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HomeMy WebLinkAboutTONJESS ESTATES BLK 2 LT 8Tonj ess Estates Block 2 Lot 8 #051-832-21 On -Site Wastewater Disposal System Permit Permit Number: OSP131144 Tax Code Number: 05183221000 Work Type: Septic Permit Effective Dates: July 03, 2013 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 to July 03, 2014 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: TONJESS ESTATES Site Legal Address: TONJESS ESTATES BLK 2 LT 8 G:1462 Owner/Address: JOHNSON CHRISTINA T & BRIAN S 25114 PRINCE CIRCLE CHUGIAK AK 995670000 Site Mailing Address: 25114 PRINCE CIR, Chugiak This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 36392 Total Bedrooms: 3 N Private Well N Water Storage 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 7/E171 Date: 7/3 MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-832-21 Property owner(s) Barbara Pollock Mailing address P.O. Box 672628 Site address 25114 Prince Circle Day phone Legal description (Sub'd., Block & Lot) Tonjess Estates, Block 2, Lot 8 Legal description (Township, Range & Section) Lot Size 36,392 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: (El all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage Initial Upgrade Renewal TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: ❑x 0 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 630 -- Date of Payment: Receipt Number: t(o0—l1G cl Permit No. 05f 1Ut-44 Permit App__- :: :_.,:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services «c Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@paneneak.com June 11, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 5. Bragaw Street P. 0. Box 196650 Anchorage, Alaska 99519 Subject: Tonjess Estates, Block 2, Lot 8 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request a permit to upgrade the septic system be issued for this property. The proposed systems will serve an existing three (3) bedroom house. Currently the lot is developed. The existing trench is in failure and will be re -used as a reserve. This lot is served by a private well that is over 100 feet from the existing and proposed septic system. The surrounding lots are also served by private wells that are located over 100 feet from this system. 1. Soils. One test hole was excavated by Pannone Engineering Services in May of 2013, and the ground water monitored for seven days. Groundwater was observed in the hole monitor tubes after the seven day monitoring period at a depth of 14 feet during the month of June. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used for a conventional wastewater system. A diverter valve will be installed and the existing drain field will be re -used as a reserve. 2. Soil Absorption System Design. a. See Sheet 2 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The topography slopes from southwest to northeast at approximately 18% in the area of the proposed drain field. There are no steep slopes in the area. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, •P�....•, �4 . 16/ ♦ •• • • i4 E* St o�•• ••: i Steven R. Panno• ne ' /•• Steven R. Pannone, P.E. Owner/Civil Engineer Attachments - Soils Log - Septic System Design Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 44 \ \ EXISTING SEPTIC AREA WELL (� `� ''142.Q Y ' [X| NS -' / / SEPTIC AREA / DRAIN FIELD (P) 35.0LFx15'@/x08'EDx0.0'TD' � /DRAINFIELD (E)IN FAILURE, REUSE AS RESERVE ABANDON SEPTIC TANK (E) � PER CODE —'-- , SEPTIC(P) W/DCO AND DV 8// / //|y/ / / �" _�" ' / / . �^_—��~ / I /EXSONG i '''�� ' / //�, � ,,///•'/�� / // ,� �: /, >/ ' / / `"�� / NOTES: FOR CONSTRUCTION PANNONE ENG SVC, LLC F.