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HUNDRED HILLS BLK 1 LT 5
Hundred Hills Block 1 Lot 5 #078-181 - 09 Municipality of Anchorage Page / of - 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 S 1i/Q8030..5 PID Number. 078' /8'/-09 Permit Number: Name: - -L ti/N/Sol 8Reg7 Y Wastewater System: • New El Upgrade Address: p, U' , I30,K 9,2 77,:2 AM, An2 415 AK 995o9 ABSORPTION FIELD Phone:3 J Cy- a ,3 00 I No. of Bedrooms: 0 Deep Trench El Shallow Trench 0 Bed 0 Mound 0 Other LEGAL DESCRIPTION Sou Rating: f 02 GPD/Sq.Ft. Total Depth irom�ginalgrade: Lot: s Block: )- aSubdivision: Urod( d di LLS Depth to pipe bottom from original grade: ii Ft. Gravel depth beneath pipe 1 Ft. Township: "'^ Range: .._.. Section: _. Fill added above original grade: a .. Ft. Gravel length: /l 7 0 Ft. WELL: • New • Upgrade Gravel width/ : 5 Ft. Number of lines: Distance belweenlines: Ft. Classification (Private, A,B,C): P 1vA!PrC. ../04(r. Total D Ft. Cased To: Ft. Total absorption area::/ 4/00 7" so. Ft. Pipe material: As1M any/F8/0 Driller: pL $ t Date Drilled: Static Water Level: Ft. Installer: 7 /EC., Date Installed: 9`10-Y 8" Yield: GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES ® Septic O Holding O S.T.E.P. To From Septic Tank Absorption Field Litt Station ' Holding •Tank Public/Private Sewer Lines Manufa8/cturer: �,/�c/t0 P-41 G---rAd�-,/ Capacity in gallons: /Olio Weft /00'1 /00// �. y sS7-66-S7-66- c- Material: Number of Compartments: a Surface Water /00/7i- /O07' LIFT STATION Lot Line / / ,5V / O / 7 / Size in gallons: Manufacturer: Foundation 9 8 /02J / "Pump on" level at: "Pum evel at: High water alarm at: Curtain Drain /-SONE 4/06,.)," �_ Pump Make el Elec rical Inspections performed by: Remarks: BENCH MARK Location and Description: IZAA = To P 0 r c✓Ct-c' ,4/CAl, Assumed Elevation: /00 Ft' EN L "fit O� I ••44 F.• C iv a 3lN81NCPRINek1 17034 Eagle River Loop Road, No. 204 Eagle River Alaska 99577 9'-16 -9&` by: Dates 1st �y . ek },.* 4 pi t, .,«.« .:.«....i....../ Inspections performed 2nd /O y $ C. COWAN 1,@ t,�;? Department of Health and Human Services approval . 0,(.;•..,`ROBERT CE -8801 /417 f, ' '' �� '��;oress���a� -r by: e, Y 4 Date• %/" 7- 1 R ,'�;row, +"`' Reviewed and approved 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW980305 PAGE 2 OF 2 DEPARTMENT OF ANDhHUM�AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Tele hone) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 1, HUNDRED HILLS S/D P.I.D. NO. 078-181-09 TH A CO2 CO3 MT1 111 I INSULATION CO2 = 95.8' CO3 = 92.5' FINAL GRADE CO2 = 89.8' CO3 = 89.5' MT1 = 85.5' • NO WATER FOUND 79.5' H.O.H. NEW TRENCH DBL1 CO2 DBL2 A B FCO 7.0' 18.0' C01 59.0' 66.0' ST1 100.0' 103.0' ST2 106.0' 108.5' DBL1 109.0' 111.5' DBL2 110.5' 112.5' CO2 125.5' 127.0' MT1 161.0' 161.0' CO3 162.5' 162.5' ST1 ST2 96.4' FINAL GRADE INSULATION NEW 1000 GAL. SEPTIC TANK 93.8' 93.8' EXISTING 3 BDRM HOUSE EXISTING WELL SCALE 1" 40' Try 144x`' 4l v IIAr ",{+ ROBERT C. COWAN 4-% CE -8801 4, w..1i��k�rw MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW980305 Legal Description: HUNDRED HILLS BLK 1 LT 5 Design Engineer: 3 S itS Owner Name: Brent Jennison Owner Address: PO Box 92772 Anchorage , AK 99509 - This permit is for the construction of: 39rn Date Issued: Aug 13, 1998 Expiration Date: Aug 13, 1999 Parcel ID: 078-181-09 Site Address: Lot Size: 164613 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 Disposal Field VI Septic Tank Holding Tank I 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (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: 7 � Issued By: Pc -/y ?5/ Date: Date: 8.i 3. s r 4- /PA,ak' f41 o_"S & S EnGrnfening MVP ALASKA HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. July 31, 1998 MUNICIPALITY OF ANCHORAGE Depaltlnent of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 5, Block 1, Hundres Hills Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Request you issue a permit to install an upgrade septic system to serve the three bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 7/22/98 water was not encountered in the test hole. After seven days of