Loading...
HomeMy WebLinkAboutGRANITE VIEW BLK 7 LT 4 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ADDRESS/~('~'~ ,~,-~."J "~"~ NAME ~ '/~. ,~Z'/~- ~;:'/~' :f~2/~'/ MAILING LOCATION ~.~2_5"'~.~.2- /(//~, ~_/,,~. ~'~ ~-~-"/~-z-~'~.f~' LEGAL DESCRIPTION ,,~Z--~.~;.. SEPTIC TANK: DISTANCE FROM WELL /"J~ ' LIQUID CAPACITY .///~2~'-";' GALLONS. NUMBER OF MATERIAL r~'-~--~2~ COMPARTMENTS INSIDE LENGTH ~ INSIDE WIDTH ~ LIQUID / _ DEPTH~~---~ SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH. . . DISTANCE FROM WELL /~'~-"~-~ / /J / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH,DEPT BUILDING FOUNDATION':'~,~ / .SQ, FT, TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL ..~-~"~, FOUNDATION "~.._ , NEAREST LOT LINE , OF LINES NUMBER OF LINES ~DISTANCE BETWEEN LINES TRENCH WIDTH TOTAL EFEECTIVE SQ. FT. LENGTH OE EACH LINE \ D~PTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER BEN IN. ABOVE TILE__ WELL: ~,~-~/ ,~.,.,~.~/~_~. /~-,~.~2,,./~ DISTANCE FROM ,~---WATER TYPE ~/~'/'/~'~-~ : DEPTH .~ ''~ BU LD NG. FOUNDATION. ~- SAMPLE ..,'~ , NEAREST NEAREST Z~,,.~.~ SEPTiC ~ SEEPAGE / ~ OTHER LOT LINE /'-/, SEWER LINE ~ TANK , SYSTEM /':-~.~"~ , CESSPOOL , SOURCES DISTANCES: DIAGRAM OF SYSTEM GAAB-H D-2. HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT 279-2511 RESIDENCE ADDRESS /~'~'~ ~ LEGAL DESCRIPTION /-~' ~ MA,,,NG ADDRESS '¢2v ,Cf, P,0NE N0. LOCATION OF INSTALLATION ~¢~"~ '~"~'~'~ ~'¢-~' ~d% APPLICATION TO INSTALL: SEPTIC TANK ~' , SEEPAGE PIT ~ ,DRAIN FIELD ,OTHER TO SERVE THE FOLLOWING FACILITY ~ ~ PERCOLATION TEST RESULTS ~ ~ ANTICIPATED DATEOF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS ff'/~' ~¢~'~Y~'~ ,PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE '~,,~'~ TYPE ~!~,.z...,,.d~,~ . , ~ DISTANCES: SEEPAGE AREA DIAGRAM OF SYSTEM TYPE  HEA L'r H AUTHORITY OR LICENSED DESIgnER I certify that I am familiar with the requirements of Greater~Anchorage Area Borough Ordinance No. 28-68.: and that the with said code. above desc~ribed system is in accordance CREATER ,~.itCHOXf;-'-:, AREA BOROUGH ANCilORAOZ, hi,ASEA 99501 -- n ...... {~tion: Lot ~ ;~oc~~' ~~n Tes~: ._.__~ ~ +Jc~ Sketch '"' soil Ch~r~.::cte~ Feet ............. I t The G~ 6w boare ' // !f Yes~ At What Depth Reading Date Gross Time Depth To H20 Net Drop 104 West Northern Lights r Anchorage~ Alaska 99503 2061 Plat Status: Final Date: 7/7/70 BOROUGH: Engineer Public Works Department Sand Lake Fire Department School District Stzeet Names Tax Ag?e88or Alaska Depart~(.t--~t of Highways ~chgraga Natu~;aL Gas Corp. C~ntraI Alaska Utilities ghug~cb Electric Association CITY'OF A?~C~:~ORAGE: Fire Hunicipa! Light & Power Departmena Property Manager,~nt Officer Public Works Depar~;ent Telephone Utility Traffic Engineer Water Utility GAB Telecommunications, Ina. Matanuska Elect~:ic Association ~-Iatanusk~ Telephone Association Assistant Superintendent of Mails Descwiption ~f Property: Lots 7~ 8, & 9~ Blk~ 10~ Granite View Sub. Add Nee 1-.- 0.707 ace in S~'~<~ Sec~ 9~ T12N~ R~ S~M~ Alaska~ to be designated t,oi, s ?A a 8A O~,mer: P~ja~ond Po House & May Fo House Gentlemen: P(ztition has keen reca:Lvad by the Greater Anchorage Area Borough Pla~'~ing and Zoning Commission for the p)?oposed r~srl~d~'~4on of oui,~e~t property. Attached is a copy of ~e pzoposed plat. Will you please subp~t your conmmnts in writing~ specifying any easements or other requirements that your department or agency may need. If we do not hear from you by__~.~l~Cjl~?~O ........ ~ we will asso~e that you do not wish to submit any comments. If you have no further use for the attached ..... p~u~, please retu~ it' With your comments. Planning Department MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# · _(~")\ L~ -- "~')~ -~ ~ HAA# ¥-~ ~;kc~?) ((~'~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner /'~/~, ~-~'/'~ .'7~,--~ ~//~ Day phone . ~~ IJ~- ~".. ~. ~ , ~. ~ Mailing aaares~ :.