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Home My WebLink AboutLAKE HILL ACRES #1 LT 130£1 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 NAME PHONE LEGAL DESCI~IPTION {/ ' LOCATION Absorption area DISTANCE TO: /00 g' ~__~._~. ' I[ ~OME~ADE: Inside length ,.. Well I Dwelling Manufacturer DISTANCE TO: We I~) No. oflines 2- IL2'/8'°~/¢c~ J~ fi~,ish grade Foun~n Tot a,~_~t ~ f Ii rt~s Material beneath tile Depth Length Type of crib DISTANCE TO: Class DISTANCE TO: Width Crib diameter Well Depth,~j ~ Building foundation epth Building foundation Sewerline [] NEW /~PGRADE Dwell~ Width Material Neare~t lot line /o ¢ Tre~c,/~ widtl/1' inches J/inches NO. OF BEDROO~ No. of compartments / Liquid depth PERMIT NO. Liquid capacity in gallons Total effective absorP~n are/ PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO, Sept c tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST INSTALLER C C C REMARKS DATE I:)E.F'AF~:TMEIq]- OF HLEAL..TH AI ,).', ~:~,",! .... Iq'._~.,, II*':.,~ 1 Al ..... F.O, EL, TION ........... T,,E ...... , AIqCHORAE)E. AK , ? ..... .... ~,',~. , t\IO; L, 4 .....ISSUED: .... N ,.-,[.,T F::'HONE: LEGAL DESCRII::'~ LOT S]:ZIE: LO'F I_.OCA]"I ON: MAX e,-.":'n,:,r" r ,~c,. C/O S & S ENG'G. CHUCK MOWRER SRB :1.96X EAGLIE RIVER, Al< 9'957'7 694-'2979 SUBDIVI'SION~ LAKE H]:LI.. ACRES :N::I. SEC]"ION: ~ TOWNSHIP: 11,51',! 17000 (S6!~FT. OR ACRES) MILE 23 OLD GLENN I..IIGHWAY :='' EiE F;~: P'",~ I; '"I[ .... LOT: 15 .... (.,~ .... NA RANGE: 1W List. ed below ar'e t. he options ava:i, table t.o you in designing y~ul' septic svsi:.em. Choose 'Lhe op'Lion tha'L best f'its,~vo~' si'Le,, DEEF:'TFI TO F'IF'E BOTT'i]M (IrT'. ) ~6, 0 GRAVEL DEPTH ¢c.-,, T, LL~. 0 ¢. ¢ O. ,, ~ o~,... 0.. 2.5 T'OTAL DEF'TH (FT',,) GRAVEL.. WiD'I'H (F:'T. GRAVEL. LENGTH (IRT,) GRAVEL. VOLLJME (CU~'¥DS.) TANK SIZE (GAl_S) SOZI_ RAT'ZNG ("36]... FT,, /BR) GRAVEl_. L..EfqG'TH > 7':~ I--'1', ,'*,=b.JiRES MLJL..T'IPLE RIJNS (NOT tEY. CE]'ZDING 75 I':'"r' lEACH) TANK MUST HAVE ¢~'1" LI::A~)I- '~"' TWO C_,hR~"E.ARI-""dENt.:~': r-c, I centif'y 'Lhat: ].~ .! alii Familiar with t. he r'equ:i, rement, s for' on..-.sit2a sewcH"s and wells as s~t for'th by the Mun:i. cipality of' Anchcmage (MOA) and 'Lhe S'l:.a'Le c~f' A:l. aska(, 2.,, I will inst. all t. he syst. em in ac:cordar~c:e t.~i:l:..h a].]. MOA c:ades and and in compliance ~.¢J.%h the des:i, gn'c:pitepia o¢ th:i.s per'mit, 3. I will adhet*e t.o all MOA and St. ate of Alasl.::a r. equirement, s For' 'Lhe set back sewerage !~iysi:.6.)m c~t't '!:.his or any ad.ja(:E~rlt, or I]ear'by ICH:.. 4. I undel*stand that this permit, is val:i.d for a maxiFaum (:)F 4 bedrooms a'nd any enlargemeni'.. ~,;:i.].]. Pequir'e:, an additional pEn"mit. ]:F A I_:[ICT STATION IS INSTAL.LED IN AN AREA COVERED BY tflOA BUII_DING CODES, 'T'H[Elxl (1) AN EI_EC]'R]:CAL PERffl]:T AND INSPECTION MUST BE OB]"AIIqED; (2) AS-BUILTS W!M_ NO]" BE APF'ROVIED WITHOUT AN EL. ECTIRICAL INSF'ECTION REF'OFIT; AND (3) THE IEI:..IZCTIRICAi_ WI)RI< MLIST BIE DONE' BY A L..]:CENSED EL. ECTFI]:C]:AN. APP!