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MARYLAND LT 6-A
Maryland Block 6A #015-082-35 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division _ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 S — 0 —3 J ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name ❑ TRENCH ❑ BED DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address l 3 �l n t3 rte., W-Gti cis �6 WELL 4%7-%' FT Fill added above original grade Phones) .acts--S1-,za Gravel depth beneath pipe Permit No. Roo 3o y No. of Bedrooms ¢ LOT LINE i / Gravel length / LEGAL DESCRIPTION Lot Block FT Subdivision h1= d FOUNDATION Total absorption area Distance between lines Township, Range, Section Ty2N N Z�d� 7 K'� f7 f �-P ©/5--- Ka -3S AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) ill 111ill 11 111111,11 N1/1 TANKS 0 SEPTIC ❑ HOLDING Manufacturer Capacity in gallons �?lr�to ra c /21 �_o Material No. of Compartments TYPE OF SYSTEM ❑ TRENCH ❑ BED IX W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade 3.5 -Gd -r FT 4%7-%' FT Fill added above original grade Gravel depth beneath pipe Ors' FT Z / FT Gravel length / Gravel width �y FT S FT Total absorption area Distance between lines l SQ FT N1/1 FT Number of lines Soil rating Pipe material / /5a SOFT Installer 'ems- <--0 ^/ 9 Date Installed _S°l/} cz,ls- rises- I WELLS ❑ PRIVATE ❑ OTH entifv) Classification (A,B,C) I To pth I Cased to FT I Installer k REMARKS: / rr?a� CdIe�F oY Neca �oi oC/r�jo, p/ f` �� %/f 2rrb t, f S ry Tat; rP.,vBsY'�l'� Scale: f r c(D J 1� Inspections Performed by: PLS S f aw�luzresf q�j 'fart r s cLr lV_C cl X"r 2e; d 1-ecs Cr o7Z Date: •,�af1 7, /I%/ I � e. L4 C" ge, d / Je certify that this inspection was perlormed according to all Municipal and State guidelines in ellecl on 1 is date:Jam' Health Department Approval: 61 Date: 72-013 (3/85) ENGINEER'S SEAL A// Municipality of . nc orage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 January 8, 1991 Lorran Skinner 13420 Brant Way Anchorage, Alaska 99516 Subject: Lot 6A Maryland Subdivision Permit #900304, PID #015-082-35 A The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1990. A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the.installation of the on-site wastewater system, the original as -built inspection report (three-part form) must be sent to this office for review, approval and documentation. All inspection.reports must be submitted within 30 days of•.construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any quest Si hiler ly, J n Smith; J P gram Ma ager On-site Services JW/ljm:200 enc: Copy of Permit s, please call this office at 343-4744. "Kids Are Our Future" MUNIC7PAL�TY OF ANCHORAGE Department o{ Health & Human Services 82� L Street, Anchorage, Alaska 99501 343-4720 ON-Sl�E SEWER C. WELL PERMIT Parcel Id: 015~0B2~35 Lot Legal: Subdivision: MARYLAND Lot: 6A Block: ~ Section: 14 Township: 12N Range: 3W LoL S1ze 53228 (s�.�t. or acres} Max 8edrooms: This Permit: 4 Total Capacity: 4 SEPTIC TANK: Minimum total se�tic tank capacity: 1�250 gallons. Each septic tank must have at least 2 compartments, Depth to top of septic �eet requires insulation over tank(s>" WELL: Log must be �ubmitted to MuniciPality o� Anchorage Depariment o� Health and Human Services wi<hin 30 days o� well completion" THIS PERMIT EXPIRES 12/31/90 AND VALID FOR A SINGLE FAMILY HOME" l CERTlFY THAI: 1. I am [amiliar with the requirements �or on�site sewers and wells as set �orth �y the Municipality oI Anchorage (MOA) and the State o� Alaska, 2" I will install the system in accordancewith all MOA codes and regu1ations, and in com�liance with the design criteria o� this permit. 