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Home My WebLink AboutWOODBOURNE BLK 1 LT 4 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: ~...1 °t.~01 ',¢/~9 PID Number: Ol~'(~J~>-J/0 Name: '~ObJO'v't(~J ~0~ Wastewater System: ~New D Upgrade Address: ~¢/1 ~cL/m~ ~¢~ ABSORPTION FIELD Tolal DoCh lrom original LEGAL DESCRIPTION, SoilRating: '¢ff GPD/Sq. FL /O ~ Township: J Range: J Section: Fill added above original grade:- Gravel length: I I / ~ ~. ~- ~. WELL: ~New ~ Upgrade Gravel width: Number of lines: ~ Ft. ~--. /~ Ft. DISTANCES ~Septic ~ Holding B S.T,E.P. Surface ~¢~E ~0~¢ ~0~( LIFT STATION Line ~'7~~/ 5~~ '~ 7P~ Foundation ~ _ ~ i ~ t .~ "Pump on" level at: "Pump off" level at: High water alarm Curlain I Drai. ~0~ &~ ~O~ 'ump Make & Model Electrical InspocUons pedormed by: Remarks: ~5'~/~ b ~%P {~ L~ ~ BENCH MARl( Location and Desoriptiom WI&S% '~L¢Om V~Z4 Inspections performed by: Bates: 1st ? s ~ ' ~ .~ . 2nd Department of Healt) and ap Services approval ...... ,, ,. ,,. ~ ,,,",,* ,' Reviewed and approved by: ' Date: / - ~ / - ¢4 ....... '~'"~ 72-013 (Rev 9/91) MOA 25 Permit No. .~l,~ q3ol$/e Page ~ of ~ Municipality of Anchorage DEPARTMENT OF HEALTH ANDHUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box '196650 $ Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~¢'C" '-]-~ t~l,O C~,-- /; IA.,}otvJ)g.~U/Zcd~' PID No.: Permit No, 5b..Jq'~Ot.{(:, Page ~ of--~ Municipality of Anchorage DEPARTMENT OF HEALTH AND.HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~'~"~ ~, ~..0 U~- ./j I/J' ~EJ) i~o UfL~ ~ PID NO,: 015~3~II0 1 ..:.,~,_ .......... ; ¢ ¢..'c ,ar 4.',31 - [- o' ..~ -.~ STATE OF ALASKA DEPARTMENT OF NATURAL RESOUR,C,ES DIVISION OF WATER WATER WELL RECORD "~i? LOCATION OF WELL · ON ....... :' LOCA?~ON/SkErCH: WELL OWNER: ~ ~ ~ ...... DATE.OF COMPLETION Depth bf hole:..~_ ft DEPTHs NIff, ASUBED FROM:l~]casing top r-]ground Surface i DATA: Depth Color From To D~PT~ TO STATIC WATER LEVEL: ~.~, .__,fi bolow x~top of c~sing l-1 ground surface METHOD OF DRILLING; .~.air rotary ~ cable tool 0 0thor ~ USE OF WELL: [~dome,qic [] irrigation E~ monitor E] public supply .~ other CAc,,,,;(~ STICK-UP; , ~ ft, Diem: _.~_._.in, Casing type: .... ~,~..in: to*~.5~ ft WELL INTAKE OPENING TYPE: ~open end /~l screened O peFforated E] open hole RECEI IAN 1 1 94 Dept, He~l Depths of openings: .... to ~._...~_ ft SCREEN TY,PE: _~ Diem: in, Sl~t/M.osh S,~,e:~,. -. LenDth: ...... ft G~AVEI, PA~K TYPE."'~ i ' " Volume used.~_.~ Depdt ~o ~op: ' .... GROUT TYPE~ ~ Volume: ,, Depth: from DEVELOPMENT ~ETH~O: Duration:__ ~.~.~_~,, PUMPING LEVEL AND YIELD: ._.~/'~,~ ft after ~ hfs pumping_ .~d'/2 ~pm PUMP INTAKE DEPTH: ~ ._ ft Horsepower: ,, W,~.L DISINFECTED UPON COMPLI~ON? ~, YES ~ REMARKS: PLEASE N1AIL WHITE COPY OF LO~.TO: DNR/DIVISION OF WATER PO BOX 772116 EAGLE RIVER AK 99577.2116 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 AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930136 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:KROUSKOP DONOVAN & OWNER ADDRESS:8411 WILLIWA CIRCLE ANCHORAGE, AK 99516 DATE ]iSSUED: 6/01/93 EXPIRATION DATE: 6/01/94 PARCEL ID:01535110 LEGAL DESCRIPTION: WOODBOURNE BLK 1 LT 4 LOT SIZE: 102866 (SQ. FT.} NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IlS FOR THE CONTRUCTION 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 (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343--4329 OR 343-4681 AFTER BUSINESS HOURS 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: THE DEPTH OF THE TRENCH(S) MUST NOT EXCEED 8.0 FEEl' UNLESS TEST HOLES 2 AND 3 ARE DEEPENED TO 16 FEET DURING CUNSTRUCT- ION. RECEIVED ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 May 20, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 4, Block 1, Woodbourne Sub. Septic System Design hnpacts to Adjacent Properties Dear On Site Services Engineer: The subject lot slopes from east to west at rates of 4% to 7% and from north to south at rates of 3% to 7%. Surface water will not pond at or near the proposed location of the wastewater system. Testholes revealed soils suitable for the placement of an onsite septic system with no groundwater encountered. If the system is constructed as designed the following conditions will result: The system, if constructed as designed, will have no adverse impact on the wells currently in use or to be placed in the future on lots in the area. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. CHECKED DY. DATE. /" SCALE ,/ hael E, 4381 SHEET NO OF / Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST -3 4 5 6 7 9 10 11 12 13- 14--- 15- 16 17 18 19 20 COMMENTS ,WAS GROUND WATER ENCOUNTERED? . Reading D o Gross Net Wator Drop at Time Time Depth to Net I I PERCOLATION RATE .~' (minutes/inch) PERC HOLE DIAMETER ._~// TEST R~N BETWEEN _.~ FT AND _(, -FT PERFORMED BY:,~ ~.,.'~../'~'~' I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/~,5J Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 3 4- 5- 6- 7 ~ ~.- 8 9 10 11 12 13 14 15- 16- 17- 18- 19- 20- DATE PERFORMED: Qb. Township, Range, Section; SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Oepth t~ Wak' A/tu~.~. SITE PLAN Heading Date Gross Not Depth to Net Time Time Water Drop ilYe PERCOLATION RATE ~ [m~nul~nch) PERC HOLE DIAMETEH .,, ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "1." Street, Anchorage, Alaska 99502-0650 $OI1.$ LOG -- PERCOLATION TEST SLOPE PT _ .... III 1 2 3 4 5 6 7 8 9- 10 11 12 13 14 15 16- 17- 18- 19 20 DATE PE COMMENTS 'WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Time Reading Date SITE PLAN Time Depth to Water Nst Drop ~./i~, PERCOLATION RATE ~' -- (m~nul~'mch) PERC HOLE DIAMETER ~,// TEaT RLJN BETWEEN , ~'2 - FT AND -.7 - FT I' I I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELiNEa iN EFFECT ON THla DATE. DATE. 72-008 (Rev, 4/851 WA8 PERFORMED IN MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # _ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 01_5-351-J_0%' 1. GENERAL INFORMATION Complete legal description Lot 4; Block 1; Woodbourne Subdivision Location (site address or directions) . Anchorage, AK Properly owner _D~A3L~on Golde_teln Mailing address 1 1 640 Woodbourne Drive Day phone __3_45-3286 Anchorage, AK Lending agency Mailing address Day phone Agent Carol Douthit/Remax Properties Address Day phone 257-011 6 2. NU~VIBER OF BEDROO~IS: 3. TYPE OF W'A"i'Et-,~ SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: individual well x× Community well Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. t [,~: OF WAS'FEWATER DISPOSAL: NOTE: XX Individusl on-.site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (Rev. 1191) Fronl 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 Ala~ka W'ate~ gr.Wa 7320 East Ch/est'er Address A nCbnra g~_.