HomeMy WebLinkAboutHUNDRED HILLS 1ST ADDITION BLK 4 LT 9Hundred Hills
#1
Block 4
Lot 9
#078-191-12
Municipality of Anchorage Page / of Z
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW 95O3'Z PID Number. C1'7"-757/-12--
1%"-/57/-12--Name:
Name:
MoE�,�l
Wastewater System: N -New CIUpgrade
Address:
2308 �E`FrzsgY 9577
ABSORPTION FIELD
Phone:
/ 9u - 5/ ?5 /056
No. of Bedrooms:
Deep Trench 0 Shallow Trench 0 Bed 0 Mound 0 Other
LEGAL DESCRIPTION
soil Rating:
GPD/Sq. Ft.
Total Depth from oriigginal grade:
Lot::. Block: / Subdivision:
mmifrom original grade:
Depth to pipe bottom
Gravel depth beneath pipe
Township:
Range:
Section:_
Fill added above originalgrade:
/ Ft.
Gravel length: ��]]
/ Ft.
WELL: New ❑Upgrade
•
Grave l.aeptf-
(.(/! D7H Ft .
Number of lines:
/
f5
I Distance between lines:
Ft.
Classification (Private, A,B,C):
/%2 /'✓/tT-c
Total Depth:
//1 FL
Cased To:
1/'2 Ft.
Total absorption area:
75° SO. Ft.
Pipe material:
,70347 // S IA/
Driller:
S v,G--/ yr 71
Date Drilled:
1/ i7
Static Water Level:
Of Ft.So/7h'
Installer:
12e
Date installed:
//i �95---
Yield: )
VJ GPM
Pump Set at:
Casing Height Above Ground:
-/- I �� Ft.
TANK
--
Ft.
SEPARATION DISTANCES
Septic 0 Holding 0 S.T.E.P.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
public/Private
Sewer Lines
Manufacturer:
,qviL1 7-24/vx
Capacity in gallons:
/000
Well
iV
% /0 r
N/4
A//,
/ ^
l.f'0'iL
Material:
Number of Compartments:
1-
Surfac
Water
Iv IA LIFT STATION
-t/00/
Lot
Line
D t
r r
7
g/
Size in gallons:
Manufacturer: �_^
Foundation
//
�0
i"'?
/�/��
"Pump on" level at: "Pump off" f
����'
High water alarm at:
Curtain
Drain
,�//A�
Pump Make & Mo
lectrical Inspections performed by:
/Y
Remarks:
BENCH MARK
Location and Description:
_7-07 0/c- (oNe, &7
/exi/v)/// 777 DA/
Assumed Elevation:
X'0
ENGI#E Sig Ak-
o � a
OC ^
a q
V/
-t
,,4 -� r;T r.• r
.,,, ienie"�n u •ane F L,.1
/i l� "y} Lou S !'a.lL"li (❑ • s (6cf
�r ^ ,, ctY
-
Inspections performed by, �/ S Dates: 1st_(
,L2
2nd /i// /9�
Department of Healt and H a ices approval
Reviewed and approved by: GIN`'W- l ti ' Date: lAgti-S
72-013 (1/91) MOA 25
Permit No. SW950382
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: HUNDRED HILLS LOT 9, BLK 4
PID No.: 078-191-12
S 86'28'44'
a
9d
84.5
ELEVATI❑NS
(NOT TO SCALE)
t4
TANK
TOP OF CONCRETE FOUNDATION
ASSUMED ELEV = 100.0
FINISH GROUND 86.7
111
ADDED FILL3.5'I
4.3 S END 81.9
ORIGINAL
GROUND
LEVEL AT:
FIELD85.7
m
(1)S
0
\N END 81.9
MT D 76.7
MT E 76.7
j[L,O GWT @ TH1
O GWT 8 TH2
H1 69.7
TH2 72.7
SWING TIES:
A - C = 72.0
B - C = 63.5
A - D = 06.25
B - D = 03.66
- TEST HOLE
• - MONITOR TUBE
o - SEWER CLEANOUT
4 - WELL
LEACHFIELD
EASEMENT
SCALE 1" = 60'
11/15/95
ENGINEER'S SEAL
op000p0�
od���.
