ','. q~ .' /, .~:: ,, ,';',::;'.', ,;.,. , i",, i., t.o.LLa_rt ...... ,~d.~.,~,'9 rr,,.,,:,L_~. ~;; r~; ,,~,. '...:,'.~.'-~,..'~..:.".,:.' .".':": .... "' "'" , . =, . __ , .... _~ ..... From ' Ft. to .Ft:,',!:, ,',, ..... ,,,. ,, ':'::','..",'i,, From, Ft'. t,o..._._~_Ft. ...... Fro ~~t, to . .. FL ,,, :-" , ., ' ,'.~,.;', i: ,..' 'From ..... Et<fo.-, ,., ...... Fl .............. From ~t.t'o '" :'.. ~i;,.?~ "" :" ..... ' · ",l', ' From ........ Ft. to .... Fl ................ From~-._-.Ft~to ' .Ft.L.-.,. "',' '. ,",".,'. :,:':! ' ' , ........ .... ... .!';,...:,...:,: . .' .- Fro,, ....... ~t, to '. .... ~t, F,om ..-Fi. to:: - .~.: ,..,' ':'.',:':'ii'.:'" . From ..... Ft. to ...... . .... Ft. From=...._.._Ft. t'o ' Fl, ":' ""' , ' "" From .......... Ft. to.~_...._Ft, From~....-_.Ft, to ' ' Ft., ',' ," ".-' .:....: ' ,: ', ..:." From~ ..... Ft. to~Ft ..... From .Ft: to . ..' ,,.Ft, ."" "' From'., ,_ ,.I. ,. :F;,': _ .... '" ' ''' ...,, "Y: ?' tO- ,' Ft. ; ,,, From ..... ....'__Ft, tO ' ' ' ~:t.'..'" ' ". ' '; .'"." ' ' . ..... '~ ?, F n , -"fi, j.?:."~:.."' ': F,.rom.~i,.~.~._Ft, t t ............ From , , to , ,' .. :..:'.. :'i. ~"....." i' '. ' ~ =' . . MI$CL. INFORMATION ~' "' ' .... " ' ' .....:, ,.,,.. :,,:, . ..... . , ~:::- .. . '' ,' .'*" ,;,-, I". ', ;","' ·. '. ' v ,'.' -:',',,: '., ~ ',: '.,'... ~ ' / '-'~-" : -"-':';'.7, : ;, ' , -.: .......... · · '..~*.. ' . ';~' '~ '.::'~( ., :.,.' .',,' 1,' h,. ',,'t:': '""~ '.' :: ' . '. .' .. ~ .,,,, . .,,=!.~ .':; . , ...,.., ....' ,;.,....,,., ,. DRILLER'S NAME '/~ ~~'?,{';'~:!':"",'"' "? .'it. · ....... , :" .' "~'.-;',.:~: ,.. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960208 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WELLS ROBERT L & ANNETTA P OWNER ADDRESS:6612RIVERWOOD WALLERTOWN, NC 27051-9761 DATE ISSUED: 7/18/96 EXPIRATION DATE: 7/18/97 PARCEL ID:06704203 LEGAL DESCRIPTION: BOB WELLS BLK 1 LT LOT SIZE: 55617 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~~ ~~ ...... ------ neee n9 ROBERT C. COWAN, RE. ROBERT A. SHAFER, P.E. July 3, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE'WATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 3, Block 1, Bob Wells Subdivision Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation water no was encountered in the test hole and after seven day ground water monitoring, the monitoring tube was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 8~ALE gg zmm~ F- SITE PLAN ~g r- .-lm / PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~1~. ROBERT C. COWAN .it, ~" gATE PERFORMED': :,.~,;7';~"L',;..~'~ '_~ Township, Range, Section: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT pLI oL DEPTH? ~ p E Depth to Water Alter Monitoring? 'T'~./ Dale: ~,~'~o~(, Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE J"/ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN d, ~ FT AND ~ ~ FT COMMENTS .., S &S ENGINEERING -..~/~/.','// ..,~"~ PERFORMED BY: ~TG~. ~-ag;e ~,~ver L~ ~d ~0. ~1~~~ .... ~ CERTIFY THAT/THIS TEST WAS PERFORMED IN ACCORDANCE WI~[~~~~L GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ //O / ~ ~ 72-008 (Rev. 4/85) ROBERT C. COWAN, RE, ROBERT A. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 3, Block 1, Bob Wells Subdivision July 3 ,1996 3ENERAL: 1. The scope of this project includes the installation of a 1250 gallon septic tank and a leachfield trench to serve the proposed four bedroom residence located on the referenced property· Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. ~EPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of'the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 3, Block 1, Bob Wells Subdivision July 3, 1996 ® Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. ® A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 3, Block 1, Bob Wells Subdivision July 3, 1996 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic constructed manufacturer. tank proposed for installation must be by a Municipally approved septic tank The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. j When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 3, Block 1, Bob Wells Subdivision July 3, 1996 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 3~ Block 1, Bob Wells Subdivision July 3, 1996 S & $ Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE ,~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services "J On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 ParCel I.D.# 06 -/ -o~3 -O .~ 1. GENERAL INFORMATION Complete legal description CERTIFICAT!'C~ H~' "' ~:AL ~ :. AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 3; Block 1; Bob Wells SubdiVision Location (site address or directions) NHN Bob Wells Circle ¢ property owner :"~.; Disotell '"'Mailing address":' P.o. Box Lending agency Mailing address ,. Eagle River, AK Construction 770210 Eaqle Day phone River, AK 99577 Day phone 694-5797 Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 RECEIVED TYPE OF WATER SUPPLY: Individual well Community well Public water XXX APR 24 1997 Municipality of Anchorage Dept. Health & Human Services NOTE: If community well system, provide written confirmation from State ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legalitY and status of system 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. As ..certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/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. ~ ; ' , . S &S ENGINEERING ~ Name of Firm ,-,,,,,,, ~--,- ,,,:.--, .............. Phone ~ ''{ - D~ '7 ~) Eagle River, Alaska 99577 Engineer's signature _ _ .. _. Date q/3- ,.f / ~ 7 DHHS SIGNATURE '{~N Approved for ~_~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments W/~T££ ~A~?a~ ~t~zT~ 'Tiaa ~dnici~li~ of Anchorage Depa~ment of Health and Human Se~ic~ (DHHS) i~u~ Health Authori~ A)pr~a(:~ifJ~tes bas~ only upon the representations given in paragraph 5 above by an independent profe~ional engin~r registered in the State of Alaska. The DH HS do~ this as a cou~esy to pumha~m of hom~ and their lending institutions in order to ~tis~ ce~ain federal and state requirements. Employes of DHHS do not conduct inspections .or anai~e data before a ce~ificate is i~ued. The Municipali~ of Anchorage is not responsible for errom or oral.ions in the pmf~ional engin~fs wo~. 