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Home My WebLink AboutGLACIER VIEW HEIGHTS BLK B LT 4Glacier View He'D ights Block B Lot 4 #050-491-11 MUNICIPALITY OF ANCHORAGE �q DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name `` J� �C] ta5a tai DISTANCES TO SEPTIC TANK ABSORPTIONWELL FIELD Address Permit No. No. of Betlrooms 40372 3 [FROM } t�otPhone(s) } LINE 1 LEGAL DESCRIPTION Lot Block Subdivision (_ cv� I FOUNDATION �t a- _ Township, Range, Section �1See,, 1 AS -BUILT DIAGRAM driveway, water bodies, (Show location of well, etc.) septic system, property lines, foundation, TANKS �l SEPTIC ❑ HOLDING Manufacturer Capacity in gallons C Material 5T—ri�L_ No. of Compartments TYPE OF SYSTEM ❑ TRENCH BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade t6 FT Total depth from original grade I 2 FT Pt D Fill added above original grade �.0 — D, FT Gravel depth beneath pipe t 0,S FT Gravel length Gravel width I Ar up FT ti Total absorption area SQ FTrj DistanceDistance between lines FT — 1 Number of lines '75— Soil rating .Szstr pipe material D 3v3 �IIC. Installer trnnl Date Installed - I- b WELLS PRIVATE ❑ OTHER (Identity) Classification (A,B,C) f4l/ Total Depth FT Cased to FT Ins alter Date Installed: REMARKS: N Scale: Inspections Date: Performed R�--s by: _jENGIN.EER'a bEAL,, - - ` _ Y ; :i _ � -.§, uy S G# River Loop Road No. 204 cerli that Ihi inspection was performed according to all " i of Lala bra 99577 �� Municipal and Stat�>,�Ifd�iin�3 iii a Itct on t ' date:3 Health Department Approval: NL ate 1-241 72-013 (3/85) III 3T °R 1z. AS• BUILT app, SCALE ` LP 9 r 0 C33 i 1:3A � O Z r rn t m lis r C3 b rn :;u C7 CM LP o �' 0 -4� r- A :s:, 7�p C3 "fid 3 Pt O rtl —� � n y 3m r r-o3 0 D .Sf�. _ m-v .. QJ m 74co I C o( N Y2 o r -r12 CC D r N �'� rr'1 N D� I o C°' 70 3m t' �r v 0c �� o C nZ o =L " a M n Pi2M F a 3 �k-A LjJ r^I c') Ln F � 3" Ln Lrj _ r- G d • v -a N yf o° •� of c,, J7 Vyy. �•� n c 'Y' Tj •/) � C � a Municipality of Anchorage } j i Department of Health and Human Services dhh5 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 January 8, 1991 Walter and Judy Johnson PO Box 531 Concord, NH 03302 Subject: Lot 4 Block B Glacier View Heights Subdivision Permit #900372, PID #050-491-11 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1990. A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as -built inspection report (three-part form) must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Si er ly, J n Smith, Pr gram Mar. -site Sel ger ices JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" I n MUNi�1PAL1|\ dF ANCHURAGE De�artment o� Health & Human Services 825 L Street, Anchorage� Alaska 995O1 343-4720 ON~SITE SEWER PERMIT Permit�m'� i]pgrac!e kj Owner Name: �ALTER & JUDY Uwner �ddress: P O BOX 531 CONCU�D� NH Parcel Id: O50-491~11 Lot Legal: Subdivision: GLACIER VIEW HEI8HTS Lot: 4 Section: 16 Township: 14N Range: 1W Lot Size 2321� (sq.�t. or acres> Max Bedrooms: [his Permit: 3 Total Capacity: 3 Day Phone: B1ock: B SEP||C ��NK: Minimum total septic tank capaciiy: 1v0�0 �all�ns. Each septic !ank must have at least 2 compartmen�s. Depth to top o� septic tank(s) < 4,0 '+ee� requires insu1ation over tank(s), �ERMIT EXPIRES DECEMBER 31, 1990. NUlI�Y DHHS DF 1NSPECTIUNS AT 343-4744 OR 343~468i AFTEK HOURS" WA1V2R TO CURTAIN DRAIN AND L�T LINE GRANTED. l (�ER!IFY THAT: 1. l am �amar with the requirements �or on~site sewers and wells as set �orLh by the Municipaliiy o� Anchorage (MOA) and the State of Alaska" 2" i wil1 install the system in accordance with all MOA codes and regulations� and in co�pliance with the design criteria o� this permit, 3. I will adhere to all MOA and State o� Alaska requirements [or the set back distances [rom any existing well, wastewater disE,osal system or public sewerage system on this or any adjacenL or nearby lot. 4. I un�erstand that this permit is valid for a maximum o[ 3 bedrooms, l also understand that the capaciLy oi the total system is 3 bedroo�s and any enif,m t wiil r re an additional permit, « DATE Municipality of Anchorage o Department of Health and Human Services