Q��P
49TH%\ �O�O
49TH
BUTERA
6736 aO
ESSIONPQ�
D
F a,
�040ooOd�
NOV-29-95 WED 05:47 PM SULLIVAN WATER WELLS 68S 2759444444444444 P.01
(lh'rttfirh 3Qu�
6>
bac Co. don
SULLIVAN WATER WELLS
P.O. BOX 870272, CHUOIAK, ALASKA 99507 • TELEPHONE88142759
OWNER OF LAND U: /4-"J T ti/'774110,.1
ADDRESS r� � STATIC EVEL OF WATER FT 6
LEGAL DESCRIPTION 40-r 1 84 K " t' 1`f RAW D
r�dR+s� DRAW DOWN FT
DATE • Started Ended // �GALS. PER HR Q°
KIND OF CASING 0 0
DEPTH OF WELL /1 6 r'/
PERMIT NUMBER
KIND OF FORMATION:
From -Ft toFt. CAL j J/U ('rom
From_Ft, to j Ft
Front rryFt. toFt
From_4S Ft.to tof Ft.
From Ft to 7,0 Ft.
From le Ft tart v ,t_,Ft
From/05f Ft. to 7 Ft,
From Ft. to
Ft to Ft
1 U ( )Niogv-4.) From Ft to Ft.
/44/412t-�vr1 ' 63.1e.4661tit
d.l.'1-' . g404:4. From
,I
�940 1, C�Bd;ZSFrom
FI to
Fr. to
Ft
Fr
t to Ft
c!.f4Y tt?R4i IG G. From Ft. to Ft.
J,.+ '%0 6e4JEO Strerlttti Ft. to Ft.
From Ft. to Ft.
From Ft to Ft From Ft. to Ft.
From Ft. to Ft. From Fr to Ft.
From F. to Ft. From FI to Ft.
From Ft. to Ft. From Ft to— Ft.
From Ft. to.. _Ft. From Ft to Ft
From Ft. to Ft. From Ft. to Ft.
From Ft to Ft. From Ft. to Ft.
From Ft. to Ft. From Ft. toFt
From Ft to ,.Ft_ From Ft to Ft
MISCL. INFORMATION:
RECEIVED
DEC 1 1 1995
1Viiunicipam.y si: ;;:,c rioi aye
Dept. Health & Human Services
DRILLER'SNAME iZA-44
-
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: L•%. `/ /f/-dfy7 //l. ' wro
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
O
-5" )7' S4NG�
6"v/,e,4 vf4
COMMENTS
DATE PERFORMED: /0 - /o -9f
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED? N�
IF YES, AT WHAT
DEPTH?
S
L
0
P
E
Depth to Water Atter
Monitoring? otr rb /3 Dale. /°//5/9r
SITE PLAN
N
-
/U
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
S,,e.-1
/o/,,,,,/5•5-
offo/sr/
/
a:,0
6
s'- 6 ;„
/ 646
Z
2.'V0
3 o
S'- 7 "4"
3
/•
a: v,-
6
S'- 6 s/6 „
y
4
31'1'
3J
S' - 7 "//6
/ ',G
5
I,
3;77
0
S'- 68/u
6
'
3:47
3o
S'- 7 ' .
/746,
PERCOLATION RATE ?a- (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND 6 FT
TEST //eLE ,ne-C kvRTF> 7o Cc...Fo.e ' Po e /
LONA', ror, ON
PERFORMED BY:
%z 2F.i,
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7r` / 2 -7r"
72-008 (Rev. 4/85)
1�oH copy
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND
WASTEWATER DISPOSAL SYSTEM
PERMIT NUMBER:SW950382
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:MOEHN MARK & SUE
OWNER ADDRESS:2308 JEFFERSON
ANCHORAGE, AK. 99517
PARCEL ID:07819112
LEGAL DESCRIPTION:
HUNDRED HILLS 1ST ADDITION BLK 4 LT 9
LOT SIZE: 55031 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE i OF
PERMIT
DATE ISSUED:11/08/95
EXPIRATION DATE:11/08/96
pu Go -cc 41;n A-
5s(GN Gtf4JCrti'. To 91X5,
Wl5 AFF w/A. ^Jew 13'0a
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
PRIOR TO CONSTRUCTION; PERFORM AN ADDITIONAL SOILS
TEST TO CONFIRM SOILS AND PERCOLATION RATE, AND
INSTALL A GROUNDWATER MONITORING TUBE. THIS MONITOR
TUBE IS TO REMAIN ON LOCATION UNTIL AFTER FINAL AP-
PROVAL HAS BEEN GRANTED BY THIS DEPARTMENT. SUBMIT
SOILS LOG WITH AS-BUILT/INSPECTON REPORT.
RECEIVED BY: DATE:
ISSUED BY:
DATE: � /6/?.5
25%
VACANT
�o.
1000 SEPTIC
TANK
I£
a
70
\
30
30
WELL
4-100'
VACANT
NO SURFACE WATER +100'
NO KNOWN CURTAIN DRAINS
I
i
SEPTIICC
+10/
TEST HOLE
MONITOR TUBE
SEWER CLEANOUT
WELL
PROPOSED LEACHFIELD
EASEMENT
WELL/SEPTIC SITE PLA\
LEGAL: HUNDRED HILLS LOT 9, BLK 4
OWNER: THOMSON
CONTRACTOR: N/A
JOB# 95-106A
DATE: 11/06/95
SCALE 1" = 60'
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
P4% OF q4,7440 q
A. /N• #I
*.49TH *0
O
%
LOUIS A. BUTERA
* -ss CE -6736 •v=�
,� pROFESS10NP\' *,
Englc Rimer 1ansnnc ohne Sconykez
Louis Butera, P.E.
Registered Civil Engineer
October 24, 1995
Jim Cross, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Hundred Hills Lot 9, Block 4
Narrative & Permit Application
Dear Mr. Cross:
The proposed well and septic system will have very limited impact on adjacent properties for the
following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\G:\WPDOCS\1995\95-106A. NAR
P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297
LU
LU
L)
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK 99577
(907) 694-5195
JOB C10
SHEET
SHEET NO OF
DATE
DATE
CALCULATED BY
CHECKED BY
SCALE
Hundred Hills Lot 9, Block4
Single Family Three Bedroom Dwelling
10/24/95
/45
1-r-3
3 BR x 150 gpd = 450 gpd
Soil Rate = 18 min/inch 0.6 gpd/ft2 Trench System
Required Absorption Area 450 gpd / 0.6 = 750 sf
GravelDepth-= 6'
Gravel Width 3'
Gravel Length = 63'
Total Depth = 10'
"F;.
ear f .4A : F \ J�.ot ''' p6:17 D#1'
A
iovo'� '_
E
4R IeG ,f .• l.Bf.;,,of
• 4<
° Cc -6/36 60
a°
G: \ WPD OCS\ 1995195-106A. CAL
PROOUC'2O1-I (Sir¢e S7&Is) 205.1 (P241p1 7, -Inc 00;cn01471.000r1:r NONE T0± NEE 1.000&55{.380
LEGAL:
A.
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
Hundred Hills Lot 9, Block 4
10/24/95
GENERAT ,
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
9. Any remaining open test hole excavations shall be filled.
B. TRENC$
1. The trench is to follow the natural land contour to maintain uniform total depth of
the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 10' at any point.
