HomeMy WebLinkAboutT15N R1W SEC 8 LT 156TISN RIW
ction 8
Lot 156
#051 - 154-17
Municipality of Anchorage Page /-- of -,~------_
DEPARTMENT OF HEALTH AND FIUMAN SERVICES
FNVlRONME!NTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
/~)/~btG//~'/'y / /~ Wastewater System: ~ew D Upgrade
Address:
~ /~q//qO ~Id~ ~5~ / ABSORPTION FIELD
Phon '~ ~ Deep Trench ~ShallowTrench OBed OMound OOther
Tolal Depth from original grade:
LEGAL DESCRIPTION SoilRating: ~, ~ GPD/Sq. Ft.
Lot~ ~ BIock:~ Subdivision:~. Deplh Io pipe botlom from~,original~/grade: FL Gravel depth~beneath pipe Ft.
Township: /~ Range: / ~ Section: ~ Fill added above original~/grade:~ Ft. Gravel length:/,,/
WELL: D New ~ Upgrade ~/~ ,~ Ft Ft.
Classification (Private. A,B,C}: Total Depth: ~ Total absorption area: ~ P pe materi~h
Driller: _.// ~Te Drilled: Slalic Water Level: Installer: Cate installed: // ¢/
Yield: / Pump Set
SEPARATION DISTANCES ~.¢~ o uo~.0 ~ s.~.~.~.
w~ ~ ! ~ LIFT STATION ~///
Fou~datio~ p ~. ~iO/ ~ W/~ "Pump on" level at: .... . ~ High wa,er alarm a,: --
Ou.ain[)rain ~I/A -~ ~ Pu~~lectrical Inspections pedormed
Remarks: BENOH MA~K
ENGINEER'S SEAL
Department of Health and Human Services approval '~%,,, c~:-~z:~
Reviewed and approved by: Date: ~ -/~ -?~
72-0t3 (1/91) MOA 25
Permit No. Page 2 of 2
Municipolity of Anchoroge
DEPARTMIENT OF: HE-'ALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 * Anchoroge, Alosko 99519-66,50 · Telephone: 543 4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 156 T15N R1W SEC. 8
PID No.:
N 89°56'0" E
330,00
/
PROP. WELL
SCALE 1"=60'
SWINGS
330,00
S 89°55'30' \4
20/95
ELEVATIBNS
(NDT TB SCALE)
I
NW LOT CORNER REBAR I
I
ENGINEER'S SEAL
LOUIS A. BUTERA ,"~
SLLLZVAN
ertifie lri[[ing
by
SULLIVAN WATER WELLS
P.O. ~OX 870272, CHUGIAK, ALASK~ 99587 · TteLEP HON le ~.2759
ADDRESS
· DEPTH OF W£LL
PAGE 02
STATIC LEV£L OF WATER FT. I -~'
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From O Ft. to,~::~Ft. ~_~/s~.7. ~('~'IC,~IJ~) From
From ~ FI. to ~ .Pt. ~ffff ~,lt~ From .
From__ Ft. Ia ~. (~/- H- "( /.~[E r'.. From
From~Ft. to__FL
From Ft. to Ft.
From~Ft. to Ft.
From Ft. to .Ft.
F~om Ft. fo FI.
From Ft. to.~.~.Ft.
F~om~Ft. to Ft.
F~om ,Fl. to Ft.
From
From
From
From
From
From
From
From
From
MISCL. INFORMATION:
Ft. to~Ft.
., Ft. to FI.
Ft. to Ft.
,_ Ft. to Ft,
Ft. to FI, ,
Ft. to__Ft.
Ft. to Ft..
Ft. to Ft.
Ft. to__Ft.
Ft. to__Ft.
Fi. to ft.
Ft. to · Ft.
.Ft. to__Ft.
