HomeMy WebLinkAboutDENALY BLK 1 LT 22D
naly
Block
Lot 22
#067-041-28
Permit Number:.
Name:
CARL KAPPEN
Address:
DENAINA DRIVE* EAGLE RIVER, AK 99577
Phone: No. ef Bedrooms:
(907) 622-5585 4
LEGAL DESCRIPTION
Block: Lot: Subdivision:
1 22 DENALY
Towr~hlp: Ronge: Section:
WELL: · New
Ck=~r,~k~ (P.~.. A.e,c~.
PRIVATE
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904
On-Site Wastewater Disposal System and/or Well Inspection Report
SW020151 PD Number:. 067--041--28
I-I Upgrade
202 rL 200.39
M-W DRILLING 7/1/2~02 0
25+ ~ UNKNOWN rL 2
Well 100°+
Wastewater System: II New
Page 1 of 3
[] Upgrade
ABSORPTION FIELD
t'lDeep Trench I.Shollow Trench abed rlMound ~30~her
1.0 ~o/s~ r~ 6.0-7.17
1.97-~.14 ~ 4.03
1.47-2.7 n 60
5 ~ I -
600 m~ D 3034/ F-810
DICK M~ERS ~ ~/19-21/02
TANK
SEPARATION DISTANCES .s.puc =.o,=ng OS.T.~.. ao~.r
F'mM Station Tank ~/~'~ ANCHORAGE TANK 250
100'+ - - 25'+ ~ STEEL ~ '~ 2
Surface Water 100'+ 100'+ -
Lot Une 5'+ 10'+ -
Foundation 5'+ 10'+ --
Curtain Dmln NONE KNOW~
Remarks:
LIFT STATION
BENCH MARK
BOTfOM OF MANDOOR NEAR POINT
Inspections performed by: AKWWC, INC. Dates: 1st 6/19/2002
2nd 6/21/2002
3rd 6/21/2002
Developme.n.~ Services Department Appro.v. al
5W020151
\\\\\
AS- BUILT D RAWIN G
NEW 1250 GALLON
SEPTIC TANK
NEW DRA~NFIEt. D
.--- /
/
/
/
I
I
5T1
DBL1
DBL2
C01
MT1
C02
MT2
40.57
41.24
60.47
61.20
67.12
66.57
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
:'*REPAR£D FOR: PIION[ NUM~[R:
CARL KAPPEN & ASSOCIATION (907) 622-5585
DENALY SUBDIVISION; LOI 22, BLOCK 1,
AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
PARCEL ID NUMBER;
067-041-28
/
//.~/
/
/
/
/
/
/
/
10/15/2002
C.J
1" = 40'
20F3
PERUff
5W020151
AS-BUILT PROFILE DRAWING
TOP OF TANK AT-.% ~
INLET - 94.86 ~
/
INVERT OF BUNG-.~
AT INLLr~ - 94.34
fiNN.
U
GRAD;' . 99.92
~---TOP OF TANK AT
OUTLET . 94.86
NEW 1250 GALLON
SEPTIC TANK ~. ~.m' or BUNG
Ot~.L'T -
PARCEL ID NUMBER:
067-041-26
-~---RELAIW[ [~"VA'IION OF BoTrou OF
T~THOLE - 82.87 ("I'ESTH0IF DRY)
ALASIGk WATER & WASTEWATER
CONSULTANTS, INC.
PREPARED FOR: PHONE NUMBER:
CARL KAPPEN & ASSOCIATION (907) 622-5585
D£NALY SUBDIVISION: LOT 22, BLOCK 1
PROFILE AS-BUILT OF NEW SEPTIC SYTEM
DA"r[:
10/15,/2002
DRAWN BY:
C.J.G.
$CN..~:
N.T.S.
PAGE NUMBER:
30F5
~ '-KI:PPEN I-EVES FRX NO. :907-622-5~1~6 ~p. 27 L:~O2 11:17P~1 1'2
M-W brillin!l, 'mc.
tP.O. Ilex [[037BeAnchor,ge, AK g95tte
eg07-345-4000 · g07-3 ~5-3~B7 Faxe
Job ~Io.: G2.I43
Project No.:
Permk No. SW 02o16!
Groundwater Well As.Built & Lo~
· Well Owner:
· Le$ol Dr~crlptlon:
K6pl~n Homes ~ ·UseefWell:
Denaly Subdivision, Block I, Lot 2;
Eagle River, Alaska
Domestic
Construeti¢ !!
llole Dep#~: 202' e C~lng Size: . 6" · Case l To: 200.39' · Maledal:
e Ddll Method: Air Eotnv]
.... Perf.
