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HomeMy WebLinkAboutCHANDELLE ACRES LT 11 MUNICIPALITY OF ANCHORAGE DEl ,TMENT OF HEALTH AND HUMAN SER¥,_--'S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~ ~'<'~ t.... ~ ',../~,J,~::~"r'"T' ~ SEPTIC ABSORPTION Address / WELL -.., TANK FIELD ,. I,~,m,t No NO ol BedSores WELL Lot ~ Block SuDdiws,on ~t ~ ~~. ~ FOUNDATION Township. Range, Section AS-BUILT DIAGRAM ~Show location of well, septic system, property hnes, foundation, TANKS N ., N  SEPTIC ~ HOLDING ~nutamur~r Capac,ty ,n gallons Material No. of Compa~ments TYPE OF SYSTEM ~RENCH ~ BED ~ W. DRAIN ~ OTHER F [ added above ongmal grade G~avel depth beneath Grave~ length G~avel w~dth Number ~:~ hnes Sod ralmg~ Ipstaller Date Installed ~ WELLS J~ ~ PRIVATE : OTHER ildentifv) Classification (A,B C) ]oral Depth Cased to ~ ~ ~ ~ _ FT ET ]rlstaHE ~ Dale Installed: REMARKS: I ceflily that this inspection was pedormed according Io all '% t, .- ~,-r~.;. GLE ]NIt 1985 ~unicipal and State gmQeunes in ~ / ~ _. - _ ~ ,4"~'~,." .. ,-" .... '~- Health Depadment Approval: ~ . .... Date: 72 013 (3/85) owner of LAnD /'/~ Y z Y ~ o 7" LEGAL DESCRI~ION DATE,St~[ted _ ~ ~ Ended PERMIT NUMBER ST-xH(' LEVEL OF' w-~,I'F.R I)RA~V I)OWN FT. GALS. PER HR __ ~¢.5rO KIND OF FORMATION: From O · Ft. to ~ From__~' Ft. to g From ~ ~FI. to ~ From?_~ Fl. to_/I ~ From_/I O' Ft. toJ~=_~7_ Ft. From/~"q Ft. to tTot'' Ft. "Ct'~ '-q'/~-u_O__i~__~_~._~e-~' From./_'7-~'Ft.~oOol$ Ft.d,~,ff_r ~ From~ ' - _Ft. Fromc~_3g]:; Ft. Fr0m'~/. ~ Ft. '~:rom ........... Proem ...... ~-( Fl. From'___:. :. -Ft. From- , '' Ft. From" '-~' ' Ft. to_ Ft. to Ft, to._ . Ft. to . Fi. to ..FI From . FI. to ...... Ft.. From __ Ft. to__Fl From .... Ft. to__ _ Ft. From __. Ft. Io___ Fl. From .Fl. Io FI__ From Fl. to Ft. From _. Ft. Io FI. From Ft. to FI. From Ft. lo Ft From Fl. to FI. From .... Ft. lo___Ft. From Ft. to Fl From Ft. lo__Ft From ...... Ft. to_ Fl From Ft. to Ft. From Ft. to Ft. From. - .Ft. to ___Ft MISCL~. INFORMATION: ~',:::.;:;;'!: :-- _~, !:~, ._~a.:),~:,...~_., i~;., ~--~-" ' DRILLER'S NAME DE:F:'ARTMEI',IT OF HE:AL]-H AND ENVIRONMENTAL F:'ROTECTION Q~.,_, L STREET, ANCHOR'AGE, AK 9950:1. 264-4'720 .-.:.,,[,~ T ND: DAlE i E~-':JR.!ED: LJNI r.-::...: I .... I,IE:.: G A I I .... Z Y' W 0"I" T F'. (.'.). BOX 670264 E;HUGIAK, AK 99567 6 ¢¢ 4 - 5 5 .'.")0 I...E:.GPd .... i'bESCRtP: SUBDIVISION: CHANDELL. E; ACRES LOT': 11 SECTION: 3 TOWNSHIF': 15N RANGE;: 1W LOT SIZE: I.OA (Si]!.F:T. OR ACREES) tdAX BEDROOMS: 4 BLOCK: NA t...isted t:>~-.--...',to~.,~ ar-e the optior'~s available t.o you in desigr~ing your' sep±.ic system. Chc)c:,se the op'li, ior~ that. [)est. fits yC3Ltf" site. DEF'I"H 'i"E) F::'IPE BOTT'OH (F'T.) i'BF:;:AVEL.. DEF:"I'I'"i {F']". ) 'f'O'TAI .... DEPTH (F"T.) ~, ,A ', ! ...... W I D't' H { t::'"['. ~ GRAVIEL. I_E:NGTH (F']".) G R A V ElL V OI....U M El ( C U. "¢' D S. ) TANK SIZE (GAL. S) SOIL. RA'I"J:NG (SQ.F'T. /BR) 4.0 ~" 4.() 4.0 6, () ¢ (). 5 3.5 1(). () 4.5 7 .. 5 2., 5 30.0 5.0 11 '7.0 ~* 57.0 1. 5 1. () *..~- 70 ,, 5 63.4 ~. :[ 1.9 1,:'250.0 .