d1-1hs Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 November 21, 1990 Robert Shafer, P.E. S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Re: Request For Waiver To A Curtain Drain & Lot L.ine For Lot 4 Block B Glacier View Heights, P.I.N. 050-491-11 Dear Mr. Shafer: Your request for waiver of the required 50 feet separation between a drainfield and a curtain drain down gradient has been approved at this time. The approved distance is 35 feet. Also included with this approval is a lot line waiver to 5 feet from the northwest and southwest lot lines to the bed type absorption field. This waiver will remain valid providing that effluent from the proposed drainfield does not appear on the slope anywhere between the drainfield and the curtain drain and the discharge from the curtain drain down gradient does not become contaminated. This waiver approval applies to the existing drainfield to curtain drain separation only. If either the drainfield or curtain drain are upgraded in the future, all separations must be met or another waiver requested from this department. Sincerely, Daniel Roth Civil Engineer On -Site Services Concurrence,; Qohn Sm* h, P.E. Program Manager On -Site Services WE Octobe4 25, 1990 ROBERT SHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTHAUTHORITY APPROVALS c ALS p Munic a iCyu 4g o AnchoQ e APPROV DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stnee•t P.U. Bax 196650 SEWER &WATER Anchorage, At"ha 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 4; Btock "B"; Geaci-e4 View Heights PERMIT REQUEST NARRATIVE SEWER& WATER INSPECTION Request you issue a peamit to instatt the p4oposed septic system and g4ant a wa.ive4 6o4 the distance between the p4oposed teach6.ietd and the no4thwest and southwest pupe}rty tines at 5 6t. ENGINEERING STUDIES As a 4esutt o6 a 4equest - to obtain a Heatth Ce4ti6.ieate on the AND REPORTS 4e6e4eneed p4ope4ty we excavated the existing septa system 6o4 documentation.. At this time we Sound the existing system to be ene4oaching gnoundwateA and in a state o6 6aitu4e. The4e6o4e, a test We was excavated 6o4 pu4pozef o6 upg4ading the septic system. WELL INSPECTION &FLOW TEST The p4oposed system eonsizts o6 a 1000 gatton septic tank and an abso4ption bed. Due to the %efativety zmatt tot size and a4ea weft 4adtii, the4e ane thue eonce ": SITE PLANS 1. To have enough room on the pupe4ty, the puposed teaeh6.ietd must be ptaeed within 5 6t. o6 the p4ope4ty tine. 2. The pupozed teach6.ietd must be ptaeed within 10 6t. o6 the ROAD DESIGN existing seepage pit to be abandoned. The4e6o4e, the seepage pit .is to be abandoned by excavating and 6.itti.ng with sandy g4avet. Since the seepage pit 6aitu4e .is not due to so.i2 clogging, .iii p4ox-im.ity to the p4oposed teaeh6.ietd shoutd not e66ect absoiLption capacities. SOILTEST 3. The puposed abso4ption bed toeat.ion .is app4ox.i.matety 35' 64om a eu4tain d4ain on Lot 10 to the south o6 the %e6e4enced pupe4ty. Natmatty the4e is a conce4n the seepage bed e66tuent may teach .into the cuxta.in d4ain. Howeve4, we beet the 6tow o6 teachate is not in PERCOLATION the di4.ection o6 the cu4tai.n d4ain. This is because the existing TEST seepage pit is onty app4oximatety 55' 64om the eu4tatin d4ain, is sitting within g4oundwate4, and has been .in use 6o4 yeau with no appa4ent e66eet on the eu.4tain d4ain. STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 7 Page Two Lot 4; Bloch. "B"; Gtacien View Heights O ctoben 25, 1990 14 you have any questions on %equ.ite add.it onaf in�o"ati.on 4ox you L neview, ptea4e contact ua. e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST pi X .1 A. 8harst' ' No. 1157.1 .•e PERFORMED FOR: WA'I�T�e.�� t�1�V .JOa1t..d,Sac�1 DATE PERFORMED: �`'�`�°��S�—Ct a LEGAL DESCRIPTION: L,.,>-r4UL.ft4e .1!<EwT'owq!