HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 4 LT 4Great Land
Estates #3
Block 4
Lot 4
#051-133-18
Municipality of Anchorage
Development Services Department e
Building Safety Divislon
On -Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.d.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO80148 PID Number. 051-133-18
Spinell Homes, Inc.
Wastewater System: R] New ❑ Upgrade
1900 W. Northern Lts. Blvd., Ste. 200 Anchorage, AK 99517
ABSORPTION FIELD
344-5678 N,~ of B*~,s 4
0 Dasp T m Shalt Tmnrm O Bea O Mara 13 Omar
LEGAL DESCRIPTION
SetlRaa 1.0
T" Cali xittiw?nrVada 5
Gp "
n.
131= La 4 Sudameam
Doom to pp 0ooan nom onpvW Veae
Gm deem w m P"
Greatland Estates #3
1
4
Ft.
a
Taw,antp. Range Semen:
Fe saoa0 soora agar gape
Gro LMgm
2-2.5 Ft.
60 Ft.
Well: Q New ❑ Upgrade
1 ura
w, amen
5 FL
Ft
CMeamaean (Pinata. A e. C)
Tar DaFth.
Caaaa r'.
Tar attsw"w "a
Ppe Mrerimi
Private
400 Ft,
42 Ft
600 Fe
ASTM D3034 PVC
Omar
Date Dnad.
Six water Lew
Imtrer.
Dau 1,taWW.
Sullivan Water Wells
8/20/08
1 98 FL
Pisano's Dirtworks
8/18-222008
TrM.
Pure scar390
Camp nape Looe Groua.
TANK
30 GpM
Ft.
2 Ft-
L
SEPARATION DISTANCES
SEPARATION
❑ Septic ❑ Holding RI S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
lubicrPirtrate
• ac.
q
From
Tank
Field
Station
Tank
Sewer une
Anchorage Tank
1,500 Gr.
Malerw,
Nuroar a coap�.
well
>100'
>100'
>100'
N/A
>25'
Sleet/STEP
Three (3)
swt wrar
>too,
>100'
>100'
N/A
LIFT STATION
Lalme
>5'
>10'
>5'
N/A
250 Gr
Anchorage Tank/Orenco
'Pune dn' Mtw M.
'Pump ar Mw at
Npn water rum at
Feu w
>5'
>10'
>5'
N/A
42 it,
42 N
44 n
Puny Mw a Mode
Eiect Inepacoae pedalled M
caua 0n
None
Noted
OSI P2005-11
Allied Alaska Electrical
BENCH MARK
Loramn ra Daaapean.
Finished Floor.
wvawn.
100.0 FL
�
h
T. Kimbrou M 8/18/08
Inspections performed by: 9 Dates: 1
D
��� 6444
♦,`( �F A
V
e**asal•,9��+�
,,
Development Services Department Approval
49xti
1k ;
N aeN Na
Conditional Approval Date:
1 1.1.. aaa 1..•
FF°,'•MIOfAM E ANDERSON : � v
♦"�•. CE -4981 .�r'��
D f.Av-�
gF.,B -is: 6.0
and approved by: Date:8 -I_q- �A
�Reviewed
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11 OT28'3et 17247'
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Permit Number: SW080148
TBM =
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
PID No. 051-133-18
Finished Grade
_ _ Original Ground
E
II Drainfeld Rock 93.1—I II
60' (Trench Length)
83.5
Groundwater C 9'
PROFILE AS -BUILT
No Scale
89.05
now
/0004
/,�r�ed
August 6, 2009
Anderson Engineering
Attn: Mike Anderson
P.O. Boz 240773
Anchorage, AK 99524
ELECTRICAL
CONTRA CTING
'IG.'.:
FAX: (907) 677-7766
Subject: Lift Station Inspections at property stated below.
This letter is to confirm that the lift station(s) at:
• Lot 4, Block 4 — Greatland
was wired by a licensed Journeyman Electrician in accordance with the National
Electric Code requirements.
If you would like any further information, please feel free to call our office at the
numbers listed below.
Sincerely,
ALLIED ALASKA ELECTRIC, L.L.C.
L. Brown,
inR Member/Owner
cc: file
P.O. BOX 8763/0, iPoafllo, A14Ska 99687 (9O7) 3733893 afc f (907) 373-3894faz
Certitieb Ortiling Log
by
COC co. db,
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 688-2759
OWNER OF LAND: S–&/—L) Ci
LEGAL DESCRIPTION: (,l1t�TGri•Jtl �j%
iK 4 Zz T4
DATE. __E4 Cla
PERMIT NU1MB9R: J/4 Date of IssueZ-2j-
TAX IDENTIFICATION NUMBER: 45
Is well located at approved permit location?
