HomeMy WebLinkAboutSEQUOIA ESTATES BLK 1 LT 4Sequoia Estates
Lot 4
Block 1
#017-052-04
Municipality of Anchorage Page ~l__of 4
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Oisposal System and/or Well Inspection Report
Permit Number: SW940072 Pie Number: ~(~\'-'~ --
~.*,,,e: Wastewater System: ~ New ~ Upgrade
A1 ~lea
Address: ABSORPTION FIELD
6850 Pine ~ne Circle, ~choraqe, ~(
Phone: [ NO. of Be(~ooms:
907-345-1002 ~ Deep Trench C] Shallow Trench r_3 Bed B Mound B Other
LEGAL DESCRIPTION ~od R~ting: Iolal Depth from origin8lgrade:
.6 GPD/Sq. Ft. 1 3 Feet
Lot: 8lock: Subdivision: Depth Io pipe botlom from original grade: Gravel deplh beneath pipe
4 1 Se~oia Estates 3.6 FI. 8.6
--- rt. 102 ' Ft.
I
WELL: ~ New / D Upgrade G'avelwidth~I+/-
Ft. Fl SQ. Ft. PVC
F, Big Time Dirt Works 06/06/94
SEPARATION DISTANCES ~ Seplic B Holding El S.T.E.P.
From Tank Fietd Stahon Tank Sewer Lines ~cho~a~e ~ 250
weH 136.9 102.3 ~/A N/A ~o~e ~ ~7¢~ 2
Surface LIFT STATION
Water
Line 58 ~ 0~ --- ~/AI N/A
Foundation 9,1 ~4 ~
Drain ...............
I
BENCH MARK
Remarks: O~/~ ~ ~ ~/~.~
Assumed ~ ~'~ fi,
Elevation:
Inspections performed by:_~¢- /~14.t Dates: 1st ~-/q- 9y
/ /' .. /~--..- , ~/
Permit No,
SW940072 Page
W.O.
MunicipaliTy of Anchorage
DeparTmenT of Heal'th and Human Services Date
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 * Anchorage, AK 99519-6650 · Tel: 345-4744
On-Site Wastewafer Disposal Sysfem/Well Inspection Report
Legal Description: LOT 4 BLOCK 1 SEQUOIA ESTATES SUBDIVISION PID No.
1 of 3
94108
6--22-94
\
\ /
/
10' PROPERTY
LINE SETBACK
100,60'
LOT 5
RECORD DRAWING:
1"=20'
TO
INV = 98,0
NOTE
1,SEE PAGE 2 FOR SWING
TIES &INV. ELEV.
2,AT THE TEE OF THE
TRENCH NEAR THE TANK
THERE IS APPROX. 10'
OF SOLID PIPE EACH
WAY IN THE TRENCH.
THE ACTUAL LENGTH
OF TRENCH IS 102',
EXISTING
4 BEDROON
HOUSE
= 102.0±
CLEANOUT ~ T<~
ELEV = 109.5
LOWER PIPE
= 98,0
RELOCATE GAL TAN
INV @ 97,5
SEE NOTE 2
NST~LL
INV = 98.1
CONNECT TO EXIST BE~D
SYSTEM W/ 4" I&VC P~PE
SEE ~OTf ~-~t/z '
Permit No.
On -Site
Legal Description:
SW940072
Municipality of Amchorage
Deperfmenf of Heelfh end Humen Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 .Anchorage, Al( 99519--6650 'Tel: 343-4744
Wds~ew(at'er Dispos(~l System/Well Inspection
LOT 4 BLOCK 1 SEQUOIA ESTATES SUBDIVISION
Page 2 of 3
Date 6/22/94
Report
%WINO -FIE MEA%UF ,tEMENT%
BOTTOM OF
LOCATION SWIRtG TIE I SWING TIE 2 TRENCH INV. ELEV
A 2' 20.6' 102' 8 98'
B 9.[' 752.2' 97.8'
C 17.8' 57.4' 9'7.,5'
D 20.4' 39.0'
E 21.5' 39.7'
F 21.9' 40.2' 97.4'
G 326' 31.3' 89' 974'
H 41.3' 23.6' 89.5' 97.4'
I 75.4' 82.5'
d 104' il9.2'
K 58.1' 84.6' 89.7' 97.d'
k 48.3' 76' 90.6' 97.4'
M 48.7' 79.5' 89.4' 97.4'
,.~o~.~., .,,
.... 't ~, Profes¢~O~
DATE
~0 94~08 IF.B. NO. ~ J SCALE: NO SCALE C. FILE 108SSDIR
PAGE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OE HEALTH AND HUMAN SERVICES
P,O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON--SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940072
DESIGN ENGINEER:DEE HIGH ]ENGINEERING
OWNER NAME:BOLEA ALBERT N &
OWNER ADDRESS:6850 PINECONE CIR
ANCHORAGE, ALASKA 99516
DATE ISSUED: 4/13/94
EXPIRATION DATE:
PARCEL ID:01715204
LEGAL DESCRIPTION SEQUOIA ESTATES BLK 1 LT 4
1 OF
~/].3/95
LOT SIZE: 38730 SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS EOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
AL1. CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
].5.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-468]. 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:
RECEIVED BY: ~,~ ~,9-~ ~
DATE:
DATE:
¢
Permit No.,
On-Site
Legal
Municipality of Anchorage
Department of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 *Anchorage, AK 99.519-6650 *Tel: 343-4744
Wastewater Disposal System/Well inspection Report
Desoriptton: LOT 4 BLOCK I SEQUOIA ESTATES SUBDIVISION PID No.