�ip, Range, Section•. SLOPE SITE PLAN I/ 1 I 1 Gross Time Net Time Depth to Water Net Drop 1r�-L3 2 __ 3 4 Z:, -4A> P 3ohIM /#,Is ' CsP 5 � � If 6 Y� , 7 I� 8 9 � l v 10 / *.3 11 , 12 -� 13- 314151617 14- 15- 16- 17 81920 18- 19- 20 COMMENTS e WAS GROUND W/ ENCOUNTERED? S IF YES, AT WHAT L Q,t O DEPTH? p E Depth to Water After , 10 2�-�t0 Monitoring? iahi c C,. Reading Date Gross Time Net Time Depth to Water Net Drop 1r�-L3 'Z? __ / of — Zt C>-13 Z:, -4A> P 3ohIM /#,Is 4.2.s' If s— Its— /S-. VA sVA / *.3 PERCOLATION RATEa (minutes/inch) PERC HOLE DIAMETER U TEST RUN BETWEEN ?i FT AND '5 FT PERFORMED BY: (7W7 ) I "� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN 5INEF;FrCT ON THIS DATE. DATE: a 72-008 (Rev. 4/85) ir .7t 7 LLI •1 . � ti 1 �r /(� ��'�p�.•p q�.9�A M Y 1 �1 �V ihe� ( � . l�1 •{ f fy "�i A RJ }� �� a ° � `r ''.,'b,+»r.,.............r,,.� 'l Mme•., •�� l � / �p .y . ti + s 1 W J 4 fi� � f t r4t C t �` 3�tlDS ds' L C�u�1(mo0 vpt�) = woo /ekno'REo 5 IrDO/FT 7- Z. x i S i nll� SE�r7C TA n/lc is -ro c3E �ur1+��D i Li D �ci%OVE/� � FLLEt� I: n A 0 3. ou' rO Gc.J A 1 vre/z —7-0 Tt/E %AFD le€gal ie Fd41:-7-1J 7 4 A Z ed 90 16 7-er -r cvuL 0 .uD 6 EF F-7xCAVA-rF,O Fooe 7�/ /5 RF -4 -w t7M OU 'T ,IXC/411A7/ iN ry THE 412C4, 'f• °a ew �:?\ , .S b 07 07 :�� Low CeiB 15 TZ) 13E ?cJMP,ED/ — N c.1',� yy a c F',d-`zo Wi7rLl :SA-nlf> ) � A- A-NDonl6D Z. x i S i nll� SE�r7C TA n/lc is -ro c3E �ur1+��D i Li D �ci%OVE/� � FLLEt� I: n A 0 3. ou' rO Gc.J A 1 vre/z —7-0 Tt/E %AFD le€gal ie Fd41:-7-1J 7 4 A Z ed 90 16 7-er -r cvuL 0 .uD 6 EF F-7xCAVA-rF,O Fooe 7�/ /5 RF -4 -w t7M OU 'T ,IXC/411A7/ iN ry THE 412C4, 'f• °a ew �:?\ , .S b P4 �V g �y n y — N c.1',� yy a c � 1e6. w l)s C .�+ • 0 S 4�. 3 I / Y A bfi 1-k Z LLJ � h 5 OO 'Ilk 31VOS Ap CA I .V ya 1-k Z LLJ � h 5 OO 'Ilk 31VOS HEALTH AUTHORITY APPROVALS Novembers 13, 1990 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694.2979 FAX 694-1211 Munic.i paZi.ty o6 Anchorage DEPARTMENT UP HEALTH AND HUMAN SERVICES ATTN: Susan Oswatt SEWER&WATER 825 L Street MAIN EXTENSIONS P.V. Box 196650 _ Anchorage, ALa.6ka 99519-6650 REFERENCE: Lot 4; Block "B"; G2aei.en View Heights SEWER& WATER INSPECTION Dear Sudan, The 4o22ow.ing additiona2 .in6onmati-on So,% ju,6ti4icafii-on o6 the waiver reque6ted .in ours d leer dated UCtobeA 25, 1990 i3 provided: ENGINEERING STUDIES AND REPORTS we -took Cot iborm Bacteria 9 NitAate 6ampte.6 Srom the well toeated on Lot 10; Block "A"; Glacier View Heights. Both 4ampta .indicate no contamination. WELOWTESCTION & FLOW TEST we also took becal coti6orm 9 6ecal streptococci 3amptea 6rom the curtain drain tocated on Lot 10; Black "A"; Glacier View Heights and thew samples atzo indicate no contamination. SITE PLANS we request you use this .in6o4mafiion dun,ing yours evaluation when con,6idening the waiver requested. 16 you e any que6tion6, please contact u,6. ROAD DESIGN S ' eerety, i SOILTEST R T A. SHAFER, P.E. R /gm MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & PERCOLATION ENVIRONMENTAL PROTECTION TEST V-0 9Q0 STRUCTURAL& RECEIVED MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. L..011.T911e �, 5633 B STREET - ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE fox Work Order 1 30032 Date Report Printed: NOV 12 90 1 12:34 Client Sample ID:L10 E 'A' GLACIER VIEW NTS Client Name S & S ENGINEERING PWSID :UA Client Acct SNSENGP Collected NOV 9 90 1 10:30 hre. P.O.{ NONE RECEIVED Received NOV 9 90 / 13:15 hrs. Req # Preserved with :AS REQUIRED Ordered By : R. SHAPER Analysts Completed : Send Reports to: Laboratory Superviso 4=PHIN C. EDE 1)S OR S ENGINEERING Released By : G; 2) ............................................................................................................................... Special Instruct: Chenlab Ref #: 904766 Lab Snpl ID: 3 Matrix: WATER Parameter Tested FECAL COLIFORM FECAL STREPTOCOCCI Sample Remarke; Result Units 0 col/100 n1 0 col/100 ml Allowable Method Limits .............................................................................................................. 2 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Leas Than, GT -Greater Than , CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order 1 30032 Date Report Printed: NOV 12 90 / 12:34 Client Sanple ID:L10 B 'A' GLACIER VIEW NTS. PWSID :UA Collected NOV 9 90 1 10:30 hrs. Received NOV 9 90 1 13:15 hre. Preserved with :AS REQUIRED Analysis Completed :NOV 9 90 Laboratory Supe PHEN C. EDE Released By :.