3, 1 will adhere to all MOA and State o[ Alaska requirements �or tho set back distances �rom anyexisting well wastewater disposal system or public sewerage system on this or any adjacent or nearby lot, 4. I understand that this permit is valid tor a maximum o� 4 bedrooms, I also uodepstand thaL the k- ,00,0 � (Uwner) I NER Issued By: DATE: -�'--`~~�~~~ ~~-'-~--�----�~ � A ° EC ALASKA CnUIROWnTAL COnTROL SCRUICCS, InC. S o Engineerinq 6 Enuironmental Studies SPECIFICATIONS FOR A FIVE—W-IDE WASTEWATER TREATMENT SYSTEM LEGAL DESCRIPTION: LOT 6A. MARYLAND SUBDIVISION 1.0 GENERAL 1.1 The Drawings, sheets 1 thru 5, shall be a part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 All elevations and depths are advisory and are to be verified or modified in the field by a DHHS approved inspector. 1.4 It is the responsibility of the property owner or installer to adhere to approved designs for installation, to maintain the specified separation distances, and to have the appropriate inspections. 1.5 It is the responsibility of the property owner or installer to report to the engineer any observed conditions which would put the system in violation of state or Municipal regulations. 1.6 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construction, to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC SYSTEM 2.1 The existing septic tank may be used, if it meets the capacity requirements for the residence and the approval of DHHS. Older systems may need tank integrity verified. If not, then specifications 2.2 through 2.6 apply. 2.2 The septic tank shall be a UPC -approved two-compartment tank, constructed of 12 gauge steel with bitumastic coating, set level on undisturbed soil and insulated with overlying layer of 2 inch burial type polystyrene. 2.3 The septic tank shall be a minimum of -5 feet from 1412 WESC 33R6 Avenue 0 AnchORacle, Alaska 99503 0 (907) 279-5553 the house foundation, and a minimum of 5 feet from the absorption area. 2.4 The septic tank and drainfield shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class "C" wells, and 200 feet from Class "A" or "B" wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by Alaska Department of Environmental Conservation (ADEC). 2.5 Piping shall be fitted with a mechanical watertight calder coupling of the inlet and outlet of the septic tank. Piping shall be 4 inch ASTM D-3034 or cast iron, sloped a minimum of 1/4 inch per foot from the house to the tank and 1/8 inch per foot from the tank to the trench. 2.6 Cleanouts shall be installed as designated, capped with air -tight rain caps (Jim Caps or equivalent), and extend a minimum of 2 feet above ground level. 2.7 If a lift station is required, it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. using an ORENCO lift station design. Specifications and design drawings are on file with the Municipality and with the engineer. 3.0 DRAINFIELD 3.1 The gravel for the drainfield shall be 0.5 to 2.5 inch, screened rock with less than 3 percent passing the No. 200 sieve. All substitutes must have prior DHHS approval. 3.2 The bottom and side of the excavation shall be raked with the backhoe blade to ensure that it has not been compacted during excavation. The bottom elevation shall be level. 3.3 Monitor standpipes(s) shall be placed as shown in the drawings, and shall be rigid PVC ASTM D-3034, or 4 inch cast iron. The section shown with holes may be drilled 0.5 inch holes on the 6 inch centers on opposite sides of the pipe, or a regular section of perforated sewer pipe, clamped to a solid section, with either a no -hub coupling or a solvent joint. The perforated section of the monitor tube shall be located in gravel only. A rubber rain cap (Jim Cap or equivalent) shall be placed over the top of the pipe. 3.4 The distribution pipe shall be 4 inch rigid PVC with a minimum crush strength of 1500 pounds or equal. If the system is a pressure distribution system see Section B.O. All distribution pipes shall be laid level. 