HomeMy WebLinkAboutCOLIFORM BACTERIA ANALYSIS - WEC Water Sample Results - 3/13/2017 SPECTRA Laboratories — Kitsap
26276 Twelve Trees Lane,Suite C,Punjab.,WA 98370
(360)779-5141
COLIFORM BACTERIA ANALYSIS
Date Sample Collected T Sample Collected County
11 r
or, naY Vear PM 4r•�'�'�'¢'r
Type of Water System(check only one box)
❑Group ❑Group B AOther
Group A and Group B Systems-Provide from Water Facilities Inventory(WFI)
Of _
System Name:
Cormuct Person: U r
Day Phone:(3(l E6 / 4 Cell Phone:./ 1)` r -
E
Eve.Phone: Fax:( )
Email Address:
$¢0 Sand in ice t .(Ptln ul ante,atldms-:.Antl p Code or email only)
AMPLE INFORMATION
Sample collected by(name)'
Specific location where sample collected. Specialihistructions or comments:
Y.
Type of Sample(must check only one box of 41 through#4listed below)
1.11 Routine Distribution Sample 2.Repeat Sample(mnu.ansddoryrxnleq
Chlorinated:Yes NO ❑Distribution System
Chlorine Residual:Total—Free r' ❑Source Groundwater Rule(MR R psi
3.Raw Water Source Sample (Population of 1,000 or less)
❑E.co/i-GWR(A/P) Lacteafactory routine lab number:
❑Fecal-Sortxa Car,olhernumnmonl — — — — — — — —
Fiamed: Yea -Ro Unsatisfactory routine collect date:
❑Assessment Monitoring AT) /. /
❑Other Temp _ Chlorinated:Yes —No_
( L( ( ( Chlorine Residual:Total_ Free_
a.O Sample CollaL_tedfoor Information Only j Q
Investiestra_ Construction/Repairs_ Private Resitlence_ Other_ �p
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY 8
Analyst Remarks: n
❑Unsatisfactory Total Coliform Present and Satisfactory M
❑E.colipresent ❑E ccliabsenf 4a1
n
Sample Rejected(no analysts performed): `
❑Sample too old(>30 hours) ❑Low Volume ❑
❑Improper Container ❑High Chlorine(AS mg/l.) +
Bacterial Density Results:Total Coliform_/100ml. Ewi /1WmI.
Fecal Coliform_/100ml. HPC /ml. /
Method Code: Date and Time Received:
MIDR-2720 _
Date Analyzed Date Reported:
Sample Number Loon number plus rive eintel Oh Use Only0110
arepmw mrn — —
Wane Di avmoa all Lill Green-wamreuWller Gad-WH Rglcml
Septic Tank Pump & Service Report
Y i
Is this service for a d Residential ❑Motel ❑Mobile Home Park Space If
residential property O Community Drainfield ❑Youth Camp ❑Food Service Restaurant
C,j ❑RV Park ❑Campground ❑Vacant Lot
sale? yes ❑ r 0 ❑Other,Please Describe:
Property Owner � LT"1L1�f4 _ Phone#3r//�'.5�9
Business name(Bapplicable) N
Mailing address �'�n �4 C �� �'„Cib' Ar state f Zip
Site address fINr9�2_Alecify,64—W27 /l
Tax parcel#
SEPTIC TANK '
Tank Size: Gallons #of Compartments: _.Tank Construction; "anufaclured ❑ Home Made
Tank Material: [] Metal ❑Wood [-Concrete ❑ Fiberglass ❑ Other".
Effluent Level: ❑ High Normal ❑ Low 'N Tank Conditiep Satlsfadory ❑ Needs Repair
Tank Pumped: ❑Yes ❑ No Were repairs made to tlietank Yes ❑-No
If yes,please explain:
BAFFLES
Inlet Baffle Condition: QSatisfactory ❑ Needs.Repair
Outlet Baffle Condition: ❑ Satisfactory ❑ Needs } epair
Center Baffle Condition: ❑ Satisfactory ❑ Needs epair ❑ Not Applicable
Effluent,*titer C/eaned7; ❑ Yes ❑ Not Ef Not,App able.
Were repairs made to the baffles? ❑Yes Q No ;t
If yes,please explain:
PUMP OR SURGE TANK []Yes [f No If yes, tank size: Gallons
Were repairs made to the pump or surge tank? ❑Yes Cl No
If yes,please explain:
SEPTAGE
Depth of Floating Mat 1st Compartment: 2nd compartment Pump Tank
Depth of Sludge: 1st Compartment: 2nd compartment Pump Tank
r
Total Gallons Pumped \U Disposal Facility 13 Biorecycle O Other.
General Comments:
Date Pumped ` .I, ) Recommended Next Pumping Date l l )
Certified Pumper Signature \;�\`�J` `))�. " --� Printed Name •
Company Name `��s r c ✓' i"
Findings and determinations of this inspection reflect conditions as they existed on the day the septic tank was pumped. No claim is
made by this company, either expressed or implied,concerning success or failure of the septic system. Pumpers are required to submit a
report for this service to the Mason County Public Health Operation&Maintenance database.
Mason County Public Health-415 N 6'"Street-Mason County Building 8-PO Box 1666-Shelton,WA 98584
(360)427-9670 ext.400 • FAX:(360)427-7787
White copy—Pumper Yellow copy-- Owner
Revised!1/31/2014
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