,Ft. to__Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519 6650
PAGE 1 OF i
ON-SITE WELL AND WASTBWATER DISPGSAL SYSTEM PERMIT
PERMIT NUMBER:SW950146
DESIGN ENGINEER:EAGLE RIVER ENGINEERING
OWNER NAME:DAUGHERTY JOSEPH A &
OWNER ADDRESS:19923 SCENIC DR
CHUGIAK, ALASKA 99567
SERVICES
DATE ISSUED: 7/11/95
EXPIRATION DATE: 7/11/96
PARCEL ID:05115417
LEGAL DESCRIPTION:
T15N R1W SEC 8 LT 156
LOT SIZE: 108900 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION 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 OM THE SAME DAY
Bo COVERED, SEALED AND HEATED TO PREVENT FREEZING
!5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
ISSUED BY:
Louis Butera, P.E.
Registered Civil Engineer
June 30, 1995
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Lot 156, T15N RiW Section 8
Narrative & Permit Application
Dear Mr. Cross:
The proposed well and septic plan will have very limited impact on adjacent properties for the
following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic syste~ns are all +30' distance.
3. Reserve space is adequate, due to absorption capacity and lot size.
4. Drainage wilt not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\G:\WPDOCS\1995\94-091A.NAR
P.O. Box 773294 . Eagle River, Alaska 99577 · Telephone (907) 694-5195 . Fax (9071 694-3297
~~N ~9°56'0' E _
X 33o,°°_.L--__._ /
I WELL
330,00
S 8~55'30' ~
~ TEST HOLE
VACANT · MONITOR TUBE
o SEWER CLEANOUT
NO SURFACE WATER +100' ~ - WELL
PROPOSED L~CHFIELD
NO KNOWN OU~TAIN DRAINS ..... ~SEMENT
WELL & $EPTIC SITE PLAN
LEGAL: BLM LOT 156, T15N RIW SEC. 8 ~ .'
CONTRACTOR: N,/A
JOB~ 94-091AI DATE: 07,/~./95 [ SCALE = 60'
A EAGLE RIVER ENGINEERING SERWCES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-~19~ FAX: (907) 694-3297
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 94-091
Calculated By: LB ~ ~ .
Single Family 3 Bedroom Dwelling
Shallow Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 450 gallons
Percolation rate = 12 minutes per inch
Wastewater application rate = 0.8 gallons per day per square foot
Required absorption area = 563 square feet
Trench width (W) = 5 feet
Gravel depth (D) = ..2rr~feet
Required length = Shallow trench factor * Required absorption area / W
Shallow trench factor = (VV + 2) / (W + 1 +2 D)
Shallow trench factor = 0.54 ~,c~ /
Total Excavation Depth = ,.(~" feet
Required length =
SPECIFICATIONS FOR ON-SITE SYSTEM
LEGAL:
Lot 156, T15N R1W Section 8
REVISED 07/11/95
Ae
1.
2.
3.
GENERAL
The well and septic plan is for a single family residence only.
The drawing and/or site plan shall be a part of this specification.
All materials and workmanship shall meet the Anchorage Department of Health (MOA-
DHHS) requirements.
All soil tests are advisory to the design and are to verified or modified in the field by the
Engineer.
All excavations and depths are advisory and are to be verified in the field by the
Contractor to meet MOA-DHHS requirements.
It is the responsibility of the Owner to obtain all necessary perrnits or easements and to
locate any adjacent multi-family wells.
It is the responsibility of the Contractor to secure 'all utility locates prior to construction.
The excavation is to be exactly in the area shown on the site plan, any deviation requires
Engineer approval.
It is always recommended that a surveyor locate the neat'est lot line position and 'the
location of any easements.
3.
4.
6.
DRAINFIELD
The dralnfield is to follow the natural contour to maintain uniform total depth of the
drainfield bottom.
The bottom of the drainfield shall be level, plus or. minus 1.5".
The total depth of the drainfield excavation is not to exceed 5.5' at any point.
The drainfield gravel is to be covered with typar fabric material.
Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is
to be placed over the drainfield.
The area over the drainfield is to be finish graded to prevent ponding of surface water
runoff.