Page 1 of 7
W.O. 94108
Dafe 3-30-94
SITE NARRATIVE
Lot 4 Block 1 Sequoia Estates Subdivision is bordered by two lots. Both of these lots
have existing houses, wells, and septic systems. Gunnison Road borders the west side
of the property, and Pine Cone Circle borders the north property line. Lot 4 has an
existing house, and a failed bed septic system. The replacement septic system is a trench
design for the four (4.) bedroom home on site.
WELLS: The 100 foot protective well radiuses are shown on the drawing. The
wells do not affect the placement of the proposed septic system.
WASTEWATER: The placement of the proposed septic system will have no affect
on the septic systems or wells on either of the adjoining lots. When designing the
system, a wide drain field was considered, and a deep trench was chosen due to site
characteristics. By using a deep trench there is room for a replacement trench in the
same area (See Sheet 4) with no need for a lift station. Due to the required extra length
a wide trench would have used the entire area necessitating a lift station to a location on
the North East side of the house. The proposed trench system will be placed at least ten
feet away from the failed bed system. The soil type found in the three test pits done on
site was found to be consistent. Although the soil percolated fairly well, the soil seems
to be fairly sensitive to compaction and smearing. During the construction of the system,
any soil smeared or compacted will need to be raked and scarified in order to allow the
material to drain properly.
DRAINAGE: The lot drains towards the west. All finish grades wilI be sloped
to drain in direction of the natural drainage so that no ponding occurs at or near the drain
field. The disturbed soil will receive topsoil and seeding to prevent erosion.
Municipalify of Anchorage
Dep(]rfmenf of Hedlfh (]nd Hum(]n Services
ENVIRONMENTAL SERVICES DIVISION
Page 2 of 7
W.O. 94108
Date 4-04-94
P.O, Box 196650 'Anchorage, AK 99519-6650 'Teh .345-4744
On-Sire Wastewa~er Disposal Sysfem/Well InspecHon Reporf
Legal Description: LOT 4 BLOCK 1 SEQUOIA ESTATES SUBDIVISION PID No.
/
/ PINE CONE
/ CIRCLE
/
/
EXISTING BED
SYSTEM TO
BE REPLACED~,1
PROPOSED
TRENCH
SYSTEM
.30' PERC
TEST RADIUS
LOT 5
\
~ /~///,,,,
/
) /
/
/
/
\
SCALE 1" =50'
0
LOT 3
Permit No,
Municipality of Anchorage
Department of Health and Hurnan Services
ENVIRONMENTAL SERVICES DIVISION
Page 2 of 7
W,O. 94108
Date 4-04-94
On-Site
P.O. Box 196650 *Anchorage, AK 99519-6650
Wastewater Disposal System/Well
LOT 4 BLOCK 1 SEQUOIA ESTATES SUBDIVISION
/
/ PINE CONE
/ CIRCLE
/
/
Legal Description:
EXISTING BED
SYSTEM TO
BE REPLACED~-.~
/
/
/
/
/ /
LOT 4 /
/
/
/
/
/
/
/
\
30' PERC \
TEST RADIUS LOT 5 \
SCALE 1"=50'
PROPOSED
TRENCH _/
SYSTEM
"l'el: 343-4744
Inspection Report
PtD No,
LOT 5
Per.it NO.
Municipality of Anchorage
Deparfmen'l' of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
Page 5 of 7
W.O. 94108
Date 4-04-94
P.O. Box 196650 'Anchorage, AK 99519-6650 'l-el: ,545-4744
On-Site Wastewater Disposal System/Well Inspection Report
Legal Description: LOT 4 BLOCK 1 SEQUOIA ESTATES SUBDIVISION PIB No.
SYSTEM DESIGN CALCULATIONS
1. NO. BEDROOMS = 4-
2. USE TRENCH SYSTEM
,5. ABSORBTiON AREA = (# BEDROOMS)(150 GPD/BR)
TRENCH APPLICATION RATE
= (4)(150) = 1000 SF
0.6*
4. TRENCH AREA = (2)(DEPTH OF GRAVEL)(LENOTH) = 1000 SF
IF DEPTH OF GRAVEL = 7'
THEN LENGTH OF ]RENCH = 72'
PERCOLATION RATE
PIT & 'FRENCH
APPLICATION RATE
MIN/INCH GPD/BF
0 -1 NOT SUITABLE
1-5 1.2
6 15 0.8
* [ 16 30 0.6
51-60 0.45
GREATER THAN 60 NOT SUITABI_E
FILTER LAYER 1.0
MOUND & BED
APPLICATION RATE
GPD/SF
NOT SUITABLE
0.8
0.5
0.3
NOT SUITABLE
.7
Permit No..
Municipolify of Anchorage
Deportment of Heolfh Grid i-lumen Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ,~ Anchorage, AK 99519-6650 · ]'el: .545-474.4
On-Site Wos-~ewofer Disposol System/Well Inspection Report
Legol Description: LOT 4 BLOCK 1 SEQUOIA ESTATES SUBDIVISION PID No.
Page 4- of 7
W.O. 94108
Date 4-04-94
/
I
I
I
\
\ /
V
I
/i 1/
/ iz- --4
I
//
/ / oB
INV = 97.4:1:
NEc'r TO EX
-~ 93,3:k
CO
INV = 98.0
\ /\ \
I\ \
TO
\/ MONITOR
~ TUBE~'
LINE SETBACK
T
L / 30' TEST PiT /
..... ~ ~* RADIUS (TYP)~/
100,60'
LOT 5
1"=20'
/
EXISTING
~ 4 BEDROOM
HOUSE
CLEANOUT
INV = I02.0d:
TBM TOP CO
ELEV := 109.5
INSTALL CO
RELOCATE GAL TANI
INV @ 98.5
:SEE NOTE 2
ALTERNATOR K I__~._T
INV g8.1
CONNECT TO EXIST BED\
w,
IsEE NOTE ~
Permit No
Municipality of Anchorage
Department of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
Page__5__of 7
W.O, 94108
Date 4-04-94
P.O. Box 196650 *Anchorage, AK 99519-6650 "Tel: 343-4744
On-Site Wasfewafer Disposal System/Well Inspection Report
Legal DescripHon: LOT 4 BLOCK 1 SEQUOIA ESTATES SUBDIVISION PID No.
BACKFILL
SEE NOTE 14
4"¢ MONITOR 1-USE W/
AtRTIGB T CAP
SLOPE FILL TO DRAIN
SEE NOTES 15 & 16
EXISTING GRADE = 101J:
GEOTEXTiLE FABRIC
SEE NOTE 15
5.O' MtN
COVER
SLOPE TRENCH WALLS AS
REQUIRED TO MEET ALt..
LOCAL, STAFE, AND
FEDERAL REGULATIONS
4" ¢ PERF. PVC PIPE
INVERT = 98.0
SEWER ROCK PER
MINICIPAL SPECS
SEE NOTE 10
7.0' GRAVEL BELOW
PIPE INVERT
BOTTOM OF GRAVEL = 91.0
6' MIN,
BOTTOM OF TEST PIT
ELEV = 84±
TYPICAL. TRENCH SECTION
SCALE: NTS
½EAL~
Munlclpalily of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: 'l-F--'c~ '~-
LEGAL DESCRIPTION: L. ~i' ~-~ J
1
2
3
4
§
7
10
11
'1:3-
14-
1§
16
17
18
'19
20
/
DATE PERFOF
Township, Range, Section:
SLOPE
WASGROUNDWATER
ENCOUNTERED?
SITE PLAN
IF YES, AT WHAT
DEPTH?
Depth to Waist AIIqr'o~.~-,~N
~,tenitoring? t]ale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
~" ~.z~.~+ ~:zz. ~O ,..~,'-', /_.%5; '
PERCOLATION RATE ~'~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN ,ETWEEN 4.G'_FTAND /,,.G' F~
MUNIGIPAL GUlDI'LINE~ IN EFFECT ON DATE DATE'
72-~8 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
625 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
EAL)
PERFORMED FOR: "']"~.S~'- ~l~- /~0, ~-, DATE PERFOF~
LEGAL DESCRIPTION: g.. ~ ~"~ ~'~oO~ ~1-~?~ Township, Range, Section:
1
2
3
4
5
6
7
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT ~ O
DEPTH? p
E
Deplh to Water After
Moailoriflg? Date:
Reading Dare Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
fm~nutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN FT AND
COMMENTS ~b~. I. b~T~jT~c~._~ ~L.L~ ~ TI~%~T' Pc?' ~
ACCORDANCE WI~H ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON,IS DATE.