3.5 If the final grade of the drainfield is less than 4 feet from the gravel, insulation is required using burial type polystyrene rigid board insulation. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 18 inches of soil cover even though insulation is used. The solid pipe extending from the septic tank or lift station to the drainfield shall also have a minimum of 4 feet of cover or an equivalent layer of insulation to prevent freezing of the line. 3.6 Filter fabric is required on top of rock. 3.7 It is recommended that the area excavated and the area in the vicinity of the drainfield shall be planted with�a white clover, red fescue mix, or with Kentucky bluegrass. 4.0 INSPECTIONS 4.1 A minimum of three inspections are required for installation of the trench. The first inspection will be of the excavation to verify that the installation will be in the proper soil. 4.2 The second inspection will be after placement of the gravel, monitor standpipe(s) and distribution pipe to verify proper installation before backfill. 4.3 The third inspection will be after final backfill, grading and seeding to ensure that adequate soil cover has been proved over the drainfield. 4.4 The inspection of the septic tank can be incorporated with any one of the above listed inspections. 4.5 The lift station will require either an MOA electrical inspection or certification by a licensed electrician depending on whether the building code applies to this part of the city. 5.0 PRESSURE DISTRIBUTION SYSTEM 5.1 The lateral and header pipes are to be Schedule 40 PVC or ABS in the sizes indicated on the drawings. 5.2 The laterals are to be level within plus or minus 1 inch. 5.3 All joints are to be solvent welded. 5.4 There shall be 2 inches of rock over the top of the headers and laterals. 5.5 The holes in the pipe are to be properly sized and spaced. 5.6 The holes shall be clean with no cuttings still attached to the pipe or left free inside the pipe. 5.7 Holes may be reverse beveled if it does not increase the outside hole size. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907)561-5040 ees J n. G -W. M. 01411. 9+ JOB SHEET NO. ' OF S CALCULATED SY � „Q�" DATE ' CHECKED BY DATE sr.1 c ,7-7 ....7 ck- cedere._....n e7L_._. ap v _r.. vde0 z C4 S' U • 151 • • c f� o i �' e• .."i by I w zu • e- "w� OH w m h 0�i •Ov .. ¢> a m • ° ��° a '>7 w/� ° s �j .!M1` H Z U) ° w It m QpJ z � D 0 LO Z m N ❑ aZ w , m J U Y N Jo 4 N 10 Q -H + /w/ 1 ❑ En U a J N 6i M jt > V Q t O ❑H O1 U Z Y- 0 x w w z ; m N _j � w. U p� Q U �r =={. H H H �: u a. I!J I 00Id 0 O q (n , ❑ k � 0 �. w C9 U H > i { a' T m ow ❑I Hfi H w FH w! iyc UI Z ZZ Ip ¢Q IL C3 MO IL N " H }t- IL 0 w Q ; ❑F'Q CEH O j J fl- H O U¢ rj'� IL:) 4 d U IL OZQ H" w j w w Qa: N 4H1- ❑ i— H ❑ m H t' c 7 1L H U ❑ ❑ N ul F H H N = ❑ wI ❑rc �❑ 4 i ❑ HI O O tL w F w , O (3 F O H Z n Q Z H! L7 ❑ Q F Qj y H U3: x U ❑ i -C w Q I� ! ) 44 w m � U 0. e -L,%>,, s=;, —5 l7-'- E ` s-` 0. e -L,%>,, s=;, —5 l7-'- E iS'l_L 917 - 170 o O O M LD m O) Q X N ZJ O Z Q LLj w� co w O a U Z v Q ` V, uJ mm q r q tm Y D U C '- `• A N t V V C O w $ o a m M � 4 U L m O m M O C � E Q M m G m N C m L m« 0 0 m W I C m C m m 0 U O «C m V m C r C O N Z C N m u m[ Ot go 0 « m 0 < N C 0 (1 I Q L Y t LL_ Y O O. m .. O V7 ua 4 Oce '1 m UJ 0 0 > U U) Q 0 N 1D-' yNE0 a«N m O N W N LO rr iS'l_L 917 - 170 o O O M LD m O) Q X N ZJ O Z Q LLj w� co w O a U Z v Q ..i� {' AI WGINEER'SSE:AL) r r••r r••rrr• y J Municipality of Anchorage**4 '.01. DEPARTMENT OF HEALTH & HUMAN SERVICE•.... ... �•• •••x•••- 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST�� ti Y c.