4. The sewer line shall be laid level within 0.03'
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water
runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
t •uu ►O 1
TOTAL DEPTH = 10'
TRENCH LENGTH = 63'
SOIL RATING = 0.6 GPD/ft2
JMENSIONS:
GRAVEL DEPTH = 6' under pipe, 2" over pipe
TRENCH WIDTH = 3'
BEDROOM CAPACITY = 3
SEPTIC TANK = 1,000 gallons minimum
Twenty-four (24) hours notice required for all inspections.
G: \WPDO CS11995195-106A. SPC
VACANT
NO SURFACE WATER +100'
NO KNOWN CURTAIN DRAINS
e
0
TEST HOLE
MONITOR TUBE
— SEWER CLEANOUT
WELL
— PROPOSED LEACHFIELD
EASEMENT
WELL/SEP
IC SFT
LEGAL: HUNDRED HILLS LOT 9, Bb< 4
OWNER: THOMSON
CONTRACTOR: N/A
JOB# 95-106A DATE: 10/27/95 SCALE 1" = 60
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 TAX: (907) 694-3297
A# G LOUIS A. BUTERA
##11>,, CE -6736 �=�i
li p
1 q. �=
� ROFESSIONP�' ��
VAI
Engineering, Architectural and Surveying Consultants
Serving All of Alaska
PERFORMED FOR:
P.O. Box 774649
Eagle Muer, Alaska 99577
(907) 694.3574
�tlnrlred Subt d , First Add1t10n DATE PERFORMED: 7/91R7
LEGAL DESCRIPTION: Lot 9, Block 4
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(FEET)
COMMENTS
Ref. Pt. 4309
Sandy Topsoil
Sample +#1
SM, Sandy Gravel
Ferc
Test
5ott or
Vernon I_ Gnel{
No, CE 510
0
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring?
T� o
S
L
0
P
E
Date
SE
E 5
IT
P
LAN
A.
N
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1 7/10/A7
12:42;30
3 3/L"
2
12:45:3x,
4 1/R"
3
1:n0:3C
4 3/U 1„
Monito,
1 h/21/R7
1:53
No 'deter
2 7/24/87
12:47
No water
PERCOLATION RATE 18
Immulesinchl FERC HOLE DIAMETER 6
a:✓ TEST RUN BETWEEN 6 FT AND 7 _ FT
5 e-, --( /'/z 3/95—
PERFORMED BY. I.'i
CATE
� x�t
rn
O
PzI
> rnv
co
r
- � r 0
mCOZ
- 1
0
r-
rn
N 00.06'25'W
660.70
00'03'59'
13i9.4
0
N
0o,
0
z
p mm
Oa 0) ADI
Oo
SNo!iV301
N01!
8861 '1 H321VW
0
0
W0
o•C.1)
u
•
ET,55.88 6
ii.GE, flQ.66
3■9Z,ES.88 N
S 00'06'57'E
`G pLi
• Municipality of Anchorage
On -Site Water and Wastewater Program:'
(907) 343-7904 5 E T
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 078-191-12 Expiration Date: 04 J a ao
1. GENERAL INFORMATION
Complete legal description Hundred Hills #1 Blk 4 Lot 9
Location (site address) 501 Harp Circle, Eagle River
Current Property owner(s) Justin & Emily Cano Day phone
Mailing address 501 Harp Circle, Eagle River
Real Estate Agent _ Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
-9 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY:
Individual
Individual Well
®
Holding Tank
❑
Individual Water Storage
❑
Community
❑
Community Class _ Well
❑
Public Sewer
❑
Public Water System
❑
Waiver/Variance request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment / / Date of Payment
Receipt Number 067y j_G Receipt Number
COSA # X21 13 % 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 ARCTERRA CONSULTING. INC. Phone 696-6111
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS _ Date 6(30/2021
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The Flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
t
encroachments, deficiencies or discrepancies exist. >> r�f�,
DSD SIGNATURE
_ System #1 Approved for bedrooms. �� 7116
System #2 Approved for bedrooms. ®'z�
Disapproved.