ground water monitoring 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, rih°7 Robert C. Cowan, P.E. RCC/mg Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 60' 'SCALE #.4(\111 ______ DESIGN ti \Lej'A DETAILS TIM •1^'usti,3 q ;3‘`>° O v i A 0 0 0 c U S0d0Ed \181 0 A \t18 `e9 \18‘ 0 A e 1 fvoo 01292 o09 0 a N O xi n rn <mC '1Nm 0 CHUGACH STATE PARK RESERVE 1 m 0 1 to oo 0 T, O 1^1 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST so ,3 DATE PER FORMED i71i!;' :''r'7,i; LEGAL DESCRIPTION: L s 6 / 14i,Jo JJ 4a.A., ,Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 0 COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 130 Depth to Water Atteo.�� Monitoring? Date: SITE PLAN N s P ti- Reading Date Gross Time Net Time Depth to Water Net Drop i P-(v5clo - PQ --t 00 ,_1z ,'6 L 1l . Z (Q mtZ 91tt" 3" u to 1. 9---(-44--t AA— Uk ✓/Y„ _ --1K � I12. -a 31 £(--dvYr w kVA- `l 12 _ r a '74r," 3 u PERCOLATION RATE 3 (minutes/inch) PERC HOLE DIAMETER1,0 TEST RUN BETWEEN FT AND FT PERFORMED BY: S & S ENGINEERING CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Ear River Luoyo �Ro I ES N EFFECT ON THIS DATE. DATE / 3 / V ACCORDANCE Wl lie v 1;E AaasKB 99 / L t1� 72-008 (Rev. 4/85) ir �.• • (n4S&S EnGineeRinq R. ALASKA HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 5, Block 1, Hundred Hills Subdivision July 31, 1998 GENERAL: CIVIL ENGINEERS (907) 694-2979 FAX(907)694-1211 The scope of this project includes the installation of a three bedroom leachfield trench to serve an existing residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 5, Block 1, Hundres Hills S/D Jul 31, 1998 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. 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: 1. 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. 3. 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 Three Lot 5, Block 1, Hundres Hills S/D Jul 31, 1998 MINIMUM MATERIAL SPECIFICATIONS: 1. 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 Pipe 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, Fernco, 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: 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. Page Four Lot 5, Block 1, Hundres Hills S/D Ju131, 1998 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 carry 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 -4 Is ta to co (D co OD cr* Aj 4s cr, c"i Ul Ci fi t;4: 4.): 0 0 0 0 0 0 .0 o 0 0 'a 0 i— F -- Q): CNE 441:i 4w fA 4(o 0 0 o o 6 . o o o o o -1 x XCQ.7 94 w a w rx w 04 U- 1% C4 cd r4 OxW LZ4 aG ro g b z fO p U M > t), LU x QC r-4 3 > tv co ca c): al of4. Ca 1. 00 1: r- ",*� at wzr� o.; Lrl r4 ul Ub ul 0: U-1 0 0 o o C) 0 0 Oct r -i: CE 0. 6 Ul tr) 00 71 W3 LU I , .1 1 tx 0 rg cz 1w 0 0 = 2 U.. ud Pm W W. w W. ate -4 Is ta to rGC ��i Municipality ®f Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 078-181-09 Expiration Date: bQ C , 01 1. GENERAL INFORMATION: Complete legal description HUNDRED HILLS; BLOCK 1, LOT 5 Location (site address) 1101 LYNX LANE, EAGLE RIVER, AK 99577 Current Property owner(s) KRISTINE CASTILLO Day phone 254-630-5328 Mailing address 1101 LYNX LANE EAGLE RIVER AK 99577 Real Estate Agent LARRY BURKE Day phone 602-4144 2. TYPE OF DWELLING: Z 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 ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment $�2 6 a 2 Receipt Number 6 � 15 6 G Waiver Fee $ Date of Payment Receipt Number COSA # O.SG 2 ( 15 Z.0 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 (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage Alasl(a 99507 Engineer's Printed Name: Jeffrey A. Garness Date: y -2JZI In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may Fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, #AECC884 OF with the followingttlatigrUN_SITE m WATER AND By: Original Certificate Date: % o70oC 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. Nitrate Advisory Arsenic Advisory Other Jia." . %p- 0.86sor4 X 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet 10-10-12.doc 4, v . — •. 1 :} 1 i • y A.. N �. .� .}C}�F —79'-73 v� till ��u^�; . •G � Z P .