72-008 (Rev. 4/85)
FT
__ CERTIFY THAT THIS TEST WAS PERFORMED IN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~'iE.~,~' ~L~ i'.50. ~ DATE
LEGAL DESCRIPTION: ~' ~" ~ '~ %['4.)dOIA Ec~"C~,."~F-.~ 'rownship, Range, Section:
1
2
3
4
5
6
7
8
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20~
SLOPE
WASGROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
8
Depth Io Water Altqr ~
Monitoring? /'~C,~ Date:
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(m~nutes/mch) PERC HOLE DIAMETER __
TEST RUN BETWEEN -- FT AND FT
COMMENTS ~[L~ I~l~-~-bTlr-~e,.~..~ ,~L.~.~ '~ '[~q.~- ~t~',~
ACCORDANCE WITH AL.: S;ATE AND MUNICIPAL GUIDELINES IN EFFECT ON T[HIr~. DATE: ~//~,~/~¢
72'008 (Rev. 4/85}
CONSULTING ENGINEERS
Civil Surveying Planning
May 24, 1994
W.O. 94108
RECEIVED
MAY 2 6 1994
MLIn;o,pali~y oi Aachorago
l)ept, Health & Human 8er_vices
Mr. Robbie Robinson
Department of Health & Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
RE: Lot 4 Block 1 Sequoia Estates / On-Site Septic System
Dear Mr. Robinson,
As a follow up to your meeting with Carl Abrams relative to switching the design for this
lot to a sand filter system and you request to stay with a deep trench system if we were able
to verify the acceptability of the soils. We conducted another percolation test in the general
area of the upper trench as discussed. Percolation tests were conducted over a 48 hour
period. They percolate at approximately 40 minutes per inch. We have moved the trench to
the upper location as discussed and have lengthened the trench to account for the most
conservative percolation rate. At best, these soils are marginal but they do have percolation
rates less than 60 minutes per inch. Therefore, we are staying with the deep trench.
As discussed we are lengthing the trench and will tee the trench near the south property line
to get the total length required.
if you have any questions concerning the above please feel free to give me a call.
Very truly yours,
C~ulting Engineers
Dee High, P.E.
Principal
PO Box 111349 Anchorage, Alaska 99511-1349 · (90'7) 345-1385/Fax 345-1386
MUNICIPALITY OF ANCHORAGE
DL ,rlTMENT OF HEALTH AND HUMAN SER .S
Environmental Health 13ivision
825 "L' Street, Anchorage, Alaska 99502, Telephone 264~4720
ON-SITE SEWAGE DISPOSAL SYSTFM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION
'rANKS
TYPE OF SYSTEM
TRENCH ~,.2/BED [~ W;~DRAIN [] OTHER
Gravel Ion(Jr h
~'0 FT
0,~ FT
.... WELLS
PRIVATE
[] OTHER ¢ldentifv)
[~ota, Depth FT~Casod to
REI~ARKS:
FT
DISTANCES
~ T{ SEPTIC ABSORPTION
FROM ~. TANK FIELD WELL
WELL
LOT LINE
FOUNB~TION
Scale: ~!,T. ;.
~,l,nicipal and State §uiflelines in ,llect en Ibis datc: -- :¢Z.~* ~,,,/ I,'~:~,'8 G
72 013 (3/85)
No. CE-5283
I_li]i:Ei~'g ,
I-0 I !i31 Z I:i=:
t"t,q X
DI~i:F:'TI.I '['O I=']:F"E BOI'[OI'I < :3,,t':~i I':'1. I:il.~Zi!l. llF/li~l!~ J:N~LII_~'I-LI:I:IN
DI::F:'lll '10 P]:I,::'I£ i{l[)l"t'Ol'~l < fl,.O I:::'1.
II~lxll( HI. lEi I I'IhVE ~-YI' I..l~:~:t~:J'l' TWO
.1:1= ~,i I.]:1:':1 Ei l'J.~lJ:(:ibl :I.E; IIqEiIPd.,I..IED Ilxl AI'~I Pd:/E:P~ [X]VIEF;;I:O,:) ]:,IV I'~I0~'~'~
I I'l[ii:N( 1 ) t~J',.I li!:l ,Iii:l::: IF;: :1: C~I_. F:'I:ii:RH 1 T ~'~lqO I IqSF::'ECTI I]bl I~llJEi'l BEi: EIB I'~':~ i NIED; (;;~)
/4 ]: LL IqO'[ BI:i!: J, il='l::'lR(:lgl:ii:i:) W :1: 'I'HUlYl ~qN lii:l...[:i:l]:l'l::/i iL~:~I.. I I',lli~F'l;i!:C 1' 113N I:RI!i:F'OF/T;
Ii!:l.,li!:C'll:~:ll::;[~&.. I,',11::11';~1~:: MI. IEiI Btiii: Di:IIHI:!: 13Y f.'~ I,.,IC;liii:Nii~liO:) [~I..I:i:C'I'I::;~ICIAIXI~
El I
:1: S,?il.lli: O
(::O01~:Ei,
iqEb"Bl.I I l..
( :it!; ) I'l"ltii:
I::',/[J I:l:) EiANl:)li!:FISOIq ACI:RI!i:AGE SYEiFIZHEi
.........................................................
