HomeMy WebLinkAboutTURPIN #1 BLK 4 LT 3Turpin
Block 4
Lot 3
#006-095-15
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.cLanchora ge.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH .AUTHORITY APPROVAL
FOR .b. SINGLE FAHILY DWELLING
Parcel I.D. 006-095-15
t. GENERAL INFORMATION
Expiration Date:
· 0 I 00 tO
G -I~/'Ol
Completelegaldescdption TURPIN t~l, LOT 3, BLOCK 4
Location (site address or directions) 620 LILAS PLACE
Current Property owner(s) LLOYD REESE
Dayphone 337-0355
· Mailing address
P.O. BOX 141454 ANCHORAGE~ ALASKA 99514
Lending agency
Day phone
Mailing address
Real Estate Agent
Mailing address
RENEE B1ANCO Day phone 261-7650
DYNAMIC PROPERTIES 3111 'C' $iREEI' ANCHORAOE, ALASKA 99503
Unless otherwise requested, HAA will be held by DSD for plckup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site B
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 AJaska. 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 propedies served by a pdvate or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a pedod of
up to one year with valid water samples.) Certificates are vaIid 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.
STATEMENT OF INSPECTION BY ENGINEER *:.
As cerfified by my seal affixed hereto and as of the velidation date shown below, I verffy that my
Investigation, based on p~ures outlined In the Health Authori~y /~oproval Guidelines for this application,
shows that the on-site water supp~' and/or wastewater disposal system Is(are) safe, functional and ad~luate
for the numbar of badrooms and lype of stracfure lndicated herein. I further verffy that based on the
information obtained from the Munidpaliiy of Anchorage files and from rny Investiga~on and inspection, the
on-site water supp~ and/or wastawater disposal system is(are) in c~mpliance with all applicable Municipal
end State codes, ordinances, and regulations In effect at the b'me of installation. ..
Name of Firm ALASKA. WATER &: WASTEWATER CONSULTANTS, INC. Phone 33776179
Address 6901 D~BARR ROAD, SUITE 2B * ANCHORAGE, AK 99504:
'-'"*..' '. -i E~gine~'s'i=Hnt~J'~l m~) JEFFREY ;'~' (;ARNEss
i::: a ':";* , *P.E,'...i ."' .... '. Date
, ':' ..: .. ,. :.:..,Englnee(s Co~mehts: .. ,.
consdenffous eegtneedeg ana~fs of the system In a.ccordence with ADEC and MOA
DSD Guidelines & Regula§ons. The reperted msul~s descn?m~d the performance of the
system under tho conditions encountered at the time of the test, and separation ~
distances mcasumd to madib/ Identifiable features. The operational life of ail wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate du#ng the year, and the water usage of the family being setl~d by the system.
' Thesecondittonsareoutsldethecontrelofthee~/aluaterofthesystem. Satisfacterytest .
results do not guarantee future performance of tho system, nor do they guarantee that
there are no hidden defects or enc~'~achmente. AWWC, Inc. can therefore not provfde
any watrenb/ or f[rture estimate of how long the system will continue to mos! the
operational requirements of the ADEC or MOA DSD. The content of this report Is f~r
the sole benefit of the owner listed above. Any reliance upon or use of this repert by any
other peraon or party Is not authorized, nor will It confer any legal right whatsoeyer.
'5.
DSD SIGNATURE
· ~ Approved for ~ bedrooms.
Disapproved.
conditional approval.
Attachments:
HAA Checldist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
Odglnal Certi~cate Date: '~ - ~//../Z _ 0 / '.
Municipality of Anchorage
Development Services Department
Building Safety Olvtalon
On-Site Water & Waatewater Program
4700 ~outh Oragaw St,
P.O. B(~ 196650 Anchorage, AK gg519-6650
www.ci.ancttorage.ak.ua
Legal Oesc~ptlon:
A. WELL DATA
Well type ~'mVA~
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel ID:
TURPIN ~I, LOT 3, BLOCK 4
Il' A~ B, or ¢ provide FqN~ID~ N/A
Data completed PRE 1974* Sanltmyseal(Y/N) Y,E~,
Totaldepth >51 ~ Cssl!Klto 40'+ [
FROM WELL LOG
Date of test
N/A
N/A ff.
N/A g.p.m.
wetl Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
46' lt.
6.8 g.p.m.
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Data of sample: 3-5-01
Nitrate 0.5 mgJL. Other bacteria
Collected by: AWWC, INC.
006-095-15
NO
YES
12 in.
0 colonies/100 mi.
C. ABSORPTION FIELD DATA
Data installed. Soil rating (g.p.d./ft~r ~/bdrm) System type ~
Length fl. Width ft, G~ ft.
Total depth ft. Eft. absorption ama ft~~ Depression over field.
Date of adequacy test ~ass/Fall) __ For bedrooms
Fluid depth in absorpaon field be~3m-l:l~t In. Water added gal. New depth in.
Elapsed-~+~.~~''~'~. Final fluid depth in. Absorption rate >= g.p.d.
...N~y~e~uvenation treatment {past 12 mo.) (Y/N & type) if yes, give data
B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER
Tank Tybe/Matarlal Date instalJjld.~/
Tank size gal. Number of Com~arl~?~J3~,~---'"'-'"'~-eanouts {Y/N)
Foundation clean--ion over tank (Y/N) High water alarm (Y/N).
D.~t~*l~3/fl~ Pumper
D. UFT STATION
Date installed. . Size in gsflons M~ _
'Pump on' level at in.'Pump off' n. High water alarm level at in.