Conditional approval for bedrooms, wi``,(Qokf (14�G�GA1py_��stipulations:
OF
�o�_-SITE c r
=� WATER AND r ------___
WR6 vi`ATER---o
AM
By:} �� �'RL ` __�_w....... Original Certificate Date:__7
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations 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. ATTACHMENTS:
COSA Checklist X
Septic System Advisory _-__
Well Flow Advisory
COSA blue sheet 10-10-12.doc
Nitrate Advisory
Arsenic Advisory
Other e�,� ._..._.....__
COSA Checklist
Legal Description: Hundred Hills #1 Blk 4 Lot 9
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
X Well log is filed with Onsite (or attached)
Date drilled 11/13/95
Total depth 117 ft
Cased to 117 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 36 in.
Date of flow test for COSA 6/16/21
Static water level at beginning of test 56 ft
Comments
B. TANK DATA
Age of tank(s) 26 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 49
11
N Standpipes/foundation cleanout per record drawing
Date of pumping 5128/21
D. ABSORPTION FIELD DATA
Which system tested (date installed) 11/14/95
E ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced _gallons
Comments/Deficiencies:
21046
COSA Checklist yellow sheet
Parcel ID: 078-191-12
of Structure served by this system
Well production at time of test 4.6 gpm
Water storage tank volumeNA gallons
Well disinfected for coliform test? ❑ Yes E Nc
0 Coliform bacteria is Negative
Nitrate 0.246 I mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L i] Arsenic less than MRL (ND)
Collected by ArcTerra Consulting
Date of Sample 6/16/21
C. LIFT STATION
❑ Required maintenance comp
Age of lift station
Lift station mate
Com
Adequacy test date 6/16/21
Results Q✓ Pass For 3 bedrooms
Fluid depth prior to test 16 in
Water added 450 gal
New depth 42 in
Elapsed time 135 min
Final fluid depth 16 in
Absorption rate 450 gpd
Any rejuvenation treatment (past 12 months) NA
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
0 Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25'2] Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100'
® Yes if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l 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.
21046
COSA Checklist yellow sheet
*� 49311
s �
♦. KENNETH M. us i
♦'�s5t
fiCE 71 AV
`*r 0
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Septic Tank Advisory
Certificate of On‐Site Systems Approval # OSC211374
Subdivision: Hundred Hills 1st Addition Block:4, Lot: 9
The septic tank for this property is 26 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 078-191-12
1. GENERAL INFORMATION
Expiration Date: ' - 2. - l 3
Complete legal description Hundred Hills 1st Addition BIk4 Lt9
Location (site address) 501 Harp Cir., Eagle River, Ak. 99577
Current Property owner(s) Andrew &Katherine Larson Day phone
Mailing address 1380 Old Badger Rd., North Pole, Ak. 99705
Real Estate Agent Day phone
2. TYPE OF DWELLING:
• Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well 9 Community 9
Public Water System 9 Public Sewer 9
Received by: (100
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date: 10/4/2-
COSA
0/ J/L
COSA Fee $ z- cl 0
Date of Payment 6t)27112 — J
Receipt Number OCOILPI C
COSA# D5C Ic2Y-N5
Waiver Fee $
Date of Payment
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 Certif icate 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
Address P.O. Box 100217, Anchorage. AK 99510
Engineer's Printed Name Steven R. Pannone
6. DSD SIGNATURE
3 System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for
By:
Phone 272-8218
Date 12.0di' 2-7
.►fes\
��. .9? get,
✓*`° • q9 is,tzetel *?
teren, I. ponna,e
CE 0149
bedrooms, with the following stipulations:
lllttlt(1((f
1/4‘ VC? OF4 frikr
StZ
r SITE )
WATER AND
WASTEWATER f.
PROGRAM ,cry.