-t-
CE-5283 ~ ~'~
SEWER SYSTEM
.OCATION PLAN
Lot: 4- I Block:
Subd:
Dote: ~A~ .1~,, ~:S6
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION 1'EST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION:_
1
0u
2
3
4
§--
7
8
10
12
13
14
17
20
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Township, Range, Section:
SLOPE
I]epth Io Waler
SITE PLAN
c,
Gross Net Depth to Net
Reading Date 'rime Time Water Drop
.'-0
PERCOLATION RATE 12 I) PERC HOLE DIA~ER ~"
TES] RUN BETWEEN ~-'~'~ FT AND _ ~ FT
ACCORDANCE WI] H ALL S'I/~'TE A~ D MU NIOIPAL G UIDELINE~/I/~F; EC/v/~/N THIS DATE. DATE:
72-008 (Rev. 4/85)
F~om : ALPINE DRILL 90? ~ ~'
J4~, 0202 ~Tun, 29. 1990 10:57 AH PO1
WATER WELL RECORD
STATE OF AL.A&RA
DEPARTM£NT OF NATURAL RE:SOURE;8
Division of SeOlogicol E~ GeophyldC(ll Sm'veyS
I~c~ DI~¥ANCI,: ANO[~II1E~,TION F~tOM F(OAD
MUNtCIPAUTY OF ANCl4
DEPT~F-HI~AI;THd
$octlon
OWNER OF W£LL:
DepaYtment o'F anvironr~x~ntal
I~unicipa~l~.t¥ of 5nchornge
Anchorage, Alaska 99501
1990
To ~hern J.t May concern:
I'his letter authorize8 Lhe MunScipaJiL¥ e-J: Anchorage Lo
a],lew Steve Bel] te obtain a wel]. permkt for Sequoi. a EstaLes
hot 4~ 8).ook t~ Steve i8 p~xrchasi, l'1g our Aot {er Lhe purpose
of conStructin9 a home 'Per a thi. rd party.
Should yeu need any '~urther in-Forrnatien~ please cal. l me att
263,,4594 ~ I hal]k yeN.
Sincerely ~
David C, Sha'l:er
I
SEQUOIA ESTATES SUBDIVISION
LOT ~ BLOCK I
{ ;; J ~ N~°D(o OOI'W
~': ~0. O0
i the property depicted'above and that
:the proposed improvementa aod drain- ~,~..
GASTALDI LAND SURVEYING age patterns are as shown hereon. It ~.'~TH~ "~
Jeff A. Gas~aldi,R.L.S. is the responsibility of the owner, ~.~..~ ..... ~,.r~..~x
5030 Bettles Bay Loop )riot to construcLion, to verify the~~~~]~/~'~/-.~'
Anchorage Alaska 99515 )roposed building location on lot,
Tel. 907-544-4272 grade and utility connections and to /~)~ ~-~91 ...'~
determine the existence off any ease- - .9~... ..
GRID D&TE menks~ covenants: or restrictions ~N~" ...... '
~ ~'~-~0 which do not appear on the recorded
subdivision plat.
F.B. JOB NO.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT 01: 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
Lot 4, Block 1, Sequoia Estates
Location (site address or directions) 6850 Pinecone Circle
Property owner ' J': 'Grant Vidrine
Mailing address
Dayphonecontact
agent
Lending agency
Mailing address.
Day phone
Agent Prudential Vista/Matt Dimmick
Address42Zrl B Street, Anchorage, AK 99503
Day phone 273-7733
Unless otlmrwiee requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
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 WASTEWATFR DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTF:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1~) 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
Address
Enginee¢s signature
S & S ENGINEERING
1~'034 Eagle Rivet' LOOp Road No. 204
Eagle River,,Alaska 99577 ~
Phone
6~iq-~.qTq
Date
DHHS SIGNATURE
A?proved for ~
Disapproved.
Conditional approval for
Additional comments
bedrooms.
bedrooms, with the following stipulations:
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) B~ck MOAI~21
RECEIVED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICE~
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)
Health Authority Approval Checldist
Legal Description: J/_.~2T 4I' ~-~/-~ {/' ,~/t/,/~),/A~ ~5'/- Parcel I.D.:~/~ --//5~-
A. WFLL DATA
Well type /~ IV'~7~-~-
Log present (Y/N)
Total depth
Sanitary seal, N)
Date of test
Static water level
Well production
If A. B, or C, attach ADEC letter. ADEO water system number
[)ate completed
Cased to ,~ d/'1~- /
FROM WELL LOG
Casing height (above ground)
Wires properly protected, c~N)
AT INSPECTION
g.p.m.
WATER SAMPLE RESULTS:
COliform O Nitrate
Date of sample:,
El, SEPTIC/HOLDING TANK DATA
Date installed ~z-b{,¢,/~ Tank size /~,~ ~'~)
Foundation cleanout/~N)
Date of Pumping.