~. Alack Engineer's signature ... / ALASKA WATER & WASTEWATER CONSULTANTS, ARE TO BE PAID $1100.00 AT CLOSING FOR ENGINEERING SERVICES PERFORMED. 6. DHHS SIGNATURE ~ Approved for /=0 ~'/~ bedrooms. Phone Date INC Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of hemes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage i~ i.i (~ [~ IV J! [.) DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska '-?/iRONMENFAL SERVICI~$ DIVI$10~ i Health Authority Approval Checklist LegalDescription: /-O/~ ¥ ~-/~{ ~Z/¢¢O~( ~o~'~'~//¢- ParcelI.D.: A. WELL DATA Well type Log present (Y/N) V Total depth / Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ¢'~ // ' ¢~ Cased to /'~ ~' / Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG Date of test ¢ ~ Static water level Well production "~ WATER SAMPLE RESULTS: Coliform ¢ Date of sample: '7/-- ~.¢'~ AT INSPECTION g.p.m. g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed q -~ / Foundation cleanout (Y/N) Date of Pumping ~' Tanksize /2.-¢o Number of Compartments ¢- Cleanouts (Y/N)~ y Depression (Y/N) /~] High water alarm (Y/N) ,/~ Pumper Ai/¢/"//',L~.-,~I'( C. ABSORPTION FIFLD DATA Date installed '/-. Z(a --¢~ Length ! O ~_~Lr Width Effective absorption area / -¢ 5~¢-- Monitoring Tube present (Y/N)~Z/_ Depression over field (Y/N) , . q . p~S' For Date of adequacy test ~ ~¢- ~ Results (Pas~/Fafl) ~ FMd depth in ~bso~¢ion field b~fore te~t (in.); Immediately a[t~r 9~1. wmer added (in.)'. ,-~ ~/'~ ~3:~ Fluid depth~ '~ (ins) Minutes later: ~[~ Absorption rate = ~OO ~ g.p.d. ~: ). :.. r' ' ' If yes, give date .~ Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Soil rating (g.p.d./fF or fF/bdrm) 0,~4'~' System type .~'~' /,L / Gravel thickness below pipe ~, ~' ' Total depth /0 bedrooms 6 3'r D. LIFT STATION Date installed ~ Manhole/~ High w.~ate'r alarm level at* ~gcl~s tested "P~I at* "Pump off~le el~'~at* E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot ! 00/'~' Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOTTO: Foundation ~,.~.' ~- E.d~- Propertyline /£~/"" Absorption field ~"/-~,-,~,~ ~,~, ,~,~ ¢~-~,~' Water main/service line ¢-.5' / w Surface water/drainage /00/'f" Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Building foundation ~ ,2¢r 4..~/~'/' Water main/service line Driveway, parking/vehicle storage area Curtain drain t, JO~'~--- I cedify that l ha~ete~¢ined~ Jd inspectionsandreviewof Municipal~~~;~sare ,. conforman? ~th/M~¢,~,, es in effect on this date. Signature Engineer's Name HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $. Date of Payment Receipt Number RL:G-O~-1998 19:07 C]'gE ESI ANCWORAGE 907551S30'_ ?,0~,02 CI'&E Ret.# Ellen/:Sample. ID 983953001 AK Water' & W~ltewnler Serviee~ Lt 4 Bk 1/11640 Woodbouma Lt 4 Bk 1/11640 W~odboum~ Dd~¢ Wa~er Client PO# Printed Date/Time 08/04198 16:38 Colleeted Date/Time 0712~19t1 0f1:58 Ree~vedDatetTime ~/28i98 14:20 Tcclmicel Director: Stephen C. Ede Ordered By 0 Released By Z Sample Rem~.tks: "~ ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description ~::~- ~'~ .,~co ~. /j Location (site address or directions) II&qO L,'J o o~ 6Od~Z~d ¢ % f~ d~2 Property owner _~)'~ ~ '~,~'~ Mailiog ad,dress Lending agency Mailing address Agent Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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. :. ,, 'rYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. (Rev. 1/91) Fronl 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 thy 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 ,X:~J) ~?T~5o.,,J ~'~J d )/ge'¢'C'~/'J ~' Phone Address 7~.O. Engineer's signature ,~ . Ay,~~ '~ ~ Date S ~1/ _ qcl~z4 o DHHS SIGNATURE Approved for 4 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 anatyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the p.rofessional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECI(LIST Legal Description: Lo-r ~ B~o¢,tc, I) A. Well Data L.)ne b GCOk)¢--~ &"' Parcel I.D. °1~¢'~'$~11D Well type ~-It]~'7-t.~' if A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed_ ,¢/11 I-'~ ~ Driller ,~c¢~/~J ~' Total depth /,-~/~ ~' Cased to /,:¢ (.-- /=~- Casing height Sanitary seal (Y/N) ~ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG .g.p.m. /30' Absorption field on lot Public sewer main Sewer service line SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot //O / AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform O Date of sample: Nitrate c./, ¢ / Other bacteria O Collected by: /~ /'~¢,/,~¢ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) kC High water alarm (Y/N) Date of pumping Tank size /~ Z-5-O ~,~/¢4.. Compartments --7'-~'~O Foundation cleanout (Y/N) '1/ .Depression (Y/N) /~//~ Alarm tested (Y/N) /'~ / ~/J ~'~/L~J o-rto,,.J Pumper A//4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I10 On adjacent lots To property line ~> 7.%~' / Absorption field Surface water/drainage /~,'J ~" I Foundation Water main/service line 72-026(3/93)* Front CONTINUED ON BACK PAGE Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at Manhole/Access (Y/N) "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed Length /0 Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) 7//b/¢-~ Soil rating (GPD/Ft2) o Width ~Z. l Gravel thickness /, .~%-'Z. /=~T,Z- Cleanout present (Y/N) Results (pass/fail) /~ O,'J -~ .System type Total depth Depression over field (Y/N) for After test J O If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / / To building foundation / On adjacent lots )* .%'"0 Surface water ,'Jo ,,J ~' On adjacent lots ~/00 Property line ..~ O / To existing or abandoned system on lot Cutbank ,'k~o ~J E Water main/service line Curtain drain A.~ D rJ ~? t >~0 Driveway, parking/vehicle storage area *>' S-~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in~eff~¢E~ te.,of this inspection. Engineers Name M(of¥/~ Date //'~/ ~'/ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-028 (3/93)' Back IL.Ill':,.* 10' U'[il Esmt ..........~'-'24.42 ............. S~i~);(~(~l ~w~ 450.6 2OO 1322.02 TN&H 17.5¢ 512.22 COMMERCIAL TESTING & ENGINEERING CO, ENVIRONMENTAL I_AI]ORATORY SERVICES s,no~,~o8 REPORT of ANALYSIS Chemlab Ref.~[ :94.0004-1 Client Sample ID :L4, BI, WOODBOURNE SUBD. Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :ANDERSON ENGINEERING Ordered By :ALLAN Project Name : Project~ : PWSID :UA WORK Order :74584 Report Completed :01/05/94 Collected :01/03/94 @ 11:00 hrs. Received :01/03/94 @ 11:40 hrs. Technical DJ. rector:STratEgiC. EDE Released By :~~. ~_/___~ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: A.H. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 4.91 mg/L EPA 353.2/300.0 10 01/03 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than ~ ~,~ Member O! the SGS Group (Soci~t~ Gbn~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA