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HomeMy WebLinkAboutTHAYERMOORE HEIGHTS BLK 1 LT 4hayermore
Heightss,
Block 1
Lot 4
#015-081-06
Name:
Qa Ve.U Addr� ox y 1-3
� 1-3
Phone:
Municipality of Anchorage
Development Services Departments
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page j of
www.ci.anchorage.ak.us (907) 343.7904 l
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PID Number: 5-
5-0,17
SOv1 Wastewater System: IR'New ❑ Upgrade
eha°>�3ABSORPTION FIELD
7aNumber of Becraoms:
_.. Deep Trench t]shaum Trench 13 sed (]Mound E3 Other
LEGAL DESCRIPTION
Block. I Lot. � rlivision:
4,,ermore 1l
Township. Range: section:
Well: MNew ❑ Upgrade
Classifcation�(Pnva�ll%Q,C'; Tolal peptn:FCOsedWDnller. 1YlrDale onll^tln •, .,
Above
Soil Ratirg: 01,
Depth to Pipe bottom from ai iral
C J LS 9
�( Filladdedabove odor one d.:
Gravel
I peal absorption area: --/-) Pi e
JFL
/ C� FF _
Ins Ile,. Date
�AdIr�B/J�
TANK
t(Septic ❑ Holding ❑ S.T.E.P.
Sewer Line
;�5,4-
UFT STATION
BENCHMARK
5 i 5 ENGINEERING
Inspections performed by: 17034 Eagle River Loop Road NOCTpr;: II
eagle Rlv w, Alaska 99577
2nd
Developm t Services Department Approval
Reviewed and approved by: Date:
(Rcvl Ja0)
grade:: A
ice between lines:
—� Ft.
I] Other:
Ca��pacyity:/m�
/f'LA/ Gal.
Ft.
OF
T t ROBERT C. COWA14 f r
CiJ, :� CE -8801 .±a
in.
SEPARATION DISTANCES
To
From
Septic
Tannkk
Absorption Lift Holding
Station Tank
Well
(FFii�ie�l/lddJ
Surfacewater
-YL-
Lot Line
7)
i
L/73
Foundation
L—F ` t
III V
y/� t
Curtain Drain
�/o yn
Remarks:
Above
Soil Ratirg: 01,
Depth to Pipe bottom from ai iral
C J LS 9
�( Filladdedabove odor one d.:
Gravel
I peal absorption area: --/-) Pi e
JFL
/ C� FF _
Ins Ile,. Date
�AdIr�B/J�
TANK
t(Septic ❑ Holding ❑ S.T.E.P.
Sewer Line
;�5,4-
UFT STATION
BENCHMARK
5 i 5 ENGINEERING
Inspections performed by: 17034 Eagle River Loop Road NOCTpr;: II
eagle Rlv w, Alaska 99577
2nd
Developm t Services Department Approval
Reviewed and approved by: Date:
(Rcvl Ja0)
grade:: A
ice between lines:
—� Ft.
I] Other:
Ca��pacyity:/m�
/f'LA/ Gal.
Ft.
OF
T t ROBERT C. COWA14 f r
CiJ, :� CE -8801 .±a
in.
PERMIT NO. SWO30293
PAGE 2 OF 3
Municipalit of Anchora e
DEPARTMENT OF HEALTH AND HUI`AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D Box 196650343-4744
ON—SITE WASTEWATER�DISPOSArchorcAL SYSTEM AND/OReWELLe INSPECTION REPORT
LEGAL LOT 4, BLOCK 1, THAYERMOORE HEIGHTS P.1 D. NO. 015-081-06
2 I
I
I
I
3
o
SryEO
I
I
I
n
Z
17' MIN.
CO2
W
N
N// MT1
a
/ TH
roZ
U 3
FCO
M
Q
o
2
TBM
p....a
DBL1 & DBL2 C01
SEPTIC
AREA S
ST1
NEW 1000 GALLON
GRAVEL DRIVE
SEPTIC TANK
A
N
P��uS
�p0
5
oS
�� RP SCALE: 1" = 40'
IUFR�1
ROBERT C. COWAN i•'vw
CE • 8801
4 f
----
PERMIT No, SWO30293
PAGE 3 OF 3
MunicipaUt of Anchor z e
DEPARTMENT OF HEATH AND HiJRXN SERVICES
ENVIRONMENTAL SERVICES Dle IVISION
P.D. Box 196650 *Anchorage, A�ctskcL 995: 343-4744
ON—SITE WASTEWATER DISPOSAL SYSTEM1AND/OR eWELLeINSPECTION REPORT
LEGAL LOT 4, BLOCK 1, THAYERMOORE HEIGHTS P.I.D. No. 015-081-06
FINAL GRADE
77.7'/
FINAL GRAD
E
MTI =68.0'
ST1 ST2
PNEW
COI=84.0'
82.8'
C01=77.1' C01=77.1'
SR CO2=76.7'
NO WATER FOUND
60.5' B.O.H.