•REID, JR.: r PERFORMED FOR: kF Nf r DA r h3o %�c� —?A;10 LEGAL DESCRIPTION: h_dT(ori- ��(-��/anQ����Township, Range, Section: //arl�3t� �•�5l SLOPE SITE PLAN 10 I I .. WAS GROUND WATER �D ENCOUNTERED? 11 Ah f /n 2 L 3 oy IF YES, AT WHAT O 12 DEPTH? P E cY SS T �• 13 Depth to Water After Monitoring? f)T Date: 14 15 16 17 18 19 20 __] �i PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN Z FT AND 3 FT COMMENTS ye'e i 'Cine fare! i�^�% � SFJ I,7 %/S!> lac (- d // Jul ree Tss�•�o %! , '���5 sai / / - PERFORMED BY: %' �' I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /s/n Reading Date Gross Time Net Time Depth to Water Net Drop 6? 215FO CAH) 2 a o dib ,YI a /o 3- • i D /o v7 f__./D bib4,19 o e o f s s of n e / 7W z is S 5,4W ero2t!c 7 zb ya 6- 67 7 Ver 8 Gy�J 9 10 I I .. WAS GROUND WATER �D ENCOUNTERED? 11 Ah f /n 2 L 3 oy IF YES, AT WHAT O 12 DEPTH? P E cY SS T �• 13 Depth to Water After Monitoring? f)T Date: 14 15 16 17 18 19 20 __] �i PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN Z FT AND 3 FT COMMENTS ye'e i 'Cine fare! i�^�% � SFJ I,7 %/S!> lac (- d // Jul ree Tss�•�o %! , '���5 sai / / - PERFORMED BY: %' �' I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /s/n Reading Date Gross Time Net Time Depth to Water Net Drop 6? 215FO a o dib ,YI a /o D•67 p �j. D /o v7 f__./D bib4,19 o e o f s s of n e / 7W z is S 5,4W ero2t!c 7 zb ya 72-008 (Rev. 4/85) LOT G fI- TH 2 1 I� 2- 3- 4- 5 3 45 6- 7 �j 8 9- 10- 11 1011 12--- 13- 14- 15- 16- 17- 18- 19- 20 21314151617181920 ,,-T-� ALASKA RUIR011 ETAL COnTROL SHUNS, InC. Engmeerinq & Enuironmental Studies Supplemental Soils Information. Subdivision /Vl,7r y �z d Block LOT 6A LOT TH 3 TH LOT TH DEPTH (FEET) 1 2- 3a53- 4- 5 6- 7 8 9 1200 West 33rd Auenue. Suite B 9 Anchorage. Alaska 99503 • (907) 2761361 3- 4- 5 45 6 i 1 7 I B I I 9 D PAGE 1 OF 1 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 SYSTEM PERMIT PERMIT NUMBER:SW910316 DATE ISSUED:10/03/91 DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE:10/03/92 OWNER NAME:SKINNER LORRAN & OWNER ADDRESS:6620 JOLLIPAN CT ANCHORAGE, ALASKA 99516 PARCEL ID:01508235 LEGAL DESCRIPTION: MARYLAND LT 6-A LOT SIZE: 53228 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: 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 (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: l© - iO 1 f . DATE • WATER WELL DRILLING PUMP SALES AND SERVICE 38 Years Alaska Drilling :907) 243.2282 'AX: (907) 243-4852 FEBRUARY 28, 1991 MIKE PRATT PRATT CONSTRUCTION 1809 CINDY LEE LANE ANCHORAGE, ALASKA RE; LOT 6-A MARYLAND SUBD. 6620 JOLLI,PAN WATER WELL LOG `= m KEN JOHNSON 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 0 FT TO 3 FT FROZEN BRN SILT & GRAV 3 FT TO 16 FT BRN SILTY SAND SOME MED. GRAV 16 FT TO 32 FT COURSE GRAV & GRY SILT 32 FT TO 36 FT SAME WITH COBBLES 36 FT TO 38 FT BRN SILT & MED GRAV 38 FT T050 FT COURSE GRAV GRY SILT ( TIGHT ) 50 FT TO 80 FT MED GRAV & CLAY 80 FT TO 85 FT 85 TO 85-6FT COURSE GRAV AND GRY SILT CLEAN MED GRAV WATER BEARING 2-3 GPM 9FT HEAD FT 85-6 FT TO 102 105 CLAY & GRAV ( WEEPS ...DIRTY.. FINE GRAV & SAND H2O lOGPM VERY DIRTY..TEST PUMPED 102 FT TO FT UNABLE TO CLEAN UP 105 FT TO 116 COURSE GRAV GRAY SILT ( HARD PAN ) WEEPS 116 FT TO 119 119 FT SAME .DRY CLEAN MED.GRACOURSE SANDWATER BEARING.. TEST BHOURS GPM WELL YIELDS 4.5 GPM DRAWDOWN TO 116 FT AT 5 GPM RECOVERS AT 4.5 GPM STATIC WATER LEVEL 59 FT. if TOTAL CASING 119 FT. i RECEIVED SVP 2 0 1991 fvlunicipalitY of Anchorage Dept. Health & Ijurn1n Services n A• m zo z _* x� z m G m "' z IJ Do N rz U U D y fO Z ��n w m N N C i \Fl m m N < 61 0 (D - N m o v o 3 c C vnm �Dm70 n 0 < G m °m 3 a { ] 2 n 3 a .7r) r 00 1 0 ti m y mT x rf ;I O j N F5 M a^ D 0 m m 0 S ] 70 0 3 n ,o*3Z a � _ d « ° ] N o ;w o 0. S ° _ 1 ] v =a Q n V c 0 ° M 00 m = < 1 ] ° pnn < . vo ad z M R ] ^ W < W r m a r r T D O I m `1 m n h l h U0 I Dom.. z Uj I� 0 i Ar OCoom 0 zz6zw ;m �DDc0 v3 m a o r m m y D mm Zn r -I x m XO&Dem, yD C C T m�0 m®®OCc v z 0 0 N o i MR 0F 0 W d S W .. O O F 69 E47 c 1 1 S la ��n W i \Fl 3 RI 1U d a � _ _ _ 1 a . z M R I (oadc W a r I r h 1 1 S la >A 'o m m Z GI ow Z ago > I m I� i TI �m m d .w� 11 N/ _0 qO 100 I ' fVA� • 1 m v D N 0004'40"W 77.56 n z D Z N m ul c ---- A En m N � O N 0 I to m rn uy m u" S O D Z G 9 m 7 p m 31 O n0D i4.Dm 3 m °d31,< I 3 2 s 0. m n z + 3 G m m ° � ° - v I e.».. 9ca—{ Im rn LP >>S x,man I 1 ggu 0a0D _ ° 5j 0 r me a- o m ».o $' I w Rt �d n� 0 N t A iv & N o O ca N r N CD CL � CL Q OT l C Cl) P� y J WN, y w IN At mmr s 00 03'1-7"E 194.42. D A r o C w m Zznza m v r 9g-im2 aIT! 9mDm� m z D m x D \•r, 8 �d y � : :�FS+i�41 rn �' A" e D o x 4)&0eo �m a T9 � , m xr3�• N t CCm 06 C O OV • V S • \• • b+ yam, Z 6` :. If SL to i 1/ vy••, ,t� • i .a jj p. w Q i 8 III On i p o � \f O < O �ma- m 3 ago 3 a ° c I� i TI v W d .w� 11 N/ _0 qO 100 I ' fVA� cD 1 1 m m Q 9 00�4 f d- m2un91 <Q W Ir _. m m - L9 n OO N N ; . . r— o LP - U) m m 1 7 a m En C 0 tA Rt I 1. , D o z 67 ¢ � � .1 ,... n� 0 N t A iv & N o O ca N r N CD CL � CL Q OT l C Cl) P� y J WN, y w IN At mmr s 00 03'1-7"E 194.42. D A r o C w m Zznza m v r 9g-im2 aIT! 9mDm� m z D m x D \•r, 8 �d y � : :�FS+i�41 rn �' A" e D o x 4)&0eo �m a T9 � , m xr3�• N t CCm 06 C O OV • V S • \• • b+ yam, Z 6` :. If SL to i 1/ vy••, ,t� • i .a jj p. w Q i 8 III On i p o � \f O < O m Lf� C7 D LD v W 11 N/ _0 qO 100 I ' cD 1 1 n� 0 N t A iv & N o O ca N r N CD CL � CL Q OT l C Cl) P� y J WN, y w IN At mmr s 00 03'1-7"E 194.42. D A r o C w m Zznza m v r 9g-im2 aIT! 9mDm� m z D m x D \•r, 8 �d y � : :�FS+i�41 rn �' A" e D o x 4)&0eo �m a T9 � , m xr3�• N t CCm 06 C O OV • V S • \• • b+ yam, Z 6` :. If SL to i 1/ vy••, ,t� • i .a jj p. w Q i 8 III On i p o � \f O < O m O I z � �• r Municipality of Anchorage a �-� Development Services Department Building Safety Division ❑ On -Site Water 8 Wastewater Program ❑ 4700 Bragaw Street ❑ P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015— t'.'> 9.7_— Z5' COSA# n 1. GENERAL INFORMATION Expiration Date: D — — O R Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MARYLAND S/D: LOT 6A 6620 JOLLIPAN CIRCLE • ANCHORAGE. AK + 99507 LORRAN AND PATRICIA SKINNER Day phone Day phone KATHLEEN POULIN W/ KELLER WILLIAMS Day phone 865-6500 101 W. BENSON BLVD, #503 • ANCHORAGE, AK ' 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well a Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSIJ also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF 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. l further verify that based on the information obtained from the Municipality of Anchorage riles 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. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, VD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluatorof the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal tight whatsoever. 