Method of Drilling:
Depth of welt: 4E�
Casing Type 2 nr'c. Wall Thicknessyl S D ir.&
rr
Diameter_ inches, depth. 4 V1 f,
Liner Type: _- i )0 ctiC
Casing Stickup Above Ground: evZ is
Static Water Level: / 7� ft
Recover Rate: q D III*
Method of Testing:
Well Intake Opening Type:
U Perforations Start—fee t Stopped
Grout Type -/,?E .: —,s C—ri, e
Depth: from D feet, to Ll Z fe
Well Disinfected Upon Compfetion?
Methodof Disinfection: - 0dt0A1r.v.LL ZAO, ✓j
�'7Cd.Q2r•�G C�r�ti�
�3�•91�c.c 6-447'
13.=.). 4,1r,< 46,e -(
c'tq"'V 4(c .pN�
Driller's Name I� O LZ 'S
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
Of Anchorage- Department of Health & Human Services and/or Department o! Environmental Conservation. MatSu Borough: III
of Environmental Conservation. ■
■ ■
M
�__
Q- :_
Development Services Department
Building Safety Division
On -Site Water &Wastewater Program
B
4700 ragaw, Street
;
P.O. Box 196650
Mark Begich Anchorage, AK 99519.6650 `
Mayor w•.w muni oro /onpl,
190Tj 343-7904
Pump Installation Log
Well Drilling, Permit Number: SW_ Date of Issue:
Parcel Identification Number: C61" �r�$
Legal Description R 1 SK lot q s �, Property Owner Name & Address:
}7 r� Y Gy ct D/`:) jS,q t,,O
Pump
tilz1L�,
Pump Intake Depth Below Top of Well Casing:3I() feet
Pump Manufacturer's Name: - (•-[,1.It��'
Pump Model: 160 -�3 `C C tut [ V,g
Pump Size 1 hp
Pitless Adapter Burial Depth: I I feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer: P 1 S c•_ V.0
Well Disinfected Upon Completion? N111yes ❑ No
Method of Disinfection:
Comments:
Pump Installer Name: tLve h S JG(Zi—Sp tl�_
A,
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE ,
Development Services Department �J 0
On -Site Water d Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM ) WATER SUPPLY PERMIT
Initial
Permit Number: SWO80148
Date Issued: Jul 29, 2008
Expiration Date: Jul 29, 2009
Parcel ID: 051-133-18
Legal Description: GREAT LAND ESTATES #3 BLOCK 4 LOT 4
Design Engineer: 0014 ANDERSON ENGINEERING Site Address: 19758 UPPER GREATLAND DRIVE
Owner Name: SPINELL HOMES, INC. Lot Size: 72310 SO. FT.
Owner Address: 1900 W. NORTHERN LIGHTS BLVD #2C Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99517 -
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑✓ Private Well ❑ Water Storage
2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By.
Issued By.
� . - ill • .
Date:-�� G�
Municipality of Anchorage
Development Services Department
Building Safety Division
_ On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-133-18
Property owner(s) Spinell Homes, Inc. Day phone 344-5678
Mailing address 1900 W. Northern Lights Blvdl. Ste. 200 Anch., AK Zip Code 99517
Site address 19758 Upper Greatland Drive Chugiak, AK Zip Code 99567
Legal description (Sub'd., Block & Lot) Lot 4, Block 4, Great Land Estates Subdivision No. 3
Legal description (Township, Range & Section)
Lot Size 72.310 Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
El
Septic Tank
(]
Holding Tank
❑
Privy
❑
Private Well
[]
Water Storage
n
Number of Bedrooms Four (4)
THIS APPLICATION IS AN:
Initial
Q
Upgrade
❑
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Waiver Fees:
Date of Payment: 1-1 a�i`ICK Date of Payment:
Receipt Number. 5 - S I D Receipt Number.
(Rev. 11105)
ANDERSON ENGINEERING
P.O- BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
MEMORANDUM
DATE: July 28, 2008
TO: Jay Crewdson, P.E.
FROM: Mike Anderson, P.E.
SUBJECT: Lot 4, Block 4, Greatland Estates Subdivision No. 3
Well and Septic System Permit
We have modified the septic system design to include a 1,500 gallon STEP Tank to
compensate for the lack of groundwater monitoring on the subject project. The
absorption trench has been raised to a total depth of 5' below the surface. We will
continue to monitor the groundwater into the rainy season and may modify the plan at a
later date if conditions allow.