% #AECC884 OF with the followingttlatigrUN_SITE m WATER AND By: Original Certificate Date: % o70oC 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. Nitrate Advisory Arsenic Advisory Other Jia." . %p- 0.86sor4 X 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet 10-10-12.doc HUNDRED BLOCK LOT L���| n� � . Ifmore than 1septic system onlot: COGAChecklist # 1 of 1 A. WELL DATA EYVVeUlog isfiled with Onsite (or attached) 5111182 Total Tuda|depth 63 ft Cased to UNP( ft FE1Sanitary seal isfunctioning correctly [ENWires are properly protected Casing height (above ground) 18+ n. Date offlow test for7130/21�OGA Static water level at beginning of test 53 ft. Comments B. TANK DATA Age oftank(s) 23 years Tanktype/matehSTEELa/ Measured operating fluid level inseptic tank °4fMuK}.5^ ��Standpipes/foundation Date of pumping D. ABSORPTION FIELD DATA 5-WIDE[]RAINFIELD Which system tested (date installed) 9f'0198 XALL standpipes present per record drawing Total measured depth from grade 9-6 ft (max) Measured depth topipe invert from grade +49 ft (min) r_lN/A — pressurized field ----- [0-1Monitor tubes gotobottom nfeffective. |fnot, state depth into effective _____ Parcel ID: 078-181-09 Structure served by this system 1 'Well production at time oftest 3.5+~pm Water storage tank volume N/A gallons Well disinfected for coliform test? Yes RE MRColiform bacteria isNegative Vitrmte_mg/L �� Nitrate less than MRL (ND) Arsenicug/L ��Arsenic less than MRL OV[0 Collected by GEG'LT[)' ' Date ofSample 7130/21 [-1 Age of lift station Lift station material Adequacy test 7130121dmt� Results [DPaso For 3 bedrooms Fluid depth prior totest u in Water added 477 gal New depth 0 in Elapsed time 0 min FORCode-required soil cover over field Final fluid depth ~��m Fl Systempresoaked Absorption rate 450+ gpd (Required ifvacant for greater than 3Odays prior to Any rejuvenation treatment (oost12Alnndhs) N/AdotenftaeU ' ---- BeUune introduced N/A gallons )fyes, enter date Comments/Deficiencies: *THIS /oFOR THE CLEANOUT wE)(TroTHE MONITORING TUBE. oo FCO AND ar1>mMISSING, C0SAChecklist yellow sheet 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' Mv Yes if No Community Sewer Manhole/Cleanout > 100' Yes if No ft Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25'E] Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' ✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' El Yes if No ft [D Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' E] Yes if No ft rD Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No J -r ft Surface Water > 100' Yes if No ft Property Line > 5' Mv Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ✓v 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' E] 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' Water Service Line > 10' Yes if No ft Community Wells > 200' Surface Water > 100' El Yes if No ft F. ENGINEER'S COMMENTS A.A Yes if No ft Yes if No ft NOTE: SURVEY IN MOA ONSITE FILES. ONE OF THE DOUBLE CO'S APPEARS TO BE MISSING ON SURVEY. 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. COSA Checklist yellow sheet f A. GarnIss.- ��napro ion" �� #AECC884 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 # OSC211520 Subdivision: Hundred Hills Block:1, Lot: 5 The septic tank for this property is 23 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. Carroll, Rebecca M. From: Sonja Blewett <Sonja@garnessengineering.com> Sent: Tuesday, September 7, 2021 9:17 AM To: Carroll, Rebecca M. Cc: Jody Maus Subject: Hundred Hills 131 L5 [EXTERNAL EMAIL] Hi Rebecca, here is email from owner stating they don't have any freezing issues. They are trying to close tomorrow. Will you accept this email? Sonja From: Kristina Castillo <Iccastl7@me.com> Sent: Tuesday, September 07, 20219:13 AM To: Sonja Blewett <Sonja@garnessengineering.com> Subject: Re: 1101 Lynx Drive - Needing Information We have not had any freezing issues with our septic tank. Sent from my iPhone On Sep 7, 2021, at 9:07 AM, Sonja Blewett <Sonia@garnessengineering.com> wrote: Hello, the MOA is wanting an email stating that you have not had any freezing issues with your septic. Can you email us a statement stating you have not had freezing issues? Thanks! Sincerely, Sonja Blewett Corporate Secretary/Treasurer Gapless Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: (907) 337-6179 Fax: (907) 338-3246 Website: www.