~1%~ , ,~ ~, ,~,,- ~-~ ~ -~.~ .... :~-' ~ Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~'~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- 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, 1191) Front MOA#21 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. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~.~ ~,~74~ ~ ~'~-cF'~/''~L° ~ ~'~.~Phone D~HS SIGNATURE Approved for~'~__~ bedrooms. Disapproved. Conditional approval for bedroOms, with the following stipulations: Additional Comments Date The MunioipaliW of Anchorage Department of Health and Human Services (DHH$) issues Health Authority Approval Certificates based only upon the representations given in paragraph § above by an independent professional engineer registered in the State of Alaska. The DHH$ does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH$ 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 p?ofemsional engineer's work. 72-025 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ,,/~'~ ~ Driller Cased to ¥' Casing height Wires properly protected (Y/N) ~Y' Date of test Static water level Well flow Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line '~ AT INSPECTION .g.p.m. 3 ,,' '~ ; On adjacent lots ; On adjacent lots WATER SAMPLE RESULTS: Coliform ~) ~'~ ~ Date of sample: ~-~:~ '-¢~;~ B. SEPTIC/HOLDING TANK DATA Date installed / ~' ~)~O MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Cleanouts (Y/N) r'"~ Nitrate 1993 RECEIVED Public sewer manhole/cleanout /'~2c~ Petroleum tank Other bacteria Collected by: Tank size ~' d}O Eo ~-~/ Foundation cleanout (Y/N) --- ~ Compartments Depression (Y/N) ,,~,,// High water alarm (Y/N) ~ Date of pumping /V[,~ ',/' ~' ') ? :~ Alarm tested (Y/N) ~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ~-~ l?[ . To property line '~---~ Absorption field Sudace water/drainage On adjacent lots Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons ~ Vent (Y/N) High water alarm level Meets MOA electrical codes Manufs~urer~'/~ M~C'~hd]e/Access (Y/N) "Pump on"level-aL ~ "Pump off" Level at SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length Width [ ~"( Gravel thickness System type -~c~ ~ Total depth ;// Total absorption area ~[. '~ -&--- Cleanout present (Y/N) ~' Results (pass/fail) ~'~¢? ~ ~-~-~ for ~ / -/~d.' tC,gf¢/'Aftertest If yes, give date Date of adequacy test ~' Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Depression over field (Y/N) -/~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: / Well on lot To building foundation On adjacent lots Sudace water ,/,,/ Curtain drain ,/'~/") E. ENGINEER'S CERTIFICATION On adjacent lots ~ //CP ¢~ / Property line To existing or abandoned system on lot Cutbank ~ ©/3 ~ Water main/sew/ce line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineers Name HAA Fee $ ..~OO Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 ~3/93~' Back NORTHERN 3330 INDUSTRIAL AVENUE 2506 FAIRBANKS STREET TESTING LABORATORIES, INC. FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA James Sizemore and Associates Collected by: J Sizemore Sample Type: Routine Untreated Method of Analysis: Membrane Filtration Public Water System I.D.~ Date Received: Date Analyzed: Date Reported: Next Sample Due: 9/93 Comments: S = U = POS = ND = TNTC = CG = HSM = SA = Old = Comments: R = NT = 08/31/93 Time Received: 11:40 08/31/93 Time Analyzed: 17:00 09/02/93 Time Reported: 16:06 Satisfactory Unsatisfactory Positive Test Result None Detected Too Numerous To Count (>200 Colonies Confluent Growth Heavy Sediment Masking, Results May Not Be Reliable Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Sample Age >48 Hours, Too Old For Analysis Resample Required No Test * # Colonies/100 ml ** # Colonies/mi Sample Sample Total* Fecal* Other* HPC** 1 ~c~i~ande View Subd ~i~1/93 ~i~2 ~i08 ~orm ~lifo~eria ~sult S Comments Susan C. Tifental Microbiology Supervisor '~J~[PARTMENT OF ENVIRONMENTAL CONSERVAI'~'N APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION LOt, BlOCk & Subdivision or U.S. Survey This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water sample was tested and found to meet Department of Environmental Conservation drink- ing water standards for total coliform bacteria. ~ x~-.5~ ~.