C, ABSORPTION FIFLD DATA
Collected by: _
Other bacteria
Number of Compartments ~-____ Cleanout~'~N)
__ Depression (Yf~ ,/~¢ High water alarm (Y/N)
Date installed ~/~'/'¢'( Soil ratin (g,~.p.d~ or fF/bdrm) . ~ System type ~~'
Length //~)Z 0 ,Widlh ~ Gravel thickness below pipe ~ ~ Total depth /~ _
~ t
Effective absorption area ~/ ~ . Monitoring Tube present~N)~ Depression over field (¢ ~ ~
Date of adequacy test//~ Results (Pass/Fail)_~*~ For ~ bedrooms
Fluid depth in absorption//field before test (i,.); ~- Immediately affe¢~gal, water added (in.): ~/~'
Fluid depth ~* ¢~0 ¢
(ins) Minutes later: /¢¢ Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~/~/~ If yes, give date "
72~026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
/
SEPARATION DISTANCES
~/ Size in gallons
"Pump on" level at*
*Datum
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot (/(~) /4-
Public sewer main
Sewer/septic service line .4~ "¢'-
/00/¢-
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout /V J, Cr
/
Lift station AIl/'~f
/
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ,/0 '¢--- Property line ~- /'¢- Absorption field
Water main/service line ,/0 ~'~ Surface water/drainage /¢O/~--Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /'~) ¢- Building foundation /~:~ /
'-/- Water main/service line
Surface water ,/~:~2 /¢- Driveway, parking/vehicle storage area /'~2
Curtain drain //~/~,~/¢-- ~'~/~/1//A/' Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
· I certify that I have
in conformance with MOA HAA guidefines 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
11: 38 S~S ENG 1NEER I NG
909 694 1211 P.04/04
CT&E Environmental Services Inc.
Laborato~/Division ~ar. arar, l~'a~'~r~'~'~J~jm~ar-.~is~amr~a~lr~'~
Laboratory Analysis Report
Clieil! Hame
Cliea~ Sampb
Matrix
Ordered By
10003~2001
Lo! 4 Big I Sequoia
Lot 4 Blk 1 Sequoia
IMmking Wa~r
0
Sample Remarks'
Client l)On
Priatud bate~Tirae 02/0112000 ll:lO
Collected Da~ime 01~7~000 11:30
Rucdv~d Date~ima 01/~7~000 12:15
~.26
0.500 m$/~ CPA '~00.0
10 nlo~ 01/27/00 01127/00 SCL
01/27/00 ~DT
TOTAL P.04
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVlCES~
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
ParcelI.D.# OI -7-15~-0~ HAA# ~°)(~t~Oq
1. GENERAL INFORMATION
Complete legal description
Lot 4; Block ].; Sequoia Estates
Location (site address or directions)
6850 Pinecone Circle
Anchorage,
Prope~y owner A1 & Celeste Bolea Day phone
Mailing address C/O 1st Inspection Network 512 Green Bay Rd.
345-1002
Highwood, Illinois
60040
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well xxx
Community well
Public water
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.
72~2§(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.
s & S ENGINEERING ' c
NameofFirm ,~,,~-*-,-~,,..--,.---,~--.~- ,~ Phone 6
Address Eagle River, Alaska 9957?
Engineer's signature ¢:///. ~',/"~-'- Date
DHHS SIGNATURE
Approved for /-/-
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date / 2- - / 2 - ~
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 ~0V 1 S ~G~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division ". ~.~
825 L Street, Room 502. Anchorage, Alaska 99501. (907) 34~-~Iv
Health Authority Approval Checklist
Legal Description: LO T z(' /~t-a c ~: / ~'E~2 ~,0~,¢ E.['2. Parcel I.D.:
A. WELL DATA
Well type
Log present '~'/N)
Total depth
Sanitary seal(~r'/N)
If A, B, or C, attach ADEC letter. ADEC water system number
[)ate completed 6 / I ~ / ct O
Cased to ;~ ¢) 5- Casing height (above ground)
Wires properly protected ~/N) ¥ ¢-J'
Date of test
Static water level
Well production
FROM WFLL LOG
WATER SAMPLE RESULTS:
g.p.m.
AT INSPECTION
Coliform O Nitrate Io O~
Date of sample: il /Ii
B.-~_~HOLDING TANK DATA
Date installed s~-[~[ ~G Tanksize
Foundation cleanout E~/N) t/~ j _ Depression (Y~)
Date of Pumping ~/:~o /9~ Pumper ) '5446 ~
Collected by:
Other bacteria
S & S ENGINEERING
Eagle River, Alaska 99577
Number of Compartments
High water alarm (Y/~'~ /~ o
ABSORPTION FII=LD DATA
Date installed ~/~b/ Soil rating ~/f_F~or ft~/bd r m)
Length / o -;~ Width
Gravel thickness below pipe
Effective absorption area / 7.fW'
Uate of adequacy test il/~¥/'~'~6 Results(Pass/Fail) /LCSJ For .I~ .bedrooms
Fluid depth in absorptien field before test (in.);.