_ICANT: DA'TIE PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 9 10 tl ,12 -13 14 15 16 17 18 19 20 COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~,.,~ERCOLATION TEST 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SLOPE SITE PLAN 14da. I,,~7-! E IF YES, AT WHAT ,. DEPTH? Gross Net Depth to Net Reading Date Time 'rime Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) ,f ET //I/// _?/ // / Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS I~a' /~ (~Ct'7~'-, /~" PHONE LEGAL DESC.,PT,ON #,/t SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH (A~i//A NUMBER OF t MANUFACTURER ~- MATERIAL (F~4t-~r-~ ~-e.- COMPARTMENTS INSIDE WIDTH LIQUID DEPTH __.LIQUID CAPACITY I~c~O GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER LINING MATERIAL l/0~ CRIB SIZE: BUILDING FOUNDATION qzl NEAREST LOT LINE OR WIDTH I'%t, LENGTH 3~ , DEPTH ~ *' DIAMETER DEPTH C~I DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT, ADDITIONAL ABSORPTION TYPE CONSTRUCTION BU I LDI NG NEAREST NEA REST FOUNDATION__ LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM DISTANCES: INSTALLED BY: ~IF PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM APPROVED ~'~/:,~. R GrEATEr ANCHOrAgE ArEA boroUgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456 ! pERMIT NO. SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT /~ ...... MAILING ADDRESS / INSTALLATION LOCATION LEGAL DESCR,FT,ON INSTALLATION OF: SEPTIC TANK .... TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED bY ~ NOTE: THIS PERMIT I$ NOT VALID WITHOUT SOIL TEST 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. SEPTIC TAN~ SiZE TYPE 7/ .~ SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE Pit . , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALE SEPTIC TANK , SEEPAGE PIT , DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK /~)~'~ , SEEPAGE PIT WATER MAIN TO SEPTIC TANK . , SEEPAGE PIT DRAIN FIELD ' SEPTIC TANK. , SEEPAGE PIT . DRAIN FIELD TO RIVER, LAKE STREAM. ~ABT iRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. ~.~CH DIAMETER CAST~HON PIPES ON SEPTIC TANK AND SEEPAGE PIT ~lTTED WITH AIRTight REMOVABLE CAPS. DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUG~LATIONS REGARDING INSTALLATION. I CERTIFY T~T I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE · ' "7i7 ' ' ' 0 Ef E EIVGINEERING E~ DEVELOHIVlENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 333-5240 Russell Oyster Earl Ellis 694-2774 333-5240 Civil Engineering Surveying Soils &' Foundations Land Development SOIL LOG Performed for: Name: ~'~7 ~._~c.,~, k~,~,v)~.~ Tel. No. Mailing Address: ~ bAT ~ ,~G~ ~ Legal Description: ~ ~ ~,~x~- ~~ ~'~,v,~ Depth (feet) 0 1 2 3 4 5 6 7 8 9 10 11 12 Soil Characteristics Ground Water Encountered: Yes Proposed Installation: Seepage Pit__ Comments: ~,-~ ~ ~~ ~ No ~/ If yes, what depth__ ~/Drain Field Performed by: Date: 0 0 0 0 0 0 0 O~ 0 0 0 C~:- ' 0 0 0 o MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) .';.. · - (b) Applicant Name ~.~ k/G.-~,~-J~'~ 'TCephone: Home Applicant Address (c) Business Applicant is (check one): Lending Ir~stitution~L.; Owner/builder [~; Buyer I-I; Other [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone ' ' :.' (f) Mail the HAA to:the !oli0Wing address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms ~Jt~-~ Other WATER SUPPLY i' .... Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department ~f Environmental Conservation attesting to the legality and status. / , , ~ ~, 4. SEWAGE DISPOSA.L' Onsite'l~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FII. E SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date ~hown below, I verify that my investigation of this Health Authority Approval 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 "~P~e.~_~_ Address [ ~'~¢(~ ~ Date '~/[~/~ Telephone Engineer's Seal DHEP APPROVAL Approved for '?(/~,'/ bedrooms by Approved ~'~..~.~ Disapproved Terms of Conditional Approval . Conditional ,il CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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· C. ABSORPTION FIELD DATA Soils Rating in Absorption Steata Date Installed Width of Field Square Feet of Absorption A~ea Depression over Field (Y/N) Results of Last Adequacy Test MUNICIPALITY OF ANCHORAGF:: DEPT. OF HEALTH & "~'~!RONMENTAL PROTECTION RECEIVED '2.-80 .~.fz- Type of System Design Length of Field I O-~ Depth of Field {4 Gravel Bed Thickness ~ '! ~.- Standpipes P~esent (Y/N) Date of Last Ac~quacy Test I~/1~/~ "'" Separation Distanc~ from Absorption Field: To Water-Supply Well i OQqu To P~operty Line To Building Foundation (~O To Existing or Abandoned System on Lot ~/)+ ; On Adjoining Lots {0'6+ To Wate~ Hain/Service Line /O TO Cutbank(if p~esent) To Stream/Pond/Lake/or Majo~ Drainage Course To D~iveway, Parking keea, or Vehicle Storage A~ea ~(~ Cou~ents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water AlarmLevel at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Zeets MOA Combatants ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of th~i~ction. ~ / ;~.*'."~'"' ' ~"%%~..' ' ~ Signed ~ ~A~{~ Date {~/17/~~ "" ~,,~""~ O~ ~/~}%~ / ' ~**~.~., ~'~'~ 'q¢~ ~ / __ ~ .': o, u '~ KB1/d5/s ~" "'~ .... '~ " ........ ~ ~ ~_~ I ~ny D. ~arier ,' ,~ ~ [ Pa ~ 20 f 2 ] 'l ~t~~~ 2-15-84 ae WELL DATA Well Classification ~u ~__ Well Log Present (Y/N) Total Depth ~ (~q Cased to Static Water Level I O 0 Casing Height Above Ground IS+ '~ Electrical Wiring in Conduit (Y/N) ~ Separation Distances from Well.: To Septic/Holding Tank on Lot {6--Onu To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HA_A) CHECKLIST - FEBRUARY 1984 Legal Description: ~ [_~ ~_~~_ If A, B, Or C, D.E.C. Approved(Y/N)- Date Completed Pump Set At Yield 50p~/ Depth of G~outing. ~ Sanitary Seal on Casing (Y/N)~ Depression A~ound Wellhead (Y/N) ~ Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot Water Sample Collected By x~ ; Date Water Sample Test P~sults Cor~ nts ; On Adjoining Lots [6~5n~ ; On Adjoining Lots To Nearest Public Sever B. SEPTIC/HOLDING TANK DATA Date Installed %qT~/[q~4~ Standpipes (Y/N) ~ Depression over Tank (Y/N) Size Air-tight Caps (Y/N) F,( Date last Pumped No. of C~_~artn~nts Foundation Cleanout (Y/N) Pumping/Maintenance Contract on File (Y/N)- ; for ~ Holding Tank High-Water Alarm (Y/N) -- - Temporary Holding Tank Permit (Y/N) ~ Separation Distances from Septic/Holding Tank: To Water-Supply Well I~f~n~ To Building Foundation ~ To Property Line IC~q- To Disposal Field 2~ To Water Main/Service Line ------ To Strewn, Pond, Lake, or Major Drainage Comments Receipt ~ Date Paid: Amount: ~r' [Page 1 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ALrI~ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 WE.r.L DATA Well Classification ~/~ Well ~ ~e~nt~ Total ~p~ ' ~ ~d to Static ~ter ~1 /'~ ~ ~ ~ ~t At Casing ~ight ~ Gr~nd /~ ~ ~-~ Elec~i~l Wiring in ~n~it~ ~p~ation Dis~n~s ~ ~11: To ~ptic~ Ta~ ~ ~t /~ ~'~ To ~a~st ~ of ~so~tion Field on ~t /~ tLi !.. I98,5 Le, gal Description: L,Z !~',i Z e /711 If A, B, o~ C, D.E.C. ,Approved(Y/N) Date Completed ~ ~Z Yield ~ ~ ~ / Depth of G~outing. Sanitary Seal on Casin~ ~_~l ; On Adjoining Lots ~ ; On Adjoining Lots To Nearest Public Sewer LiDe /3 //~ To Nearest Public Sewer Cleanc~t/Manhole /d /or To Nearest Sewer Service Line on Lot Water Sample Collected B~ff~ ~¢fl~7/~g; Date Water Sample Test Results S/~ ~T/~'/~ ~ ~. C~,~nts /~30 ~'~/~: /'- SEPTICS'TANK DATA // Date Installe~d ./¢'1~ ~¢ ~ Size /0~ ~ No. of Compartments ~.~ Standpipes ~/~) / /,~.~ Air-tight Cap,~ _a F°undatzi°n Clean°u~! Depression~ve~ Tank (¥~i] Date Last P.umDe~-/ d //~/~ ~'~' v~- Pur~ing/Maintenan~ Contract on File,(Y~Y//T~ , for Separation Distances f~cm Septi~~ Tank: To Water-Supply Well /~o ~-/~ 'To Building Foundation__ TO P~operty Line /O ~~L To Disposal Field Z_o To ~ter Mair~/Se~vice Line /~) 7L To Stream, Pond, Lake, c~ Major Drainage /3 D Con~nts ,/C30 /xd ~ / Receipt ~ Date Paid: ~ount: [Page 1 of 2] 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorption. Stma~a Date .Installed _~ / Width of Field f/~F7 Type of System D~sign Length't' ' of Field Depth of Field /~/ Gravel Bed Thickness Feet of Absorption A~ea /~ ~30 Standpipes P~esent:~/W) Squa~e Dep=ession ove= Field ~.:~/ Date of ~st A~a~ ~st Results of ~st A~a~ ~st ~ /~ Sep~ation Distan~ ~ ~s~ption Field: To ~te~-Supply ~11 /~ '~ To ~o~rty Li~ To Building Foun~tion ~O ~ To Existing or Lot ~~ {~; ~ ~joining ~ts To Wate= Main/~rvi~ Line /~ ~ To ~t~(if pre~nt) To St~e~ond~ke/~ ~jo~ ~aina~ C~se To ~iveway, P~ki~ ~ea, ~ Vehicle St~a~ ~ea De LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm r~-vel at Tested fo~ Electrical Codes (Y/N) Dimensions /d"~ Off" Level at. ~/t :'~ Vent (Y/N) Pumping ~cles du~ing Adequacy Test. Meets MDA Comments ** Check Permitted Bedrocn Rating Against HAA Request ** certify that I have checked, verified, o~ ~onfo~ed to all MOA HAA Guidelines in effect .......... ,,. Cu, t~any MOA No. :~~~..: . ~:~'. ~ KB1/d5/s " .... ¥~'" ~ ~":' ~' ~" f [Pag~ 2 of 2] ~'hh~'F:~::%<~'~'~>%:: 2-15-84 NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479-3115 6957 OLD SEWARD HIGHWAY, SUITE 101 ANCHORAGE, ALASKA 99518 907-349-8623 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT [] PUBLIC WATER SYSTEM I.D. # ~ PRIVATE WATER SYSTEM NAME Mailing Address City State Zip Code SAMPLE DATE: ~. 1~ ~ ~ Phone Mo. Day Year Purchase Order No. SAMPLE TYPE: '~Routine [] Special Purpose [] Check Sample (for original contaminated sample with lab reference no. Sample Time ,, ~11~ [] Treated Water [] Untreated Water Laboratory Ref. No. AA 10 Signature of Representative FOR LABORATORY USE ONLY CASH CHARGE PREPAID TRANSMITTAL SPECIAL INSTRUCTIONS MAIL H010 FOR PICKUP TO BE COMPLETED BY LABORATORY Received at: ~ Anch. , [] Fbks. Date Received Time Received_ /~OO Next Sample Due COMMENTS: SATIS FACTO RY (S~ UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Verification Final b~ Comments *..~__ ~, ~rt~ Coliform Colonies Reported by per 100 mis. ii. General Information MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRON~NTAL ~ALTH DEPARTMENT OF HEALTH AND ENVIRONmeNTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE Application Date Legal pes~iptioB. ~$nc~lude subdivision, section, township, range) Location (address/or directio~ ~ ' ~ ...... (b) Applicants Nam~/~4~ t~ ~O~7~ ~Telephone - ~e Business (c) Applicant is (check one) Lending Institution ~; ~er/b~lder ~; (d) Lending Institution Ad-"d~ ss Telephone (e) Real Estate Co. & Agent Address (f) Telephone the ~ to the following address: 2~ ~pe_of Residence Single-Family~.,~. ~umber of Bedrooms Individual Well~ Multi-Family Other (describe) 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 Dis osal 0nsit Publico Community~ Holding Tank~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [page 1 of 2] 5. En~ineerin~ Firm Providing Inspections~ Tests~ File'Search~ Data and Information 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and ~ype 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 wsstewater disposal system is in compliance with all Municipal and State codes, ordinances~ and regula- tioms in effect om the dace of this inspection° Name of Firm Telephone ,~ fk C~ ~q{~]N~i{M~M~ Address · $~ JP~SX Approved for ~/ bedrooms 7 Approved ~ ~ Disapproved Te~s of Co~igion~ Approval Condition~-I CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF REALTH AND ENVIRO5%fENTAL PROTECTION (DHEP) ISSUES HE~TH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT~ ATIONS GIVEN IN PARAGRAPH 5ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERk'D IN THE STATE OF ALASKA. TH~ DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~ND STATE REQULRE- MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ~CHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 CHEMICAL & f'-~'.OLOGICAL LABOR.4TORIr~'~OF ALASKA, INC. ~.~ TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER 5633 B 'Street ~,~ Drinking water Analysis Report for Total.ColifOrm Bacteria TO BE COMPLETED BY WATER SUPPLIER WATE. S STEM: III I I I I (*) See h on back I.D. NO. Water System Name Phone No. Mailing Address SAMPLE DATE: . / my Y~ SAMPLE TYPE: ~'~outlne [] Check Sample (for routine sample with lab roi, no. ) [] Special Purpose [] Treated Water .~lrltrea!ed Water SAMPLE NO. LOCATION Time Collected I I/,'/~ Collecled ( 06,1220 (b) Rev. 1983 TO BE COMPLETED BY LA~ORATORY Analysis shows this Water SAMPLE to be: ~ Satisfactory [] Unsatisfactory [] Sample too long in transit; sample sh'0uld not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received '~ - Y~ F.~ '"" Time Received ./ C.//~ Analytical Method: [] Fermentation Tube /~Membrane Filter Lab Ref. No. Result* Analyst FTC1 CC1 IT1 BACTERIOLOGICAL WATER ANALYSIS RECORD READINSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB F r Res Its , Reported By . BGB Dale Time: TNTC= Too Numerous To Count Coilform/100ml