~-* 1,250.0 ** 1,250.() ,~* 349 284 34':;? · ~,~..~ GF;:AVEL. L. ENG'T'H > ,,j FT. RE','4UIRES MULTIPLE RLINS -x..~- ['ANI::: ,HUS'T' I...l~.~v[:. A'I LEAS] .... ['WO COMPARTME:;NTS (NO'T EXCEEDII"4(3 '75 F'T. EACH) ]. c:er"l:i£y that: .I.,, 1[ am £amilia[' wi'Lh the r-equir'er~er'~t~ for' or,-site sewer's and we].].s as seT.. Cc)["Lb by the Muriicipa].i'Ly o[' Anchor'age (MOA) and the SCare t::)[' Alaska. 2,, i will ~nsCa].]. the system in ac:c:c.~r'dar~ce with alii MOA codes and a.i']d J.i'] cc)ml:.~].:i, arlce with 'Line-.. design c:r'J, ter'Je (::)f this pepmJ, t,, :7.!;. I w:i. ll adher'e to all HOA anti State t::~f Alaska pequiPements fop the -.-:..-..et. bacl< eli. statices ['r'om any exi~t:i, ng ~e'l]., ~astewater' disposal system ol' pLtblic: s(.::*wer'age system t::)r"! this or' ar'~.¥ adjec:ent or. near'by ].c)t. .... '-" op a maximum (:].t' 4 be(:JPoE, m~ ,.?:',.F~d ,1-,: ! under'stand that. this I..3ePmit 'is v,:,.~.±d f' any eri].al-6!erner'.,t ~:i. ll r'equ±r'e.', an additic~nal 'fl:::' A I...:i:t:::T S]"ATION IS INST'AI....I....ED tN AN AREA COVERED BY MOA BLJILDING C[)DES, · . .I.N,=~F~.L,] ~.t..ll,I MUST BE ("IBI"AINED; (2) AS'-"BLIII....TS THEI".I ( :f.'~ AN EL.E:C'I'RICAL. PERMI]" A.N[) " c'"',,- ....... ~ .... . .... WILl .... NO"I' BE AF'PROVED W["I"HC.tLtT AN IEL. EiI]'TRICAL. II'4SPE:C".rION RE{F:'ORT; A. ND (3) THE i!!Xi....I!it3'T'R I CAI... W.r.]Fi'.K MUST BE DEiNE: BY A L.. I CEIx!SED E]....iECTI:-;~ i C ! AN. .... TLI4 ......... · "'~"" "'""'"' '~' 4 '::, ~ L ':~411'~ T ¢-H'" c' b.[ t...-t-'-lnl ~ ?, .............. ~ ,. · PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ! ! ~-~.~l O~ ~(~;.l~.~ri~_R'S SEAL) DATE SLOPE ENCOUNTERED7 IF YES, AT WHAT DEPTH.;' Depth to Water Alter Monitoring? 1'~ C~'--~,~ DaZe: S L SITE PLAN ' I Gross Net Depth to Net Reading Date Time Time Water Drop ~ q-~-~ ~ fl' ~, ~ ~,~ ,,- ~ ~ .... PERCOLATION RATE q('~ (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN ~)' FT AND FT COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI~S IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN Z/O / S & S ENGINEERING SRB 196X EAGLE RIVER, AK 99577 ,o Z iCIpA~ITY Ol: ANCHORAge' MUNICIPALITY OF ANCHORAGE 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. # ~.~\ - OIc)q')' ~ ~ HAA # GENERAL INFORMATION Complete legal description ,Z'o/- // Location (site address or directions) Property owner ~'~'~-~Jc¢ ¢' "~7-/-/7" ~(.J,,f~,~,,~:~-z. Day phone Mailing address Lending agency Day phone Mailing address Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: 72-025(Rev. 1/91) Front MOA#21 ~'~/'~ 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. 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. David R. Dayton P.E. Name of Firm 20210 Dona]ar St. Phone Chugiak, Alaska 99567 Address L'/~/~-~ ~/:;;2/~ .~ '~x/--~ Date Engineer's signature ,~_ '- -~- .- -/.. DHHS SIGNATURE Approved for ~-o~-~',- (~L/) Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ./~,,~u~ ~-~ 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 DH HS does this as a courtesy to purchasers 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. 