SE9tc��,\\�
et0
Original Certificate Date: /0 -.2-1,a
The Municipality of chorage Development Sery ices Division (DSD) issues Certificates of On -Site Sy stems Approval (COSA) based only
upon the representations 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. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1-12.doc
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: Hundred Hills 1st Addition BIk4 Lt9 Parcel ID: 078-191-12
A. WELL DATA
Well type Private
Date completed
Total depth 117 ft.
1111385
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (Y/N)
Cased to 117 ft.
FROM WELL LOG
11/13/95
86
ft.
20
g.p.m.
WATER SAMPLE RESULTS:
Coliform d_- colonies/100 mL
Arsenic:
Nitrate O'iZI mg/L
ug/L date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Tank size 1000 gal.
Number of Compartments
Foundation cleanout (YIN)
Date of pumping 9/22/12
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 39
AT INSPECTION
9/20/12
89
5.8
ft.
g.p.m.
in.
Other bacteria colonies/100 mL
i2 Collected by: PES
Depression over tank (Y/N)
Pumper J.R.s Pumping
Date installed 11/14/12
Cleanouts (Y/N) Y
High water alarm (Y/N) N/A
C. ABSORPTION FIELD DATA
Date installed 11/14/95 Soil rating (g.p.d./ft2 or ft2/bdrm) o.sgPdlsf
Length 75 ft. Width 3 ft.
Total depth 9 ft. Eff. absorption area 750 ft2
Date of adequacy test 9/25/12
Fluid depth in absorption field before test 9
Elapsed Time: 80 min.
System type Deep Trench
Gravel below pipe 5 ft.
Monitoring tube Y
Results (Pass/Fail) Pass
in. Water added 464 gal.
Final fluid depth 0 in.
Depression over field N
For 3 bedrooms
New depth in.
Absorption rate >= 450+
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N/A If yes, give date
g.p.d.
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off level at
Datum Cycles tested
Manhole/Access (Y/N)
in. High water alarm level at in.
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+
Water Service line 10+
Curtain drain 50+
F. COMMENTS
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout
Holding tank 100+
100+
Manure/animal excrete storage areas 100+
Absorption field 5+
Water service line 10+ Surface water 100+
Building foundation 10+ Water main 10+
Surface water 100+ Driveway, parking/vehicle storage 10+
Wells on adjacent lots 100+
G. ENGINEER'S CERTIFICATION
I certify that 1 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
Date / ZO97 7-
COSA brown sheet_9-1-12.doc
_ �l1,
tor
heaven ' . annoRe'/�'
'- CE 8149- :'��f
7, //Z /1/2-7(27/X-6.,-
-.4105:'‘
1/2 -f// 2
ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
,/ill;/a6.C%141 crQ . /fr• -�Lj QCT eec".0 %
AND THAT NO. ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
BASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA "HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
D
DATE
0
GRID:
may/ //sG
FB:
,j6"/
DRAWN:
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
2° 1999
NIDO
JUL`` O EBS C— GS 01
Parcel I D # 078-191-12 HAA# 1L� )1 a
1. GENERAL INFORMATION
Complete legal description
Lot 9; Block 4; Hundred Hills Subdivision
Location (site address or directions) Wolf Drive and Harp Circle
Eagle River, AK
Property owner Mark & Sue Moehn Day phone
Mailing address C/0 Prudential Vista Real Estate Eagle River, AK 99577
Lending agency Day phone
Mailing address
Agent Eva Loken/ Prudential Vista Day phone 689-6476
Address 16635 Centerfield Dr. Eagle River, AK .99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
XX
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
XX
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA 021
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 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 compl nce with all Municipal and State codes,
ordinances, and regulations in effect on the date of inspection.
ALASKA WAT W R •�,? "]-6 ) 7
Name of Firm / ��kn. � r _' . iN Phone
Address
Engineer's signature
- •9
.,• -.�;c. .�:.• _ Date
Alaska Water &
Wastewater Consultants, i
SbafibePAID $ Ii)O._
or prior to, closing for the
Engineering _Services Provided.
