HomeMy WebLinkAboutARGYLE LT 6
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 LPHONE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION~., ~S~~ ~ t NO. OF~ROOMS
DISTA;CE TO: I Wellp~ , AbsorPtion are¢ Dwelling ~ PER~
~ ~ Mater~ ~ ,o. ~0artments
Liq. c~pacit~ in_qallons Insi0e length ~idth ~iquid depth
/~--~ IF HOMEMADE:
~ ~ ~ DISTANCE TO: Welt Dwelring PERMIT NO,
~ Z
O Z ~ Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO: ~ ~.~ Foundat~ ~ , ~e.rest Iot~ ,~ ,[,MIT ~0~/
~ ~ 7es L gt ~/line Total~g~lines *ren~h Distance~Tn line~~
~g No, of
_ inches Total ef
~ ~ ~ Top of tile to finis~ Material beneath tile ~ / inches ~bsorption area
Length ¢ Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
SOIL TEST RATING ~O /
APP~ DATE LEGAL
72-01 3/78)
PERMIT NO.
FIPPLICFINT WES HARTLIEB
LOCATION LIPSCOMB
LEJHL L 6 B ~ ARGYLE =,,.D LOT _,I~E
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
[:'EF'FIR, TMENT ( HEALTH RND EN',/IR. 3NMENTRL , )TEC:TION
,=,~.., L" :,TREE
~,4-4 ,'
':'
i~._.i W 7TH 274-4762
MH,*:, I MUM NLIMBER OF BEC E LOM:, = SO I L RAT I Nb < SQ ,--., ~,,.... =
THE REQUIRE[:, SIZE OF THE :,OIL ABSORPTION :,v.,TEM IS'
[:,EF'TH= 11 LEr-~STH= 65 GRR%-'EL BEF'TH==
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIEL. D.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SLIRFFICE OF THE
GROUND AND THE BOTTOM OF THE EXCFIVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFFILL PIPE
RND THE BOTTOM OF THE EXCFIVRTION (IN FEET).
F.,."EL--I-.IJ I F.,:E[:, SEPT I L--:. TI=Ill-,IF=::_
PERMIT APPL I CANT HRS THE RE_,FLN_ IBIL ITY TEl INFORM THIS DEPARTMENT [:,UR I NG THE
INSTRLLRTION INSPECTIONS OF ANY NELLS ADJF~C:ENT TO THIS PROPERTY FIN[:, THE
NI3MBER OF RESIDENCES THFIT THE WELL WILL
-~,~.;;1% , ~..
T &.,l Cm ,:'..'~'.':. I F4 $ P Em]: T I m] l-,i S ARE R E m=-Q... I_1 I F.;ED
BRE. kFILLINU OF ANY =,~=,TEfl NITHOUT FINFIL INSF'ECTION RN[:, APPROVAL BY THIS
DEF'FIRTMENT N ILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTFINCE BETWEEN A WELL AND FINY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR FI PRI9FITE WELL OR i50 TO 200 FEET FROM R PUBLIC NELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE NELL TO FI PRIVFITE SEWER LINE IS 25 FEET AND
TO FI COMMUNITY SEWER LINE IS 75 FEET.
NEL. L LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DFIYS
OF THE NELL COMPLETION.
OTHER REQUIREMENTS MRY FIPPLY. SPECIFICATIONS AND CONSTRUCTION DIFIGRAMS FIRE
AMFIIL~BLE TO INSURE PROPER INSTRLLFITION.
PERt.1 I T E.,~<p I E:ES [:,ECEr4E:EE: _~=:2L.. 1'_-~,~ '-_::1
I CERTIFY THAT
1: I AM FRMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF FINCHORFIGE.
2: I WILL INSTRLL THE SYSTEM IN FICCORDRNCE WITH THE CODES.
~: I UNDERSTAND THFIT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
:, I GNED'
RPPLICRNT WES HARTLIEB
~ ;~r%"~ (,'t7
ISSUED BY DFITE__'L,£:_~L.£:~i ..... V4. '-'
Applicant:
Location:
Department
825
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
~L~ 11~ __ Mailing Address:
MUNICIPALITY OF ANCHORAGE
Health and Environmental £otection
L Strest, Anchorage, AK. 99501
Phone Number:
Legal Description: ~ /~ ~ !