The septic tank and dralnfield must not be closer than 100' to any existing private well,
150' to any Class "C" well, or 200' to any community well.
t[ECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 5.5' GRAVEL DEPTH = 3' under pipe, 2" over pipe
DRAINFIELD LENGTH = 66' DRAINFIEI,D WIDTH -- 5'
SOIL RATING = 0.8 gpd/ft2 BEDROOM CAPACITY := 3
SEPTIC TANK SIZE =: 1,000 gallons minimum -OR-
SEPTIC TANK WITH LIFT STATION, if required by grade. Anchorage Tank 1,250 gallon
septic tank with integral OSI lift station pump model OSI-20~HHF, wired to code with receipt by
licensed electrician provided to engineer.
Twenty~four (24) hours notice required for all inspections
O:\VYPDOCS\ 1995\94-091A.SPC 1
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, A[aska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
OESDR,PT,ON:
GATE PERFORMED:
Township, Range, Section: '~"/5/V~
R/A/ o°
1
,w 2
3
4
5
6
?
8-
9-
10-
11
12
13
14
15
16
17
18
19
2O
SLOPE SITE PLAN
WAS GROUND WATER
-- ,y~j,,r .
ENCOUNTERED?
S
IF: YES, ATWHAT ~ / (~
DEPTH? ' p
E
Maniloring? 6/.2.?, f) Oate:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ / {mmuLes/,nch) PERC HOLE DIAMETER
TEST RUN BETWEEN /'~FT AND __'~'~-- FT
COMMENTS ~'~? ~- g'~' ~/~ ~ ~ ~ ~ ~'~ V~
PERFORMEO BY: ~ I ~ ~ CERTIFY THAT THIS TESI' WAS PERFORMED IN
(Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:__
LEGAL DESCR,"nON: /.-O/" /SLa
DATE PERFORMED:
Township, Range, Section:
2
3
4
5
6
7
8
9
10
11
13-
14-
15
16
17
18
19
20
COMMENTS
SI.OPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
DFPTH?
Depth tO Water Alter /~ /Z' Date: ~,//~/~..~
Monitoring? 1(/~ I ~
Reading Date Time Time Water Drop
PERCOLATION RATE /;~' (minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN --~- FT AND __~' . FT
ACCOROANCE WITH ALL STATE ANO MUNiCiPAL GUIDELINES IN EFFECT ON THISOATE. OATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SE-'RVtCES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TES'r
PL:R FORMED FOR:
LEGAL DESCRIPTION: ~' / ~ ~"~
Township, Range, Section: '~'/5,,4/ ,/~/,~/-/ 5~"Z~, oo'
3
4
5
6
7
8
SA~ID
OF'
10
11
12
13-
SLOPE
WAS GROUND WATER
ENCOUNTERED? __ ~/~
S
L
/
IF YES, AT WHAT ?_~-_ F
DEPTH?
Moflilering? Oale:
SITE PLAN
14-
15
16
17
18
19-
20-
COMMENTS
Gross Net Depth to Net
Reading Date Time Time Water Drop
-- ! (,/,~,/'¢¢- /~';~ '3,, .-.,,~ 2'L.2 '~,' ~,.,
PERCOLATION RATE
TEST RUN BETWEEN
(m~nules/mch) PER(; HOLE DIAMETER
____ FTAND ~':~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Muldcipality of Anchorage
Development Services Department
Building Safely Division
On-Site Water and Wastewater Program
~,700 Sou~h Rragaw St.
P.O. Box 196650 J~chorage. AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
Parcel I.D.
· . Expiration Date:
1. GENERAL INFORMATION
Complelelegaldescripti~n'Lot 156, Sec. 8, T15R, R1N,
Localion (site address or directions) 199 22 Sunse
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY.DW.ELLING .:..
-/7 HAA#
Chugiak, AK 99567
CurrenlPropedyowner(s) Joe Daughert¥ Day phone 688-0219
Maili,gaddress PO Box 6711/,6 Chugiak, AK 99567
Lending ngency
Day phone
Maili.g address
Real Eslate Agent
Mailing Address
Brook Stiltner
Remax/ EaRle River
Day phone 694-4200
.Unless otherwise requesled, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual Well
Individual Waler Slorage
Community Class__
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~
Individual Holding tank
Community On-site
[] Public Sewer
The Municipalily of Anchorage Development Services Department (DSD) Issues Certificates of Health Aulhority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
~,gineer registered in the Slate of Alaska. Certificates al Health Authority Approval are required for the transfer of
title (except between spouses) lot propedies served by a single family on-site waslewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Cerfificales al Health Authority Approval are
valid tar 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new waler sample results less than 30 days old. (Cedificates may be reissued [or a period al up to one year with
valid wa~er samples.) Cedific~les are valid for one year for propedies served by Class A or B wells ar a public
waler system. The Municipality al' Anchorage Is nol responsible for errors or omissions in lhe professional
englneer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certi~ed by my seal at'fixed hereto and as of Ihe validation date shown below, I verity It, at my Invesflgalion,
based on procedures outlined In Ihe Health Authorl~/Approval Guidelines for lhis application, shows that the
on-site water supply and/or wastewater disposal syrian1 Is(are) safe, functional and adequate for the number of
bedrooms and lype of structure Indicated herein. I fuflher ~/erify tha~ based on the Information obtained from the
Municipality of Anchorage files and from my Investigation end Inspection, the on-site water supply and/or
wastewaler disposal system Is(are) In compliance Wilh all applicable Municipal and Stale codes, ordinances.
and regulations tn effect at the time ol' installalion.
Name of Firm
Address
$ & S ENGINEERING
17~ ;'ag;e ~[ver Loep head No.
Eagle River, Alaska
Engineer's Printed NameRobert c. Cn~n
5. DSD SIGNATURE
x Approved for
Disapproved.
3 bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
The well serving this property has received a variance.Because of low water
production the casing is perforated from 19' to 34'. Chapter 15.55 of the
Anchorage Municipal Code for water well~ require~ non-perforated casin~ ~0 a
minimum depth of 40' unless a variance is granted.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
~ t WASTE'WATER
.
Maintenance Agreements
Supplemental Engineer's Repofl
Other
Original Certilicale Date: ~ ' Z./- (2 ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bregaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
ww~v.ci.anchorege.ak.us
(907) 343-7904
Legal Description:
A. WELL DATA
Wall type~
Date com.io~-~l ?~'
To~I riel~h ~
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C provide PWSID # --
.Sanitary seal (~/N) Y~ J'
FROM VVELL LOG
Date of test '7 /
Static water level / ~ lt.
Well production O. 5- g.p.m.
WATER SAMPLE RESULTS:
Coliform o colonies/100 mi. Nilrate I.'f t mgiC.
Log E)N) ~'e.~
Arsenic: o, OO~ mg./i. Date of sample: ,~/~,/o~
B. SEPTIC/HOLDING TANK DATA Eagle RI~,,
TankType/Matefial -;¢~;', ¢- f 5'r t~a- 4. Date installed '7 ~/ ~//~
Tanksize .,/eeo gal.' Number of Compartmente ~-- Cleanouts(~)N) ¥~
Foundationcteanout~/N) y4~. Depression over tank (Y,~ /vo High water alarm (Y~
C. ABSORPTION FIELD DATA
Date installed 7/tq/qY' Soil rating~or It2fodrm) t). ~' System type
Length (~ G It. W~lth ~-' ff. Gravel below pipe ~ ff.
Total dept~ ~ fl. Eft. at~orption area ~(, ~ ~ Monitoring tube ~e.~ Depression over fielri
Oate of adequacy test '~-//(p/0"~- Resulte~5~'~Fall) /~'-~J' For 3 bedrooms
Fluid rieptt~ in absorption field before test~ '3/'in. Water edded¥~';Xgal. New depth~ ' in.
Elapsed Time: ~' o ~min. Final fluid dept~)/~'/'
in. Absorption rote >= /-/~' O g.p.d.
Any rejuvenation treatment (pest 12 mo.) (Y/N & type) ~v~ ,,,~. ~< ~o~,,~,, ff yes, give date --
collected by: ~
i~M4 F. agl~ ~llv~ goep Ro~rNo. 2O4
Wires property protected (:~N) Y · f
Casing height (above grounri) I ~' ~' in.
AT iNSPECTiON
:~/~/o ~-
g.p.m.
Other becterta O colonies/100 mi.
D. LIFT STATION
Date installed
'Pump on' level at__
Datum
Size in gallons Manhole/~ ~
in~~er alarm level at in.
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanldlifl station on lot JO0
Absorption field on lot / o o. Y-
Public sewer main /d /,4
Sewer Iseptic service line ~.5"
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation. 3'~ '/" Property line ~- ry...
Water main ~ /4 Water sen, ice line /o '*
Wells on adjacent lots. / o 0 '~-
Absorption field 5-- ~-
Surface watar /0o ~+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Propert~ line. /o
Water Service line /o "f"-
Cudaln dtalfl.'Nd-'~-~'~'/'"/
F. COMMENTS..;:~
Building foundation /o -~
Surface water ,/o o /+-
Walls on adjacent lots / o o '-/
Water main /~ /A
Ddv~vay, parldng/vehlcle storage )o /~'
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
mv~ew of Municipal records that the above systems am in
conformance with MOA HAA guidelines in effecf on thi~ date.
C.
Engineer's Printed Name
D te
HAA Fee $.
Date of Payment
Receipt Number
(Rev.
Waiver Fee $
Data of Payment
Receipt Number
FIOB ERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
February28,2002
CIVIL ENGINEERS
(90T) 694-~9T9
FAX (907) 694-1211
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 S. Bragraw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 156; Sec 8; TISN; RIW
19922 Sunset Boulevard
Chugiak
This is to request a variance for tile perforations that exist in tire well casing between lire
depths of 19 feet and 34 feet (see attached well log).
Mitigating circumstances for approving this variance are as follows:
A clay and hard pan layer exists between 9 and 19 feet. This layer ~.,,ould have a
confining affect ~hich ~ould trot allow contaminated water from easily reaching tile
aquafer.
2. The nitrate levels from water produced from this well have been measured at 1.4
mg/I. This nitrate concentration is within allowable limits.
3. No bacteria has been found in tire water.
4. A layer of sand and gravel exists between lire 4 foot and 9 foot depth. This wottld
have a filtering affect of any water passiog down through the soils.
5. The well does not lie in a drainage course and as such, auy water absorbed around
tile well would be minimal rain or snow melt.
17034 NORTH EAGLE RfV~R LOOP · SUITE 204 · EAGLE RNER, ALASKA 99577
Page 2
Lot 156; Sec 8; TISNi RI If'
! 9922 Sanset Boulevard
Cltugia~
February 28, 2002
Additionally, there have been problems in drilling wells with suitable production rates on
this lot. Therefore, Ihe owner wishes to continue using this well, as tile flow rate coupled
with tile water storage meets the minimum requirements for a Health Authority
Approval. This would avoid the need for potable water storage and water hauling, which
in our view would be a higher health risk than tile perforations as they exist in the well.
Please issue a variance for tile perforated casing.
Sincerely,
Robert C. Cowan, P.E.
RCC/glc
FEB-13-02 06:13Pg
FROM-CT&E Efl¥1RON~NTAL SRV 9075615'101 T-325 P.03/03 F-808
CTIE Environmental Services Inc. "
Laboratory Division ~s=P",,~.~",~.".~,~,-.dr',~m.~,~,ar_dr.,j,.,,~,.,.~.,~,;,,~,,~,~.,~m~UA
200 W. Po~ur Drive
inking Water Analysis Report for Total Coliform Bacteria A.nhora.*. AK.SS'm-',SOS
Tel; (907) 562-2343
READ INSTRUCTIONS ON REFERSE SIDE BEFORE COLLECTING SAMPLE Fox: t907~ 561.5301
MUST RE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM I.D. #
PRIVATE WATER SYSTEM
SAMPLE DATE:
SAMPLE TYPE:
Month Day Year
Treated Wafer
Untreated Water
Routine
Repeat Sample (for routine sample
with lab rtl. no. )
Special Purpose
Time Collated
SAMPLE LOCATION Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
Sails fdctory
Unsatisfactory
C~ Sanqnle over 30 hours old,, results may
be unreliable *
Sample too Ion~ in er, melt; samp]e should
out be over~)gT~ours etd a~ examination
to iud:cate reliable results. Please scud
new s;~mplc via special delivep/mail.