72-025 (Rev. 1/91) Back MOA f/Z1 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL,~ERVICE,S DIVISION Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: A. WELL DATA Well type Log Present {~)'N) '~ ~ Total depth I'Z I ~ Sanitary seal ~tN) ' 'Ys S Parcel I.D.: O~, '/ - o'f~, - o--% Date completed Cased to I ~ t If A, B, or C, attach ADEC letter. ADEC water system number . ~ /.~ -//al(, Casing height (above ground) I Wires properly prOtected (~) FROMWELL LOG Date of test ' ", "7 Static water level Well production' /~'O WATER sAMPEE RESULTS: Coliform O Date of'~saniple: H- B. ~0LD'ING TANK DATA Date installed Cl/~'/~i~-' Tank size Foundation cleanOt~N) '~/as Date of,'Pumping ~ ed · c. ABSORPTION FIELD DATA'." Effective absorption area Date of adequacy test ~ AT INSPECTION Pumper :g.p.'m. Nitrate 1. ~ (, Other bacteria O Depression (Y~l). iI~ o Collected by: 17034 Eagle RLver. Loop Road NO. 2~ ~le ~, AlaSka 99577 N umber of Compa~me~ts High water alarm (Y~ ~o Soil rating ~ or ff~/bdrm) I.T.. System type *1"Re, otc H Gravel thickness below pipe -'~ Total depth · - 1 o' Monitoring Tube present (~/N) Ye;- Depression over field (Y/~ FJ o Results (Pass/Fail) ---'--' For ~ .bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after ~ gal. water added (in.): "" Fluid depth "'-- (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) "--' Absorption rate = g.p.d. ~ If yes, give date ' ' 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) ~el at* High wate~ *Datum ~ ,~ C~-~t'~ste d E. SEPARATION DISTANCES F. SEPARATION DISTANCES FROM WELL ON LOT TO: ~h'o. ld!ng tank on lot Ioe~ f- Absorption field on lot Public sewer main ~/A Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station . SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Foundation to .I- Property line Iot'l, Absorption field _R;L-I- Water main/service line )o~+ Surface water/drainage Ioot4' Wells on adjacent lots IooI+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I o t+' Building foundation I o I ~ Water main/service line Surface water ~ oo I ~ . ' Driveway, parking/vehicle storage area Curta!n drain ~J o,,t~ ~t~.~,,,I Wells on adjace, nt lots ENGINEER,S CERTIFICATION , ~. :.~.~ .., . of Mun,c,pal recor..{~_l~" ~a~ ,~S are I ce~i~ that I have determined thru field inspections.and review ..... in conformance w~h~~i~s in effect on this date. Signature ~ ~ -- Engineer's N'~me ~0~?J r'.~. ~o~ ' ' Y, ,/ -'3 ',7 Date ~' ~'"' HAAFee $ '~ C)-'O ' /-~ Date of Payment ~/~/'~' 7 RoceiptNumber ~--~/r/ :7~)~ ) 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number APR-~9-1997 16:5~ CT&E ESI ANCHORAGE 909 561 $J01 P.04×0'? CT&E Environmental Serv;ces CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Sample 971968003 S & $ Engin~riag N/A L3 B1 Bob Wells S/D Outsd Fauc Drinking Water Client PO// Primed Date/Time 04/29/97 16:08 Collected Date/Time 04/23/97 11:30 Received Date/Time 04/23/97 17:00 Technical Director: Stephen C. ii;de Sample collected by: J.L,M. CT&E Microbiology Dnaklag W~tcr Program cc~tification stares is provisional as of 4/8/97. Parameter ~esuits PQL Units N(trate-N 1,~6 0.100 mg/L Toter Co[fform 0 Co[/IOOmL A[towabte Method Limits SM18 &500-NO3F 10 mar Prep Analysis Date Date Init 04/25/97 JBL 0&/24/97 RAM APR-29-1997 16:55 CT&E ESI ANCHORAGE 90? 