6. DHHS SIGNATURE
l� Approved for T f lRE
Disapproved.
Conditional approval for
By.
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date 7 - I
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.
72-025 (Rev. 1/91) Back MOA *21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES99
Environmental Services Division AVL 2p A9 c��K
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343 4 X44 AN As'♦
EN`1tR ``EtiA�SERv1GFs o
Health Authority Approval Checklist
Legal Description: HUNDRED HILLS #1; LOT 9, BK 4 Parcel I.D.: 078-191-12
A. WELL DATA
Well type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A
Log present (Y/N) YES Date completed 11/95
Total depth 116.75' Cased to 116.75' Casing height (above ground) 2'+
Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
FROM WELL LOG AT INSPECTION
Date of test 11/95 7/15/99
Static water level 86' 71'
Well production 20 g.p.m. 6.3 g.p.m.
WATER SAMPLE RESULTS:
Coliform ---(-" Nitrate ' t 1
3) YY1C )1_ Other bacteria _ tJ
Date of sample: 7/15/99
B. SEPTICAMINIP TANK DATA
Collected by: AWWC. INC.
Date installed 11/14/95 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N) YFS
Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) NO
Date of Pumping 7/13/99 Pumper JR PUMPING
C. ABSORPTION FIELD DATA
Date installed 11/14/95 Soil rating ....d./ 2 •r ft2/bdrm) 0.6 System type TRENCH
Length 75' Width 3' Gravel thickness below pipe 5' Total depth 8.8'-9.7'
Effective absorption area 750 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO
Date of adequacy test 7/15/99 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test (in.); 0" Immediately after 700 gal. water added (in.): 35"
Fluid depth 24" (ins) Minutes later: 30 Absorption rate = 450+ g.p.d.
Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed N/A Size in gallons
Manhole/Access (Y/N) "Pump os" - • - at* "Pump off" level at*
High water alarm level at* *Datum
Cycles -- -•
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Lift station N/A
SEPARATION DISTANCES FROM SEPTICAINNIMIS TANK ON LOTTO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main/service line 10'+
Surface water 100'+ Driveway, parking/vehicle storage area 50'+
Curtain drain NONE KNO
F. ENGINEER'S CERTIFIC
I certify that 1
in conforman
Signature
Engineer's Name
Date 7
Wells on adjacent lots 100'+
d inspections and review of Municipal recd
nes in effect on this date.
o600pp\1
- .44,/;;‘,‘#177s ms are
HAA Fee $
CVD
Date of Payment
Receipt Number
v o q
q9W &%
72-026 (Rev. 3/96)*
ey ness,.
CE -7953 .`` 6'4:0
�dR oress\.1"\�
�OO000��
Waiver Fee $
Date of Payment
Receipt Number
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
Parcel I D # 078-191-12
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA # ���� 1U f 1 7,O1
1. GENERAL INFORMATION
Complete legal description
Hundred Hills #1 Lot 9,
Block 4
Location (site address or directions)
NHN Wolf Way, Eagle River
Property owner John Thomson
Mailing address 17343 Santa Maria Way, Eagle
Lending agency Norwest / Vicki
Mailing address
Agent
Address
Day phone
River, Ak 99577
696-5070
Day phone
6g4-1144
Eva Laken / Vista'
-• - - • 1
••
Day phone 689-6464
••
Unless otherwise requested, HAA will be held for pickup.
3
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
x
X
72-025 (Rev. 1/91) Front MOA P21
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 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 Eagle River Engineering Services Phone 694-5195
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature- Date — z/9�
6. DHHS SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By.
Additional Comments
Date 4 -25-9S.
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.