�ai-nessen(ineerin�,,.com. <image001.jpg> <image002.png> <imoge003Jpg> 1 Carroll, Rebecca M. From: Jeff Garness <Jeff@garnessengineering.com> Sent: Tuesday, September 7, 2021 12:46 PM To: Carroll, Rebecca M. Cc: Sonja Blewett Subject: Hundred Hills, 131, L5 - Septic Tank Liquid Levels MERMEMBEM Hello Becca. In regarding to your concern with the differing liquid levels in the septic tank, it is important to remember we pushing (in some cases stuffing) a flexible steep measuring tank down a 4 inch pipe an attempting to determine where the top of the liquid (could be the scum layer) is and where the bottom of the tank is (often below thick sludge). It is also possible that the tank is out of level. In short, this is not an exact science. The two measurements noted (46" and 48.5") are well within the acceptable liquid depths in a septic tank. I am not I am not concerned regarding the differential readings and request that the COSA be approved. Jeffrey A. Garness, P.E., M.S. President Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 Mobile: (907) 244- 9612 Website: www.garnessengineerinq.com GARNESS ENGINEERING GROUP. Ltd ENGINEERING —SALES,,COUSUl7SNG , a 0an,cs XERX ES' A r ) CORPORA`"ON PU,AF . Aaihadr od 0..Yor Atith Qil(f tL?iJ°ka DiWAX40t • •t15_— Municipality of Anchorage �;"- `„, On-Site Water and Wastewater Program I la SEP i i �0_ 2'' (907) 343-7904 tic trtg ti Certificate of On-Site Systems Approval `l a 6c:\ g "s' fl Parcel I.D. 078-181-09 Expiration Date: I -9- 1 7 1. GENERAL INFORMATION Complete legal description Hundred Hills Block 1 Lot 5 Location (site address) 1101 Lynx Lane Current Property owner(s) Joel Williams Day phone Mailing address 1101 Lynx Lane Eagle river, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex E 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 H Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Imi ifV Received bc 1 . %or ,'''J I Date: q/i e f i-i' COSA to be released to the engineer,unless otherwise requested by t 41;gineer. COSA Fee $ 5:g to _ Waiver Fee $ Date of Payment WO?” Date of Payment Receipt Number 6239% Receipt Number COSA# 65e-111144Z 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. In conducting an adequacy test,I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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 and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 9/11/2017 OF AL k ,raCo•P 1 0I j*: 49TM �\ * r 6. DSD SIGNATURE .�, � System #1 Approved for t' S}eaPonnone: - y pp oved bedrooms ti CE System #2 Approved for bedrooms .* .•r Disapproved �4OFESSti6A Conditional approval for bedrooms, with the following stipulations: `G;PPUTY+O •p y► WAsrEWAND t rr A pRO GRA�R _. By: - Original Certificate Date: q`(f i 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_f - • If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system ' Certificate of On-Site Systems Approval Checklist Legal Description. Hundred Hills Block 1 Lot 5 Parcel ID: 078-181-09 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) N Date completed UNK Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth UNK ft Cased to UNK ft Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test UNK 8/31/2017 Static water level UNK ft. 50 ft. Well production UNK g.p.m. 4.0 g p m WATER SAMPLE RESULTS Coliform NEG colonies/100 mL Nitrate 0.142 mg/L Arsenic<5.00ug/L Date of sample: 8/30&31/2017 Collected by• PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/SteelDate installed 9/10/1998 Tank size 10002 Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y _ Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 8/9/2017 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 9/10/1998 Soil rating (g p.d./ft' or ft2/bdrm) 1.2 GPD/SF System type Wide Trench Length 40 ft Width 5 ft. Gravel below pipe 4 ft. Total depth 8 ft Eff. absorption area 400 ft` Monitoring tube Y Depression over field N Date of adequacy test 8/31/2017 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 455 gal. New depth 0 in. Elapsed Time: 120 min. Final fluid depth 0 in. Absorption rate >= 450+ g p d N Any rejuvenation treatment (past 12 mo ) (Y/N & type) If yes. give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 1 00+ F. COMMENTS Survey on file. G. ENGINEER'S CERTIFICATION P .? ,� I certify that I have determined through field inspections and p'�.