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HomeMy WebLinkAboutRIVERVIEW ESTATES BLK 10 LT 6 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 Permit Number: ..j~'Lj ~"~OOI-7 PIg Number: 0~0~ Na~e: 'U~ ~o~e~c~ /~ u~ u~c~o~e~ Wastewater System: ~New D Upgrade Address: ~o ~0~ ~ ~, ~ ??~ ABSORPTION FIELD Phone: No. of Bedrooms: I" ~O~ f ~ ~O~ r,,. ~ D Deep Trench Shallow Trench ~ Bed D Mound ~ Other Total Depth from original grade: LEGAL DESCRIPTION Soil Rating: j, ~ GPD/Sq. Ft. Block: Subdiv~ion: Depth to pipe botlom from original grade: Gravel depth beneath p~pe Lo,:~ 10 ~_¢~¢~ ~ ~ I Ft. Ft. Township: ~ Range: Section: Pill added above origieal grade: Gravel length: WELL: ~New D Upgrade Gravelwidth: G i Number of lines: ] Distance between lines: R. I / ~ Pipe material: Class~oation (Private, A.B.C):. F~T~ , Total Depth:~oO Fl. Cased To:~, Ft. T°lal abs°rpti°n ~a?5 ~... SQ. Ft. .~%a ~ ~¢~/F ),il[er:¢~O~ U~ ¢~ Date D~7~ Static WaterLeveb~ Ft .... Installer' , ¢'&A~ ~e" uateinstalled: ~-~' Pump Set at: ~ Casing Height Above Ground: Yield: 1' G I 2 ' ~,. TANK SEPARATION DISTANCES ~eptic ~ Holding D S.T,E.P. F¢om T~.~ ,i.~d S~a~o* T..* S.~rU... ~0~ ~ ~.~ [000 __ Surf.~.Wat.r iO¢~r ~¢',~ ~ ~ LIFT STATIO~~'~. Lot ~ Size in ~allons: ~anufactumr:~ Fo,ndation ¢ I~ IO ~ ) ~ "Pump on" ,ev~ump of "e : High ;ate, alarm CurtaiODraiR ~- ~¢ ~.~¢¢~./ Pu~odel Electrical Inspections performed by: Remarks: BENOH MARK Location and Description: Assumed Elevation: ~ ¢ O Ft. inspections performed by: s & s ~ue~u~U~lU~ Dates: lst_~-~- 97_ ~~~~'~ .... ~'" ~ ................. RaCe River, Alaska ~ ~ ff - 15 - ~ ~ ~,~¢. % CE- 8801 ~ Department of Health and Human Services approval ~;~+;~;, ............... '~>~ Reviewed and approved by: ~ Date: ~ 72-013 (Rev 9191) MOA 25 ~/ ?ER]aT NO. SW970017 PAGE 2 o? 2 HunlclpaLity oF Anchorage DEPARTNEN¥ OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DDVISION P,O, Box 196650®Anchor~ge, A~s!<o 99519-6650 ®Telephone', 343-4744 ON=SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT h~CAL LOT 6, BLOCK 10, RIVERVIEW ESTATES S/D P.I.D. NO. 050-801-05 A B rCO 5.5' 31.0' ST1 12.0' 33.5' ST2 20.0' 36.5' DBL1 21.5' 37.5' DBL2 23.5' 39.0' C01 52.0' 38,0' MT1 51.5' 37,5' C02- 85.0' 57.0' MT2 84-.5' 57.0'. NEW TRENCH ST1 ST2 x~ WELl C01 C02 97.9' 1250 GAL 9 4' MT2 = 98.2' S.T. *MT1 = 89.5L~ *MTg = 90,8' C02 = 98.2' ..~CO1 = 93.3' C02 93.4' MONITORING TUNES ?/ERE INSTALLED *AFTER SE~IER ROCK WAS INSTALLED A NO WA'I'ER FOUND 83.4' B.O.H. \ \ \ \ DOC Co. ooe, SULLIVAN WATER WELLS P,O, BOX 870212, CHUGIAK, ALASKA99557 · TELEPHONE885-2759 KIND OF FORMATION: From (~ Ft. to _~ -Ft. . . ~rom 02 Fl, to ~ ,om_ff 3 F,. _ From ~_FI. to__ Fl. __ ~,~i¢,~,~/'''J FrOm From Ft, to Fl, From From_ Ft. to Ft From From Fl. lo Ft, Fronl From Ft. to~ Ft ~ From~ From ~Ft, to~Ft From.~ Ft. lo __Ft, lo F~I to__ .~Ft, to,__ Ft. to __Fl. lo ~Ft, to ~FI. to Fl. to__ Fl. to Ft. ¢o___ MISCL. INFORMATION: Ft Ft .Fl. · Ft. Fl. Ft. Fl, ,Fl AUG 19 1997 Municipality of/k,~chorage Dept. Health & Human Services DRILLER'S NAME PAGE 1 OF 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 PERMIT NUMBER:SW970017 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:CARL VAN VECKHOVEN OWNER ADDRESS:P.O. BOX 871647 WASILLA, AK. 99687 DATE ISSUED: 2/07/97 EXPIRATION DATE: 2/07/98 PARCEL ID:05080105 LEGAL DESCRIPTION: RIVERVIEW ESTATES BLK 10 LT 6 LOT SIZE: 40093 (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: 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 (18~AC72) 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: RECEIVED BY: / /~/~// '' <~t'~-'-~ DATE: ISSUED BY: ~~'~')'~ ~ '~ ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. January 27, 1997 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WA'rE R INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TES1 STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWArER DISPOSAL SYSTEM DESIGN CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALZTY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 6, Block 10, Riverview Estates Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, the monitoring tube was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. RCC/gk P.E. Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 . EAGLE RIVER. ALASKA 99577 1" = 60' SCALE © II .© PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~,.-cr[ ~ ~'~-~,'~ ~.~.~;~..~.[Township, Range, Section: ~t~''''' ~_~. '~-.~J,~ SLOPE SITE PLAN 1 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ;l ~ DEPTH? ~ p E Depth to Water ~ Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop ~- / ,,. q' )" PERCOLATION RATE __ (minutes/tach) PERC HOLE DIAMETER Lou~ TEST RUN.ETWEEN ( FT AND '~,¢" FT COMMENTS PERFORMED BY: ':~'~/~Z~v~'v0~) I , , CERTIFY THAT]HIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: l~ ~ ~ 72-008 (Rev. 4/85) ROBERTC. COWAN, P.E. ROBERT A. SHAFER, P.E. CIVIL ENGINEERS HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN E)(TENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTESr FERCOLAI ION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 6, Block 10, Riverview Estates January 27, 1997 GENERAL: 1. The scope of this project includes the installation of a 1000 gallon septic tank and five foot wide drainfield to serve the proposed three bedroom residence for 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 Wast,water 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° On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 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. ~EPTIC 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. Ail 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 6, Block 10, Riverview Estates January 27, 1997 6 0 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and 'the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill° 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. 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 6, Block 10, Riverview Estates January 27, 1997 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: ~¥pe of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 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. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 6, Block 10, Riverview Estates January 27, 1997 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: 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. 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. 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/OWNER ROBERT C. COWAN, RE. ROBERTA, SHAFER, P.E. HEALT~IAUTHORITY AI~PROVAL8 SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORT8 WELL INSPEOTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTtJRAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER OISPOSAL SYSTEM DESIGN CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED APR 21 997 De~tU. nicip~,!lily of Anchora e Flea/tn & Human Ser[/~ce~ The septic nsDeqt].ons for the,referenced property were performed on ~/~;~7 and ~/~5/~ · Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the ~/~-~i-~ ~ t o be completed. If we may be of further service please contact us. Sincerely, C. Cowan, P.E. 17034 NORTI4 -EAGLE RIVER LOOP . SUITE 204 · EAGLE RIVER, ALASKA 99577 Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SEFtVIGE~,~w~^~' 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 HAA # 1. GENERAL INFORMATION Complete legal description Lot 6; Block 10; Riverview Estates Location (site address or directions) NHN Ken Logan Circle Eagle River, AK P. roPerty owner Ma'iling address Lending agency Mailing address Nerak Construction P.O. Box 871647 Day phone wasilla, AK 99687 Day phone -A, gent Address Day phone Unless otherwise requested, HAA will be held for pickup. 