Well Compl~ion- Op~ ~d X Screen )~oraled Mahod:
e Scree~ Peffor~tlon descr~tlon: None
*Grout Not~: (7) Jackt- No. ~ ~ntonite ~u es
~ Not~:
A 53 Steel
· WelIDe~elol;ment: Method: Air Surge
e Searle water level ($WL) ~ (M~eee) (below) t,,p o/e~slng CTOC).
· WellyleM test al 25+ gallon~ per minute (CPM)/~ ellaa, Fee hou, (CPll)for I
· Method: Air
· Dale ofcampleSo#:
Depth in feet from
0 TO 2
2 TO
S TO 39
39 TO 51
51 TO 70
70 TO 122
122 TO 182
182 TO 192
192 TO 199
199 TO 202
TO
TO
TO
TO
TO
TO
TO
01 July 2002 · Pump Install:
Well Log
Details of forma6ons penetr titS, size of material, eolor and hnrOne~.
Casing stickup
Fill
Sandy._grav~l: cobbles
Silty: brown
Gravelly silt: gray
Silt: g_.my, hard, dry
Clay
Clayey gravel
Sandy gravg..l: wet
Water bearing_gravel and c.c~,b]
MUNICIPAUTY OF ANCHORAGE
Development Services Department
On-Site Water & Waslewater Program
4700 Soufh Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAl. SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jun 07, 2002
Expiration Date: Jun 07, 2003
Permit Number:. SW020151
Legal Description: DENALY I~LK 1 LT 22
Design Engineer. 0001 AK Water & W~stewater Consul[an'
Owner Name: Carl Kappen
OwnerAddress: PO Box770489
Eagle River, AK 99577-
Parcel ID: 067-041-28
Site Address:
Lot Size: 40189 SQ. FT.
To[al Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:.
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
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 ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either. A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date: ,//?/~ ~
Municipality o.f ~nchorage
Development Servlc~es Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel I.D.
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
7-Oql-c ? Permit Number
Property owner(s) CARL KAPPEN
Day phone
Mailing address (1) P.O. BOX 770489 EAGLE RIVER. AK
Mailing address (2)
Zip Code
Legal description (Lot, Block & Sub'd.) LOT 22. BLOCK 1: DENALY SUBDIVISION
Legal description (Section, Township & Range)
Lot Size ~://')1 ~ ~' ~' Ac~e~
?HIS APPLICATION IS FOR;
Sewer Only
Sewer and Well
Sewer Upgrade []
N,/A
Number of Bedrooms
622-2719
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
99577
4
Well Only
Water Storage
Jacuzzi
Water Softening Unit
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
ALASKA WATER & WASTE'WATER CONSULTANTS, INC.
(Signeturc of propcrly owncr or outhorizcd egcnt)
Permit Fees:
Date of Payment:
Receipt Number:
Waiver Fees:
Date of Payment:
Receipt Number:
ALASIG WATER & WASTEWATER
CONSULTANTS, INC.
June4, 2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragraw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Proposed and Well Septic System Design for Lot 22, Block 1, Denaly Subdivision
To whom it may concern:
The proposed 4 bedroom house will be served by a private well and septic system. A test hole
was excavated in the area of the proposed septic system. The proposed septic system will be
designed around the 30 foot radii of these test holes. We are proposing that a 1250 gallon septic
tank and a five foot wide drainfield be installed. Comments regarding the proposed design are
summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that an application rate of 1.0 gallons/day/ft:
should be used.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate: 1.0 gallons/day/ft2
c. Number ofBedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 600 ft2
f. Total Depth: 7.5 feet (max.)
g. Effective Depth: 4 feet
h. Width: 5 feet
i. Reduction Factor: 0.50
j. Minimum Length: 60 feet long
k Effective absorption area = 600 ft2
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
3. SURFACE WATERS: There arc no surface waters within 100 feet of the proposed septic
system.
4. TOPOGRAPHY: The area for the proposed septic system is a 5%-10% slope running
approximately northeast to southwest; in short, there are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
Sinceretb/, ~
'S'pres~de~if~
NOTE: ,4ttached is a site plan drawing, a design drawing, two soils log, and a 7 page
construction specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
6/5/2002 ~,.~- b"~ ~"
......................... ~ ~: ~x .' /11 L ".~h
AI~sI~ ~I'ER & ~STEWATER ~ J.L.M.