- V,/EZZ. '-- ~ ~/-~'~'~.,~ F:'"~'~4~-.~' ,~'-~' Date WAST EWATER DISPOSAL The domes"~,.stewater system was: . ~ [] inspected by the. Department of Environmental Conservation~wd found to be in compliance with applicable requir'e~s of 18 AAC 72; ~ [] inspected bye Profess"k~nal Engineer who certifie.~A~at the system complies with applicable re- , quirements of 18 AAC 72~,,, J. [] installed by a Certified Installer'W~o cert~ system complies with applicable requirements of 18 AAC 72; or ~/ i [] tested ~hat the performance of the system is satisfactory and that the system c~_l' with the n~_imum separation distances specified in 18AAC 72. Thisapproval~al I single family U ~amily unit with a total of .__ bedrooms. Name ~ ~ . Date 18~0404 (Rev. 8/85) DISTRIBUTION: WHITE--BANK/LENDING INSTITUTION; CANARY--APPLICANT; PINK-'DEPARTMENT ANCHORAGE/WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 1334 / ANCHORAGE, ALASKA 99503 · STEVE COWPER, GOVERNOR 563-6775 June 1, 1988 James Sizemore & Associates Attn: James F. Sizemore, P.E. 6410 Switzerland Drive Anchorage, AK 99516 SUBJECT: Lot 5, Block 7, Granite View Subdivision, Anchorage (8821-FA-076) Dear Mr. Sizemore: The Department has reviewed the plans on the subject property. The well meets the separation criteria required in 1971. Therefore, we are approving the system based on former regulations. This approval is valid for two single family residences connected to this well. If improvements or additional connections are made to this well, additional approval must be obtained through this office. Sincerely, SWE:sa cc: Clifford Ellis NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 ° FAX 4.56-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 J Sizemore 6410 Switzerland Drive Anchorage AK 99516 Attn: - Report Date: 08/23/93 Date Arrived: 08/13/93 Date Sampled: 08/13/93 Time Sampled: 1020 Collected By: JS Our Lab #: A125300 Location/Project: - Your Sample ID: L4B7 Granite View Sample Matrix: Water Comments: Lab Number Method Parameter Units * Definitions * B = Below Regulatory Min. H = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Date Date Result * MDL Prepared Analyzed A125300 EPA 353.3 Nitrate-N mg/1 <MDL 0.1 08/13/93 Reported By: Susan ~: T~ental Microbiology Supervisor NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456 3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA James Sizemore and Associates 6410 Switzerland Drive Anchorage AK 99516 Public Water System I.D.# Date Received: Date Analyzed: Date Reported: Next Sample Due: 08/13/93 Time Received: 11:30 08/13/93 Time Analyzed: 17:00 08/17/93 Time Reported: 10:42 Collected by: J Sizemore Sample Type: U Untreated Method of Analysis: Membrane Filtration Comments: S = U = POS = ND = TNTC = CG = HSM = SA = Old = Comments: R = NT = Satisfactory Unsatisfactory Positive Test Result None Detected Too Numerous To Count (>200 Colonies) Confluent Growth Heavy Sediment Masking, Results May Not Be Reliable Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Sample Age >48 Hours, Too Old For Analysis Resample Required No Test * # Colonies/100 ml ** # Colonies/mi Sample Sample Total* Fecal* Other* HPC** ............... ..... .... 