Fluiddepth ~-/~'/(ins) Minutes later: /~ Absorption rate = 6~ ¢ ,g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~'~ '~'~ If yes, give date --
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) "Pump on..~'~~ "Pump off" level at*
High water alarm level at* J *Datum
Cycles tested
E. SEPARATION DISTANCES
L~-~_L~holding tank on lot
Absorption field on lot
Public sewer main
SEPARATION DISTANCES FROM WELL ON LOT TO:
jO0 /4-
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer/septic service line / o o 4- Lift station
SEPARATION DISTANCES FRO~HOLDING TANK ON LOT TO:
Foundation ~ Propertyline ~'-0 4- Absorption field
Water main/service line ~o ~ Surface water/drainage / ~o Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line /o Building foundation '~' ~/ Water main/service line
Surface water / o o '~ Driveway, parking/vehicle storage area
Curtain drain ,v 0 ,¢ ¢ N ~ ¢ '¢ '¢ Wells on adjacent lots ~ O / ¢
F. ENGINEER'S CERTIFICATION
certi¢ that l have determined thru field inspections and review of Municipal reco~:~e abe,
I
in conformance with ~OA ~AA guid~lines in effect on this date. ~ ~/
Engneer's Name ~t OZ~,/~t ~ ' ~ ~ ¢ ~ ~OBE~I C COWAN
HAAFee $. ~ '/-~'~
Date of Payment
Receipt Number
72-026 (Rev. 3~96)*
Waiver Fee $
Date of Payment
Receipt Number
11/1~/96 17~R1 CT&5 5SI ~CHOR~S5 ~ 90769a121i ~0.457
Environmental Ser~ice~ Inc.
CT&E Ref,#
Clia~t Name
Project
Client Sample ID
Matrix
Ordered By
PWSID
966043001
$ & S B~giimering
LA B1 Sequoia Bst.
L4 B [ Seqnoia Bsl,
Dfiuking Water
Sample Collected by: R. Cowaa
Clle~t PO#
Prlnted Date/Time 11/14/96 14:08
Collected Date/Time lj./11/96 09:30
ReceivedDate/Tlme 11/11/96 10:05
Technical Director: Stephen C. Ede
Nitrote-N
Toro[ CO{ i f.ornl
ALLo~ob[e Prep analysis
bleth~ ~ kJmits ~te Dele Inlt
1,03 0,100 mg/L $M15 4500-NO3F 10 max
0 0 eot/lOOmL $M18 92220
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANLCAL
INSPECTIONS
ONS~TE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
ROBERT C. COWAN, RE,
ROBERTA. SNAFER, RE.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
December 10, 1996
RECEIVED
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
Attn: Jim Cross
P.O. Box 196650
Anchorage, AK 99519
DEC 1 1996
Munic~ )ali~y ol Ar~crl!~rage
DE;pt Health & Human Serv ces
REFERENCE: REFERENCE: Lot 4; Block 1; Sequoia Estates
Dear Mr. Cross,
This is to resolve discrepancies with the previous septic inspection
reports dated 5/16/86 and 8/94. We have verified the bed leachfield
installed in May 1986 was installed in the location we have drawn on
the attached asbuilt.
This location has been confirmed by the owner of the adjacent lot (Lot
5) who was present at the time of construction. Additionally, the bed
could not have been installed in the location shown on the 8/94
inspection report, as the sewer rock would be surfacing in the ditch
along Gunnison Drive. The separation distances are as indicated on
our Health Authority Approval checklist dated 11/15/96. No waivers
are required.
Please approve the Health Authority Approval at this time. If you
require additional information, please contact us.
Sincerely,
Robert C. Cowan
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
P;N~CC~F: C;RCL~
]',~E INF'ORHA?ION FE~[OM 15 FOR DE ~ OF
LENDING IiX~T;TUTIOi,F3 SPECIFICALLY TO
F'B 8F-6
I FEREBY CERTIFY THAT I HAVE PERFORIdF_D A
IdOIRTGAGEE'$ INEPEcTION OF THE FOLLONIixG
12~.~C, RII3EO pROPERTY
LOT 4. ~LOCK I, SEDUOIA ESTATES StJ~
ANCHORAGE RECOROING DIS~RI~F. ALASKA Am
ENCROACH~NT~ EKiST ~T~R THAN ~]'[D.