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage ~i~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ // ~,~,,u~.-~ ~ Parcel I.D. A. Well Data Well type j),~ ~'4.'r~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~ ~-"';,.~- Date completed ! 5' ~(~ Driller Total depth 'Z- ~' ~ Cased to Z. ~. ~' Casing height Sanitary seal (Y/N) y' Wires properly protected (Y/N) )/ FROM WELL LOG AT INSPECTION Date of test 7_//~/,f,~, / 0,//~/~ Static water level 2. ~ ~ 2,~' I=1=1 Well flow, ~', 7 ,'- g.p.m. ~' ~' g.p.m, r'r'l Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ / O~ ; On adjacent lots Absorption field on lot J cu~) ; On adjacent lots I c~.~.t-- Public sewer main ~ ,,~ Public sewer manhole/cleanout Sewer service line ~"~'~"~ Petroleum tank OZ WATER SAMPLE RESULTS: Coliform c> Date of sample: Nitrate ' c>, z~> Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA installed F' //~'~ Tank size Date Cleanouts (Y/N) "/' Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping I P-~ Compartments ~" ~' Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I c~ 5"- To property line ~ C~ Surface water/drainage On adjacent lots Absorption field j ~, --I.-- /' 0 0 "~ Foundation Z- ~ / ~, Water main/service line /~:~ ~-' 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 Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed /-A~/J Length I I-7' Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) ~ ~'~ Width Z0 ~' ~ Gravel thickness /~o ~ Cleanout present (Y/N) y ~ c)/t ;5 / ~ _~. Results (pass/fail) '¢~'¢¢,¢--- System type ~, ' Total depth /~ ' Depression over field ~/N) ~ for After test ~ If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation ~,~ ~' On adjacent lots On adjacent lots ~ 'r- Cutbank Surface water Curtain drain E. ENGINEER'S CERTIFICATION Property line To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area Z.~ ~ ~ '1'~>,~ I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date David R. Dayton P.E. 20210 Donalar St. Chugiak, Alaska 995.67.. HAA Fee $ -~ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number D. R. DAYTON P.E., R.L.S. ~~)~:~ Chugiak, Alaska 99567 20210 Donalar . (907) ~~-]~ 696-2417 October 14, 1993 WELL FLOW TEST Legal Description:' Lot 11, Chandelle Acres Date of Test: October 13, 1993 Well ~ .pth: 238' Stati~ Water Level: 208' Requirements: 4 BR - 600 gallons per day Test: The well was tested with the existing pump through an outside hose bib. Volume and drawdown were measured at regular infe~vals. Results: The well ~roduced 657 gallons in 120 minutes at an average flow rate of('5.5 ga.~ons per minute, Max~imUn drawdown was 4'. The drawdown was fully recOvered within 10 minutes after pumping was stopped. The well is currently producing adequately for a 4 bedroom home. D. R. pAYTON, P.E., R.L.S. ~~)~; Chugiak, Alaska 99567 (907) 20210 Donalar 696-2417 October 14, 1993 ADEQUACY TEST Legal Description: Lot 11, Chandelle.Acres Subdivision Date of Test: October 13, 1993 Septic Tank: 1250 gallon, 2 compartment, steel tank (DHHS Records) Absorption System: 117' long x 6' effective depth trench (DHHS Records) Soils Rating: 349 sq ft per bedroom (DHHS Records) Requirements: 4 BR - 600 gallons per day Test: As the house has been' vacant, the system was presoaked for 24 hrsl with 1000 gallons of water. Oh~10/1~/93 650 gallons of water were pumped into the trench and the water level rise measured. After 24 hrs the water level was remeasured. ResultS: After 24 hrs the water level was lower than the initial level. The absorption system is currently functioning adequately for a 4 bedroom home. COMMERCIAL TESTING ENVIRONMENTAL LABORATORY SERVICES & ENGINEERING CO. ......... RLlJOS'.T of ANA£.Y~IS Ct;emi ab Ref.~ :93.5268-1 Clier~t Sample ID ~Lll CI-{ANDEr. LLE ACR~lS Matt ix ~ WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Na~e :DAVID DAYTON, P.E. Ordered By :DVID DAYTON Project Name : Project~ PWSID :UA Sample Remarks: ROUTINE., SAMPLE COLLECTED BY: WORK Order :71751 Re[~t Completed :10/08/93 Collected :10/04/93 @ 15:00 hfs Received :10/05/93 @ !1:00 hrs. Tecb3~ical Director:STEPHEN 6. EDE D.~. DAYTON. QC Allowable Ext. Anal Para~eter Results Qual Units Method Limits Date Date Init .................................. ~ ............ .~__ __ .... ~ .......~__; ................. i ...... .~- .............. ------~ ~ ..................... Nitrate--N 0.!0 U mg/L EPA 353.2/300.0 10 10/06 LLH * See Special Instruciions Above UA : Unavailable *~ Se~, S~J~ple Remarks Above NA = Not Analyzed U :: Undetected, Ret~)rted value is the practical quantification ].].mit. LT = Less ThaD D --: Secondary dilution. GT = Gre~:~%er That% ~SGS Member of the SGS Group (Soci~,~ G~n~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA ? MUNICIPALITY OF ANCHORAGE ~ ~ / DEPARTMENT OF HEALTH & HUMAN SERVICES o,= s ,v,c s CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL "' OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date Januar~ 29, 1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1!; Chandelle Acres Location (address or directions) Immelman Circle (b) Property Owner Andy' Zywott Telephone: Home 688-2914 Mailin9 Address P.O. Box 670264 Chuqiak, Alaska 99567 Business 276-2761 (c) Lending Institution Home Savin~s and Loan Mailing Address Anchorage Telephone 276-1451 (d) Real Estate Company and Agent Re/Max- Andy Zywott Address 2600 Cordova Anchorage, Ak. 99503 Telephone 276-2761 Mailthe HAAtothefollowino address:or:Check herein, ifholdforpickup. Listcontactperson and day phone numberbelow. ordered by Andy Zywott (e) TYPE OF RESIDENCE Single-Family IX:I Number of Bedrooms 4 WATER SUPPLY Individual Well~[ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite:~j Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 trey 8/86~ Front ENGINEERING FIRM P ~ROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and 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 Telephone .~ & .~ ENGJI~iEERIN~ Address "l~'n~a, ~'.~1. I~1~ L_~,,~_ ~ _~__...~_~_ H~. Date Eagle River, Alaska ~577 DHHS APPROVAL Approved for .~b,.- ('~) bedrooms by Approved /~ Disapproved Terms of Conditional Approval Conditional CAUTION 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 purchasers 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. Page 2 of 2 72-025 fBpv 8,86/ Back MUNICiPALIF¥' OF AI'.:CHO:~t~[INICIPALITY OF ANCHORAGE (MOA) ENVi;~ONMENFAL $~:,:~.,';:.J~ DWtR~I. TH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ~ , ~:~ 2~-4744 Legal Description: ~ ~T // RECE VFD WELL DATA Well Classification Well Log Present ~N) Total Depth Z..~ ~ Cased to Z.,~ ¢:~' Static Water Level ~_ Casing Height Above Ground / Electrical Wiring in Conduit (~N) Separation Distances from Well: To Septic/Hofffmg Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments -~ V,J · -~. ~ If A, B, C, D.E.C. Approved (Y/N) Date Completed / 9 ~, L _~ Yield Depth of Grouting Pump Set At L~, I~... Sanitary Seal on Casing ~)'N) Depression Around Wellhead (Y/~ · On Adjoining Lots /~/ · On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~, ~- ~ ~ ~Z~,,/~J~/~_~,,,/u- ' Date ~- - / - B. SEPTIC/H;~E;;B;~ilG TANK DATA / z.. S'o Date Installed Standpipes ~N) Air-tight Caps ((~) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~//~:3~ Separation Distances from Septic/Holding Tank: No. of Compartments ~__ Foundation Cleanout (~N) Date Last Pumped .~. 2_- ~ - ,~ .~ ; for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation ~-'~ To Disposal Field /(-~ ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 (Rev 8/86~ Front Co ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed L~ - / O Width of Field Type of System Design Square Feet of Absorption Area /~/0~ Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / ~ To Building Foundation , ~'¢' ~ Lot ~/~ Length of Field To Water Main/Service Line /c~/¢- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Depth of Field /c~ f Gravel Bed Thickness (.~ i Standpipes Present (~%1) Date of Last Adequacy Test To Property Line ~-- ~' ~ To Existing or Abandoned System on · On Adjoining Lots .~/'/ To Cutbank (if present) /w/Pr Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 ~Rev 8/86~ Back Date MOA No. & GEOLOGICAL LABORATORIES OFALASKA, INC. ~_.~ 5633 S STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)562-2343 FEDERAL TAX ID # 92-0040440 AI~LYSlS I~EPO~ BY SAMPLE Ci lent POt : VERBAL Req t: Client Smpl ID: Lll, CHANDELLE ACRES 8a~kole Rec'd : FEB 1 88 Ordered By : Send Reports To: $ & $ ENGINEERING R 8CHAF. FER 17034 EAGLE RIVER LOOP RD., 1204 ~GLE RIVER, AK. 99577 Work Order No. : 4997 Client Account : 8NSENGP Date Report Printed: FEB 3 88 Released By : Reports Aaaress #Z 14:23 Special ~PLg COLLECTgD 2-1-88 AT 1100 HI~. COLLECTED Instruct: Chemlab Ref 1:8986 Lab Smpl ID: 1 Matrix: Water Allowable Parameter Tested Remit/Units Method Limits NITRATE-N NI)(O.IO) mg/I EPA 353.2 10 Sample ROUTINE &~H~Lg Remarks: ANALYSIS CO~P~D: 2-1-88 LABORATORY ~UPERVISOR: b'TEPHEN C. EDE ~---~- ~ I Tests Performed , See Special Instructions Above ND= None Detected ** See Sample Remarks Above NA= Not Analyzed LT=Less Than, bT=oreater Than