72025 (Rev. 1(91) Bac( MOA N21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: /1/OND2E.1) ///LLS -/
A. WELL DATA Gar % 8L�
Well type /7E/ V/176: If A, B, or C, attach ADEC letter. ADEC water system number /Y//q
Log present (Y/N) Ye -S
Total depth /1 7 I
Date completed ///95
Cased to 1/ 7 / Casing height (above ground) 1 /
Sanitary seal (Y/N) Yes Wires properly protected (Y/N) % 5
FROM WELL LOG AT INSPECTION
Date of test ///9S NAI — n/EW
Static water level �(y'
Well production 2-O g.p.in. g.p,m.
WATER SAMPLE RESULTS:
Coliform Nitrate ods Other bacteria
Date of sample:
0 NVD 9 /960
Collected by: 6/2E1S
B. SEPTIC/HOLDING TANK DATA
Date installed / / 9S Tank size /000 Number of Compartments Z- Cleanouts (Y/N) Y 5
Foundation cleanout (Y/N) %5 Depression (Y/N) /\/0 High water alarm (Y/N) /V//9
Date of Pumping /`//19 ' A/EW Pumper
C. ABSORPTION FIELD DATA
Date installed / l9 S Soil rati ;. (_. e14eibtlriu) 0, (o System type /)EC/p %Pc/VC-/l
Length % S Width 3 Gravel thickness below pipe C' Total depth '
Effective absorption area 750 Monitoring Tube present(Y/N) /ES Depression over field (Y/N)
Date of adequacy test /✓�,4 ' /k,/-0 Results (Pass/Fail) P its 5 For -J bedrooms
Fluid depth in absorption field before test (in.); ///A- Immediately afteral-watefadc�ed—(in,
Fluid depth (ins.) Minu - . Absorption rate =
Peroxide tre
g.p.d.
ent (past 12 months) (Y/N) If yes, give date
D. LIFT STATION /WA
Date installed Size in
Manhole/Access (Y/N) 'ump on" level at* "Pump off' level at*
High water alarm le - *Datum
s tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /Z0 ; On adjacent lots i-100
Absorption field on lot 13 U / ; On adjacent lots /00
Public sewer main N/A Public sewer manhole/cleanout /`//
Sewer/septic service line f 50 Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation % U I Property line 80 � Absorption field
/7
Water main/service line 7o Surface water/drainage "f/0(J Wells on adjacent lots
f/UD'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation % 5 / Property Line 3 5 1 Water main/service line 74/00 /
i
Surface water 4-/00 Driveway, parking/vehicle storage area / 10
/
A/ON G
Curtain drain "Mill 6N7 Wells on adjacent lots *100
F. ENGINEER'S CERTIFICATION
1 certify that 1 have determined thru field inspections and review ofMunicipal records that the above systems are
in conformance with MOA HAA guidelines in effect on this date. ?
Signature
Engineer's Name LOU/S
Date //%C
ren PE.
000gggysana,
-8 2�IN8 qu 7.A 9`
y Leeen$g Seal Hdre's
cu.:
HAA Fee $
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
04./t2/96 i8:07 CTg:E ESI ANCHORAGE_ -4 907 694 3297 NO.958 DP13
CT&E Environmental Services Inc.
Laboratory Division rai►�erisom► waosnerim
Laboratory Analysis Report
CT&E Refit 961257,9929
Client Sample ID HUNDRED HILLS 9/411257-01
Matrix Drinking Water
PWSI1) 0
Collected Date 04/08/96
'Technical Director
Releaseril J6x, s —
Sample Remarks:
Parameter
Nitrate -44
Resutts 0C POL Units methal Allowable Prep Analyets [nil
dual__ Limits Dote Date _
0.150 0.100 mg/I,EPA 353.2 04/11/46 EMB,
200 W. Potter Drive, Anchorage, AK 99518-1605 — Tei: (807) 662-2343 Fax: (907) 561-5301
3180 Pager Road, Fairbanks, AK 89709-5471 — TO: (907) 474-8656 Fax: (9017) 474-8685
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA