The URL can be used to link to this page

Home My WebLink AboutTIMBERLUX #1 BLK E LT 12 ~.~.~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 1AILING ADDRESS DISTANCl Well Material Liq. capacity in galh DISTANCE TO: DISTANCE TO: Manufacturer No, of llnes // Length~libr~7 / Top of tire to finish grade Length Widt)~ri~ Type of crib ri ' meter DISTANCE TJ ~ ~elt · DISTANCE TO: oundation Width Liquid depth Dwelling PERMIT NO. Nearest lot line.~ Trench width Foundation Total length of lines / '97 Materia~ beneath, file Depth OTHER PIPE MATERIALS SOl L TEST RATI N G I.NSTA~LER Liquid capacity in gallons PER~,IT NO. / Distance between lines Total effe~ti~e absor ~Li n.~rea PERMIT NO. / Crib depth Total effective absorption area Building foundation Nearest lot llne Driller Distance to lot line Sewer line Septic tank APPROVED DATE LEGAL 72-013 (Rev, 3/78) MLmNI £:I?~F~LIT'¢ OF R~4C:~]F~AGE DEPRRTMENT OF HERLTH RND ENVIRONMENTBL PROTECTION 825 'L~ STREET~ ANCHORBG6 BK. 99501 264-4720 O[4--SITE SEWER LIPGRADE PERi, IT PERMIT NO. ( 7809G1 > APPLICANT LOCATION LEGAL D~S UNLTD. RABBIT CREEK RD ARE8 LT. 7800 DEBBRR LOT SIZE 20000 SQURRE FEET TYPE OF SOIL 8BSORBTION SYSTEM IS: TRENCH MBXIMUM NUMBER OF BEDROOMS = 5 ~SOIL RBTING (SD FT/BR>= 85 THE REQUIRED SIZE OF THE SOIL 8BSORPTION SYSTEM IS: [~EPTH= 5 LEr~GTH= 85 ORR'eEL [~EPTH= _--< THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFACE OF THE GROUND 8ND THE BOTTOM OF THE EXCAVBTION (IN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE ORBVEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN THE OUTFBLL PIPE 8ND THE BOTTOM OF THE E~CBVBTION <IN FEET>. PERMIT 8PPLICBNT HBS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTBLLBTION INSPECTIONS OF 8NY WELLS 8DJBCENT TO THIS PROPERTY 8ND THE NUMBER OF RESIDENCES THBT THE WELL WILL SERVE. ]-~40 ( 2 ) INSPECT IONS ARE RE@L~ 'r REt:. B~CKFILLING OF 8NY SYSTEM WITHOUT FINBL INSPECTION 8ND 8PPROVAL BY THIS DEPBRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTBNCE BETWEEN 8 WELL RND 8NY ON-SITE SEWBGE DISPOSBL SYSTEM IS 100 FEET FOR 8 PRIVBTE WELb OR i50 TO ~00 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MBY 8PPLY. SPECIFICBTIONS 8ND CONSTRUCTION DIBGRBMS 8RE 8V~ILBBLE TO INSURE PROPER INSTBLLBTION. PE~.~M I T' E.XP I RES DEm~E~E:ER --~l, 1978 I CERTIFY THBT l: I 8M FBMILIBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS 8S SET FORTH BY THE MUNICIPALITY OF 8NCHORBGE. 2: I WILL INSTBLL THE SYSTEM IN 8CCORDBNCE WITH THE CODES. ~: I UNDERSTBND THBT THE ON-SITE SEWER SYSTEM MBY REQUIRE ENLBRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THBN 5 BEDROOMS. ..................... MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST Pouch 6-650, Anchorage, Alaska 99502 276-222~ SOILS LOG - PERCOLATION TEST 7- 8- 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop / PERCOLATION RATE (minutes/inch) PERFORMED BY: CERTIFIED BY: DATE: ,. Department of Environmental Quality ~ : 3330 C Street Anchorage, Alaska 99503 ~ I~SPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME_]'~C'~~ MAILING ADDRESS LOCATION LEGAL DESCRIPTION PHONE SEPTIC TANK: O FROM WELL.~--v~~'~/- I MANUFACTURER INSIDE LENGTH INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY/~~ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NUMBER OF LINES i __ DISTANCE BETWEEN LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE NEAREST LOT LINE TOTAL LENGTH OF LINE~ ~'~ TRENCH WIDTH IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE MATERIAL BENEATH TILE IN. ABOVE TILE ~ IN. WELL: TYPE _ BUILDING FOUNDATION_ CESSPOOL __ APPROVED --- CONSTRUCTION NEAREST NEAREST LOT LINE__ , SEWER LINE , OTHER SOURCES DISAPPROVED- _REMARKS DEPTH SEPTIC SEEPAGE TANK SYSTEM DISTANCE FROM: DISTANCES: INSTALLED BM: ~'~ ~'~ SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE:'~''J~ REMARKS: ~.