CARL KAPP[N · ASSOCIATIO~ (907) 622 5585 1 OF 2
~u~ ~u~ws~ou. [0~ 22. ~ocn ~
~E OF WORK:
SITE P~N FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM
INSTNJ. I~)UNDA"TION
INSTA~ DOUBLE
\
\
..-/
/
/
ALASIr~ WATER & WASTEWATER
PROPOSI~ 1250 GN. LON
$(P11C TANK
\\
/
/
/
/
/
/
~/~/~oo~
(;.J.G.
1" = 40'
CONSULTANTS, INC.
CARL KAPPEN &: ASSOCIATION 622-5585 2 OF 2
DENALY SUBDIVISION; LOT 22, BLOCK 1,
DESIGN DRAWING FOR PROPOSED WELL AND SEPTIC SYSTEM LOCATION
PROPOSED DRAJNFIELD.~CAVATE A
TRENCH 11~T IS 7.5 ttz~ DEEP Iff
5 t~l WIDE BY 60 FEET LONG.
ADD 4 ~u:.l OF C~..~. WASHED
SEWER. DR~NROCIC INSTALL 11~E~CH
pAR,~ t n TO SLOPE CONTOURS.
~?.:"...~ ...... '" ~2~
ALASIC k WATER & WASTEWATER
~G~ DESCRI~ON: D~Y $UBD~SION; LOT 22, BL~K 1, ~
PERFORMED FOR: ~L ~PEN DATE: 5/29/2~2
, ~ ML ~EST HOLE ~11 '~<~
B,0.II.
15--
SOIL CLASSIFICATIONS
ORG
~ GP ~ ME
GM CL
6C OL
SW NH
SP CH
SM OH
SC
DEPTH TO
GROUNDWATER DATE
DRY 5/~9/2002
DATE
5/30/2002
READING CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
2 - <1 O' 6"
3 - - B" -
4 - <1 O" 6"
6 - <1 O" 6'
16--
17--
18--
19--
20
SOILS LOGGED BY:
COMMENTS:
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA.
TEST RUN BETWEEN 6.0 FT. AND 6,5 FT.
A FOUR HOUR PRESOAF. WAS PERFORMED: r-]YES m NO
JODY MAUS PERCOLATION TEST PERFORMED BY: CALEB CALL
PERFORMED BY AKWWC, INC. Io JEFFREY A. GARNESS, CERTIFY THAT THIS )VA~ PERFORMED
WITH ALL STATE AND MUNICIPAL OUIDEUNES IN EFFLCT ON THIS DATE:
6 (iNCHES)
IN ACCORDANCE
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorag e.ak.us
(907) 343-7904
O
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 067-041-28
1. GENERAL INFORMA'rION
HAA# j--/
Expiration Date:
Completelegal description DENALY SUBDIVISION; LOT 22, BLOCK 1,
Location (site address or directions) DENAINA DRIVE * EAGLE RIVER, AK 99577
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CARL KAPPEN &: ASSOCIATES Day phone 622-5585
P.O. BOX 770489 * EAGLE RIVER, AK g9577
Day phone
Day phone
Un/ess otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-s~te
Public Sewer
The Municipality of Anchorage Development Services Depadment (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Cedificates may be reissued for a period of up to one year with vahd
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a pubhc
system. The Municipality of Anchorage is not responsible for errors or omissions in lbo profess,ona~ engineer s
work.
IVote: Alaska Water and Wastewater Consultants. Inc. shall be paid $ at. or pnor
to closing for the engineenng services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As codified by my seal affixed hereto and as of the validation date shovvn below. I verify that my
investigation, based on procedures outlined in the Health Authority 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 f~les 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 ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone ,357-6179
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, A.K 99504 ,
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation. AKWWC. Inc. attempted to provide a thorough.
conscientious engineering analysis of the system in accordance with ADEC e.'~d 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, groundwaler levels that may
fluctuate during the year, and the water usage of the family being served by tl~o system.
These conditions are outside the control of the eveluator of the system. Satisfactory test
results do not guarantee future performance of tfle system, nor de they guaranlee that
there are no hidden defects or encroechment$. AKWWC, Inc. can there[ore 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 re, cart by any
other person or party is not authorfzed, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
J-'/'"' Approved for ~ bedrooms.
Disapproved.
Conditional approval for __
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
bedrooms, with the fllowing stipulations:
,,~,,~
·
.....--.
~ ', vdASTEWATER,
'~ '-.. ?ROg,q~,~,l ..:
Manitenance Agreements :~,~?,~,'HT S~-' ~' ,'?
Supplemental Engineer's Reort
Other
Odg[nal Certificate Date: / I -- / c~. ~, ,,,2....