Type of Soil Absorption System
Trench: P-~ Drainfield: Seepage Bed':
Lot Size: (-/ .~/~./
Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) ~~
The Required Size cf the Soil Absorption System Is:
DEPTH , / / _ LENGTH (~ ~. GRAVEL DEPTH 7 WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum~depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~00 GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wStls adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without ~final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days o.f the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9 8 1 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is emod led to include more that 3 bedrooms.
Applicant
Date:
SWP/024 (1/81)
Municipality
of
Anchorage
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE 114. SULLIVAN,
MA YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEC, TION
December 31', 1980
Wes Hartlieb
1331 West 7th Avenue
Anchorage, Alaska 99501
Permit ~ 800404
Subject: Lot 6 Argyle Subdivision
A permit issued by this department for well and/or sewer
system has expired as of this date.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent
to this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for
our files.
If there are any further questions, please call' this
office at 264-4720.
Sincerely, / / /~
Senior Environmental ~cialist
LNB/ljw
enc: Copy of Permit
SWP/057
PERMIT NO.
r41_lr4 I CIPF~LIT%' mDF 8NI]HORSGE
DEPSRTMENT '' HEFlLTH FIND ENVIRONMENTSL~ OTECTION
825
264-4720
I~ELL ~t-~E:, IDt4--SITE SE~dE~ PERPIIT
( 8~0404 >
RPPLICRNT WES HRRTLIEB l]:]:l W,
Lo,XION LIPSCOMB ....... ?
TYF'E OF SOIL BBSORPTION SYSTEM IS: TRENCH
7TH
LOT SIZE
274-4762
44681 SQURRE FEET
MRXIMUM NUMBER OF BEDROOMS
SOIL RRTING (SQ FT/BR>= 250
THE REQUIRED SIZE OF THE SOIL 8BSORPTION SYSTEM IS:
C, EF'TH= it LEhlGTH= 65 GRRVEL DEPTH= 7
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND 8ND THE BOTTOM OF THE EXCRVRTION (IN FEEl'>.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
8ND THE BOTTOM OF THE EXCRVRTION <IN FEET>.
~,Em~-~..I_I I F-'.ED SEPT I L--: TRt4~( S I ZE= ':LOOO m3RLLm3~4S
PERMIT 8PPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF 8NY WELLS 8DJRCENT TO THIS PROPERTY 8ND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
TP~O (2> I t-4SPECTIOt-4S 8RE REm~LIIRED
BRCKFILLING OF 8NY SYSTEM WITHOUT FINRL INSPECTION 8ND RPPROVRL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND 8NY ON-SITE SEWRGE ,DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL,
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO 8 PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET,
WELL LOGS RRE REQUIRED 8ND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION,
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
AVRILABLE TO INSURE PROPER INSTRLLRTION.
F"ERFI I T E:~:P I F-:ES DECEFIBER _---:-'-:1.., ~l.-~!~- 8~-'-~
I CERTIFY THRT
i: I 8M FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN 8CCORDRNCE WITH THE CODES.
~: I UNDERSTRND THST THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS.
SIGNED:
RPPLICRNT WES HRRTLIEB
ISSUED BY
V4. 0
I--lIJl'4 I C: I PFIL I T"-r' . OF' Flr,iLDHORHL]E
DEPHRTt1EN-' q.F HEALTH 8ND~ENYIF.~ONt'IENTF~' PROTECTION
PEP.. IIT No. <
LOC:RTION ~ ~5Co'~ ~
LEGRL .~
TYPE 0F SOIL RBSORPTION-.CV~T~M .......
MRXIMUM NUMBER 0F BEDROOMS
STREET, ANCHORAGE, AK. .50i
264-4720
L,l'-,I--$ 'r TE :SEI4ER
PERI'I I T
LOT SIZE ~6~[ S,~I.IRRE FEET
SOIL RATING (SO. FT,,'BR)=
THE F.:EO. UIFED SZZE OF THE SOIL ~BSOFtPTION SYSTEM
[:,E F'TH =: It LEI"4'3TH= ~'~ ,3 F~: R".-' E I-- [:'EPTH
THE LENGTH D~MENSION IS THE LENG,TH <IN FEET) OF THE TRENOH OR DRAINFIELD.
THE [:'EP'f'H OF R TRENCH OR PIT IS THE D~TRNCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETHEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE E×CRYRTION (IN FEET).
RE¢:!LI I I:;."EI2:' SEF'T I C TRI'--i[( $ I ZE= l 0E) 0
PERMIT APPLICANT HRS THE RESPONSIBILITY'TO INFORM THIS DEPRRTMENT [)uRIr~G THE
INSTALLATION INSPECTIONS OF ANY WELLS AD.fRC:ENT TO THIS PROPERTY RNC, THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TblC, < 2 > I f'q_'~PEOT I 01'4'~- ARE RELTILI I I~:E[:,
BACKFILLING OF ANY 5¢_TEM WITHOUT FINAL INSPEC:T[ON AND, RPPROVRL BY THIq
[:,EPRRTMENT W!LL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN Ft WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
iD40 FEET FOR A PRIVATE WELL OR 450 TO 200 FEET FROM R PUBLIC HELL DEPEND, lNG
UPOH THE TYPE OF F'UBLIC HELL
MINIMUM DISTANCE FROM R PRIYATE WELL TO A PRIYRTE SEHER LINE IS 25 FEET
TO R COMMUNITY SEWER LINE IS 75 FEET.
HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE D, EPARTMENT WITHIN 3k'~ DRYS
,_'iF THE HELL C:OMF'LETION.
OTHER REOUIREMENTS f,lRN' APPLY. SPECIFICATIONS AND C:ONSTRUCTION DIAGRAMS ARE
RYAILRBLE TO INSURE PROPER INSTALLATION
PER. P1 I -r E;-<P I F-:ES DEi_-:Er-IE:ER 31... it 19 :B~3
I C:ERTIFY THAT
1: I RM FAMILIAR WITH THE REQLIIREf'IENTS FOR ON-SITE SEHERS RN[:, HELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I HILL. INSTALL- THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: ~ Ur.~DERSTRNC, THAT THE ON-SITE SEIqER SYSTEM HAY F.'.EOL~IF:E ENLARGEMENT IF THE
RE~IE>ENCE IS REMODELED TO INCLLIDE flORE 'THAN ~ BEDROOMS.
I SSIJED
iF'F'L I CANT. ~ .
.DATE
Y4. 0
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[~PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
SLOPE
SITE PLAN
o 5'- /. ,3- -~,,~-~,0~ 5/4.7'
/.5-- /~-
10
----~11
12
13
14
15
16
17
18
19
20
COMMENTS
NO. 1732-E
J.ne 22~ 1968
WAS GROU.DWATER /J 0 s~
E.COU.TERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMED BY: ~'d~57--
/5'
FT AND
(minutes/inch)
Z° FT
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE ~i~ '
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.#
1. GENERAL INFORMATION
Complete legal deScriPtiOn L° ~- ~ /4r'~,y/~ ._c/.~
Location (site address or directiOns)
Property owner
Mailing address
Lending agency
Day phone
Mailing address
Agent t'la~-y 7'~/-<:r~c,,~ ,,T'~¢~'
Address .,R ~O( '~'" ~,.,,,
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
~. Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC E'ttest-
ing to the legality and status of system.
4. TYPE OF wASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
· CommUnity on-site
:Public sewer': ...... ·
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72.~25(Rev. 1/91) Front MOA#21
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 ~'1~/-/'o? 7"~cAnlc~/
Address J ~5"-~ ~ EcAo ~'/z. A/)c~ c~r~'v~'¢~
Engineer's signature ,"Y'~ ~. ~
Phone
/'/'~: ,:~)'~ I
Date ,a~", I,y
DHHS SIGNATURE
---~-.- Approved for 3
Disapproved.
" Conditional approval for
-......-...-...............,.,TAMP
bedrooms.
bedrooms, with the following stipulations:
Additional Comments ~/3~'"7--~'..~ .77'~
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
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 a courtesy to pumhasers 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-(3~5(Rev. 1/91) Beck MOA~Zl
SEPTIC SYSTEM ADVISORY
HEALTH AUTHORITY APPROVAL NO./7/?~ ~"'~) Z ~
Prior to a recent adequacy test on the septic system for this lot, ~ inches of
standiung water was observed in the absorption field. This indicates that
approximately ~ % of the absorption area is inundated. However, this system
did meet the minimum absorption requirements for a -~ bedroom residence.