(\BOX 10021TANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 PLAN TONJESS ESTATES, BLOCK 2, LOT 8 BARBARA POLLOCK 25114 PRINCE CIRCLE CHUGIAK, AK 99567 4W Jr .79110 CE 8149 Date 6/27/2013 Scale l"=s0' mo.wu 051-832-21 PERMIT NO. oSp1o1144 Sheet SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 3. SCOPE OF WORK: INSTALL NEW 1000g SEPTIC TANK. INSTALL DRAIN FILED 4. GROUNDWATER WAS ENCOUNTERED AT A DEPTH OF 13 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 13 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. FOUNDATION CLEAN OUT 0 CLEAN OUT w ss 0009 SEPTIC TANK (P) .5 .5 16.0 TH-1 OR GP/ SP 30 60 40 —13.0 (5/30/2013) SECTION CLEAN OUT MONITOR TUBE FILTER FABRIC 4' 0 DRAIN PIPE DRAIN ROCK 6" ABOVE PIPE INV FILTER FABRIC 4" 0 DRAIN PIPE -DRAIN ROCK 6" ABOVE PIPE INV MONITOR TUBE PROFILE LEGEND w WATER LINE/ WELL RADIUS NEW SEPTIC DESIGN PARAMETERS UPGRADE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g PERC RATE = 1.6 MPI SOIL RATING: 1.2 GPD/SF AREA RQD: 375 SF SYS. TYPE: DEEP TRENCH 6.0' E.D. MIN LENGTH: 31.25 LF USE: 35 LF X 2.5' WIDE, 6.0' E.D., 9.0' TD TOTAL AREA: 420 SF DRAIN ROCK ABBREVIATIONS DIP TH FC T# C# M# R.I. DCO DV FS BFG OG FG TS&V DUCTILE IRON PIPE TEST HOLE FOUNDATION CLEAN OUT TANK CLEAN OUT NO. CLEAN OUT NO. MONITOR TUBE NO. RIGID INSULATION DOUBLE CLEAN OUT DIVERTER VALVE FLOW SPLITTER BELOW FINISH GRADE ORIGINAL GRADE FINISH GRADE TOPSOIL & VEGETATE NOTES FOG QDIUSfRtACbbN PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DESIGN DETAILS TONJESS ESTATES, BLOCK 2, LOT 8 BARBARA POLLOCK 25114 PRINCE CIRCLE CHUGIAK, AK 99567 —tacit:4OF A�gslll • Steven Pannone CE 8149 II $9% t �/lj�• os�G� Date 6/27/2013 Scale NTS P.I.D. NO D51-832-21 PERMIT NO. OSP131144 Sheet 2 OF 4 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 TEST HOLE 1 OR ML GP/ SP BOH ORGANICS SILT POORLY GRADED GRAVEL AND SAND v 5/30/2013 0 — 6/11/2013 DATE PERFORMED: 5/23113 SOILS LOG - PERCOLATION TEST SLOPE X TH WAS GROUND WATER ENCOUNTERED? Y IF YES, AT WHAT DEPTH? -13.0' DEPTH TO WATER AFTER MONITORING? -14.0' DATE: 6/11/2013 SLOPE TH X READING DATE CLOCK TIME NET TIME WATER LEVEL READING NET DROP 1 5/30/13 10:22 - 5.92 - 2 10:32 10 MIN 12.10 6.18 a 10:32 - 5.92 - 4 10:42 10 MIN 12.10 6.18 5 10:42 - 5.92 - 5 10:52 10 MIN 12.10 6.18 PEROLATION RATE 1.6 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS. Test hole excavated by JR's SEPTIC PUMPING. Perc hole was presoaked. Test ran for at least one hour. Last 3 readings recorded. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: .gym -Moir V4 W-OONLY Fol- eowsitac n eM PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SOILS LOG TONJESS ESTATES, BLOCK 2, LOT 8 BARBARA POLLOCK 25114 PRINCE CIRCLE CHUGIAK, AK 99567 gF44gk ft:74% Oh fi Date 6/27/2013 Scale NTS s Steven R. Pannone Awe CE 8149 P.I.D. NO 051-832-21 PERMIT NO. OSP131144 Sheet 3 OF 3 MUNICIPALITY OF ANCHORAGE Development Services Department _W 1" Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-832-21 Certificate of On -Site Systems Approval Expiration Date: / - Is—, Z 0 Z( 1. GENERAL INFORMATION Complete legal description TONJESS ESTATES BLK 2 LT 8 Location (site address) 25114 Prince Cir Current property owner(s) CINTRON ALEXIS JAVIER Day phone 521-6180 Mailing address Real estate agent Nicole Day phone 521-6180 2. TYPE OF DWELLING: Fx_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ y 1 d o 5 6 6V I D Waiver Fee $ Date of Payment 10/13 /a D Z Date of Payment 03-1816 Receipt Number Receipt Number COSA # 0 5 C��_© 15 (0 `� Waiver # 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, vase( on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that th( on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number o bedrooms and type of structure indicated herein. I further verify that based on the information obtained from th( Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/'or wastewate disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations it effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Banc 770724, Eagle :River Engineer's Printed Name Steve Eng Date 10/3120 G. DSI? SIGNATURE Systern +11 Approved for bedrooms System #r2 Approved for bedrooms Disapproved OF P � or * .-49"2L* -- Steve Eng CE -6256 iFA 10/3•%2Y Conditional approval for bedrooms, with the following stipulations: ON-SITE yc NATER AND Original Certificate Data: 10— The Municipalily of Anchorage Development Semites Division (DSD) issues Certificates of On -Site Systerns. Approval {COSH}lased only upon tht representaijons gKen in paragraph 5 by an independent professional civil engineer recgislereM in 4he tate of Alaska. The Winiaipality chi Anchorage is not responsible for errors or omissions in tho professional enginow's viork. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory_ Septic System Advisory Arsenic Advisory Legal Description: COSA Checklist TONJESS ESTATES BLK 2 LT 8 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA e❑ Well log is filed with Onsite (or attached) Date drilled 319187 Total depth 309 ft Cased to 32-bdrk ft A Sanitary seal is functioning correctly ❑E Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/21/20 Static water level at beginning of test 46 ft. Comments B. TANK DATA Age of tank(s) 7 years Tank type/material septicStl Measured operating fluid level in septic tank 50 ❑E Standpipes/foundation cleanout per record drawing Date of pumping 1/31/20 D. ABSORPTION FIELD DATA 7/11/13 Which system tested (date installed) same ❑ ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-832-21 of Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes X Nc ❑e Coliform bacteria is Negative Nitrate 9.7 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑E Arsenic less than MRL (ND) Collected by NRimEng Date of Sample 9/21/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/21120 Results ED Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 6 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date no E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 1.00' 2] Yes Community Sewer Manhole/Cleanout > 100' n-- Yes if No ft rV1 Yes if No It Neighboring Tank > 100' 21 Yes if No ft Private Sewer/Septic Line > 25' E] Yes if No ft Absorption Field an Lot > 100' [v:] Yes if No ft Holding Tank > 100' � Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 21 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > -10' - 21 Yes - - if No - - - - -- - ft - - - - - -- Surface Water- >- - -10-0' 111 -1 11 1 - 1111111, --------- -- , , " -- - Yes if No ft Property Line > 5" 2] Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No ft Private Wells > 100* Yes if No ft Water Main > 10' ft Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' R Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if NoX ft Wells on Adjacent Lots: Water Main > 10' El Yes if No ft Private Wei Is > 100' Water Service Line > 10' � Yes if No ft Community Wells > 200' Surface Water > 100' f7l Yes if No ft F. ENGINEER'S 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. [D Yes if No ft R Yes if No ft AW Vc .r 49 TH Steve Eng CE -62566 WA .