��^'�G' ZL� Client Name S & S ENGINEERING Client Acct SNSENGP P.OA NONE RECEIVED Req 1 Ordered By : R. SHAPER Send Reports to: 1)S A S ENGINEERING 2) ................................................................................................................................ Special Instruct: Chenlab Ref 1: 904766 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result Units Method Limits --------------------------------------------------------------------------------------------------------------- NITRATE-N ND(0.10) mg/l EPA 353.2 10 Sample ROUTINE SAMPLE, Remarks: SAMPLE COLLECTED BY RAY. ......................................,........................................................................ 1 Teste'Perforwd ' See Special Instructions Above UA -Unavailable ND- None Detected " See Sample Remarks Above NA- Not Analyzed LT -Lass Than, GT -Greater Than w , L , y - • e NamePhone No. S & S ENGINEERING Road No. 204 Eagle River Loop Malling %qtjver, Alaska City State Zip Code SAMPLE DATE: = ERU Mo. Day Year SAMPLE TYPE: cEgRoutine ❑ Check Sample (for routine sample with lab ref. no. 1 ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 1 1 L✓ (o I :3 a 64 2 1 VIF,A) dl-> 31 4 5 1 —I ❑ Unsatisfactory ❑ Sampa too long in transit; sample should not b over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received G Time Redeived Analytical Method: Membrane Filter t No. of colonies/100 ml. Lab Ref. No. Result" Analyst FTn 90.4766 Z m I m U m U m a BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter. Direct Count ColiformMOD ml BEFORE COLLECTING SAMPLE Verification: LTB Final Membrane Filter Results _ Reported By� r TNTC = Too Numberous To Count OB = Other Bacteria ml Date z Time: lS�� a.m. p.m. PART ONE OF TWO REMAINDER TO FOLLOW NORTHERN TESTING LABORATORIES, I 0 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 o FAX 274-9645 3330 INDUSTRIAL WAY FAIRBANKS, ALASKA 99701 907-456.3116 < FAX 456.3125 Municipality Of Anchorage D.H.H.S./Water Quality Section P.O. Box 196650 Anchorage AK 99519-6650 Attn: - Our Lab #: A106811 Location/Project: Glacier View Heights Your Sample ID: Lot 10, Block 8 Sample Matrix: Water Comments: Method Parameter SM 909C Fecal Coliform Reported By: Fran is Rodigar' Anchorage Operations Manager Report Date: 11/06/90 Date Arrived: 11/01/90 Date Sampled: 11/01/90 Time Sampled: 1450 Collected By: SD Flag Definitions U = Below Detection Limit DL Stated in Result B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Units Result Flag Analyzed ----------------------------------------- #/100 ml 20 11/01/90 MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION E010 A 1990 RECEIVED Municipality of Anchorage On -Site Water & Wastewater Program _ (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-491-11 Expiration Date: / ~� 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent GLACIER VIEW HEIGHTS; BLOCK B, LOT 4 22846 MYRTLE DRIVE *EAGLE RIVER, AK 99577 CRAIG JAEGER Day phone 227-7710 22846 MYRTLE DRIVE *EAGLE RIVER AK 99577 DOUG GOODWIN Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: 947-3829 TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ F J n Received by ` r' Date: COSA to be released to theengineer, unless COSA Fee $ 4t ()— / Waiver Fee $ Date of Payment I O,� 2l 3/ (tet" Date of Payment Receipt Number 0 5� /�G Receipt Number COSA # 05c,/ 313 (1 Waiver # 5. 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, 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. 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. GEG, LTD. 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. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for 0 bedrooms. bedrooms, with the following Phone 337-6179 Date 7l 14.3 OwSITE WATER ANO Original Certificate Date: The Municipality oLAnchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11105) C'11/_ Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: GLACIER VIEW HEIGHTS; BLOCK B, LOT 4 Parcel ID: 050-491-11 A. WELL DATA *PER GEG INSPECTION **PER SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) Date completed PRE1991 Sanitary seal (YIN) YES Wires properly protected (YIN) Total depth *3g+ ft. Cased to **40+ ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test NO WELL LOG 6/27/13 Static water level ft. 23 ft. NO 12+ in. Well production g.p.m. 4.66 g,p.m. WATER SAMPLE RESULTS: Coliform C) colonies/100 ml. NitratE' 3 mg./L. Collected by: GEG, Ltd. Arsenic: )1O ug./L. Date of sample: 6/27/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 1/2/91 Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/26/13 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 1/2/91 Soil rating (g.p.d./ftor /bdrm 0.5 System type BED Length 45 & 30 ft. Width 26 & 30 ft. Gravel below pipe 0.5 ft. Total depth *2.91 ft. Eff. absorption area 975 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 6/27/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 1030 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth E in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lob Absorption field on lot 100'+ On adjacent lots Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout **100'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water, 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *5' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain ***35' Wells on adjacent lots 100'+ F. COMMENTS *WAIVER APPROVED ON 11/21/90 **COULD NOT FIND SEPTIC SYSTEM ON GLACIER VIEW HTS, BLOCK B, LOT 5 (NO RECORDS O THE MOA, PER JEFF POET). ***PER MOA DESIGN DRAWING & 1997 HAA (WAIVER APPROVED ON11/21/90). 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 71x24 d (Rev. 11/05) ASBUILT SEWARD &ASSOCIATES LAND SURVEYING 694-08,: 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE' fF FOLLOWING DESCRIBED PROPERTY- `"' �daaa�Ra r i- tli AND THAT NO ENCR ENTS EXI'ST i«KCEPr AS % ? INDICATED. IT IS THE RESPONSIBILITY OF THE „ 4tH OWNER TO DETERMINE THE EXISTENCE OF ANY GRID= ' •^�A- VISION EASEMENTS, COVENANTS, OR RESTRICTION5..WHICH DO NOT APPEAR ON THE RECORDED SUBDI- a a a Merx PLAT. UNDER NO CIRCUMSTANCES SHOULD FS: 5 +dam', ANY DATA HEREON BE USED FOR CONS'iRUCTlON ' � yss4V OF FENCE LINES, OR FOR ESTABLISHING BOUND-DoiAWN gat "fi'{ ARY LINES, -i.' Drilling b) DOC Co. ew SULLIVAN WATER WELLS P.O. BOX 9702M CHUGIAK, ALASKA 98597 • TELEPHONE 9811-2759 OWNER OF LAND _&dS:C, 4t riaFi.u.t Ct4)EI'TH OF WELL �y13 r Ca, ADDRESS - . STATIC LEVEL OF WATER FT. J O ei LEGA LDESCRIPTIONCoTJO 4'31.r (; fd'4e4Cr6tl, 6) 19 DRAW DOWN FT. DATE •StartedS% Ended /87 __ GALS. PER HR a49 PERMITNUMBER KIND OF CASING f,50 KIND OF FORMATION: From - FL to Ft. From Ft.to_,3_Ft.- QUiPoC A.,:44E - From - Ft. to _ Ft. From Ft.toL Ft.S/Ari CtAYi-6AArcA, From Ft. to Ft. From _L_Ft. to as Ft..S#4,u0 ? GR r4.r• c 41Ae F om Ft. to Ft From O?s Ft. to '73 Ft. N44 )Ow -j s �outpc,t jrrom Ft. to Ft From �Ft.to g7 FL_�)Aw-d' := RA-0t,L c -+El -'1c/—� - � _ From Ft. to._Fp�I�tuFNTALSERVICES MUNICIPALI - DIVISION From_ -Q79?� Ft. to-JC—Ft. TIcnj '�t'z� ! CQA✓EL From - Ft. to Ft From 9r to ,oa_Ft. S,q -, ,4- From Ft. to Ft. From 10 a Ft. to /_�~ FL SA!wQ--6QAucL = ulA�Fromo Ft. too. FRFr+ _FaVED �y From�Ft.to�Ft. S1,& C R,g✓ec From Ft. to Ft. From / ! k FL to+ rT, Ft. J?Mdaflr- . AAAL +IG From Ft.. to Ft. From Ft. to Ft.If IN A 'I From Ft. to - Ft. ` From Ft. to Ft. From—Ft. to—Ft. From Ft. to Ft. - From - Ft. to Ft. From Ft. to FL From. Ft. to Ft. From Ft. to Ft. From Ft. to - Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: i t jag Ra•rt I Q� h TO 11 60, Ctj1��6 �� J°Erc.pon.+ifid DRILLERS NAME -t„265 LOCATION OF WELL (Plea,* Complete either la, Ib or la.) MATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOUR£S Div(sioR Of GealOg(eal a Geophyslcai Surveys Drilling Permit No. A.O.L. Mo. tall BarauOh Anc SUDdlvicerion Glacier Lal 12 BIOCY B Ib. 1/a of .af_ot_of_ Saallon No. TownshipN� B❑ Range EE) W0 NMdlan le. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS View Hghts. Myrtle St, and Eagle River Rd. S. OWNER Of WEL, a H,Y, y Witman Addy.,.: Eagle River, Ake Street Address and Area of Well Location E. WELL LOG F hal Saar Material Typo Top Bottom q, WELLOQPT"(1(nol)Surtoe• f TPLET1 09 -- 3 G. ❑ Cable toot XtRIblery ❑ Drlv*a ❑ Out ❑aeq•r ❑d*fted ❑Rena ❑ Other : T,� Dam.Otto ❑ PaDIIe Supply ❑ Indusley ❑ Irrigation ❑ Recharge ❑ Commerical ❑bet well ❑Omar; Soil, Sand *vel 4 12 Sand , gravel , damp s 11t 2 an , , si Sand, avel, silt, water 40 46 an grave , clay S, CASING, ❑ Threaded X-JqW.Ided dial. 6 1.. t*60 it. Depth W6141,11 ib..1 ft. diem._ln. to_ it. Depth Stickup- ,t. S. FINISH OF WELL: TCD*= Olamotor. Slot/Muh $las: Length: Set hetvu ft. and It. Backfilllas Gravel peak 10. STATIC WATER LEVEL: —O /1. 11 28/8 ❑ Above or X)gLesia. land surface Data Eatllpm.nt used: II. PUMPING LEVEL beta. land .orlon .and YIELD _ft. off.,—ho. pumpino_g.v. m. _ft. after_hr., pumping 99 U e IB.GROUTING Wall Grouted' ❑ an ❑ Na (j Dt Sri De Material: ❑ Neat Cement ❑ Other: rtv82 IS. PUMP+ (ii available) NP Length of Drop Pipe eft. capacity g.p.m. ❑ S.A.. ❑ jet Q Cantelfleal ❑ Other 14.11EMARNsPerforations from 40 -45 -ft. Production of 1 GPM 18. WATER WELL CONTAACTOR'S CERTIFICATION: IS, Water Temperature ❑ F ❑ C Thi.sit ra. dri lied under m jurisdiction and this report Is true to the out of y knorleddo and belief{ Magnuson DriYing AA 5385 R.01.1er*d Busines. Nam. Ada .... :P.O. Box 770504 Eagle River, Ak. CoNroat Lines.. -Number 99577 Maned: Dat.: OV 30. 1983 Auotorlaed representative jy ♦ r�.n, oz vrWn UUdq �a,,y ahtiiaurion: V+HtTE-Slora GGf.T. PIKNNdler. enuanvc,...�,... K,W MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services RECEIVED On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 SUN 2 3 1997 343-4744 Municipality of Anchorage CERTIFICATE OF HEALTH AUTHORITY W, Health & Human SerVice: APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. # 0 S O- H Ct l— U HAA # X R �1 7 003 1. GENERAL INFORMATION Complete legal description Lot 4; Block "B Glacier view Heights Location (site address or directions) 22846 Myrtle Drive Eagle River, AK Property owner. Jeffrey M. Badger Day phone � Mahing•address 'C/O Vista Real Estate 4241 "B" Street Anchorage, AK Lending agency City Mortgage Day phone 696-0701 Mailing address Attn: Jeannie Eagle_ River Branch Agent Tom Bauer/ Vista Real Estate Day phone 273-7298 -Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 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 xxx 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 5. STATEMENT OF INSPECTION BY ENGINEER. wv 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 17034 age Iver p o. Phone 6 g �— �� 7oJ Address Eagle River, Alaska 99577 Engineers signature Date G / ` 3 PLEASE RELEASE THE CONDITIONAL HEALTH AUTHORITY APPROVAL DATED 2/19/97 AND ISSUE A FULL H.A.A. . ALL WORK REQUIRED HAS BEEN_SATISFACTORILY COMPLETED. WE WERE UNABLE TO LOCATE MISSING MONITORING TUBE, THEREFORE A NEW ALLED NEXT TO THE CLEANOUT. ••. 1 aA. t 6. DHHS SIGNATURE Approved for By: Disapproved. Conditional approval for Additional Comments A ROBERT C. COq- 6��, 't `:� CE - 8801 �fffffj bedrooms. i+t, fir,, •. `-��% bedrooms, with the following stipulations: aI The Municipality of Anchorage Department of Health and Human Services (DHHS).issues HealthAuthority 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 courtesyto 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) Back MOA N21 - S&S nG June 17, 1997 ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED HEALTHAUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE JUN 2 3 1997 Department of Health and Human Services P.O. Box 196650 Municipality of Anchorage Anchorage, AK 99519 Dept. Health & Human Services SEWER&WATER MAIN EXTENSIONS REFERENCE: Lot 4; Block "B" Glacier View Heights 22846 Myrtle Drive SEWER&WATER INSPECTION A Conditional Health Authority Approval (HAA) was issued on 2/19/97 for the referenced property. All work required for the Conditional HAA has been completed, however monitoring tube #2 was not located. A ENGINEERING STUDIES new one was installed next to the cleanout. AND REPORTS Please issue a full Health Authority Approval at this time. If you require additional information, please contact us. WELL INSPECTION & FLOW TEST Sincerely, SITE PLANS ae Robert C. Cowan, P.E. RCC/gk ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE204 • EAGLE RIVER, ALASKA99577 „•tom..' n.1`, �� m ��'� I�.F�� N Co M` i Ln r4 U Ln M =r-+ 0 q X Q U- A o `; .