DATED AT ~AGE. ALA~A THIS 1~'~_
HOLT LAND ~URVEYING ~
SCALE: 1' = 4~'
AS - BUILT SURVEY
NO CORNER'S SET THIS DATE
Parcel I.D. #
~ MUNICIPALITY OF ANCHORAGE ~NVIRON44EN'i'AO~-PANCHoRAr~=
Department of Health & Human Services '~"~'I~V/c~,2 OiVi~ii;N
DIVISION OF ENVIRONMENTAL343.4744 SERVICES JUL ] .Z ]9,90
CERTIFICATE OF INSPECTION FOR HEALTH A UTH.OERFIAT~ iAL,,~?v~EVLAL~ NO? ~*C~" / V'
ON-SITE SEWER AND WATER FACILITY FOR SINGL · ~ D
~/"1 ~ I~)~-~- C].u~ HAA# t:'~°1(
1, GENERAL INFORMATION (M~st be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
O
Location (address or directions)
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address I~',
Telephone: (home) -- /kJF~c
'relephone ~'':/':'
Business
(d) Real Estate Company and Agent
Address _ ;
Telephone
(e) Mail the HAA to the following address: (or check here ¢~, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family Z[/ Number of bedrooms_
3. WATER SUPPLY
Individual Well Bi''/' Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certifi ed by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is
Health Authority Approval 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 arid
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm ¢_,vkl~ ~' A ,~,~_b~'_,. )l,,~.C
Address ? ,0, .¢C3~ ,,¢..
Telephone
Engineer's Seal
6. DHHS APPROVAL
Approved for Z~ bedrooms by
Approved ~ Disapproved
Terms of Conditional Approval
Conditional
Date_
' _ iJ';~JiJl I1 lei ~ --
Tile Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 DH HS 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 7/88) 8ack Page 2 of 2
A. WELL DATA
Well Classification
Well Log Present (Y/N) .
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: (.1~
'~'" _Date Completed
Total Depth ~9~ Cased to .
Static Water Level ¢[I ~
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) _
SEPARATION DISTANCES FROM WELL.:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~
Water Sample Test Results -;~-~
Zg~_Uepth of Grouting _ ,L4¢¢¢~ /k.3,/'cZ~-
Pump Set At ~-'~--~-'-~----'~., ~,
/¢~~''~ Sanitary Seal on Casing (Y/N) "~"
W Depression Around Wellhead (Y/N) "~
If A, B, C, D.E.C. Approved (Y/N)
Yield ] ~- ~ ?~-~'t~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B, SEPTIC/HOLDING TANK DATA
Date Installed ,~L¢~'~'~ Size
Standpipes (Y/N) ~ _Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line .'¢',~Z~t
To Water Main/Service Line
/~.-'~® No. of Compartments
I Foundation Cleanout (Y/N) _
Date Last Pumped_
; for
Temporary Holding Tank Permit,(Y/N)
To Building Foundation
To Disposal Field''~
To Stream, Pond, Lake or Major Drainage Course
Comments
72-028 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /~.~ ~_~.z I¢~I)~'~ Type of System Design
Date Installed ~ [~.~ Length of Field ~O~
WidthofField /~-Zll
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
1 oo
Depth of Field '~, O
Gravel Bed Thickness O, ~ I
~_.~_z Statndpipes Present (Y/N) ~'(
Date of Last Adequacy Test ~%~/~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well j~o-~
To Property Line
To Building Foundation
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Existi0g or Abandoned System on
;On Adjoining Lots I~I / ~-
To Cutback (if present) F,~ / ~
D. LIFT STATION
D te~_stalled
Size in G~'h~-~
"Pump On" Level at
High Water Alarm Level at '
Tested for
Meets MOA Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Comments
**Check Permi)t~ B,,edroom/ating Against HAA Request**
I certify that/I/l~c/~/e ch ~ckeC¢, retried, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed
Date ( / ~[1~O Engineer's Seal
MOA No. ~ ¢ ~.; '-'~
Receipt No. ~ ~ ~ .,~ Receipt No..
Date of Payment 7 --///~ .,~ (~) Waiver Fee: $
Amount: $ / ~;~0 ~ Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
0 5
CttEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633BSTREET. ANCFIORAGE, ALASKA 99518 · TELEPHONE (907)562-2343
FEDERAL TAX I.D. #92-0040440
ANALYSIS REPORT BY SANPLE for Work Order I 25218
Date Report Printed: JUt 11 90 ~ 14:07
Client Sample ID:L4 BI SEQUOIA SI
P~SID :UA
Collected JUL 6 90 e 10:50 hrs.
Received JUL 6 90 ~ 11:45 hrs.
Preeezved with :AS REQUIRED
Client Name : CORWIN & ASSOC.
Client Acct: CORWINP
P.O.! NONE RECEIVED
Req {
Ordered By : BRUCE CORWIN
Analyeie Completed :JUL 6 90 Send Reporte to:
Laboratory Supervleor :SIEPHEN C. ROE lJcoRWIN & ASSOC.
Releaeed By : ~-~,~
Special
Chettlab Ref l: 902272 Lab Smpl ID: I gatrlx: WAIER
Allowable
Parameter Tested Result Un. its Method Llmite
NITRATE-N 0.4! rnq/1 EPA 353.2 10
Sample ROUII~ SA}4PI, E.
Rensarke: DAI~PLE COLLECTED BY B.C.
Teete Performed See Special In, truetiom Above UA-Unavailable
~one Detected "See Sample Remarke Above
Not Analyzed LI-Le~e Ylmn, OT-Ozeatez Ihan