5. DSD SIGNATURE �� Approved for -4 --bedrooms. Phone 337-6179 Date— —1/16 b Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: / COSA Checklist (/ Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other — By. Original Certificate Date: O (Rw 11105) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MARYLAND S/D; LOT 6A :Parcel ID:01,5_ 00-2--36— A. WELL DATA Well type MATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Datecompleted 2/28/1991 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 119 ft. Cased to 119 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of I test 2/28/1991 6/1/2009 Static water level 59 —ft. 60 Well production 4.5 —9 -p -m- 4.8 _g.p.M. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0 mg./L. Other bacteria 0 colonies/100 ml. Arse nic: N ug./L. Date of sample: 6/2/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 1/7/1991 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) NIA Date of p I umping 3/2/2009 Pumper ISAACS PUMPING SERVICE C. ABSORPTION FIELD DATA PBELOW EXISTING GRAD -El Date installed : 1/7/1991 Soil rating (g.p.cl.tfeor(f/bd 150 System type TRENCH Length 84 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth *5.5+ ft, Eff. absorption area 600 ft' Monitoring tube YES Depression over field NO Date of adequacy test 6/1/2009 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth In absorption field before test 8 in. Water added 610 gal. New depth14 In. Elapsed Time: 925 min. Final fluid depth 10 In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN _ If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off" leve High water alarm level at in. Datum — Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS ff� G. ENGINEER'S CERTIFICATION I certify that f have determined through field Inspections and review of Municipal records that the above systems are in �(�J conformance with MOA COSA guidelines in effect on this 0 date. Q Jef A. Gar s: es Engineer's Printed Name JEFFREY A. GARNESS QQ� �J •, E-7953 FQO / e ••7Et6�O�o� Date "7 JIGSyq �0 dptofe!ltone4o �0400000`� , COSA Fee $ Waiver Fee $ Date of Payment Date of Payment r, Receipt Number Receipt Number (Rev. 11/05) t Municipality of Anchorage " Development Services Department Building Safety Division \ On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519519 -6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL �c FOR A SINGLE FAMILY DWELLING�//) Parcel I.D. 01 S'68,2.3 � COSA# C r ✓i�212 1. GENERAL INFORMATION Expiration Date: 1 0 — fl q —0-9 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MARYLAND S/D: LOT 6A 6620 JOLLIPAN CIRCLE • ANCHORAGE. AK • 99507 LORRAN AND PATRICIA SKINNER Day phone Day phone KATHLEEN POULIN W/ KELLER WILLIAMS Day phone 665-6500 101 W. BENSON BLVD. #503 • ANCHORAGE, -AK + 99503 Unless otherwise requested, COSA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site N Individual Water Storage ❑ Individual Holding tank ❑ Community Class Welt ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENG114EER 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 systen 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 riles 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. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the testand separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE Approved for ? bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date 0 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: (Rev. 11ID5) 1rEy ".-ness.