� LAA f�i v, y� �. 3W W_ o r, Cl W Ii m 0 � N V� N C3 Cl Jn C J L4 tiLL. 11- ii �J G OJ % o F Li C7 I- 0 K W m Z =3 S w a CalQ L] J CC ("� O 30 C3 nr u C] p ,Ln 711ri9.5b d 2 LZ O E R w 0 � N V� N / r- - W C J tiLL. �J G d 2 LZ O E R w MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P r1 Rnv 1arrrn Annhnrana Alaska QQri1Q-RR5n Location (site address or directions) 22846 Myrtle Drive le River, AK Property owner Jeffrey M. Badger Day phone Mailing address 'Cjo Vista Real Estate 4241 "B" Street Anchorage, AK Lending agency ,'City Mortgage Day phone 696-0701 Mailing address Attn: Jeannie Eagle River Branch Agent 9 Tom Bauer/ Vista Real Estate Day phone 273-7298 Address Unless otherwise requested, HAA will be held for pickup. 5. 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.,l 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 & 5 ENGINEERING Name of Firm Phone 6� � - �-cT 7 a 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 Engineer's signature Date l y 1571 7 REQUEST YOU ISSUE A CONDITIONAL HEALTH AUTHORITY APPROVAL TO LOCATE AND/OR REPLACE MONITORING TUBE 472. MONITORING TUBE TO BE LOCATED AND/OR REPLACE NO LATER THAN 15 June 1997. OF Municipality of Anchorage I` ECE1 VE DEPARTMENT OF HEALTH & HUMAN SERVICES ® i Environmental Services Division E0 7 g 1 o7 825 L Street, Room 502 *Anchorage, Alaska 99501D��, 4744' Health Authority Approval Checklist ea/th &Hunan Se v ces Legal Description: L -OT L 1"5' (!A:s �{ � t 122 Parcel I.D.: 6)S -a - y'/ / - // A. WELL DATA Well type C P,,d ` If A, B, or C, attach ADEC letter. ADEC water system number Log present(�2?`N) Date completed j �L I -1 F Total depth i Cased to C) Casing height (above ground) 1 Z � r�>`A Sanitary seal &N) Fid J r ¢ ti Wires properly protected OYN) L (vS FROM WELL LOG Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate O, �'Sk AT INSPECTION Other bacteria D Date of sample: / -a L i % Collected by: S r �. B. SEPTIC/HOLDING TANK DATA Date installed Tanksize )o ao Number of Compartments Z Cleanouts(�61\1) Foundation cleanout ON) q Depression (yo) --j— High water alarm (YIN) P,N Date of Pumping t -29_s0 Pumper PJ M.P Y3 U C. ABSORPTION FIELD DATA Date installed 12 - 3 ('Sb Soil ratin . .i. r ft2/bdrm) D. 5 System type 131;_o Length 3E) `/5 Width o26 Y--3 Gravel thickness below pipe De �S_ Total depth -�•� - 5—S Effective absorption areaL�� Monitoring Tube present (D1)� Depression over field Date of adequacy test I-�fr 719 . F7 Result Pas Fail) PASs For 3 bedrooms Fluid depth in absorption field before test (in.); b H Immediately afteal. water added (in.): S /1 r �0g Fluid depth O (ins) Minutes later: / / / U Absorption rate = '4� j g.p.d. Peroxide treatment (past 12 months) ()o r)dP)-L- l'47)d„)Y) If yes, give date 'J( 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at` E. SEPARATION DISTANCES Size in gallons "Pump on" level `Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot �� \ Absorption field on lot Public sewer main r�, Li Sewer /septic service line On adjacent lots "Pump off" level at* 1k:�>o � I-- - On adjacent lots o D Public sewer manhole/cleanout A Lift station �A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation S f Property line l D t Absorption field Water main/service line /D t f Surface water/drainage /) b I T& Wells on adjacent lots /Do SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line �� l" �`5a�uilding foundation Water main/service line Surface water / D o 14- Driveway, parking/vehicle storage area Curtain drain 3S 1 >)o�)d 6pA-yrd.J -Is Wells on adjacent lots P FL e- / W 4 M, T7-9,0 arm 1 5.J F. ENGINEER'S CERTIFICATION �rJ,htp /I�21 �jb% i certify that i have determined thru field inspections and review of Municipal record.,4h'hh0fiboi in conformance w' h AOA HAA guidelines in effect on this date. Signature Engineer's Name ��e13 /e C Co 4,ft�✓ , ROPERT� c. coy Date a / 1 `t / eq % `�Y;G;�; .� CE - 8301 HAA Fee Date of Payment Receipt Number 72-026 (Rev. 3/96)' O 0-0 'a/3j617 ;4 1 )L ( s" o _7 , Waiver Fee $ Date of Payment Receipt Number /5 1 (- t d - /AN A are S& February 13, 1997 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX (907) 694-1211 RECEIVED HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE FEB 18 1997 Department of Health and Human Services urlPcipality of AnchorageP.O. Box 196650 Dept. Health & Human services Anchorage, AK 99519 SEWER&WATER MAIN EXTENSIONS REFERENCE: Lot 4; Block "B"; Glacier View Heights Due to winter conditions request you issue a Conditional Health SEWER&WATER Authority Approval on the referenced property to locate monitoring INSPECTION tube #2. The septic adequacy test and the well flow test performed verify the septic absorption rate and the well production rate meet Municipal ENGINEERING STUDIES requirements for a three bedroom single family residence ( check sheet ANDREPORTS attached) . Monitoring tube to be located and/or replaced no later than 15 June, 1997. WELL INSPECTION &FLOW TEST If you require additional information, please contact us. Sincerely, SITE PLANS /#Z Robert C. Cowan, P.E. ROAD DESIGN RCC/gk ENCLOSURE SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 ;: ;°' w RTZ ✓t ,��3 'j (f ! , � � -�. (JFj a -•' y�t3>,�l��fl�� t 5 �,5r, 2 - � �1� _f A5 - BUIL A � �3 lr�t�("�"��., fi 5 � � :� �! "�syb1 Ufa s-r� `` ��♦� `Y32 }. 1 f Yom"` tr ir+ t , •11 �j ;.., 1. 1 1 1 i oto _ n hh Y� �,3 n ^0 r E go 9t �m 1 ->4``1 _� S C a -� ryN n� j1 I � 11 7 t * • r if i t ✓t ,��3 'j (f ! , � � -�. (JFj a -•' y�t3>,�l��fl�� t 5 �,5r, 2 - � �1� _f �i��F �} � { �� A � �3 lr�t�("�"��., fi 5 � � :� �! "�syb1 Ufa s-r� `` ��♦� `Y32 }. 1 f Yom"` tr ir+ t , •11 �j ;.., 1. 1 1 1 CT&i. Environmental Services lne,• Laboratory D i vi si v n sorl��%.i.I/�oyw�r//�I.r��/�.��/r�i1'�.r.I.rr./.�riw 7 00 W. Potter orive Drinking 'Water Analysis Report for Total Coliform Bacteria Anchorage, aK 99518-1606 Tel; (907) 562-2343 RkAD INSTRUCTIONS ON REVERSE SIDEBEFORI; COLLECTING SAMPLE Fax: (907) 561.5301 TO BE COMPbE D 13Y LABORATORY 1 MUST BE COMPLETED BY WATER SUPPLIER Analysis shows this Water $MAPLE to be: o PUBLIC WATER SYSTEM T.D. s Satisfactory pC PRIVATY WATER SYSTEM p Unsatisfactory p Send Invoice ,� a Sample over 30 hours old, results may s3= send R� u to be unreliable 1 should wuer Jrn.MVom dmP.r9 �M" Q Sample too long in tran$lt; sample not be over s8 hours old at examination r lease send to Indicate reliable results. P new sample via special delivery mail, mann, Add,... I P Date Received "y Time Received G Send Beau/u O Sendinvoice Analysis Began aun. r1_0 -_1 Me My rna A Yi "y SAMPLE DATE: MonthDay Year SA'JMPLE TYPE: ,a- Routine p Repeat Sample (for routine sample with lab ref. no.� p Special Purpose SAMPLE LOCATION LAN Comments: Treated Water p Untreated Water Time Collected Collected By Pleats t Analytical Mcthod: Membrane Filter 0 M"'10-iI a Number of colonies/ 100 ml- * Result" Anal/yst 97,0433 Q 5, finch Fbks Jun Foxed Dace: � Time: ,_-_ Client noticed of unsatisfactory results: Q $poke with Fold Phoned bete: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD NIMQ-MUG Result: Total Coliform E. Call Colonie3/100 ml Membrane Filter. Direct Count Verification: LTB ---- BGB ��COLIFIIiM Fecal Coliform Confirmation Coliform/loo ml Final Membrana F Iter R1essu is ^fa V ' j t ET.t� hrs Reported By tt� Date ASI/ r"T6. An Nmno••ur r. Cr-•, z 111I�la Member of the SGS Groue (SoCidtd GgnArale de Surveillance) - nr FN\llonu..c.ry.• �, wr. ..•.n r. nnCYO npr renOn•rA Cr r+orfae yr nrnlf ,^var ..r.1 z& w ====:" S®rvices Inc. CT&R Ref.# Client Name Project Namel# Client Sample fD Matrlx Ordered By PWSID ianrle RZe�na kb 970438001 S & S E,rgineering L4 Blk "B" Glacier View L4 Blk "B" Glacier View Drinkixlg Water Client PO# Printed Date/Time 01/31/97 14:15 Collected Date/Time 01/28197 14:30 geeeived DatePltime 01129/97 09:25 Technical Director: Stephen C.1✓de Released BY �' 1 (/� 40, Allowable Prep Analysis Meth d _ Limits Date Date_ Init Results Pot Unit�� --- parameter— 01l29(97 JUL 0.658 0.100 mg/l. 5M18 4500-NO3F 10 max 01/Z9/91 7AV Nitrate -N 0 coll100mL SM10 92228 Yotal Golifiorm I