1 L4 B7 Granite View 08/13/93 10:20 AB2117 0 NT / 12 ~ NT S Subd ~ Susan C. Tifental Microbiology Supervisor DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date / / MUNICIPALITY OF ANCHORAGE GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO sUBMITTAL) (a) Legal Description (include lot, block, s.ubdivision, section, township, range) Location (address or directions) ~._.~_ A;. C_; ?c. 1 ~ .. ~ r 4 ,4->. (b) Property Owner '~"" C ~/; '~'~. ~ ~, ~,/~elephone: Home-~/-~-/.¢ --: ~usiness ~~,~O Mailing Address ~%~ ~ ~0 ~'~~. Q~3-qfi~ /. (c) Lending Institution Telephone Mailing Address. (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here I-], if hold for pick up. List contact perso~ and day phone number below. /~ r-. c /:r 'p.'p" .~.. ///._~ _ .~-,$ ?-..-,..~ ~ c::, © TYPE OF RESIDENCE Single-Family ~, Number of Bedrooms WATER SUPPLY Individual Well [] Community,,~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting'to the legality and status. Page 1 of 2 72-025 IRev 8~'86~ Front '~JO~A S,JO@U!~iUO leUO!SSejoJd oql u! sue!ss!we Jo s Jo J Jo JoJ elq!suodsoJ leu si obeJoqou¥ ~o ,~l!led!o]unbl eqJ. 'ponss! s! e~eo!~!l~eo e eJoJeq elep eZAleUe to suo!~o@dsu! ~onpuoo ~ou op SHHQ jo so@Aoldwq 's~uouueJ!nboJ o~els pue leJopoJ u!epoo Ajsjles o~ JopJo u! suo!~n~!~su! 5u!puol J!aq~ pue sowoq jo sJoseqoJnd o~/%o~Jnoo e se sjqi seep SHHQ oqJ_ 'e~tselv jo o~e~S aq~ u! peJa~s!baJ Joau!bu@ leUOiSS@~oJd ~uopuod@pu! ue ,~q @^oqe ~; qde~beJed u! UOA!8 suo!lelueseJdaJ oq~ uodn /~lUO p@seq so~eo!¢!pao leAoJddv A~Moq~nv q~leaH sanss! (SHHQ) seo!AJeS ueu~nH pue qlleeH jo iuoualaed@o obeJoqou¥ jo Aliledio!un~N oql NOllllYO leAoJddv leUO!~!puoo Jo SWJOJ. leUO!~!puoO pe^oJddes!Q ,,~ po^oJddv ~-. Jo~ poAoJdd¥ 'l'¢A 0 I::ldd Y SHHQ MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Leg _, Description: /-'¢ WELL DATA Well Classification if A, B, ~D.E.C. Approved (Y/N)~~~ / Well Log Present (Y/N) //~/t Date Completed J? ~'? Total Depth Cased to Depth of Grouting Static Water Level ~/~ ¢, ? Pump Set At Casing Height Above Ground J ¢~- // Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead Electrical Wiring in Conduit (Y/N) Separati°n Distances fr°m Welh /~/_.,!.~,~. ~(L%///bG~(~ To Septic/Holding Tank on Lot -' ~ 3_ ~ (2') ;On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Lin~ '-/~)tC:~t L"'b.) To Nearest Public Sewer Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot J-~.~ ~ "~7-. ~_.~-'/¢ ~/'-'~ ;Date Water Sample Collected by Water Sample Test Results G_--~ ."~; 5 2Od~ C '-/(- _~¢) ,F"- y Comments ¢ B. SEPTIC/HOLDING TANK DATA Date lnstalled {~"~::)~) Size l~)(OO~) / (~ No. of Compadments ~ Foundation~ :. ~ Standpipes(Y/N) ~ Air-tightCaps(Y/N) ~ ~ ~'' ,_ ,~__ ~%~ %~ ~umpin~/Maintenance Contract on File (Y/~) HolOm~ Tank Hloh-Water Alarm (Y/~) Temporary HolWn~ Tank ~ermit (Y/~) Separation Distances from Septic~Hol~no l~nk: ~ ~ To Property Line ~ ~ ~V '1%% Disposal Field ~ ~'~' ~ TO Water Main/Service Line To Stream, Pond, Lake, or Major Drainage ourse Page 1 of 2 72-026(1~/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata /"~"'~ ~Y(¢/~, Type of System Design Date Installed ~)C''Fr Z / ¢~'~(¢~ (~ Length of Field ,~ ~ ~ Width of Field / ¢'¢'/~ /~ // Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Depth of Field ~2 Gravel Bed Thickness '~..~ ~'~ Standpipes Present (Y/N) Y ~ Date of Last Adequacy Test ~ ,-.~-Y Separation Distance from Absorption Fie,LC: To Water-Supply Well /~! (~ To. Building Foundation 7-~- .'~ [' Lot ~//~."J ~ ///'2 ~ To Property Line / ~:' ~ To Existing or Aban~d System /,,o //--/-- ; On Adjoining Lots ~ ~- ~ . 3.) on To Water Main/Service Line ,~ ('0 ~ %f=:' To CutbankLif pC'esent) ~f~/O~'~__ C To Stream/Pond/Lake/or Major Drainage Course ~-"~/(:~;~/"')~..