*,W Nitrate Advisory Certificate of On -Site Systems Approval # OSC 201564 Subdivision: Tonjess Estates BLK 2 Lot 8 A water sample revealed a nitrate concentration of 9.7 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. �, x �� ��Mail�ng'Rdc�ress P SO Box:196650x*Anchorage, Alaska 99519 6650 * w�n►w m�ir�� org � � � � From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry __. oxygen. _For this reason, methemoglobinemia is.referred_to as "blue -baby" disease. disease. -The-EPA limits the - concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filterthat contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. '�x�,.x Mailing address P�,O�`Box 196650s'� Anchorage, Alaska 99519 6650 * wwuv muni orgy � � Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. #051-832-21 Expiration Date: LA—PM /3 1. GENERAL INFORMATION Comp)gte legal description Lot 8, Bk 2, Tonjess Estates 1` • 25114 Prince Circle, Chugiak, AK 99567 (site address) Jrrent property owner(s) Barbara Pollock Day phone 688-2565 PO Box 672628, Chugiak, AK 99567 Mailing address Real Estate Agent Raney Hardman @ RE/MAX Day phone 440-7257 2. TYPE OF DWELLING: ID Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: _ -4, ° Yi It t4A r�EL-� 1`vtt t 1? COSA to be released to the engineer, unless otherwise requested by the engineer. Date: ?II I� COSA Fee $ —t o O Date of Payment ala -1/l3 de -451(03 Receipt Number 1(4,051'5a COSA# 05031041 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, 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 Pinard Engineering Address PO Box 871347, Wasilla, AK 99687 Engineer's Printed Name Paul E. Pinard, P.E. 6. DSD SIGNATURE ✓ System #1 Approved for 3 bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for Phone (907) 357-3647 Date 2/15/1 • p00 �0 fi® -rCE-4793 lite 3tcJ�o e��oo es�� st' .t Rairst of e bedrooms, with the following stipuidttiVIO° Paul E. Pinard 4's ON -SITES WATER ANU WASTEWATER 6 PROGRAM J/)`` rsERlll,�v M44/10 8141147 Original Certificate Date: a/i?//3 Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet r Nitrate Advisory `' Y Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Lot 8, Bk 2, Tonjess Estates Parcel ID: #051-832-21 A. WELL DATA Well type PVt If A, B, or C provide PWSID # NA Well Log (Y/N) Y 3/Date completed9 87 & 4/18/84 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 309 ft. Cased to ffi to °tl"`ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 3/9/87 2/4/13 Static water level 128 ft 46.0 ft. Well production 10 g P m 4.O 9.1).m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 10.2 Rio_ Arsenic NA ug/L Date of sample: 1/31/13 Collected by: Pinard Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/84 Tank size 10002 gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Date of pumping D 9 la Pumper JKS (lyr9Pinnc' C. ABSORPTION FIELD DATA Date installed 9/84 Soil rating (g.p.d./ft2 or ft2/bdrm) 143 ft2/bdrm System type Trench Length 58 ft. Width 2.5 ft. Gravel below pipe 4 ft. Total depth 4 ft. Eff. absorption area 464 n Monitoring tube ¥ Depression over field N Date of adequacy test 2/4/13 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test45 in. Water added 480 gal. New depth 52 in. Elapsed Time: 185 min. Final fluid depth 45 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date Depression over tank (YIN) NA High water alarm (Y/N) D. LIFT STATION AJ A Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons "Pump off' level at in. Cycles tested Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main Sewer /septic service line 25'+ Animal containment areas 50'+ NA Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 1001+ On adjacent lots 100'+ in. Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main NA Water service line 101+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Absorption field 5'+ Surface water 100'+ Building foundation 10'+ Water main NA Water Service line 101+ Surface water 1001+ Curtain drain None Known Wells on adjacent lots 1001+ F. COMMENTS Driveway, parking/vehicle storage 11+ 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 Paul E. Pinard, P.E. Date 2/15/13 COSA brown sheet 10-10-12.doc ,r�e��t�tti .00, atgs';9a+t te..9TH .*r# d..sz n, ...:� .. 1,: Paul E. Pinard !zoo r1, '. CE -4793 Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC 131049 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 8 of Tonjess Estates subdivision. This inspection revealed a nitrate concentration of 10.2 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Septic System Advisory Certificate of On -Site Systems Approval # OSC131049 During a recent adequacy test on the septic system for Block 2, Lot 8 of Tonjess Estates subdivision, 45 inches of standing water was observed in the absorption field. This indicates that approximately 94% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval PROPOSED FMK, FLOOR EREV..(ASSUR30 - / PROPOSED PIA1MG CORNER ELEV. (A59Mfa) /--- I/ $1119.40(/QQ'G� V FRONT RMONM SPE SONG snaAac - �j`` REAR ROW YIRAIX \��`\G� n [, / / `v 1 / r- 4cc • Nyy 5 ., / / y6w I')Lr -- —' LOT 7 3 s op 5 vs N, INFILL s ::. s • �S�°o p�c'� N E�1S 6�0� LOTS co.3i� ABs 1�R610 3pE co 31 LOT 13 1g5 N1oa 26 2g E LOT 12 UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTASIJSHING BOUNDARY OR FENCE UNE& THE SURVEYOR TAKES RESPONSISIUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING, REPRODUCTION MAY CAUSE ERRORS IN SCALE. LJ LOT BURLEY SURVEY TYPE SYMBOLS • FOUNDATION AS-BUILT • SET REBAR ir w DRAINAGE • TINAL STRUCNRE AS-®JILT o FOUND REBAR�'=A..A...A'i CONCRETE ❑ PLOT PL... AS-BUILT ... LOT SURVEY... TOPOGRAPHY MI 'B'�" 0 wpm FENCE 00 B ASSUMED ELEV. NM ® AS-BUILT ... NO CORNERS SET • RECERIIFlCATIG N AS-FJLT ... NO CORNERS SET % X % METAL FENCE WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: . IT 15 THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN ANO LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATIONPrepared by PLOT PLAN l Many cony ,al I in pOa[ay aaNRNE paw Ian. ENO 1 pet.:\, OF ��� „•,`Q..•• 0 Robert E. Johns, Jr. & Assoc. La Professional Land Surveyors w w draw an and MWMtl dl 4 O,• Iol s rr__ Vl; 1700 Brink Drive. her NW or /ann wow re e. pa as te me bee a nr grMl•ps a emn.lmN Ira bolo �t ' ANCHORA( , ALASKA 99504 as roma marred °''• a° comet / 4 %'� . Y. i \ X Rec. Lot SF. Rec. Plot Fde Na. ` 'r; tt+ _ ••••0 Scale: 1 *I = 40, FOUNDATION AS-BUILT N. Rm.R E. JpnA Jr.. henry ae'*RP 6411 / --%. .,. TI Date Surveyed: 01/16/13 Wolin b "REJ Checked by h§ Apoodatlal ar Wort wad e w`aua":...or - orffe W L WL we eanma awn Nam, an M ed a a.ae+.nat• Nat tors . RODER '. JOHN JR N ! i / ••.4. Date Drawn: 01/16/13shown Caid: NW1462 W.O. othorrbb •'.• 41 21 — : • 13-15 FINAL STRUCTURE AS-BUILT t Rab* E Johns, X. jIt W brat I ^-Suers m:.111;4111P" +° ••y .•.e. t • 41 le •., . yJ • ^' .• Legd Description: TONJESS ESTATES Olrebeicoo a = a� +O�i�nnold*** 2 LOT 8 one too a„„ o BLOCK AARON PUMP & WELL SERVICE, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 • Fax (907) 345-02029a, Eagle River: (907) 622-9335 OMIKDKE ,/,00r No. 9693 I CUSTOMER , .:/�J/OB SITE / /ean -e��1 nod/f //J 2� o/d.,%,n t y �i // Apse cJ ' gess 64,-74c5 6c -2 ort57 J 937-'vct ?z INVOICE DATE �? �r,'' y2'/' J WELL DEPTH SWL / CHLORINATED y PUMP DEPT SALESPERSON �� �P ,7�S QUANTITY DESCRIPTION PRICE AMOUNT 4.4".1/ era, -,7e vac, 04":7 --"Al c71.1 7 J.2S1 cc 74--,/ n" " " Jo - r7 C2.5 CI 3i" g" scjeC "'. r it c .4c-, /rc.(!5 CCar/Cr nester1Gse - 4 S .0 .554 ? it. CIO ...2e jr -fr 1.7 /0l-'46.5@ " 5' LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR / / / 7 WORK ORDERED BY DATE COMR TOTAL LABOR PAY THIS AMOUNT 3 s 07 Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work Is not paid for In 90 days I agree to allow Aarow Pump & Well Service, L.L.C. the right to remove unpald for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. LOCATION: Lot 8, Block 2, Tonjess Subdivision DRILLER: Unknown DATE WELL COMPLETED: 4/18184 & 3/9/87 WELL DEPTH: 309' STATIC WATER LEVEL (top of casing): 46 0' PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST JOB NUMBER: 13-014 DATE OF TEST: 2/4/13 FIELD STAFF: PJ Pinard Time Elapsed Time (Minutes) Static Water Level Flow Rate (gpm) Cumulative Gallons Pumped Remarks 3:05 PM - 46.0' 4.0 - Start Test - Meter 547220 3:20 15 58.3' 4.0 60 547280 3:35 30 64.1' 4.0 120 547340 3:50 45 62.5' 4.0 180 547400 4:05 60 63.9' 4.0 240 547460 4:20 75 64.7' 4.0 300 547520 4:35 90 62.3' 4.0 360 547580 4:50 105 63.1' 4.0 420 547640 5:05 120 64.0' 4.0 480 547700 5:20 135 62.8' 4.0 540 547760 5:35 150 61.4' 4.0 600 547820 5:50 165 64.6' 4.0 660 547880 6:05 180 64.2' - 720 Stop Test - 547940 RECOVERY 6:25 20 48.9' All well protection features are adequate. 6:30 25 46.0' Average Flow Rate: 4.0 gpm Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF PRODUCING 4.0 GPM FOR LIMITED PERIODS. THIS TEST DOES NOT NOT CONSTITUTE A WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE Reviewed by: Paul Pinard Date: 2/11/13 LOCATION: Lot 8, Block 2, Tonjess Estates APPLICANT: Barbara Pollock PO Box 672628 Chugiak, Alaska 99567-2628 PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST SEPTIC TANK TYPE/SIZE: Stee111000 Gallons, per MOA Records ABSORPTION SYSTEM: Deep Trench, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAL/BR = 450 Gallons TEST DATA JOB NUMBER: 13-014 DATE OF TEST: 2/4/13 FIELD STAFF: PJ Pinard NUMBER OF BEDROOMS: 3 SCUM: 0.0' SLUDGE: Minimal NEEDS TO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes XX No Time Flow Rate Volume Cumulative Volume Septic Tank Septic Tank Soil Absorption System Comments pM (GPM) (GALs) (GALs) Liquid Level * A Level Monitor Tube 1* A SAS Level Monitor Tube 2* A SAS Level 3:05 4.0 - - 40' - 3.8' - Start Flow - Meter 547220 3:20 4,0 60 60 4.1' 0.1' 3.9' 0.1' 547280 3:35 4,0 60 120 4.1' 0.0' 4.2' 0.3' 547340 3:50 4.0 60 180 4.1' 0.0' 4.3' 0.1' 547400 4:05 4.0 60 240 4.1' 0.0' 4.3' 0.0' 547460 4:20 4.0 60 300 4.1' 0.0' 4.3' 0.0' 547520 4:35 4.0 60 360 4.1' 0.0' 4.3' 0.0' 547580 4:50 4.0 60 420 4.1' 0.0' 4.3' 0.0' 547640 5:05 - 60 480 4.1' 0.0' 4.3' 0.0' Stop Test - 547700 RECOVERY Date Time ST MT SAS MT 2/4 6:10 4.07-0.1' 3.8'/-0.5' *ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: This system appears to be operating satisfactorily, though the SAS is approaching the end of its useful life. There was 3.8' of measurable liquid in the SAS MT prior to beginning the test. With the addition of 480 gallons to the system (slightly more than the design daily flow), the level rose 0.5'. A recovery measurement, taken 65 minutes after stopping the test flow, showed satisfactory absorption with a return to the starting level. j��- Reviewed by: Paul Pinard I W Date: 2/11/13 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P -O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING: Parcel I.D. n,TI - 73a a 1 .1. GENERAL'INFORMATION ". Complete legal description r' Lot 8, Block HAA # WP -O I b bag Expiration Date: 2, Toajess Far:,rnc Location (site addressor directions) - 