Municipality of Anchorage
Development Services Department "- "
6uadmg Safety D~vtslo. '
On-Site Water & Wast~water Program
4700 60ulh Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
WWw.ci.e nchorage.ak.us
(907) 343-79O4
Legal Description:
A. WELL DATA
HEALTH AUTHORITY APPROVAL CHECKLIST
DENNY S/D; LOT 22, BLOCK 1, Parcel ID:
Well type pRIVAI[: IfA, B, or C provide PWSID~ N//A
Date completed 7/1/2002 Sanitary seal (Y/N) YES
Total depth 202 ff.
Date of test
Static water level 0
Well production 25+
WATER SAMPLE RESULTS:
Coliform ~} colonies/100 mi.
Arsenic: N/A mgJL.
SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tanksize 1250 gal.
Cased to 200.59 ff.
FROM WELL LOG
7/1/2002
Foundation deanout (Y/N) .,YES
Date of pumping NEW
ABSORPTION FIELD DATA
067-0¢1-28
Wall Log (Y/N) YES
Wires property protected (Y/N) YES
Casing height (above ground) 24+ in.
AT INSPECTION
ft.
g.p,m, g.p.m.
Nitrate 0,~ mgJL. Other bacteria (~ cctonies/lO0 mi.
Data of sample:10/14./2002 Collected by: AKWWC, INC.
STEEL Date installed 6/19-21/02
Number of Compartments .2 Cleanouts (y/N) YES
Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Pumper -
PB[I.OW fiNN. ~]
System type TRENCH
Gravel below pipe 4.03
Depression over field
Data installed 6/19-21/2002 Sctl rating (~or ff~rodrm) 1.0
Length 60 fl. Width 5 fl.
Total depth ,&6,~ .ff. Eft. absorption area 600 ff~ Monitoring tube YES
Date of adequacy test NEW Results (Pass/Fall) -
Fluid depth in absorption field before test - in. Water ad~ed - gal.
Elapsed Time: - min. Final fluid depth - in. Absorption rate >=
Any rejuvanation.treatment (past 12 mo.) (Y/N & type) -
NO
For 4 bedrooms
Now depth - in.
- g.p.d.
If yes, give data -
O. LIFT STATION
Date installed Size in gallons Manhole/Acc~:o (Y#,I)
"Pump on" level at in. 'Pump off' levgl at In. High water alarm level at
Datum Cycles tested Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/claanout N/A
Sewer/septic service line 25'+ Holding tank N/A
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:
Pmpen'y line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Sudace water 100'+ Driveway, parfdngNehide storage 10°+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Munic/pal records that the above systems are in
conformance with MOA HAA guidelines in effecf on thia date,
Engineer's Printed Name JE~-i-I<EY A. GARNESS
Date
HAA Fee $ .~,~1'.;~'. "--
Data of Payment
(Rev.
in,
Waiver Fee $
Date of Payment
Receipt Number
OCT-21-OZ 10:38/Ua F~T&E ENVII~flI~KTAL SRV
.~E CT&E Environmental Servlce~ Inc.
9075515~01
T-331 P.OZ/03 F-552
Cf&l: Ref.~
Client l~ame
Pt~Jecl Name~
Client Sample ID
I)WSID 0
Sampte Remark:
1026922001
AK Water & Wnatewater Con.~ltants Inc.
Denalv S/D; Lot 22, Block l
Denaly S/D; Lot 22, Block 1
Drinking Watcr
All Dates/Times art Align Standard Time
Printed Date/Time 10/21/2002 8:51
Coll~tt, d Date/rime 10114/2002 8:37
Received Date/lime 10/14/2002 12:15
T~hnleal Dlrettor
Relen.~ed By ~~
Rtaulla PQL Units
Allowable Prep Am~tysi~
Limits Date Date Init
Nitrnte-N
0.200 U 0.200 mg/L EPA 300.0 (<~101 I0/14/02
JS
Total Coliform TNTC OR
col/lOOmL SMI8 9222B
10/14/02 YAP
CT&E Environmental Services Inc.
; . H/'" ;' '" ,... ", 200 W, PoUer Drive
Drinking Water Analysis Report for Total Coliform' Bacteria ^.cho~.,. ^K.S,S-,60S
Tel: (907) 562-2343
READ INSTRUC270NS ON REFERSE ~DE BEFORE COr.~.FCTING SAMPLE Fa~: i907) 561-5301
MUST Be
P~VATE WATER SY~M
. CONS~T~; ~C,
~CiI~P.',~E, tgl
TO BE COMPI,~-TED BY LABORATORY
Anal¥~i$ zhowa dii~ Water SAMPLE to
Satisfactory
Unsat/.s factor/
O Sample over 30 hours old, results may
be unrdiable
O Sample too long m transit; ~ample should ' '
not be over~)hours old at examination ; .... j
to indicate reliable results. Please send
ample v/a special del ail. · :
'' ,,..i ' 7' ne~s i~ .
Time Reselved -- z..t' O ' :.
Analysis Began
Analyiieal Method: '~-Mem'orane Filter
'o hIMO-MUO :
· Number ofcolon/es/lO0 m{.
Result* Analyst
~ 102B~!22
I:
Treated Water ..... .ach I~oks 3un ~'~
Untreat~ Water
II
Time:
T~me Collected Client notified of unsatisfactory results:
· Cofietted By
Phoned Spoke with,
Date: Time: ,
Fazed
Faxed
Month : . Day
SAMPLE TYPE:
O Routine D
n Repeat Sample (for ~'o~flne sample ~/
with'lab ref. no. '.)
{3 Special Purpose
SAMPLE LOCATION
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Remit:. Total C~liferm ~ CMl.
Membrane FHter: Dlrte, Couut 'T',&)'~ ~_~ ~oloal~/lio m,
Verification: LTB ~GB COLIFIRM
Fetal Coliform Conflrmotiou ~09~JL~"/-~ .
~ ~E~GS Mnml~r of ~he SGS Grou~ ISociM, Gdndrnle de Suw~lllence)
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA. ILUNOIS, MARYLAND. MICHIGAN, MISSOURI. NEVi/JERSEY. OHIO. WEST VIRGINIA '
G su]s~]~J~G
$221
~ : K~PI~N HOI~S
~tt §¥; I~A-A~UIN & HI~i
;
i
~EN'T BY: IlEA ADMYN
I
NO. :9{37-622-~--~36 Oct. 2~ 213~2 11:141:~1 P~
71! 134~; ~T-I~-0~ 'a:41PW~ f~ Ih~0
BY:.
'1
:
II'ATI{ 0{= .~L.A&'(A i :
NOTARY PUBLIC
PA'I'R1CL~ A.
I~,l~m'l~. IIE~F O BOX~n,.p~u.~q~. A~S~CANS4~
I
:
FROH :ICeFFEH HOI~ES FP.X HO..'9~7--622-5586 Oct. 21 2i~2 ll:SE~tl
lt~m osP Efta 907 761 26~6 ~0/18 '02 '~1:48 N0.~,93 02/03
:~biz.lllN YOUR CDIIII~ANY o-, tilt
~ NON-OBJECTION TO t~ E~OA~~~T
By ~i, ~t M,~ Tel~ne ~o~ ~c..~~ ~t ii ~ no abandon to the
e~t oft ws~ w~ ~d d~ewty w~ ~..p~.l~' Telephone · EI~c E~sement ~on
.~"'
PI~ bc ~ad ~a ~A.~ou~ &e l~*~e of~s d~t d~ not fo~cit ~y of i~ d~ to ~e ~e
b~ ~ s~ ~l~i~s ~fi~ wi~i~ ~ ~ ~y r~iir~ ~at may ~ t~r~ ~ ~
~ ~t ~&or~ ~ pI~t of ~y ~sl ~~ ~ ~ ~t u~.
This di~menc is. Ir~ no way. an aitl~e~t to v~te any porlion of ~he utili~' ts~em~t and should not bc
iMc~rctcd as such.
Issued for Matanusk~ Telephone Association, Inc. ~ 180' d~y of ~to~, 2~. ~,
~ ~s TO C~, ~ on ~s l Sd] day of~, 2~ ~f~,~ me ~e ~d~i~ a No~ Pubic ~ ~
for ~e S~ ofA~ d~7 ~mmi~{~ ~d ~m ~ su~ p~17 ~ Bo~¢ B~l~ ~o~ ~
me ~ ~ m~ ~ mb¢ ~ in~du~ n~ ~ ~d who ~t~ ~c fore~ing i~t ~d
~owl~ to me ~ he ~ ~ s¢~ ~e s~c ~ a vol~t~ ~ ~d d~ for ~o ~el ~d p~
~ m~fioncd.
llq .~W~.V~.~ff~ OF. I h~ve hereunto set my hand and of~cqal s~al the ~y
.....;2)
TM
G~-~e:.".' ~ ;~ .....
"'~'h~ '. :: ': ' '
."~'J' ·
Me~nusk~ Telephone A~6oo[etiorh Inc.
P.O. ~ox 356~ 6 Palmer. Alaska
1.e(M,744LOElD. eoT.Tel.2w10 · FdIK