ANDERSON ENGINEERING
P.O.. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
n?
July 22, 2008
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 4, Block 4, Great Land Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 4, Block 4, Great Land Estates Subdivision No. 3 intends to construct
a new four-bedroom home on the lot. We are therefore requesting a permit be issued
for the construction of a new well and septic system to accommodate the home. The
attached Site Plan and backup documentation identify the location and configuration of
the proposed septic system along with the alternate site. No existing wells or septic
systems are closer than 100' from the proposed well or septic system. Drainage arrows
are shown on the site plan showing the grade and direction of flow on the lot. The
drainage pattern will not be changed as a result of this project.
The test hole placed on the lot in the area of the absorption trench and alternate site
indicated well graded sand and silt (SW) with some gravel. The percolation rate of the
soil was determined to be less than 1 minute per inch. No groundwater was found
during the placement of the test holes and none was noted during the monitoring
period. The test hole was only 11' deep, but holes on adjacent lots do not indicate the
presence of bedrock in the area. A second test hole will be placed during construction
to verify no bedrock is located on the lot. An application rate of 1.0 gallons per day per
square foot was used in the design of the absorption system. We are proposing to
place a new 1,500 -gallon STEP tank and a 60' long by 5' wide by 4' effective depth
absorption trench to treat and dispose of the effluent generated in the house. The
elevation of the distribution line in the absorption trench will be 1' below the surface and
the total depth will be 5'. A minimum of 3' of fill or 2" of insulation and 2' of fill will be
placed over the absorption trench and 4' over the septic tank.
The ground surface on the lot in the area of the absorption trench slopes to the south at
a grade approximating 5%. The new trench will be constructed parallel with the slope
Lot 4, Block 4, Great Land Estates Subdivision No. 4
July 22, 2008
Page Two
as much as possible in conformance with Municipal requirements. The new septic
system will be constructed a minimum of 100' from all wells and any surface water and
10' from the proposed and existing water services in the area.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. 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 reserve
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. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
G
LOT 4, BLOCK 4, GREATLAND
ESTATES SUBDIVISION NO. 3
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home
Perc. Rate: LT 1 Min./Inch
Application Rate: 1.0 GPD/SF
5' Wide Trench System
1,500 Gallon STEP Tank
4' Drainfield Rock
4 Bedrooms X 150 GPD/1.0 GPD/SF (Application Rate) = 600 SF Absorption Area
600 SF/5 SF/LF(-.5 (Red. Factor) = 60 LF Trench Length
THEREFORE: Construct a 60' Long x 5' Wide x 4' Effective Depth Absorption Trench at the
Location Shown. Flow Line Elevation in Trench to be 1' Below Original Ground Surface. Total Depth
to be 5' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench or 2" Insulation and 2' of Cover. Maintain 100' Separation from Wells in the Area.
A
A
4'0"
Natural
Backfill
9
5'
Insulation
Geotextile Fabric
1" Perforated
PVC (Holes Down)
3/16" Diameter
30 Holes @ 2' Spacing
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE) 4
04
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock. •.....
Minimum 4' Separation From Groundwater.
�....;
Minimum 100' Separation From Wells in the Area. �
Minimum 100' Separation From Surface Water or Streams.
49th
No. cea ,
EAGLE RIVER ENGINEERING
10421 VFW RD. SUITE 201
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
00
SOILS —
LOG PERCOLATION TEST 0 s * CE -10387 "°°
#;; • c =
PERFORMED FOR: DOLLY DUSHKIN DATE PERFORMED 8/22/2006 414l*�Es�= ���
LEGAL DESCRIPTION: GREATLAND ESTATES LOT93 LOT 4 BLOCK 4 TOWNSHIP RANGE SECTION T15N.R1W.SEC.10
ornTH TEST HOLE # 1 SLOPE SITE PLAN(NOT TO SCALE)
(FEET)
1
Sw
•••• SUGHTLY SILTY SAND
"."o W/SOME SMALL GRAVEL.