1 25114 Prince Cirri Current Property owners) '• ' rti chart • tt„rbridge Day phone CRugiak;..Alaska Mailing address ' n R^1/4 671790 688-3438 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone - Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 WIZ`a2,,n, /S-4 TYPE OF WASTEWATER DISPOSAL: [ Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Tess than 30 days old. (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 Cate shown below, 1 verify that my investigation,-„, based on procedures outlined in the Health Authority; Approval'Guidelines for this application, shows'that the on-site water supply and/or wastewater disposal system ii(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: . " 5 8 5 ENGINEERING 1 ., :. T •; 17014 E_gb t'iv" Lott R^ : 4�4 :,c: Name of Firm Phone • 6 9 y- a 9 79 Address Eagle River, Alaska 99577 Engineer's Printed Name . Robert C. Cowan • ( Oates :-C/d-? /01 • _._: •`� tt10Fgii'' �� of �L pit #40#7- ekt GINE .2 ON SITE ... .n„-',' . Jsl to, t -- .:.WATER AND m„'/ '� ' �_ TEWATER •` i cc •- WAS �. »..� 5 +,i1 RO PGRAM _.DSD SIGNATURE; �, �,� •- ,;� 1 _����, -s App?oQed for 3 bedrooms, lam' %A% k ' 1 11 c, ..+: Greg clan / a c:. :sDisapproved /)U71] Conditional approval for bedrooms, with the following stipulations:. Th ROBERT C. COWAN Q•Ii o ' CE -8801 /14"" �hrf •• `. TC 'ti t �!y°fFeressto� Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It '. Current nitrate concentration' is 7.37 mg/I. EPA maximum concentration is 10.0 mg/1. More inforai,,tiuii-uu-nitrates is available -from the un -site Services Program, at 343-7904. a 1 1 11 • IP IP 1 41 By: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory (Rev.12/C0) 7,? Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 7- ✓r- 0 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: for 9 &oti.29 74A37 -5S t Cr Parcel ID: s/. A. WELL DATA Well type%VMt— If A, B, or C provide PWSID # = Well Log (Y/N) /tS (Z' )4 Date completed ?;) IV' t Sanitary seal (Y/N) * ( Wires property protected (Y/N) )16-r T7 -r Total depth 309 ft. Cased to ft. Casing height (above ground) /in. in. FROM WELL LOG ROCK- AT INSPECTION Date of test 31 q,8q- 6'/26/0/ Static water level 1 Zg ft. 11 I ft. Well production /9 g.p.m. 6.5- g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate 7.3 7 mg./I. Other bacteria 0 colonies/100 mi. • ti Date of sample: Collected by: S at S by & Ki etiz, iJ1— B. SEPTIC/HOLDING TANK DATA �+ Tank Type/Mate. ype/Mat Trial CJI tr(G 1 / [«frl-L Date Installed / /64 Tank size 1000 gal. Number of Compartments 2i Cleanouts (Y/N) YeS Foundation cleanout (Y/N) Depression over tank (Y/N) NO High water alarm (YIN) /V/A Pumper 0Q's Date of pumping ?/PO C. ABSORPTION FIELD DMA Date installed Soil Soil rating (g.p.d./ft2 or /bdr )f43° System type i c i Length 60 Width /Z .0 ft. Gravel below pipe 4 ft. Total depth 4" ft. Eff..,abs�orrpt�ion area 4�4 ft2 Monitoring tube 7 /Cc3 Depression over field P1 �) Date of adequacy test �Glo 1 t/ 1 Results (Pass/Fail) °WKS For •A bedrooms Fluid depth in absorption field before test in. Water added52gal. New depth2 in. Final fluid depth 14 in. Absorption rate >= 'g CD g.p.d. ft. Elapsed Time: if min. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NI 0 If yes, give date "-' D. LIFT STATION Date installed Size in gallons Manhole/Access (WN) 'Pump on" level a _ in. `Pump oR• level at _ in. 