- t CE 7 53p ` • ON-SITE WATER AND : WASTEWATER PROGRAM ••r0'4 Original Certificate Date: -7-///-09 \ Municipality of Anchorage Development Services Department Building Safety Division ' On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MARYLAND S/D: LOT 6A Parcel ID: 015-- 05?2-3S— A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N A Well Log (YIN) YES Date completed 2/28/1991 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 119 ft. Cased to 119 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 2/28/1991 6/1/2009 Static water level 59 ft. 60 ft. Well production 4.5 g.p.m. 4.8 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0 mg./L. Other bacteria 0 colonies/100 ml. Arsenic: N D ug./L. Date of sample: 6/2/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 1/7/1991 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 3/2/2009 Pumper ISAACS PUMPING SERVICE C. ABSORPTION FIELD DATA " LOW EXISTING RADE Date installed 1/7/1991 Soil rating (g.p.d./Wo4EEO 150 System type TRENCH Length 84 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth •5.5+ ft. EH. absorption area 600' ft' Monitoring tube YES Depression over field NO Date of adequacy test 6/1/2009 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 8 in. Water added6� 00 gal. New depth 14 in. Elapsed Time: 925 min. Final fluid depth 10 In. Absorption rate >= 450+ g.p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" leve High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 59+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 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 JEFFREY A. GARNESS Date '7Iq/05 COSA Fee 't Date of Payment 749/ 9 Receipt Number 99 S� `/;L (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number SGS Ref.N 1092379001 Client Name Garness Engineering Group, Ltd. Project Name/N Maryland Lot 6A Client Sample ID Maryland Lot 6A Matrix Drinkin.- Water Sample Remarks: Printed Date/Time 06/12/2009 10:59 Collected Datefflme 06/022009 9:00 Received Date/Time 06/022009 16:20 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results POL Units Method Container ID Limits Date Date Init Metals by 1CP/MS ug/L Arsenic ND Waters Department 06/08,'09 06/11/09 Total Nitrate/Nitritc-N ND Microbiology Laboratory SM204500NO3-F Colony Count 0 Total Coliform 0 Fecal Coliform 0 n 2 of 4 5.00 ug/L EP200.8 C (<10) 06/08,'09 06/11/09 NRB 0.100 mg/L SM204500NO3-F 13 (<10) 06/10/09 LCE col/100mL SN1209222B A (<200) col/100mL SM20 9222Q A (<I) col/100mL SM20922211 A (<1) 06/02109 DLC 06/02/09 DLC 06/02/09 DLC i ° aD o�0 0 Top 0000ppp Z5!orn-i o" z C: ;o m On OQ >; p�+r* p o u'i DO�a •: Cfl •� 000 Oz m A N In O -1 0 0 r? —1 .• 00, r> X C rn o o ' c �H i' : IS 'rl� Z --I � m y LANTECtI rt° Q7 Q �. ,o 0 m A r �0 0i - 0° O �Q nLA>r ` moI Qo oo �� ?rnr^Z co LA A 44S��y '. • o -,Orn o z g n o ��p0000�a r p D Z o m o rn x 1 'o or CD > Z N Z 00 o w 96'LL M„OV,b0.00N , % o l rnrncZi ° NZrn I O� m '1ws03 ol)lDal3 N 'wwo�alal ,OZ v S 9 °r e @ r---------------------------- o n � w s. x i O N 3 a I D ° rD o a0i� . e C' °C 0 x fi CP 0 3 c. m ; ”' 3 , �s A N 3 i to L4 I o R n Q N m l _ N , x I loo o °° 67.3 r Rof x it 5t o I u(, °o � rw 7 R , do aanc n'R o ° gyp-^ ppool Z'J 3 J n 2 J •J „ N •3 S O 5J!t A. psoy N S! c hoc a\ O \ ^ 20 o nYan°y pyp6ON� .O Q ° .. s Y Rog°s n ;.g Wy n o a �! o Vn 32 it JY ..n Rte. „R` 1 Zb't6L M„LL,£O.00N \ gg�c9 Qya , oa a.{ nal o-. 00 \ M3o�R Sop c,+l � j O •;-,3 goy V opo i n.�s ?R� MUNICIPALITY OF ANCHORAGE ` R 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.# 01�-0tqa-3�> HAA# �12g1mil��L, 1. GENERAL INFORMATION Complete legal description LCE &,A k Aey LNIA1� Location (site address or directions) /1 D kan- Property owner n i V, -e- Day phone Mailing address +; C t't4 1.., Lez Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: L— 3. TYPE OF WATER SUPPLY: Individual well x Community well Public water Day phone Day phone 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: y( 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. 72-025(Rev.1/91) Front MOA#21 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 Address Engineer's signature a '1 to �1 6 F � too "7Y e S) �`Re To,:L•en Sp�-'�•�nd �© S°uae C:•24 i ° 9 e C "ev 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: Phone _Date bedrooms, with the following stipulations: Date le - 03 - %/ 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 orderto 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 Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L. o i (o A HA YLAN j-,> Parcel I.D. O I — D X ;Z — 3 15- A. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Cased to Casing height_ o2D 41 Sanitary seal (Y/N) % Wires properly protected (Y/N) it FROM WELL LOG AT INSPECTIONZ O 0 y Date of test o n Static water level a � ey> Well flow g,p,m, o g.4 C"i LLJ Pump level a W V w o SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot On adjacent lots i 100 Absorption field on lot I 0 -h ; On adjacent lots i /06 Public sewer main Public sewer manhole/cleanout N/A Sewer service line IY/A. Petroleum tank N bs, WATER SAMPLE RE ULTS: Coliform Nitrate ND Other bacteria Date of sample: j'� % �(' 1 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /2-24-90 Tank size 11250 Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) / Depression (Y -/N) tom/ High water alarm (Y/N) -NSA Alarm tested (Y/N) ty�A Date of pumping IYllleh. Pumper n SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1110 - On adjacent lots % / &0 Foundation oZC7 f To property line 3 Absorption field I Water main/service line > Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION N/ Date installed Q Size in gallons Vent (Y/N) High water alarm level _ "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water . Date installed 14494—/2 i 94--/2 -24 - %Soil rating 190 System type 9�t4_ Length Ry Width Gravel thickness 2 t Total depth V Total absorption area Lov Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) �- Peroxide treatment (past 12 months) (Y/N) Date of adequacy test N/A for NVA bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 I 0 On adjacent lots > f A -D Property line 3� t To building foundation 02 0 To existing or abandoned system on lot NIA On adjacent lots 7 e Cutbank NZ6r Water main/service line i 4;,C) Surface water Driveway, parking/vehicle storage area`>r0 f Curtain drain N E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature - n Engineer's Name 10 64 `A S e f, VU0, R G Dates 1'3 4 4 I HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY c�Q A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WORKoxd.erf- 38233 Date Roport Printed: SEP 16 91 0 08:43 Client Sample ID:POTABLE SLATER L6A MARYLAND PWSID :Uk. Col.lectod SEP 13 91 0 .tO:30 hrs. P.eceived SEP 13 91 e 11:00 hrs. Preserved with :AS REQUIRED Client Name :TOBBEN SPURKLAND, P.E. Client Acct :TOBBhNS BPO B PO § lJONE RECEIVED Roy 8 Ordered By :TOBBEN SPURKLAND Send Reports to: 1 r.naiysis Cemplo..rn :,aP _ 1 1)TOBBEN SPURKLAND, P.E. Laboratory SUper.visor :STEPHEIII C. EDE. 2) P•.el e..4 sed Gy Ciiomlab Ref fk 915718 Lab Smpl ID: 1. hlatxix: WATER Allowable Parameter Tested Resuli Units Method Limits --------- NITRATE-N ND(0..10) mg/1 EPA 353.2 10 Samule ROUTINE SANPLE COLLECTED BY: SPURKLAND. Remarks: 1 Tests'Performed `60` v'3.._ v= See' Specia].,Inst;.uctions Above UA=Unavailable ND 'Jane Decocted Soo Savoie Remarks Above I'A= liot Analyzed LT -Leas Than, GT.=Greaie'r Than Qh Sr'S Member of the SGS Group (Societe Generale de Surveillance)