11
12
13
is
15
19
21
:•]ljj
::%
BOULDERS
WAS GROUND WATER
ENCOUNTERED? NO
INTERLOCKING BOULDERS
WATER TABLE DATA
DATE WATER LEVEL
00./22/200(31 NONE
PERC TEST RESULTS
READING
DATE IGROSSTIME NET TIME DROP
1
ff!!!ff!EEr
2
3
PECOLATION RATE WAS FASTER THAN 1 MINUTE PER INCH
4
5
6
7
8
PERCOLATION RATE= rAJ ILK INAN 1
MIN/INCH pERC HOLE DIAMETER"
TEST RUN BETWEEN 4 FT AND 5 FT
COMMENTSNER APPLICATION RATE OF 1.0 GPC/SCR
SOILS LO ED Y: HRI T HER WOOD_ PERCOLATION TEST BY: CHRISTOPHER WOOD
CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: hQ vo6
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and 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
051-133-18
1. GENERAL INFORMATION
Complete legal description
COSA# 06,2 k1
Expiration Date: I / - I Cl - O
Lot 4, Block 4, Greatland Estates Subdivision No. 3
Location (site address) 19758 Upper Greadand Drive Chugiak, AK 99567
Current Property owner(s) Spinell Homes, Inc.
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone 344-5678
1900 W. Northem Lights Boulevard, Suite 200 Anchorage, AK 99517
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four (4)
3. TYPE OF WATER SUPPLY:
Individual Well❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site Q
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 Onsite 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 Onsite 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 sample results. (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. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
Date 8/612009
OF A4 Itt
t;'• 491e��3';9*�'
f„ :MprnEC E ANDERSON :%,w
6. DSD SIGNATURE CE-4381Approv
Disapproved. for bedrooms. ��i11 � oN `
Conditional approval for bedrooms, with the following stipulations:
GSiFRi rT i -nt 0,
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:
(Rev. I IM)
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: Lot 4, Block 4, Greatland Subdivision No. 3 Parcel ID: 051-133-18
A. WELL DATA
Well type. Private
Date completed =0/08
Total depth 400 ft,
If A, B. or C provide PWSID # _
Sanitary seal (YIN) Y
Cased to 42 ft.
FROM WELL LOG
Date of test 8120108
Static water level .. 98 ft.
Well production 30 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 3.87 mg/L
Arsenic: NY mg/l Date of sample: 7113/09
B. SEPTICIHOLDING TANK DATA
Tank Type/Material STEP/steel
Tank size 1,500 gal Number of Compartments Three
Foundation cleanout (Y/N) Y. Depression over tank (YM) N
Date of pumping New Construction Pumper
Well Log (YIN) Y
Wires properly protected (YM) Y
Casing height (above ground) >24 in.
AT INSPECTION
i7
Other bacteria 0 colonies/100 mL
Collected by: T. Kimbrough
Date installed 8/18/08
Cleanouts (YIN)
High water alarm (YIN)
Y
rA
C. ABSORPTION FIELD DATA
Date installed 8119108 Soil rating (g.p.d.tft2 or ft'/bdrm) LO GPDrSF System type 5' %Mde Trench
Length 60 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 7$ ft. Eff. absorption area 800 ftz Monitoring tube Y Depression over field N
Date of adequacy test New Const. Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. LIFT STATION
Date installed 8/19/2008 Size in gallons 250
Manhole/Access (Y/N) Y
'Pump on' level at 42 in. 'Pump off" level at 42
in. High water alarm level at 44 in.
Datum Bottom of Tank Cycles tested New Const.
Meets alarm & circuit requirements? Y
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,
On adjacent lots >100'
Public sewer main N/A
Public sewer manhole/cleanout N/A
Sewer/septic service line >25'
Holding tank N/A
Animal containment areas None
Manure/animal excrete storage areas Nona
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 >10'
Water Service line >10' Surface water >100'
Driveway, parkingtvehicle storage >25'
Curtain drain None Noted 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 Michael E. Anderson, P.E.
Date 8/9/2009
COSA Fee $ G
Date of Payment q - I 0 - D
Receipt NumberC) gz!�-o .6-0
(Rev. 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number,
SGS ReEM
1093392001
Client Name
Anderson Engineering
Project Name/M
4/4 Greatland
Client Sample ID
Hose Bibb
Matrix
Drinking Water
PrintedDate/fime
07/21/2009 8:47
CollectedDate/Iime
07/132009 8:30
Received Date/ hric
07/132009 9:35
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results
PQL
Units
Method Container ID
Limits
Date Date
Init
Metals by SCP/M9
Arsenic
ND
5.00
ug/L
EP200.8
C
(<10)
07/16/09 07/17/09
NRB
Waters Department
Total Nitrate/Nitrite-N
3.87
0.100
mg/L
SM204500NO3-F
B
(<10)
07/13/09
LCE
Microbiology Laboratory
Colony Count
0
coVIOOmL
SM20922211
A
(<200)
07/13/09
DLC
TotalColifixm
0
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