~~~ ~~ ~~ To Driveway, P~king Area, or Vehicle S~orage Area __ ~ . ~ D. LIFT STATION Date Installed Dimensions ~s Manhole/Access (Y/N) ~ "Pump On" L~% '~1 at High Water Alarm Level at ~~ Vent (Y/N) Tested for Electrical Codes ~ Comments cles during Adequacy Test, Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that.) have chec. b)ed,(~erifie¢, or conformed to all M dA and HAA guidelines in effect on the date of this inspection, Signed ~¢'..-~~ Date Receipt No, Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) NORTHERN TESTING LABURATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479-3115 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT ,~ PUBLIC WATER SYSTEM I.D. [] PRIVATE WATER SYSTEM Zip Code SAMPLE DATE: J~ ' II --_~"~hone ~ /--~--/~7~_ Mo. Day Year Purchase Order No. SAMPLE TYPE: [] Routine [] Treated Water [] Special Purpose [] Check Sample (for original contaminated sample with lab reference no. Sample TimB Location Coll~'ted .Untreated Water ) Collected by ~Laboratory Ref. No. 10 Signature of Representative CASH CHARGE TO BE COMPLETED BY LABORATORY Received at: ~'Anch. [] Fbks. Date Received %'~//5/¢~ °C/ Time Received /O ,~ O Next Sample Due T~,-4'L~ ~'~J/ COMMENTS: SATISFACTORY S~ UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Verification Final Count LSB BGB Result* *No. of Total Coliform ~olonies per 100 mis. Rep°fred b~---//V 0~ Date 1~3o Time 600 UNIVERSITY PLAZA WEST, SUITE A 2505 FAIRBANKS STREET FAIRBANKS, ALASKA 99709 ANCHORAGE, ALASKA 99503 907-479-3115 907-277-8378 Quality Control Report Client: ID#: James Sizemore & Assoc. A051188-16 Listed below are quality control assurance reference samples with a known concentration prior to analysis. The acceptable limits represent a 96% confidence interval established by the Environmental Protection Agency or by our laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at the same time as your sample, ensuring the accuracy of your results. Sample # Parameter Unit Result Acceptable Limit EPA 378-12 Nitrate-N mg/1 7.32 7.17 - 8.01 Francois Rodigari, Anchorage Operations Manager 600 UNIVERSITY PLAZA WEST, SUITE A 2505 FAIRBANKS STREET FAIRBANKS, ALASKA 99709 ANCHORAGE, ALASKA 99503 907479-3115 907-277-8378 James Sizemore & Associates 6410 Switzerland Drive Anchorage, Alaska 99516 Attn: James Sizemore Page 1 Date Arrived: 5/11/88 Time Arrived: 1025 Date SM.pled: 05/11/88 Time Sampled: 1000 Date Completed: 05/16/88 Source: Lot 5, Block 7 Granite View Sample ID#: A051188~16 Parameter Unit Result ADEC MCC* Nitrate-N mg/1 0.02 10 Francois Rodigari, Anchorage Operations Manager * MCC = Maximu~n Contaminant Concentration STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION Lot, Block & Subdivision or U.S. Survey . ~ - .-_.;/;:?:..;-:- ." . i. - .' ~': ~. . - '.- '" / o% ..5, 7 Certificate Issued for Application -- This approval does not co ~stitute a guarantee.of.any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. - . - WATER SUPPLY -A recent ~/ater sample was tested and found to meet Department of Environmental Conservation drink- lng water standards for total coliform bacteria.~._:L.,,~.S~' C- . ~/E/.Z. -- ~ ~/.,J~L.~ ~-'¢-~/~-,;~' ',~E'--f/~'-~ Date · . WASTEWATER DISPOSAL The wastewater system was: ' '" I--I. insl Department of Environmental Conservation applicable ~ents of 18 AAC 72; - [] inspected by a nal Engineer wh¢ quirements of 18 AAC - [] installed by a Certified of 18 AAC 72; or .. ......-'r~'..'.~'' :.':~.~':~. -- '.--' .... ..... ~ tested~by ~ Prof~Sione~l Eng~ii' and that the the This approval is vail( [] Sin(. Name ,nd .to be in compliance with '" the system complies with applicable re- hat the system complies with applicable requirements ifies that.tl~e performance of the system is satisfactory imum separation distances specified in 18 AAC 72. Itl-family unit with a total of ' · - bedrooms. Date 18-o4o4 ('Rev. 8185} DISTRIBUTION: WHITE--BANK/LENDING INSTITUTION; CANARY--APPLICAN'~ PINK--DEPARTMENT