~-~ L~'~IAGRAM OF SYSTEM GREATEr ANCHORAGE AREA BorouGH 3330 "C" STREET ANCHORAGE, ALASKA 99503 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. FINANCED THROUGH ' TO be ,NSTA,LeD BY ~ h~ ~ FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SE.T. TAN '7 /T pE SEEPAGE A. A MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL ~ SEPTIC TANK , SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK -- DF~AI N F{ELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, , SEEPAGE PIT TO RIVER, LAke. STREAM, -, DRAIN FIELD SEEPAGE PIT ALSO CONSI~)ER AREA WELLS. , SEEPAGE PIt DRAIN FIELD CAST IRON INTO AND OUT OF SEPT[C TANK AND ]NTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIE, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC, TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILl. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. TYPE DIAGRAM OF SYSTEM CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE GrEATEr ANCHORAGE AREA Borough 3330 "C" STREET ANCHORAGE, ALASKA 99503 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT FINAL INSPE(:TION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEePAOE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK * SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK ~ DRAIN FIELD SEEPAGE AREA SIZE DRAIN FIELD -, DRAIN FIELD , SEEPAGE PIT ALSO CONSIDER AREA WELLS. · SEEPAGE PIT TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-G8 AND THAT THE ABOVE , (Id. AT_ ( AdC k/U,I ?,MA b0R.) ~x=~/I)epartmenL of [nv ron,lc'nLa] ft~ ty 3330 "C" Street Anchorage, A1 as ka 99503 N()II,N J,O(i - Iq.;I{O],A'FI()N 'I'I.;,~T ',~ Perforlilcd ~. ~ ~ 7~ Performed for_ _ 'Legal Uescription: ~'Ihis form reports:'-' ~ ]~[~.]~'~V'-]?- -- ': .: Percolation Lest X Dep Feet ] - Topsoil 2 - ~L (~75) 3 - ML (275) 4 - ~$ (275) 5 - Ov (225) 6 - m' 7 - ~f (225) i5 - ~w (leO) i6 -ow (leo) i7 (leO) ~w iS - o~ (leo) i? 4 oi~ (ioo) Was ground water encountered? ~.a_ If yes, at wilat depth? Reading IDa~e Gross Time Net Time {_Depth to Water [let bro? I ...... ~:2~ ..................... j___i,J_ _ .i/_ ~i!z_ .............................. ~: ~0 ............ 21Z'Z'f 2 ZZ-- __x~'..~z~ ........ ~ e~._- ................. o. o5 .............................. :t%9:~O .......... ~ ...................................... ................ o7 a/q" 1 Percolation rate z~.8 minutes per -Proposed insta la'F~h-~--'~'Pa~le Pit .............. Drain Fichl Depth to bottom oF I)it or trench Depth of Inlet ................ . ..................... COMMENTS: ~ ~-~ ....... ~'a ~-=- ~ .... q .~. s ....... t .... . Performed By GR~:~TER ANCHORAGE AREA BOROUGH ~, ~ HEALTH DEPARTMENT ..~._.2 327 EA~LE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ~ . SEPTIC TANK: DISTANCE FROM WELl LIQUID CAPACITY /! '7~-L~ NUMBER OF MATERIAl. COMPARTMENTS ~L~ ~::~L/~('7 ~, ) LIQUID GALLONS~ INSIDE LENGTH INSIDE WIDTH. ~DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: LINING MATERIAl DISIANCE FROM WELL BUILDING FOUNDATION__ NEAREST LOT LINE __ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL~~- / , FOUNDATION ~'~ /~J~ . NEARES[ LOT LINE NUMBER OF LINES=' ~ '~ ';' ~- ~DISTANCE BETWEEN LINES~ ~ IRENCH WIDTH ABSORPTION AREA , SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE T ~H GRAD DEPTH OF FILTER MATERIAL BENEATH TIL~'_ TOTAL LENGTH OF LINES ~f) ~ IN. TOTAL EFFECTIVE _IN. ABOVE TILE WELL: "~ '~ ~~c~t<O /~ ~ __ DISTANCE FROM / 0 ~ WATER ~ TYPE_ DEPTH , BUILDING FOUNDATIOn. '~. SAMPLE , NEAREST NEARES1 SEPTIC -- ~ / SEEPAGE ~ [, OTHER LOT LINE i/ SEWER LINE ~ __ [ANK~'~ , SYSTEM / CESSPOOL ~ , SOURCES DISTANCES: DATE DIAGRAM OF SYSTEM APPROVED ( ~:~ HEALTH AUTHOritY ~ ~/ GREATF. i.._ANCHORAGE AREAL .. )ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279.2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTION MAILING ADDRESS ~/,~/~ LOCATION OF INSTALLATION ,~;' APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS , SEEPAGE PiT , DRAIN FIELD , OTHER ~ /~.'~; TO BE INSTALLED BY ~)~/~//BO~F~ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED '~. '~'-~-~' ~-~-~ , SEPTIC TANK SIZE ~ TYPE~~ SEEPAGE AREA. ~ TYPE DIAGRAM OF SYSTEM ~'~ I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. .. 'REATER ANCHORAGE AREA BOROUGH~ HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE~ ALASKA 99501 c^s~ # This Form Repo.~ts a: Depth Feet Soil Characteristics Was Gmound Water Encountered?._~___ 9o~1 If Yes, At What Depth__..~.~ ~-.------~ Reading Date e~eolation ~a~e' l"/ Gross Time Net Time Location Sketch Depth To H20 Net Drop Pmoposed Instal~Seepage Pit ,~,, Drain Field Depth Of Inlet 3 2~ ~ r5~ ..... Depth To Bottom Of Pit Or{ Test' PerformedB~:.~~ e Data Certlf&ed By, ~ -- Date: ~_~__~ ~ ~¢, 7 ~) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION a25 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE 349-3977 1. PROPERTY OWNER w Pat Br±an' MAILING ADDRESS 476 - H Star Aouta A, Anchorage, Alaska 99502 PROPERTYRESiDENT(Ifdifferentfromabove) I PHONE NHN Bay View Drive, Anchorage, Alaska 99502 I 349-3977 2. BUYER PHONE Narvair S. Gibbs 279-7044 MAILING ADDRESS 2301 West 36th, Anchorage, Alaska 99503 3. LENDING INSTITUTION Coast Mortgage Co -~j~ . MAILING ADDRESS P. O. Box 1200, Anchorage, Alaska 4. REALTOR/AGENT Alaska Associated - ~lov~ ~r~ 99510 MAILING ADDRESS 4467 Business Park Blvd, Anchorage, Alaska 99503 ~ If unable to reach owner, please contact real es[ate agent. PHONE 279-0665 PHONE 5. LEGAL DESCRIPTION Lot 12, Block E. Timberl~x ~1 STREET LOCATION Bay View Drive TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY E~] Two ,~ Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL~ ~ ATTACH WELL LOG. A well Icg is requ'ired for all wells drilled [] COMMUNITY since .June 1975, For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVI DUAL/ON-SITE~ [] PUBLIC UTILITY **If individual/on-site, give installation date //! If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 724)10(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTOR INSPECTOR INSPECTOR '\ DIRECTIONS: 1. TYPE oF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX " PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL COMMUN!TY DATE DRILLED [] PUBLIC UTI L[TY Connection Verified LOG RECEIVED 3, SEWAGE'DISPOSAL SYSTEM PERMIT NUMBER []PUBLIC UTILITY O ~.IG, lYlA(~ Connection Verified INSTALLER [~]Septic Tank or []Holding Tank Size:~lf Tank is homemade SOILS RATING give ding'ohs: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank.. Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line · 5, COMMENTS ~PPROVED FOR ._5 BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE 3Y (Title) , LEGAL I~ESCRIPTION' ~ ~/ ~ ~._.~_.~ ~ v - ~._ 72-010 (Rev, 3/78) P.O. ~ox 4-1270 4649 BUSINESS PARK BLVD. ANCHORAGE, ALASKA 99509 PUBLIC WATER SYSTEM: TELEPHONE (C07) 2794014 Drinking Water Analysis Report for Total Coliform 'Baderia TO BE COMPLETED BY WATER SUPPLIER I.D. NO. SAMPLE DATE: Public Water System Name Ealllng Address City State Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no.. [] Special Purpose t..-~fytv SAMPLE NO. LOCATION 3 I 4 I. Zip Code [] Treated Water [3 Untreated Water Time Collected Collected By TO BE COMPLETED BY LABORATORY LABORATORY: CHEM & GEO LABS CF AK., IN C~ NAME 4649 BUSINESS PARK BLVD. ADDRESS ANCHORAGE, ALASKA Date Received Time Received Analytical Method: CITY I I,q [] Fermentation Tube [~"Membrane Filter Lab Ref. No. Result* No. of colonies 1100 mi, or N o. el Positive porllons. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected 9-1-78 Source ed-- 9-1 -~7~ Received ~ ~ .... Lab. No. ]~593-1 . Broth 48 hours=_ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quali 3330 "c" Street, Anchorage, Alaska 99503 Date Received May 24,1976 Time of Inspection~ Date of Inspection ~-~-Q~ /~ ~ REQUEST FOR APPROVAL OF ~. INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. 1. Approval requested by: Safeco Title Mailing Address: 3201 c Street Phone: Property Owner: Harold V. & Patricia Heppeard Phone: 344-7382 Mailing Address: Rabbit Creek Road 3. Legal Description: Lot 12 Block E Tin~berlux Addition 4. Location: Approx. 1.1 miles up Rabbit Creek Road 5. Type of facility to be inspected Single Family 6. Well Data: Individual No. of bedrooms 5 ,~/~ B. Depth 146' A. Type C. Construction ,~/~, D., Bacterial Analysis Sewage Disposal Sy~te~: ~-site system A. Installed approx 19~2 .B~:tnstaller I¢ 7o C. Septic Tank: 1. Size ~/~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total .length of lines Distances: A. Well to: Septic tank Nearest lot line , Absorption area , Other contamination , Sewer~ Lines B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages P~ge 2 of two pages - Ret t for Approval of Individual ~._~r & Water Facilities .Legal Description Lot 12 Block ~ Timberlux Addition #1 Comments Approved ~ Greater Anchorage Area Disapproved Date Approval Valid for one year from date signed Borough, Department of Environmental Quality DIAGRAM OF SYSTEM c'ertify that the information contained.in this request for approval to be a true and ~ccurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) ' 'MJ'~ iq.'q~ qf r',!:~,. · ~.'~ DEPARTmEnT OF HEALTH AND E~IRO~E,T~L PROTECTION ~JJ ~/V~I,0 E.a~udor Road, Anchorage, Alaska 99504 276-2221 .... :, ~; ~ ~EQUEST FOR APPROVAL OF [~ ~ ~. ~ INdiVIDUAL SEWER and WATER FACILITIES 1. Typeof Inspection: CMRO VA FHA ~CONV Mailing Address: ~~ 8,~ ~ Day Phone: MailingAddress:~/f/ ~l~ ~/ Day Phone: 4. Name ~Lendina Institution: Mailing Address: ,~ ? 5. Name of Realtor or Agent: Mailing Address: ~'~ 6. Legal Description: ~,o Y /<? Location: Phone: 7. Type of Facility to be Inspected: No. Bdrms. Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If Individual, depth of well / ~ Individual / 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation ~//'~,~'/~/~/ , i:' ~, '-,,-":· ,/ , Individual (on-site) 72-003(3/76) ADHW- ~8-2W DATE D" \RTMENT OF HEALTH AND WEI,' ~ DIVISION OF PUBLIC HEALTH, BACTERIOLOGICAL WATER ANALYSIS CITY When? READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lob, No OFFICE Records in this office indicate Ibis WATER SUPPLY 1o be of: Analysis shows Ibis Water SAMPLE to be: Satisfactory ~] Questionable [~] Unsalidoctory. R an "Unsatlsfaclory" or "Questionable" slafus is indicated above you shoulc[ ta['e immediale action as recommended below. 5ANITARIAN'S REMARKS BACTERIOLOGICAL WATER ANALYSIS RECORD Dote Received ~ 'L ;~ ) Q Time Received /: pm '[.ob. No. Laclose Broth : I 10cc 10cc 10cc 10cc 10cc 1.0cc 0.1cc 24 hours EMff AGAR Cobform Densby ~ (Most probable No. per 100c~.) , , ~'This analysis indicales C61iform Organisms to be;