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 on on lot 100'4- On adjacent lots 600 /'F" Absorption field on lot /06 CZ On adjacent lots /00 /IL Public sewer main N/A Public sewer manhole/cleanout Sof /septic service line ZC 4- Holding tank N SEPARATION DISTANCES FROM SEPTIC/HOEBIRGGTANK ON LOT TO: Building foundation 914- 5 Property line f Water main N /± Water service line /0/4- Wells 0-.'Wells on adjacent Tots /00 f -+- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ) Q el 14- Building foundation I O '1 Water main Water Service line I 0 / 7" Surface water Curtain drain N OF/6 I LNQWt j Wells on adjacent lots 10n -i— Absorption field 5 't - /00 t/00 '"f - Surface water N /a r /(/ L • - Driveway, parking/vehicle storage L'� F. COMMENTS G. ENGINEER'S CERTIFICATION 'I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name !f o 4.t,tr C. Co+'1a"J Date (o 71. 'i /O i i'sA� ,till Gil. --,•••it •.,t•�'e A`'C..4 YE''fi1�01t AV cz. sr 1 1 i0ii nclab' HAA Fee $ 3 Oa e o Waiver Fee $ Date of Payment 60 65- ? H Receipt Number Date of Payment Receipt Number (Rev. 12/00) ‘/?-1,101 JUL-02-2001 17:14 MS ENGINEERING ...-.- ..M -... •••••••••••••• MI6 Y... LRE eu:ac:aaul 907 694 1211 P.02.'02 carr r.usiU 1•-b44 CT&E Environmental Services Inc. lI Laboratory Divisionapyy 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform BacteriaAnehorape. AK 99616.1606 TSI: (907) 562.2343 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE far. .71551-5301 MUST BE COMPLETED BY WATER SUPPLIER t7 PUBLIC WATER SYSTEM I.D. R krPRIVATE WATER SYSTEM Jr Send Res hr 0 Send hooks 54 5 ••&-n(cep) NEtFwes/4G- CI Send Enrolee v...,» e..— 17034 Eagle River Loo' React No. 1:144 Caa, ems. rhMs.m'aa Fegte River. ltiae!r• er'I:l is; Vet NYnNH t.aig .aa u or ).r r.. ,:nc pCm.. D Send Rnubr CI Send Enrolee &Imo..... Car. en MJroomers. or ).r lee* SAMPLE DATE: SAMPLE TYPE: ••' Routine O Repeat Sample (for roiMne sample K Untreated Water with lab ret. no. ) O Special Purpose Month Day oil Year 0 Treated Water Time Collected SAMPLE LOCATION Collected By leg 1,2Tbni s s'r 120 Pv1 v sw..Pmr TO BE COMPLETED BY LABORATORY ysis shows this Water SAMPLE to bit Satisfactory D Unsatisfacmry O Sample over 30 hours old, results may be unreliable O Sample mo long In transit; sample should not be ovey3 atom ofd at examination to indicate tellable results. Please send new sample via al delivery mail. Date Recelvcd �61 Time Received tto-In Analysis Began IS Aadytici i Method: Membrane Filter O-MUQ • NuLrtbeLQfeolonies/100mi. 101361 F3 Anullysstt .un ❑ Fazed Date: Time: Client notified of unsatisfactory results: ❑ ❑ Phoned Spoke on Fated Dote: Time: Comments: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result Total Coliform 6 Coli Membrane Filter: Direct Coapt Coioatwloa ml Verification: LTB ace COLifRM Fecal Coliform Coafirmuke 01 -o.ra.rn. Final Membrane Fi Knul7_ O Coillffermil00 mt Reporsed BY4 �c a tS ..r ince (Ot%/�If` Time E 11V V !ry rave T.e Nissen T. Ce.., 0131313 Mambo( of ma 805 Group (Social' Umtata ao Suneillenem ENVIRONMENTAL. FACILfTIES W ALASKA Gf30aru ileums a: runty Wein ...n ••••••001 oft TOTRL P.02w JUL-02-2001 17:14 En ENGINEERING ••- •- -. I••••• Iwin. 1se enemata IAL SIiV atatt. CT&E Environmental Services Inc. CT&E Seta Client Name Project natal Client Sample 1D Matrix Ordered By rwsm Sample Rename: 1013676001 S & S Engineering LS B2 Tonlcu Est LS B2 ramjets Est Drinking Water 0 • 907 6941}211 P.01/02 9075615301 T -OT fj P.02/03 F-544 Client POA Printed Date/Time Collected DatWttme Received Date/Time Technics! Director 07/02/2001 14:31 06/26/2001 12:50 06/26/2001 16:30 Stephen C. Ede ate Parameter Paolo PQL Units Method Waters Department Nitrate -N 7.37 Microbiology Laboratory Total Coliform 0 0.500 tng/L EPA 300.0 Allowable Prep Analysis Limits Date Date Init (<10) • 06/26/01 SCL 0 col/100;nL SM/139221B (<1) 03/26/01 KAP