•' 4� -�}�� review of Municipal records that the above systems are in ;I*:•4 I\ • * conformance with MOA COSA guidelines in effect on this date. ' —__•_ ' . -• • •• 0 Engineer's Printed Name Steven Pannone •••. teveri .•Nririorie:•-fr. 9/18/2017 61:-. CE-8149 . Dates + ksstc+ ir- COSA canary sheet_2-6-15.doc Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 078-181-09 Expiration Date: 0 6 - 2 <- Bdit 1. GENERAL INFORMATION Complete legal description Hundred Hills, Block 1, Lot 5 Location (site address) 1101 Lynx Lane Current Property owner(s) Verena Gill Day phone Mailing address 27336 Golden Eagle Ct. Chugiak 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: n Single Family (w/wo ADU) Duplex Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 n II n 9UBM I TAL AUG 14 2014 TYPE OF WASTEWATER OISP, SAl. Individual Holding Tank Community Public Sewer u Waiver/Variance request fat; Distance: 1 Received by: ' F Lir COSA to be released to the,engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 62—ca — Waiver Fee $ Date of Payment 21 to kO Date of Payment Receipt Number `01-151 a l01 Receipt Number COSA # OS c -I N! I -j 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 an 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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 and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 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 Date 8/14/2014 • .S/even ernone CE -8149 .• A?OFES9c•' bedrooms, with the following stipulations: :r' r /C 'in ' By: The nici ali of n, I Original Certificate Date: -az - 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Hundred Hills, Block 1, Lot 5 Parcel ID: 078-181 09 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed Unknown Total depth unknownft Date of test Sanitary seal (Y/N) Cased to ft. FROM WELL LOG Static water level ft. Well production WATER SAMPLE RESULTS: Coliform /L�colonies/100 mL Nitrate 00 74 )' mg/L Arsenic NL ug/L Date of sample: 74.13. aot.q B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/ Steel Tank size 1000 gal. Well Log (Y/N) N Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 1/16/2013 56 3.8 ft. g.p.m. Collected by: 1 > Y 24 in. Date installed 9/10/1998 Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N)Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping i/0)3 I ,-,0 1 y Pumper U2. is Pc -4--p'? C. ABSORPTION FIELD DATA Date installed 9/10/1998 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 gpd/sf Length 40 Total depth 8 ft. ft. Width 5 Eff. absorption area 400 ft2 Date of adequacy test 1/16/2013 Fluid depth in absorption field before test 0 Elapsed Time: 120 min. System type Wide Trench ft. Gravel below pipe 4 ft. Monitoring tube Y Depression over field N Results (Pass/Fail) Pass For 3 bedrooms in. Water added 456 gal. New depth 0 in. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (Y/N) in. High water alarm level at Cycles tested Meets alarm & circuit requirements? in. "Pump off' level at E. SEPARATION DISTANCES WELL ON LOT TO: Septic tankfift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ in. On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Curtain drain 50+ F. COMMENTS Water main 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Wells on adjacent lots 100+ 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 Date /1 3 COSA brown sheet_10-10-12.doc •Tittr,� ..S1eVa k•Pannone•'•� CE -8149 'mm mom mkzm ®o; k /\ ?k§ o/ 109 =13:3WOS --1062 �� %0. 