84.5'
77.5'
A B
FCO 50.0' 43.0'
STI 64.0' 96.5'
ST2 65.0' 92.5'
DBL1 67.5' 88.5'
DBL2 68.5 86.5'
C01 69.0 85.5
MT1 92.0 64.0'
CO2 94.0' 59.5'
NOTE: COMBO FITTINGS
ROD CAN'T REACH INVERT
N, T. S.
rP ? 1 ROBERT C. COWAN f� f
.% CE - 8801 r'
It
It
M-W Drilling, 'mc.
eP.O. Box Z~O378*Ancho~ge, AK 99§1~·
*907-345-4000 · 907o345-3~'87 Faxe
Job No,: 03-177 Project No,:
Permit No. SW030293
Groundwater F/eli/is-Built & Log
· P/ell Owner: Anderson, Dave & Palxicia · ~lse o/P/ell:
· LegalDescrlptlon: ,,,,Thayennoore l'lei~hts Subdivision~ Block It Lo! 4
, 9800 Hillside Drive- Anchorage. Alaska
Domes[lc
,,Construction
· lioleDeptA: 196' eCaslngSl:e: 6" eCnsedTo: 195.41'
· DrlllMetAod: Air Rolar~/
· P/ell Completion- Open end X Screen Pecl'oroted
· Screen/Petforotlon descr~tlon: None
· Grout Notes: (3) Sacks- No. 8 bentonite granules
cArat·rial: A ~3 Steel
Per/:.
Afethod:
· Notes:
· Well Development: Method: Air surge Notes:
e Statlc water level (SW£) 168' (c~c:'c) (below) top of casing (TOC).
· Wellyleld test at 20 Gallons per minute (GPM)/ge~nef~ke4~C,P~) for __
with 100% of drowdown (DD) from static level (SWL).
· MetAod: Air lilt
I itou~
· Dot·of completion: 22 September 2003 ePumplnstall:
Well Log
Depth in feet from
top of casing. Details of formations penetrated~ size of materialt color and hardness.
0 TO 2 Casin~stickup
2 TO 4 Fill
4 TO 10 Cobbles: gravelly
10 TO 17 Gravel: silty clay
17 TO 28 Sand: dry
28 TO 115 Cobbles: gravelly, sandy
115 TO 136, Silt}' sand: gravelly, clayey
136 TO 142! Sand: wet
142 TO 170 Siltyclay: dry
170 TO 185 Gravel: silty~elayey
185 TO 196 Water bearing gravel
TO
TO
TO
TO
r
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Renewal
Date Issued: Aug 04, 2003
Expiration Date: Aug 03, 2004
Permit Number: SW030293
Parcel ID:
015-081-06
Legal Descri tion:
1AYERMOORE BEtGjJTS BLYC
Design Engineer:
0003 S & S Engineering
Site Address:
009800 HILLSIDE DR
Owner Name:
Dave & PatriciaAnderson
Lot Size:
24725 SQ. FT.
Owner Address:
PO Box 231021
Total Bedrooms:
3 Permit Bedrooms: 3
ANCHORAGE, AK 99523-1021
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: o'
0-3
Municipality of Anchorage
• Development Services Department s
ip �
Building Safety Division
On -Site Water and Wastewater Program 'slpf,.
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
0-,S!TE SEWERIWELL PERMIT APPt_!CAT!On!
FOR A SINGLE FAMILY DWELLING
Parcel I.D. I t rAi cfL►Ma02� 1i,1� lS ll� IT 4r Permit Number SW03aZ?3
Property owner(s) ��$ �� � Day phone B';;n -10-4
Mailing address (1)'CIO.�53Y. G560L1 F�NCat. 7+1L
R
fig-address(2) 1<� Co Qf2 -I�V,
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size 2-qOaS Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Zip Code %523
Number of Bedrooms ?S
Sewer Only ❑ Well Only ❑
Sewer and Well Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
that the above information is correct. I further certify that this application is being made for a
Single t II' d is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: X00 Cl O Waiver Fees:
Date of Payment: 7 I2 'f lc)-? Date of Payment:
Receipt Number: 3 / 0 73 Receipt Number:
(Rev. 12/00)
Rruc- Ld 7131103
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South 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: Jul 31, 2002
Expiration Date: Jul 31, 2003
Permit Number: SW020258 Parcel ID: 015-081-06
Legal Description: THAYERMOORE HEIGHTS BLK 1 LT 4
Design Engineer: 0003 S & S Engineering Site Address: 009800 HILLSIDE DR
Owner Name: Dave Anderson Lot Size: 24725 SQ. FT.
Owner Address: PO Box 231021 Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE, AK 99523-1021
This permit is for the construction of:
Z Disposal Field 7 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
Issued By:
Date:
-7/ 1?1 G -Z-
zl� �q� Date:.i/ O 2
li uffielpality of Atithot agte
., beVelophiet t Seivices bcpetimeht
Building Safely bivision =o e
n
On -Site Water and Wastewater Program
SA ETY
4700 South l3ragaw St.
P.O. box 196650 Anchorage, Alk 99519-6650
www.cl.anchotage.ak.us
(907)$43-7904
ON-SITE SEWERMELL PERMIT APPLICATION
rOR A SINGLE rAMILY DWELLING
Parcel 1.0. 0/5—O9 ! —OCo Permit Number SWO20238
Property owner(s) k\ E1 A n A'_R S o n
bay phone Z Z--"' I l'- Z -
Mailing address (1) ?,.,b
2 31
o Z
Mailing address (2) k ac ti
Al•Pcltr
Zip Code
a9 SZ3
Legal description (Lot, block & Sub'd.)
LOA 'q
610 1{ J1
Legal description (Section, Towhshlp & Range)
--
Lot Size Acre q.P
Number of Bedrooms 3
THIS APPLICATION is POR:
Sewer Only
❑
Well Only
❑
Sewer and Well
Water Storage
❑
Sewer Upgrade
❑
THIS PROPIERTY CONTAINS:
Not Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct. I further certify that this application Is being made for a
Single Family bwelling and is In accordance with applicable Municipal Codes.
44yl �5 & 5 ENGINEERING
(Signature of property owner or authorized agent)
Permit Fees 4 5-5-0,
Waiver Pees:
bate of Payment: '7 / a- e lo z bate of Payment: -
heceipt Number: 0 ;L 3 a I`6 Receipt Number: _
(Rev. 12100)
17034 Eagle River LOOP M
Eagle River, Alaska 99577
HEALTHAUTHORITY
APPROVALS
SEWER&WATER
MAIN D(TENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
PNDREPORTS
WELLINSPECTION
& FLOW TEST
SITE FLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
UnG ROBERT C. COWAN, P.E.
7 CIVIL ENGINEERS
(907)694-2979
FAX(907)694-1211
July 23, 2002
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 4, Block 1, Thayermoore Heights S/D
It is requested that you issue a permit to install a well & septic system to serve the
proposed three bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test was performed. The approximate location
of the test hole is located on the attached site plan. At the time of excavation 7/2/02 water
was not found. After seven days of ground water monitoring the test hole was found to be
dry.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
�-)WZ4�
Robert C. Cowan, P.E.
RCC/jbm
Enclosure
17034 NORTH EAGLE RIVER LOOP : SUITE 204 • EAGLE RIVER, ALASKA 99577
' SITE PLAN
DESIGN
W
----------------
Anchor Esmt
1" = 60'
I I sew
XZmm
¢ !v
F s HOp
o �RoOk y rk
a � _ sg r
c o
9 G %
9 �O
m �m
o
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HILLSIDE DRIVE
PDo v
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+.10
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om
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44TFR
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Z JVD CMM
VATF`S/J'f
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F -.y
1" = 60'
I I sew
XZmm
¢ !v
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o �RoOk y rk
a � _ sg r
c o
9 G %
9 �O
m �m
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�PTIC AREA
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SITE PLAN
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WELL
b�m;..��
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C' M
s,eA / SW(T-e �J
(rR/�vcc wtTly
Recce S � c9cc»s�c,vac
j3DJ q X62 WAS GROUND WATER
ENCOUNTERED? At 0
S
IF YES, AT WHAT DEPTH?� L
Depth to Water After 5511 O
Monitoring? IDPy PE
Date:% 21-0 2—
itL7
ItV'l SAND
N1L
I'i L c.w3
Site Plan
E
z�_c
Reading
Municipality of Anchorage
Development Services Department
11 R'S Al f
r t
Net Time
Building
4700n SafetyDivision
On -Site Water and Wastewater Program
4700 South Bra aw St.
7�% I
�.. Ml ••
P.O. Box 196650 Anchorage, AK 99519-6650
.,� � •••......�
ROBERT C. COWAN
www.ci.anchorace.ak.us
(907) 343-7904�
A `
CE - 8801
9999 '�
Soils Log - Percolation Test
Ilk
Performed For: JAV f
hA/106A S'0 Date Performed: 7�a���
R.oT iP r -a csc
Legal Description: 714A yL+2 MOs; A4– ke IC•-aF>'j Township, Range, Section:
1
1
1
C' M
s,eA / SW(T-e �J
(rR/�vcc wtTly
Recce S � c9cc»s�c,vac
j3DJ q X62 WAS GROUND WATER
ENCOUNTERED? At 0
S
IF YES, AT WHAT DEPTH?� L
Depth to Water After 5511 O
Monitoring? IDPy PE
Date:% 21-0 2—
itL7
ItV'l SAND
N1L
I'i L c.w3
Site Plan
E
z�_c
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
30
-
G"
150
3o
C o
YtHUUL tJUN HAIL (mmutesAmh) PERC HOLE DIAMETER 6
TEST RUN BETWEEN Fr ANDFT
COMMENTS
PERFORMED BY: S R, g ENGINEERING I CERTIFY THAT THIS TES WA
PERFORMED IN ACO ifgWlR fAtIL&VI 9*4bfftr2( IPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
we River, Alaska 99577
r'ny1neeRtnG ROBERT C. COWAN, P.E.
We
"1A4fA
CML ENGINEERS
(907)694-2979
FAX(907)694-1211
HEALTH AUTHORITY
APPROVALS
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICE$
and
MATERIAL SPECIFICATIONS
SEWEgBWATER
MAIN EXTENSIONS
REFERENCE: Lot 4, Block 1, Thayermoore Heights Subdivision
July 23, 2002
SEWEfl 8 WATER
INSPECTION
GENERAL:
1 The scope of this project includes the installation of a 1000 gallon Premier
ENGINEERINGSTUDIES
AND REPORTS
polyethylene septic tank and a new trench to serve the proposed three
bedroom residence located on the referenced property.
2. Construction shall be in accordance with the approved site plan and design
a LOW TEs;71ON
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
SITE PLANS
3. The contractor shall be responsible for obtaining any necessary underground
utility locates.
4. Unless specifically agreed otherwise, the property owner shall be responsible
ROADDESIGN
for final grading areas subsequently depressed from soil settling.
5. Contractors installing wastewater disposal systems must be certified by the
SOIL TEST
Municipal Health Department for system installations. Owners installing their
own systems must also receive prior approval from the Municipal Health
Department.