Time Received [0 ~ ~
Analytical M~hed: [~ Membrs~e Filter
'CI MMO-MUG
' Number o f colonies/100 mi.
Lab Re;: No. Rflult*
'1o2o~-S~ ]
Sent to A.D.~C. Anch Fbks
Analyst
Date: Time:
Client notified of unsattsfacfory resulte:
ID .
Spok~ wish
Time:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Re~N: Total Coiffure
Membrane Fllttt:. Did. e% Count
Verification: LTB
Fecal Coliform Confirmation
Final Membrane Flher Remits
Reparl,d By . .~_~.t~
ColooleJ/IO0 mi
BGB COLIFIRM
Coliform/lO0 mi
i~~ Member of the loll Group Igoeial4 GiMtal. aa Sur~e~llaflcei
I~/IRONMENTAL FACILITIES IN ALASKA. CAUFORNIA, FLOfllOA. ILLINOIS. MARYLAND. MICHIC~,~N. MISSOURI. NEW JERSEY, OHIO. WEST VIRGINIA
FEB-13-02 06:I3PM FROM-CTIE ENVIRONI~NTAL SRV
~I~K ~"T&E Environmental Services Inc.
90?561530!
T-32S P.02/03 F-808
CT&£ Ret.#
Client Name
CHant Sample ID
Matrix
Ordered By
PWSID
Sample ICemarks:
10207.37001
S & R Engineering
L156: Sect 8; RIW; TISN
L156; S~ct 8; RIW; TISN
Drinking Water
Client PO#
Printed Date/Time 02/13/2002 13:57
Collected Date/Time 02/0~2002 14;50
Received DateJTlme 02/07/2002 10:35
Technical Director Stephen C. Ede
Pmsmett~ Po:salts PQL Unils Me~b0d Limi~ Date Date Init
.A~'~nie
0.00200 0.00200 mg/L EPA :200.9 f<0.05) 02/12/02 .IMP
W&=ern Depar~men=
Nitmte-N
1.41 1.00 mg/L EPA 300.0 (<10) 02/09/02
Microbiology Laboratory
Total Coliform 0
col/100mL SMI8 922213
(<1) 02/07/02
WELL FL(~W TEST DATA
LEOALDESCRIPTION: LOT" I.t'-'c 5',~.-c. ,~
WELL DEPTIh ~. O O · CASING DEPTH:
DATE DRILLING C~~
.MISC DATA:
~I~BErITC
-' . COWAN, P.E.
FtOSERI'A. SI IA,r Erl,
ClV1L ENGINEERS
(907) 894-297g
FAX (907) 694-1211
TEST DATA:
CASING IIEIGIIT: I ~[ 'J-'
WIRES IN CONDUIT: ~,~ j'
BACTERIA AND NITRATE SAMPLES COLLECTED (date):
DATE:,
DRILLi:R: J"'v'
SANITARY SEAL:
GRADING O.K.:
METER Pd~INO DEPTII TO
CLOCK READING RATE WATER .'* ~ REMARKS
TIME (GAL) (GPM) (FT) '
I: 3 ;Z 0~.1'~ o,~,-~. ~. ~' sw~ --
~-~ 9~17~o
-, o.t~ ~ / E~ ;~ ~'
[~ESULTS: WELLCURRENTLYPRODUCES.O..Iy OPMWlTtlA 13.7 DRAWDOWN
TESTED By: I~O~ C.. '
FLOW RATE NOT GUARANTEED-SUBSEQUENT VARIATIONS CAN OCCUR.
17034 HORTI I EAGLE RIVER LOOP · surf E 204 · EAGLE RIVER. ALASKA 99577
.I
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FOLLOWIN6 DESCRIBED PROPERTY~
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NO £NCROA(~MENT$ EXIST EXCEPT AS
INDICATE~ IT'I8 THE R£$PONSIBIMTY OF* THE
(76'NER TO DETERMINE THE EXISTENCE OF ANY
EASEMENT~, C, OVENANT$~ OR RESTRICTIONS
$~/AIID & ASSOCIATE3 ~ Sb'RVlPIII'~ 694-0~2~