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 {Rev. 1/9'i) Front MOA #21 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 Roa,'l No. 204 Address Ea~lle River, Alaska-~9577 ,/ Engineer's signature ,"~,~/~/- Phone Date ~///'! / R 7 DHHS SIGNATURE ,/ Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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 MUNiCiPAU fY Ct-/:xNCHOk'AG~ I/luni¢ipality o( Anch°rageSERr~J/~'~'~mTAgE'S" st!~v~(:Es DEPARTMENT OF HEALTH & HUMAN Environmental Services Division AUG i 9 1997 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)343-4744 Health Authority Approval Checklist [~ E 6 E ~V ~ Legal Description: A, WELL DATA Well type Log present.N) ~/~, Total depth ,,~ Sanitary seal ~)'N) (¢ I ¢~¢c~ 10~ l~'~,~.r~q~tJ Parcel I,D,: If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/"1 -f Cased to g'l' (~ ¢eo~,~ Casing height (above ground) Wires properly protected ¢~/N) Date of test Static water level Well production WATER sAMPLE RESULTS: Coliform O Date of sample: (~ 11 ~/' FROM WELL LOG AT INSPECTION g.p.m. ~ g.p.m. Nitrate B. SEPTIC/HOLDING TANK DATA Date installed '~-~-~ Tanksize_ Collected by: Depression (Y~ /,J 0 Other bacteria S & $ ENGINEERING Foundation cleanout ~YN) Date of Pumpihg ~:F__.,~'''~ ' C. ABSORP. T!ON FIELD DATA Date installed Length" ~ Width Effective absorption area ~'7£- Date of adequacy test J~ 17034 Eagle River Loop Road NO, Eagle River, Alaska 99577 Number of Compartments -Z-.. Cleanouts (~N) High water alarm (Y,~[~ ~,l Pumper I.?. Gravel thickness below pipe Soil rating ~r ft2/bdrm) Fluid depth in absorption field before test (in.); System type ¢~ ' Total depth Monitoring Tube present (YJ~I) Yes Depression over field (Y~I~) ResUlts (Pass/Fail) ~ For ~, bedrooms ¢ ' Immediately after gal. water added (in.): Fluid depth ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Absorption rate = .g.p.d. If yes, give date ~ 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) ~ '~ *DatUm~cycles tested ' Size in gallons "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot % Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots i <2o I ~ On adjacent lots toe t'rr Public sewer manhole/cleanout I~ /A Lift station /q/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation .~ .-F Property line ~,~ ~ 4- -- Absorption field '~o Water main/service line I o + Surface water/drainage Io~I'+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Zo ~ Building foundation .~¢ i ~.~ Surface water 100~ 4- Curtain drain ,4/,~, Water main/service line HAA Fee $ Date of Payment Receipt Number Driveway, parking/vehicle storage area lo ~ 4- Wells on adjacent lots I ~)o~''r ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal rec~c~"~~stems are in conformance with MQA HAA guidelines in effect on this date. ~.~./~?.~,-,'"~'",,.7,.~,~.~. En ineer'sName /r~'~Z~r~tF ~' ~ Waiver Fee $ ~/~/~ Date of Payment ~/~¢ (~4:¢ Receipt Number 72-026 (Rev. 3/96)* ~]UG-i~-I~D? 15:~ CT&E ESi ~NCHOR~GE 9075615~0! P.0~×05 ZiCT&£ Environmental Servioe$ ,,r~~ CT&E Ref.# 974589001 Client Name S & S E~lgineering Project Name/# N/A Client Sample ID L6, B'10 Riverview l~st, Matrix Drilfl6ng Water Ordered By pwsID Samgb Remat-ks: Corrected Report: Sample ID. Resu[t~ 4.58 Nitrate-~ 0.00 Total CoLiform Client PO# Printed Date/Time 08/19/97 [5:30 CollectedDate/Time 08/12/97 13:00 Received Date/Time 08/13/97 13:00 Technical Director: Stephen C, Ede PQL Units 0,~00 mg/L co[/lOOmL ALLowabLe Prep ~ethod Limit~ Oate $M1§ 4500'NOSF 10 ~ax 5M18 92Z28 Init 08/14/97 JBL 08/12/97 TH~