This advisory must be attached to all copies of the subject Health Authority
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type ~r~c, =/-~
Log present (WN) Y~_~
Total depth '~ 0" I'
Sanitary seal (Y/N)
~.o~' 05~ t4r~/[~ .5'/./) ParcelI.D.
If A, B, or C, attach ADEC letter. ADEC water system number
('_~=~clo.~e~.) Date completed 8/~-~/~/ Driller ~o0
Cased to To"/' Casing height
T Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG
AT INSPECTION
6' /.3'0
lOc g.p.m. 7,
SEPARATION DISTANCES FROM WELL TO:'
Septic/holding tank on lot
Absorption field on lot I
Public sewer main /,~, A.,
Sewer service line ;> 'ZS"
g.p.m.~BL 1 ?- 1°J~J~
~ci alit¥ oi Anc~_o~age .
Mun' P - -~n~erwces
Dept. Hearth &
WATER SAMPLE RESULTS:
; On adjacent lots ~ ~oo '
; On adjacent lots ;> t oo'
Public sewer manhole/cleanout
Petroleum tank Non~ ~ ¢ ~'0
Coliform 0 ¢ol /~oo re ..~
Date of sample:
S. SEPTIC/HOLDING TANK DATA
Date installed ~/~'f/'8 (.
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Nitrate ~, ~'E ,~,,~ /'-.~ Other bacteria Collected by:
Tank size I e:,;'O ~,/ Compartments
Foundation cleanout (Y/N) y' Depression (Y/N)
N, ,~,' Alarm tested (Y/N) N.
$/11/9~" , Pumper ~or~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ';> I oo~ On adjacent lots I0~"' -to op~,o Foundation ~.~"
To property line ~ ~ o' Absorption field ~ ' Water main/service line ;> ~"'
Sudace water/drainage ;> I o0'
72-026 (3/93)* Front
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water.
D. ABSORPTION FIELD DATA
Dine installed IF / z ¥ / 8/ Soil rating (GPD/Ft2) ~O ~'/.6',~'r~ System type '7"r¢~
Length ~ 8 ' Width .3 ' Gravel thickness 7 ~ Total depth I I,
Total absorption area ~ ~. Cleanout present (Y/N) T' Depression over field (Y/N)
Date of adequacy test e"/,?0 / 9~5'" Results (pass/fail) , f'p.~ for ~ .,Bedrooms
WaterleVelinabsorptionfieldbeforetest E~' (11 below., h&r ,~'~ ~. Afteftest ~,,~ " ~ ~1' & ¢le ~
Peroxide treatment (past 12 months) (Y/N) No~' lone, c~,,,~ ,,.,~ If yes, give date N..4:
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I {)5'
To building foundation ~'
On adjacent lots ) E~"
Surface water ;> ~
Curtaimdrain Non ~
On adjacent lots '~ I Cc,' Property line
To existing or abandoned system on lot
Cutbank N. ,9, Water main/service line
Driveway, parking/vehicle storage area $ '
E. ENGINEER'S CERTIFICATION
I cerUfy ~hat I have checked, verified, or conformed to all MOA and HAA guidelines in e~~]~,~of this inspect'on.
Signature
Eng,neer's Name '7"~o~.~0r¢ ~.. /"1'oo,'C ~'~'~.'%o~)~ £..~
Date
Waiver Fee $
Date of Payment
Receipt Number
..~Ial~__'"~'~'"' -':CT&E nmronmental Sermces Inc. : ~ ~ ~ ~ ~ .... :
~lffill~ Laboraton/Division ~~r~jjj~,j~r~'J~r~r~e'JJ~r~
Drinking Water AnalYsis Report for Total Coliform Bacteria 2oo w. pot~ ~r~e
- Anchorage, AK 9951 8-1605
READ I;vTTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Tel: (907) 562-2343
~ Fax: (907) 561-5301
MUST BE COM~PLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM I.n, #
eP~V^TZ WATER s~s~.~
~ SendResults 1~ Sendlnvoice
Water System N~Comp~y
Phone Number lax ~umber
M~ling Addr~s
~ Send Results ~ Send Invoice
M~ling Addr~s
Ci~ State Zip Code
993-q'
Zip Code
SAMPLE DATE:
SAMPLE TYPE:
SAMPLE LOCATION
Month Day Yea r
Routine
Repeat Sample (for routine sample
with lab ref. no. )
Special Purpose
n Treated Water
[] Untreated Water
Time Collected
Collected By
i ~' qs ~.,r-t '7' ~,'-',
Please Print
TO BE COMPLETED BY LABO1L~TORY
Analysis shows this Water SgaMPLE to be:
~ Satisfactory
[] Unsatisfactory
[] Sample over 30 hours old, results may
be unreliable
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received
Analysis Began
Analytical Method: ~'~Membrane Filter
[] MMO-MUG
* Number of colonies/100 mi.
Lab Ref. No. Result*
Se.t toA.D.E.C. ~ Fbks
Dat¢:~'~ "O~'~ Time:
Analyst
Jun
Client notified of unsatisfactory results:
Phoned Spoke with
Date: Time:
Faxed
Faxed
Comments:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result: Total Coliform E. Coli '
Membrane Filter: Direct Count (~ Colonies/100 mi
Verification: LTB BGB COLIFIRM
Fecal Coliform Confirmation ,,
Final Membrane Filter Results
Reported By ,?;~-'a ~/~
Coliform/100 mi
Date ?, 0/- C-/3'- Time / ~ ~ hrs
TNTC = Too Numerous To Count
OB = Other Bacteria
'5
t~ SGS Member of the SG$ Group (Soci&t& G?nL~JL~dTSu~i~a~r~'-~) 0 F
~,,,v,~o,,,,,,,~,,,-,.~.,_ ~c,,_,-,.,~s ,~ ~.~.s~. ~,.,~o~,,,.~.. ~,_o,~,~.. ,,,_,,,,o.s. ,,,,~,~.~,,,,~.r,~-~. ;~;~,~,.,.e~ ~to,-,,o. ,,,,~-,-v,~,,,,,~.
CT&E Ref.#
Matrix
Client Sample ID
CT&E Environmental Services inc.
Laboratory Division w~wm-m.~w~m-~w~w~w~w~v~w~~~~~~~
95.2724-1 Laboratory Analysis Report
WATER
L6 ARGYLE S/D N HOSE BIB
Client Name FLATTOP TEC~INICAL SRV WORK Order 15939
Ordered By TED MOORE Printed Date 07/05/95 · 12:59 hrs.
Project Name Collected Date 06/30/95 · 12:45 hrs.
Project# Received Date 06/30/95 ~ 13:45 hrs.
PWSID UA
Technical Director
STEPHEN C. EDE
Released By.~"--'/~ ~._~-/~.~.~
Sample Remarks: SAMPLE COLLECTED BY: T.F. MOORE.
QC Allowable Ext. D~nal
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 2.62 D m~/L EPA 353.2 10. 07/03/95 CMR
See Special Instructions Above UA = Unavailable
See Sample Remarks D~bove NA = Not knalyzed
Undetected, Reported value is the practical quantification limit LT I~ss Than
Secondary dilution. GT = Greater Than
200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
This well is producing gaP'
INVOICE
· ,H,,4' T Z.
MOON DRILLIN
SR BOX 668, BOGARD RD.' LA /~C/'//-/0///"/~ )//~r
PALMER, ALASKA 99645
TELEPHONE 745-4071
. . .~ ~lk. ,~ ~ WELL LO~
'~ of water per hour. Set pur .~__ feet.
~-~ ,~vo,c~l~b.W") v/y- ~./~.) ~ '
TEI~MS -'~ J
SALESMAN
FOR~dA~ION SIN FORMATION
~ 6 106 2O6
? 107 20?
~8 , '108 o08
O ~ ~ fl /3 /~ 109 200
214
18
iiX 122 222
_24
124 224 '
125 225 HA /) //
1S0 2S0
~02I 18~ 282
133 283 ' ' '
_88 134 234'
~84 135 ' 235
~36 136
.~? , 137 23?
..888 138 238
O 139 239 ~ ;~,
~40 140 240
~48 ] 148 248
IJ . 150 ' 250
I52 152 252
~8 153 25S
I54 154 -- 254
I§5 ~ 155 255
~56~ 156 256
157 ~ 25?
s65 . 165 265 ·
~66 . xI/ ' '166 266
I?4 ' ' .', 174 2?4 r
08 xss' / '} r~ 1/ 208
~oe -- 196 .... -- 296
~ 167 ~ -- 297
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