561 5501 P.06×07 CT &E Environmen talSe ~ices Inc. Laborato~ Division Drinking Water Analysis Repo for Total Coliform Bacteria 200 w. R~.qO hVSTR~C[IOi~S ON RKV~RS~ $IO~ BEFORK COLLKCTING Sa,*tR~E Tel: {~07~ ~ PRIVATE WATgR $YSTg~I ~ Satisfacto~ ~ ~(ndR~ul~ ~ Se~ffln~oic~ ~ Unsatlsfa~to~ - . be unreliable ~,. u.~, -- not bc over 48 hours old ar examination [la~ ~' ~t~ ~ ~ gl. , ~ to ;.dicate reliable results, Please send ~AG~ ~4~ ~ ~q ~7 new sample via special deliv~ mail. s,~:, *ec~, -- Dale Received __.. · , Time Received Analysis Began . ~[,,s:~*-, Anal~Ocal ~iefhod: ~ Membrane Filter ~ MMO-MUG [,~ ' . * Number of colonieS/[ O0 mi_ ~ Routine D Treated Water Sent to A.O.E.C. inch 0 Repeat Sample (for routine sample ~ Lrntreated Water 0 Special Purpose -- '" Time Collected Client aoli~cd ot unsa~isfa~to~ results: SAMPLE LOCATION Collect~ By ~ , Phoned Spoke wilh Foxed ~UG~ Pla~ ~n~- Olio: Time: Comments: BACTERIOLOGICAL WATER AiqALYSIS R..ECORD MMO-,ML'G Result: Total Coliform E, Coil Memhe.qne Filter: Direct Count ~ Colonles/100 mi BGB COLIFIRM Verification: LTB Fecal Coliform Confirmation Final .Membrane Filte Results ~'~ ... Program certification status is - --~.,, provisional as of 4/8/9~ ...... ~A;i~/.,'. ~,.. ,'Vvt-,CTrfU./ rv ¢ou.t Colil'orm/100 mi hfs ( the SG$ Group ($ociatd Gan4rale de Surveillancol ENVIRONMENTAL FACILITIES IN ALASKA. (~LII'vm~,,~% rs.v, ..... ILLINOIS. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO. WI~$T VIRGINIA A .C]'_&! i-viroflm~_. Iii !!~_wim InD. "· ............. L L¥_-_ .... Claret POe Printed Date/Time 04/29/97 16:08 CMI.~/~I Date/llme 04/Z~/~ 11:30 Received Date/~ime 04/23/97 17:00 Teduarad Direetor: Stephen C. Eda SampJe e, Oltectzal by: $.L,M, CT&.I~ Microbiology Dmdd~g Warn Program eertilrr.~on stama is provido~ as of 4/8/97, 10 ml~ 04125/97 del 0&/~4/97 RAIq CT&E Environmental Services lac, Drinking Water Analysis Report for Total Coliform Bacteri~ zoo w. AnchOrage. AK 9951 Rg. 4D INSTR~CT~O~ ON Rg~E~ SZD~ ~gFOSE COL~ECT~:%~ Sd,tfP~g Tel; (907) 562-2343 Fsx: {SO~) 581.~30~ PUBt,[C WATER SYSTE~I I,D. # l-t" i ]'1 PRIVATE WATE:R SYSTlf:)I SAMPLE DATE: SAMPLE TYPE: 1~ Koadoe Rope:, Sample (for roe*inn sample will, lab ret, no.= . ) Special Purpo$c SAMPLE LOCATION Y.or 0 Trea~ed Wirer Time Collected Calleeled By TO BE ED BY LABOR.a, TO&Y Satis~acto~ o Sample o~cr ]0 hou~ old. resul~ may be unreliable no~ bc over 48 hours old a~ examlnjtion [o ;~dJeace mli~ble ~elul~, Please sen~ ae~v ~mple via special deliv~ mail, T~me Received Anal:,tical ~lethod: C~ .~lembr~ne Filter Dna:: =: , _ Time[ :_. Client notiAcd of' uflsatL~Pactory results: Phoned Spokf wilh · Dale: ~ Time: .... O BACT£1~[OLOG[CAL WATER AI~ALYSI$ I~COIU:) ~IMO-.~I[,'G R,elmlt: TOtal Coliform Mem~ratle Filt~t: Dir~l Count Veri~toA: LTB _. BOB Colonies/I O0 mi COL~FIR,~I~ milt .... i IN~IRONMENT4L FACILITIES IN ALA$1r~, CAurvfle~, ,'w,,,v,% ILUN01$, MAJ~T~0, MICHM."MI$$OUIU. NEw ,I~IISG'Y, OHIO,