8188T kk 0 co 0 a7 00 8 31V0 SIH113S SiJ3N800 ON ■ ! «o 0 \ 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 # 078-181-09 1. GENERAL INFORMATION HAA # '`A 4-A Complete legal description Lot 5, Block 1, Hundred Hills S/D Location (site address or directions) NHN Lynx Lane Property owner Brent Jennison Day phone 346-2500 Mailing address PO Box 92772, Anchorage, AK 99509 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX 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 XXX 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 1121 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 S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 , Engineer's signature ; �ji�/ ( /�/✓�-- — Phone 6`1"1-- )--°1 7 `) r rj ?,1>,1 ROBERT C. COWAN i 11 - Oa c.','• CE - 8801 rr y. 47 6. DHHS SIGNATURE'���',,� I. Approved for 1 7// E� bedrooms. " ;:::._ —"~ Disapproved. Conditional approval for bedrooms, with the following stipulations: Date I? / / By. Additional Comments Date (� - 1 cl 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. Municipality of Anchorage 0 3 1999 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: LO ' 6'-° "c / /4°"4".6 )1(-S Parcel I.D.: a 7 F -° 'f A. WELL DATA Well type PR If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/) N v Date completed x.1 Total depth a Cased to 4 o Casing height (above ground) 1/), Sanitary seal (9/N) Date of test Static water level Well production WATER SAMPLE RESULTS: rc_5 FROM WELL LOG g.p.m. Wires properly protected&N) X i AT INSPECTION 11/���� g.p.m. 0 0a 0 Coliform Nitrate Date of sample: ° ° B. SEPTIC/HOLDING TANK DATA Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 :.agle River, Alaska 99577 Date installed C1 I/ O (' Y Tank size l p a v Number of Compartments -2- Cleanouts (9/N) Y �� Foundation cleanout&N) '" J Depression (Y4 C' D High water alarm MO r 0 Date of Pumping 10/ 4 — 4" Pumper C. ABSORPTION FIELD DATA N1ct.aw Date installed cl /' ° if Soil rating g.p.d./ft2 • r ft2/bdrm) 1 > a System type T A4'- C �/ Length 110 Width S Gravel thickness below pipe H Total depth / O Effective absorption area ° 0 o'r Monitoring Tube present &N) Y4 -f Depression over field (Y/fjj c Date of adequacy test (R — ' `-' Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field before test (in.); Immedi < - - - _ gal. water added (in.): Fluid depth (ins) Minutes - - . Absorption rate = g.p.d. Peroxide treat • -st 12 months) (WN) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level a * "Pump off" level at* High water alarm level at* *Datum Cyci E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic/holding tank on lot /00 On adjacent lots / c u Absorption field on lot / D o '4_ On adjacent lots / o 0 i -- Public sewer main N f A- Public sewer manhole/cleanout N / A_ Sewer /septic service linea s Lift station N / A - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON -LOTTO: p Foundation 9 � Property line / 0 c 4-- Absorption field ,/ s r 4- Water main/service line /0 1 Surface water/drainage / 0 a Wells on adjacent lots /0 0 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / o0 } Building foundation /00 t Water main/service line Jo Surface water / Driveway, parking/vehicle storage area S' Curtain drain N ° - t k /4 aW is) Wells on adjacent lots /0 0 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records � L terns are' in conformance with O e uide%lines in effect on this date. `P .• ......... "�,S Signature l�dZru'' ;0 r'h ) Engineer's Name R041 4- 2 C - Cd �-.f"/ Date % a I HAA Fee $ O©* o0 Date of Payment Receipt Number 72-026 (Rev. 3/96)* // --- 0 3 ZPo/ (2L) Waiver Fee $ Date of Payment Receipt Number HU) Ub :J`A3 1b= 1b L I &L Lb I HIJL!-IUKHbL 1�. CT&E Environmental Services Inc. movaxavavvouros CT&E ltef.A 986487002 Client Name S & S Engineering Project Name/A N/A Client Sample ID LT 5 Elk 1 Hundred Hills Matrix Drinking Water Ordered By PWSID 0 Released By 90 561.53 i1 P.03/10 Client POA Printed Date/Time 11/06/98 10:47 Collected Date/Time 11/02/98 16:00 Received Date/Time 11/03/98 16:00 Technical Director: Stephen C. Ede JP A Sample Remarks: Parameter Total Coliform Nitrate -N Results 0 Allowable Prep Analysis POL unite Method Limits Date Date [nit col/100mL SM18 92228 11/03/98 KAP 0.266 0.100 mg/L EPA 300.0 10 max 11/04/98 11/04/98 GCP RECEIVED NOV 9 1998 Municipality of Anchorage Dept. Health & Human Services