PERCOLATION
SEPTIC TANK INSTALLATION:
TEST
1. A septic tank is to be constructed by a certified septic tank manufacturer.
MECHANICCAL$
Construction shall include two 4" cleanouts for pumping access.
INSPECTIONS
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
ON SITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
Page 2
Lot 4, Block 1, Thayermoore Heights SID
July 23, 2002
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock)
placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 3
Lot 4, Block 1, Thayermoore Heights S/D
July 23, 2002
MINIMUM MATERIAL SPECIFICATIONS:
I Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pine Perforated Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
Page 4
Lot 4, Stock 1, Thayermoore Heights 3/D
July 23, 2002
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
cant' out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage e,
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 015-081-06 Expiration Date: Z /
1. GENERAL INFORMATION
Complete legal description THAYERMOORE HEIGHTS S/D; BLOCK 1, LOT 4
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
9800 HILLSIDE DRIVE ANCHORAGE, AK, 99516
COLEMAN & DELLA CUTCHINS Day phone
9800 HILLSIDE DRIVE, ANCHORAGE, AK, 99516
2. TYPE OF DWELLING:
N Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Day phone
538-1360
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
■
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by: ��wC._ ,goLlet— Date: r X13
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
Date of Payment
Receipt Number
COSA # 0 S L I I l •;), 2
Waiver Fee $
Date of Paymen
Receipt Number
Waiver #
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, based on procedures outlined in the Certificate of On -Site Systems 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 files 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 GARNESS ENGINEERING GROUP, Ltd. Phone
Address
3701 E. TUDOR ROAD, SUITE 101 " ANCHORAGE, AK, 99507
Engineer's Printed Name
Engineers Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluator, GEG, LH). attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines B 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 solls condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore 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 report by any
other person or party is not authonzed, nor will it confer any legal tight whatsoever.
6. DSSIGN TURE
DSD
#1 Approved for bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
337-6179
Date 7 /10 [13
bedrooms, with the following stipulations:
OF
O�y_SiT�
SAT FWA DR
VVHJ'
?AA
0
Original Certificate Date: _
The Mimlci)fality or Anchorage Develop, emit Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 11105)
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: THAYERMOORE HEIGHTS S/D; BLOCK 1, LOT 4 Parcel ID: 015-081-06
A. WELL DATA
Well type PRIVATE If A, B, or provide PWSID# N/A
Date completed 9/22/2003 Sanitary seal (Y/N) YES
Total depth 196 ft. Cased to 195 ft.
FROM WELL LOG
Date of test 9/22/2003
Static water level 168 ft.
Well Log (Y/N)
Wires properly protected (YIN) YES
Casing height (above ground) 18+ in.
AT INSPECTION
7/18/2011
159 ft,
Well production 20 g.p.m. 5.4+ g.p.m.
WATER SAMPLE RESULTS:
Coliform�� colonies/100 ml. Nitrate G.9 3 mg./L. Collected by: GEG, Ltd.
Arsenic: / pu o ug./L. Date of sample: 7/3/2013
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 8/11/2003
Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping 7/5/2013 Pumper ONE STOP PUMPING
C. ABSORPTION FIELD DATA
Date installed 8/11Z2003 Soil rating OZEd.l r ft2/bdrm) 0_6 System type
TRENCH
Length 46 ft. Width 3 ft. Gravel below pipe 8.5 ft.
Total depth *13.9 ft. Eft. absorption area 782 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 7/18/2011 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 8 in.
Elapsed Time: = min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at in. "Pump off' level
E. SEPARATION DISTANCES
level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot loo ,+ On adjacent lots 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption Feld 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:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION pP`� "' • '.
I certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date. Q e A.
Engineer's Printed Name JEFFREY A. GARNESS
Q��QC9j 7 g15.33
Date `11143 professo• a\ F',o•o`Ao o
o
(Rev. 11105)
Municipality of Anchorage
p,
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 111276
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 4 of
Thayermoore Heights subdivision. This inspection revealed a nitrate
concentration of 6.93 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-081-06 COSA#
Expiration Date:
1. GENERAL INFORMATION Ex p
Complete legal description THAYERMOORE HEIGHTS S/D; BLOCK 1, LOT 4
Location (site address) 9800 HILLSIDE DRIVE * ANCHORAGE, AK * 99507
Current Property owner(s) DWANYE & LISA DORAU Day phone 720-7651
Mailing address
Lending agency
Mailing address
Real Estate Agent
-- Mailing address
9800 HILLSIDE DRIVE * ANCHORAGE, AK * 99507
Day phone
D'ETTE OWENS W/ KELLER WILLIAMS Day phone
440-2313
101 W. BENSON BLVD, #503 * ANCHORAGE, AK * 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Municipality of Anchorage. �—
��
Development Services € epartment -
0
Building Safety Division tT
Individual Holding tank
On -Site `Nater & Wastewater Program
❑
4700 Elmore Road
❑
P.O. Dox 196650
Public Sewer
Anchorage, AK 99519-6650
www.r.-i unt.org/onsitte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-081-06 COSA#
Expiration Date:
1. GENERAL INFORMATION Ex p
Complete legal description THAYERMOORE HEIGHTS S/D; BLOCK 1, LOT 4
Location (site address) 9800 HILLSIDE DRIVE * ANCHORAGE, AK * 99507
Current Property owner(s) DWANYE & LISA DORAU Day phone 720-7651
Mailing address
Lending agency
Mailing address
Real Estate Agent
-- Mailing address
9800 HILLSIDE DRIVE * ANCHORAGE, AK * 99507
Day phone
D'ETTE OWENS W/ KELLER WILLIAMS Day phone
440-2313
101 W. BENSON BLVD, #503 * ANCHORAGE, AK * 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems
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. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
❑
Individual Holding tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems
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. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECT!ON BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, / 'verily that nttly
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply ardfvr wastewater disposal system is (are.) safe, functional and adeMuate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
r i ,✓ r_ c n s„ s n -,# r f,'1 f n my in�ieJ.ation and :^spectior' the
it ill7rl, ation obtained b ort, the ifunicipali, o, 11n-orage ;lees and ,rom +; ., .
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
Address
GARNESS ENGINEERING GROUP, Ltd.
3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Enaineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and 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, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore 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 report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
_Z Approved for bedrooms.
Disapproved.
Phone 337-6179
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COS^ Checklist
Septic System Advisory
Well Flow Advisory
Nitrate r.uViSo;y
V
tars_ .if �i'3V`i�fl \!
e -n..- ..- -
Maintenance Agreements
Supplemental Engineer's Report
Outer
By:— ��` ; Original Certificate Date:
...............
aA. rness..
rofess�o��o
If OFri, C
er
\�� •.,..,• yet
ON-SITE
WATER AND : rn
WASTEWATER
PROGRAM
ia:*, rc Yrs
(Rev. 11105)
Municipality of Anchorage ,t ,:5�
Development Services Department "'
Building Safety Division ,',. T
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: THAYERMOORE HEIGHTS S/D; BLOCK 1, LOT 4 Parcel ID: 015-081-06
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES
Date completed 9/22/2003 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 196 ft. Cased to 195 ft. Casing height (above ground) 18+ in.
Date of test
Static water level
Well production
FROM WELL LOG AT INSPECTION
9/22/2003 7/18/2011
168 ft. 159 ft.
20 g.p.m.
5.4+
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrates. &3mg./L. Collected by: GEG, Ltd.
Arsenic: _�g./L. Date of sample: 7/18/2011
B. SEPTIC/HOLDING TANK DATA
Coli }or rr% —4 P cI 1
Tank Type/Material SEPTIC/STEEL Date installed 8/11/2003
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping Pumper ONE STOP SERVICES
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 8/11/2003 Soil rating p.d./ orft2/bdrm) 0.6 System type DEEP TRENCH
Length 46 ft. Width 3 ft. Gravel below pipe 8.5 ft.
Total depth *13.9 ft. Eff. absorption area 782 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 7/18/2011 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in.
Elapsed Time: — min. Final fluid depth 0 in. Absorption rate >= 450+ g,p.d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access (eveY/N
"Pump on" level at in. "Pump off' level High water alarm ll at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
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,
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+
100'+
Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed N me JEFFREY A. GARNESS
Date Z 8J f
COSA Fee $ Ifq d
Date of Payment srh
Receipt Number G3 I q 0-0
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS_
SGS Ref.#
1113371001
Client Name
Aarow Pump & Well Service
Printed Date/Time
07/28/2011
15:14
Project Name/#
9800 Hillside Drive
Collected Date/Time
07/26/2011
9:00
Client Sample ID
9800 Hillside Drive
Received Date/Time
07/26/2011
9:40
Matrix
Drinking Water
Technical Director
Stephen C. Ede
PW SID
0
Sample Remarks:
Allowable Prep
Analysis
Parameter
Results LOQ
Units Method Container ID
Limits Date
Date Init
Microbiology Laboratory
E. Coli
Negative 1
100mL SM20 9223B A
07/26/11 CR
Total Coliform
Negative 1
100mL SM20 9223B A
07/26/11 CR
Municipality of Anchorage Gt 8
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 01508106
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 4 of
Thayermoore Heights subdivision. This inspection revealed a nitrate
concentration of 5.83 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
SGS Ref.#
1113220001
Client Name
Garness Engineering Group, Ltd
Project Name/#
Thayer Moone Hts Bl, L4
Client Sample ID
Thayer Moone Hts Bl, L4
Matrix
Drinking Water
Printed Date/Time
07/21/2011 16:34
Collected Date/Time
07/18/2011 11:25
Received Date/Time
07/18/2011 12:05
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date snit
Metals by ICP/MS
Arsenic
I Waters Department
Total Nitrate/Nitrite-N
Microbiology Laboratory
E. Coli
Total Coliform
ND 5.00
5.83 0.100
Negative 1
Positive 1
ug/L
EP200.8
C
(<10)
07/19/11 07/20/11
NRB
mg/L
SM20 450ONO3-F
B
(<10)
07/18/11
AYC
100mL SM20 9223B A
100mL SM20 9223B A
07/18/11 DLC
07/18/11 DLC
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Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING r� R�-15Sv`re
Parcel I.D. ois-o8i-o6 COSA#
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Thayermore Heights Block z Lot 4
Location (site address) a800 Hillside Drive Anchorage, AK g95o7
Current Property owner(s) David Anderson Day phone (480) 2i6-o5L_
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
121; S Alma School Rd #ss26 Chandler AZ 85224
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3 _
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone 317-f_75�a
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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,
based on prdcedures outlined in the Certificate of Onsite Systems 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 files 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 _Pannone Engineering Services LLC Phone 272-8218
Address P.O. Box 102og4. Anchorage AK agsio
Engineer's Printed Name Steven R. Pannone. P.E. Date_ (795P) (Zi/
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with h10A DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system
These conditions are outside the control of the evaluator of this system. All systems eventually fail an
satisfactory lest results do not guarantee future performance of the system, nor do they guarantee that
there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory _
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:_
(Rav 11leS)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Thavermore Heights Block a Lot y Parcel ID: o2s-oei-o6
A. WELL DATA
Well type P
Date completed 91221200
Total depthX06 ft.
Date of test
Static water levet
If A. B, or C provide PWSID # _
Sanitary seat (YIN)Y
Cased to 205.42 tt.
FROM WELL LOG
012212003
468 ft.
Well Log (Y/N) Y
Wires properly protected (YIN) Y
Casing height (above ground) 12+ in.
AT INSPECTION
7/22/2008
z5S ft.
ZD
Well production 20 g.p.m. s.z g.p.m.
WATER SAMPLE RESULTS: 9.57
Coliform colonies/100 mL Nitrate mg1L Other bacteria colonies/100 mL
Arsenic: bW— mgll Date of sample:14Z&3 Collected by: Laura Pannone
B. SEPTICIHOLDING TANK DATA 1710/0 Fi
Tank Type/Material Anchorage Tank Steel Date installed 812s12ooa
Tank size s000 gal. Number of Compartments a Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YM) NIA
Date of pumping 7fta12oo8 Pumper Isaacs Pumping
C. ABSORPTION FIELD DATA
Date installed 8/2s/2oo3 Soil rating (g.p.d./ft2 or ft2/bdrm) 25o System type Deep Trench
Length 46 ft. Width a ft. Gravel below pipe 8 ft.
Total depth 21.75 ft. Elf. absorption area Lft2 Monitoring tube Y Depression over field N_
Date of adequacy test 7/2,4/2oo8 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth In absorption field before test o In. Water addedS2o gal. New deptho in.
Elapsed Time: o min. Final fluid depth o in. Absorption rate >= &So+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date
F. COMMENTS
G. ENGINEER'S CERTIFICATION ��:���. ,,,����0
I certify that I have determined through field inspections and
4 •., s r}
review of Municipal records that the above systems are in ,
...I .. .. ....
conformance with MOA COSA guidelines in effect on this date. �
Engineer's Printed Name Steven R. Pannone. P.E. # C sle+en f.' Pannone!
• t:'• No CE 814�ri
Date C r2_11
,;:. ..........
. .......••'c;:
COSA Fee $_
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number,
D. LIFT STATION J� %
Date installed Size in lions
Manhole/Access (Y/N)
'Pump on' levet at —in. 'Pump off" el at —in.
High water alarm level at in.
Datum Cycl t
(Y \\
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot loo+
On adjacent lots aoo+
Absorption field on lot soo+
On adjacent lots aoo+
Public sewer main m, joo-I itU
Public sewer manhole/cleanout
Sewer /septic service line u+
Holding tank loo+
Animal containment areas soo+
Manure/animal excrete storage areas soo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation so+ Property line so+
Absorption field c+
Water main 7c+ Water service line
xc+ Surface water aoo+
Wells on adjacent lots soo+
SEPARATION DISTANCE FROM ABSORPTION FIELD
ON LOT TO:
Property line ao+ Building foundation _ao+ Water main 75+
Water Service line zc+ Surface water aoo+
Driveway, parking/vehicle storage ao+
Curtain drain Wells on adjacent lots
aoo+
F. COMMENTS
G. ENGINEER'S CERTIFICATION ��:���. ,,,����0
I certify that I have determined through field inspections and
4 •., s r}
review of Municipal records that the above systems are in ,
...I .. .. ....
conformance with MOA COSA guidelines in effect on this date. �
Engineer's Printed Name Steven R. Pannone. P.E. # C sle+en f.' Pannone!
• t:'• No CE 814�ri
Date C r2_11
,;:. ..........
. .......••'c;:
COSA Fee $_
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number,
Municipality of Anchorage
• '� Development Services Department
Building Safety Division
` s• arr
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 080264
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 4 of
Thayermore Heights subdivision. This inspection revealed a nitrate
concentration of 6.57 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
14
WIE U�J
SCS Retia
Client Name
Project Name/N
Client Sample ID
\latria
Sample Remarks:
1086627001
Pannone Eng. Srv.
9800 1 lillsidc
9800 1 lillside
Drinking Water
Printed Date lime
Collected Date rime
Received Dale/rime
Technical Director
12/18/2008 13:13
12/10/2008 11:05
12/10/2008 17:05
Stephen C. Ede
Parameter
Rcsults
POI. Units
Method Container ID
Allossablc
Limits
Prep Analysis
Date Date
Init
Waters Department
Total Nitrate/Nitrite-N
6.57
0.100 mg/L
SX1204500NO3-F
B
(<10)
12/16/08
JDZ
Microbiology Laboratory
Colony Count
0
cot/100ml.
SM20 92228
A
(c200)
12/10/08
DLC
Total Coliform
0
col/100ml-
SN1209222B
A
(<I)
12/10/08
DLC
Fecal Coliform
0
col/100mi.
SM209222B
A
(<1)
12/10/08
DLC
Municipality of Anchorage
Development Services Department 4, -,
Building Safety DivisionOn-Site Water and Wastewater Program4700 Bragaw StreetP.O. Box 196650G'
Anchorage, AK 99519-6650 0l/ 111% �
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING o
Parcel I.D. o15-o8i-o6 COSA #
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Thayermore Heights Block i Lot 4
Location (site address) 9800 Hillside Drive Anchorage AK gg5o7
Current Property owner(s) David Anderson Day phone 1-480) 236-og6
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
129 S Alma School Rd #1126 Chandler. AZ 85224
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 'A
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ED
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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,
based on procedures outlined in the Certificate of On -Site Systems 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 files 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 Pannone Engineering Services LLC Phone 272.82-18
Address P.O. BOX 2029S4. Anchorage. AK g9rio
Engineer's Printed Name Steven R. Pannone. P.E. Date
Engineers Comments: In conducting an adequacy lest, l attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system.
Tlese conditions are outside the control of the evaluator of this system. All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
confer any legal right whatsoever.
S. DSD SIGNATURE
_( 11104 Approved for _ e2bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory x -
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: 0 3;0,
(nom tfa5
Municipality of Anchorage
Development Services Department
/ Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Thavermore Heights Block s Lot
Parcel ID -oaS-obi-o6
A. WELL DATA
Well type P
If A. B, or C provide PWSID # _
Well Log (Y/N) Y
Date completed 9L221200-4
Sanitary seal (Y/N)y
Wiresed
ro
p p y protected (YM) Y
Total depth 196 ft.
Cased to 1GS.L3 ft. Casing height (above ground) sz+ in.
FROM WELL LOG
AT INSPECTION
Date of test
hga000
7/21/2008
Static water level _
268 ft,
Well production
zo g.p.m.
WATER SAMPLE RESULTS:
— �— 1 _:_ g•p.m.
Coliformcolonies/100 mL Nitrate (s. 0-2 mg/L Other
bacteria colonies/100
Arsenic: 4& mg/I
Date of sample: 71211os
mL
Collected by: Laura Pannone
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material _Anchorage
Tank Steel
Date Installed 8/iihooa
Tank size _%000 gal,
Number of Compartments a
Cleanouts (Y/N) Y
Foundation cleanout (Y/N).y
Depression over tank (Y/N) ),I
High water alarm (Y/N) NIA
Date of pumping _24518 oB
Pumper Isaa s PUMDinO
C. ABSORPTION FIELD DATA
Date installed 8/11/2oo2 Soil rating (g.p.d./ft2 or i
Length 66 ft. Width a
Total depth 13jS ft. Eff. absorption area Lft2
Date of adequacy test Zh1/2oo8 Results
Fluid depth in absorption field before test c in.
Elapsed Time: o min. Final fluid depth o In.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
t2/bdrm) zco System type Deep Trench
ft. Gravel below pipe _8.S ft
Monitoring tube Y Depression over field LI
(Pass/Fail) Pass For 3 bedrooms
Water added5oo gal. i New deptho in.
Absorption rate >= bSo+ g.p.d,
N If yes, give date
D. LIFT STATION
Date Installed
'Pump on" level at_ In.
Datum
Manhole/Access (YIN)
'Pump ollf�' vel at _In. High water alarm level at in.
Cycles).6Pb,d�.,_ Meets alarm & circuit requirements?
E. SEPARATION DISTANCES / �
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankflift station on lot aoo+
Absorption field on lot %oo+
Public sewer main 15+
Sewer /septic service line ac+
On adjacent lots ioo+
On adjacent lots ioo+
Public sewer manhole/cleanout .acO l f f
Holding tank ioo+
Animal containment areas zoo+ Manure/animal excrete storage areas aoo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation io+ Property line %o+
Absorption field ;+
Water main 7s+ Water service line ZS+ Surface water loo+
Wells on adjacent lots zoo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line zo+ Building foundation zo+ Water main 7s+
Water Service line z5+ Surface water ioo+ Driveway, parking/vehicle storage so+
Curtain drain P'Y? *f' Wells on adjacent lots aoo+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field Inspections and
review of Municipal records that the above systems are In
conformance with MOA COSA guidelines In effect on this date.
Engineer's Printed Name Steven R. Pannone. P.E.
Date 0�-7
COSA Fee $ ✓v �po Waiver Fee $ _
Date of Payment g �d0 Date of Payment
Receipt Number 5'ZPW-% Receipt Number
(Rev. 11105)
'en R Ponni
No CE 8149
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 080264
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 4 of
Thayermore Heights subdivision. This inspection revealed a nitrate
concentration of 6.07 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
SGS RCU
1083569001
Client Name
Pannone Eng. Srv.
Project Name/N
L4,B1 Thayermore Iits
Client Sample ID
L4,B1 Thayermorc fits
Dlatric
Drinking Water
PN'SID
0
S.vnplc Remarks:
All Dales/Times are Alaska Standard Time
Printed Date/rime
08/052008 8:32
Collected Date/Time
07212008 13:30
Received Date/Time
07212008 13:55
Technical Director
Stephen C. Ede
ParametttAllowable Prep Analysis
Results PQL Units Method Container ID Limits Date Date
Init
Metals by ICP/MS
Arsenic ND 500
Waters Department
Total Nitratc/Nitritc-N 6.07 0.100
ug/L EP200.8 C (<IO) 0725/08 07/31/08 NRB
m8/L SM20450ONO3-F B (<IO)
Microbiolow Laboratory
Colony Count 0 col/IOOmL SM209222B
Total Coliform 0 col/100mL SM209222B
Fecal Coliform 0 col/IOOmL SM209222B
A (<200)
A (<I)
A (<I)
08/01/08 JDZ
0721/08 DLC
0721108 DLC
0721/08 DLC
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Municipality of Anchorage
1'1'•� PAGE eU/
•';(' Development Services Department ,
Building Safety Division o
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
0CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 015-081-06 HAA# LJLi DUB
Expiration Date: j,)&2/U4
1. GENERAL INFORMATION T
Complete legal description Lot 4; Block 1: Thayermore Heights Subdivision
Location (site address or directions) 9800 Hillside Dr. Gai5a7
Current Property owner(s),;Dave & Patricia Anderson Day phone 227-1172
Mailing address
Lending agency
Mailing address
Real Estate Agent
PO Box 231021 Anchorage, AK 99523
Day phone
Day phone
Mailing Address 7
Unless otherwise requested, HAA will be held by DSD for pickup. /o
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well MK
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
X❑{
Individual Holding tank .
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a'public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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,
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 files 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 S & S Engineering
Phone _
694-2979
Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK //99577
Engineer's Printed Name Robert C. Cowan Date^ `7,//(O�
5. DSD SIGNATURE
_ Approved for bedrooms.
Disapproved.
ROBERT C. COWAN
CE -8801
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: k . Q - Original Certificate Date:
(Rev. 01/02)
lvtu
Deveto
On-
��"
If A B, or C rdutde PWSID # Well l o YE:S
/ xz'o3 Sanitary weal /N) �s Wires properly protected &N) Y&5
Y"°t#'a"
ft Cased to r9 ft Cd''surg"Iieight (above ground)
MOM
>W' N_" R0
9Pm. q 6 J" 9Pm
R�S'tUL`r. ' L�ns�riA
WY
colomes/900 ml Nitrate mg
A. Other bacteria o colonies/100 mf
}aY%a� r�°'�.# u#. � z'.t, c ,w�, �'w�✓�'-:^b°`,^�"`?�4R '`,e°�'x+" z±�.d��Fr+�e>w: L.r:+ ar ar � a�� ✓ s w :
m / a e o semi e. �/ 2R u S & SENGINEERING _, .
a a" a u 7 ap • ver Loop Wad No 204
'�agteiver,
rro .. .. Fun,4+m�FS�`m?�✓""s�'si�a.a�`w...� a tx f"+dFce'k.4 ,.�Z+,,:a. �a,�n�f�•ata• strs�, � '
03
�, v .. ... �`". ..a �4 4��¢Y�ffi`'dzi� .. r H �"� ue�' F:'�,^}� iv}2�✓x.54. .�h� ..,.'�.; 'S
a 'gal. � f;i"um,6er of'Compartments` �� Cleanouts �) `i£ S
ou N) YES _pepression oger tank
High-water alarm"(Yf� /V
` N A NEw Pumper
1449 _7
4we� �:= f'eyKYEa x«r haw gcm4.�+ Y3TM+ Nv � v} P
"/ �� Soil rating / z or ftZ/bdrm) © 6,. System type bE trti y7Rjr v cN
ft." : Width '�� ft Gravel below prpe � $ �.<e„ahft
_ ft � Eff abs�orpYibn areae a- ftp Monitdring ube YDS Depression over fieltl _
c est NEw' Results (Pass/Fail) For bedrooms
orption Ia a ore'tes in at added_ gal. New depth to
= Mn., :: ' al fluid depth _ In: Absorption rate"5 -� gp.d.
atment'(past 12 mo.) (Y/N &'type) If yes, give date
n
u
records that
off level at igh water alarm level at in.
tested Meets alarm & circuit requirements?
fir.. ..
C3
)Ove systems are in
s in effecfon this date.
�.
' p�� ROBERT L COWAN
W C0("ig ���� -8801
..4+/ar7er-Fee $ 17
Date of Payment
i w `�^s ?n 5+."' ar .gr CWF �a ✓'' �� . _'.r,: a�+.�i .
_ !� Receipt Number
9- 1-04; 4:25PM;
CT&E Ref. #:
1045556001
Client Name:
S & S Engineering
Project Name:
Thayermoore Hts, Lt 4, Bik 1
Client Sample ID:
Thayermoore Hts, Lt 4, Bik 1
Matrix:
Drinking Water
PWSID n/a
Sample
;907 5615301
ME Environmental Services
200 W. Potter Drive
Anchorage, AK 99518
Tel: (907) 562-2343
Fax: (907) 561-5301
All dates/times are Alaska Standard Time
Printed Date/Time:
09/01/04 16.30
Collected Datefrime:
06/29/04 19:00
Received Date/Time:
08/30/04�
//�12:21
Technical Director:
Stepher).,�fe
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Total Coliform (MF) 0 COV100 ml SM92228 09/01/04 DC
Nitrate 4.23 1,00 mg/L EPA 300 10.0 09/01/04 JJB
08/03/04 1Q:18 FAX 1 907 563 6139 SIEMENS BLDG TECH-LANDIS
N
O
N
O
HILLSIDE DRIVE
D
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414
N
O
HILLSIDE DRIVE
D
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