Datu___~m Cycles tested Meets alarm & drcuti requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Sep~c tank/lift station on lotN/A
Absorption field on lot N/A
Public sewer main '30'+
Sewer/septic service line * 10'+
*SEE NOTES BY TED MOORE,I
P.E. ON 1990 HAA.
I
On adjacent Iota N//A
On adjacent lots N//A
Public sewer manhole/cteanout
Holding tank N/A
'65'+
SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK ON LOT TO:
Building foundaUon Property line ~
Water main ~ Surface water.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation.~
~~ Driveway, pa~ng/vehlcte storage
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
mvtew of Municipal records that the above systems am in
conformance with MOA HA4 guidelines in effect on this date.
Engineer's Printed Narpe
Date
JEFFREY A. GARNESS
HAA Fee $ ,-~(~)-
Data of Payment
Rece pt Number.
(Rev, 12a30)
Waiver Fee $
Date of Payment
Receipt Number.
03-09-01 16:18 FI~M-CTE ENVII~NTAL
~ CTI£ Envlr~lmental 5e~k:e~ In~.
$615301
T-418 P.gZ/O~ F-OGT
Client ~amph ID
MltrL~
Ordeal
1011145001
AK Wa~cr &: Wu~wam- Comuhnts Inc.
~t3 B~4
Chat
Cdbff~d
Te~hsleeJ Director
03/09/2001 14:52
03/05/2001 14~$
03/06/2001 12:15
0500 U
0500 m~L EPA 300.0 10max 03/o~01
Tolg Coliform 0
coYl00mL SMI8~'x22B
03/06/01 SKW
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner ~-/o,v~-- ~.¢~'.4¢_ Telephone: (home)
Mailing Address
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
~_7 ~. -Gt3y
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 [] Number of bedrooms
3. WATER SUPPLY
Individual Well ~ Community [] Public
~IJNICIPM~.iTY OF ANCHoRAc.~
DEPT. OF HEALTH --
£NViRoNMENTA[ PROTECTION
RECEIVED
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 legailty and status.
72-025 IRev. 7/es) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown bel ow, I verify that my investigati on 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 and
State codes, ordinances, and regulations in effect on the date of this inspect[on.
Name of Firm ~'1 ~¢-/~,¢¢ 7-~6/~'~! _~'¢-,/'~c -~ Telephone
Address I
Date
:;Engineer s Seal
6. DHHS APPROVAL
Approved for "~
Approved [-"'"'~D i s a p p rov e d
Terms of Conditional Approval
bedrooms e
Conditional
The 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 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 (MOA)
Health Authorily Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: /-"~
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth~ qb" Cased to ~' /'lC' Depth of Grouting
Sta:tic Water Level 'Y ~/'
Casing Height Above Ground I 'f'
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot H..4. ( C,/-.y ~'~.cc,¢¢-)
To Nearest Edge of Absorptio~ Field on Lot ~/--'~.
~¢'~.,.,'c~/'~ If A, B, C, D.E.C. Approved (Y/N) Date Completed _/of'e 19 7' ~ Yield ~' ..¢.. ?.5'~.-,.
Pump Set At ~'
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Line¢: ~O ' To Nearest Public Sewer To Nearest Sewer"Service Line On Lot ~ to'
Water Sample Collected by . Date
Water Sample Test Results ~~¢~- ~¢4 ~z~¢c~6{~
8EPTIO/HOLOIN~ TANK DATA
D~te ln~talled size No. o~ Oompartm~nt~
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
MUNICIPALITY OF ANCHOP, AGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROT[CTION
To Buiiding Foundation
To Disposal Field
i~L~,.,L i V LI./
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
To Water Main/Service Line
To Stream. Pond. Lake or Major Drainage Course
Comments {,,,/¢~7-x~'¢~ Co,,~,~ ~c /'~o.n jo
72-026 (ROY. 7/88) Fronl Page I of 2
C. ABSORPTION FIELD DATA N,/~,
Soils Rating in Absorption Strata
Date Installed
WiSth oflField
Square Feet of Absortion Area
D~pression over Field (Y/N)
Res,u,l!s of L, ast Adequacy Test
SEPARATION DIS'~'ANcE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot . . ...
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Coume
To Driveway, Parking Area, Rr Vel~icle Storage Area
Comments.. (./¢¢i~,~'¢,~' ~op,~c ~o.* /~
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To E>~isting or Abandoned System on
-. ; On Adjoining Lots '
To Cutback (if present)
Dm LIFT STATION N. ,~,
Date I'nstalled
Size in Gallons
"Pump On" Level at
High Water Alarm Level at'
'Tested :[Or
Meets MOA Ei~iricar Code's (Y/N) '
Comments
Dimensions
._ Manhole/Access (Y/N)
"Pu'mp off" Level'at'
Vent (Y/N) '
7 ......................... 'Pumping Cycles during Adequacy Test.
**Check Permitted B6droom Rating Against HAA Request**
I certify that I haveichecked, verified, or conformed to all MOA and
inspection,
Signed..~~
Date 0ec
MOA No.
,ffect on the date of this
Engineer's Seal
Receipt No,
Date of Payment
Amount: $ __
/2-026 (Rev, 7/88) Beck
Receipt No.
Waiver Fee: $
Date of Payment.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel i.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lo/
Location (address or directions)
(b) Property owner
Mailing Address
Telephone: (home)
_ Business
(c) Lending Institution ~'/"/'~'~
Mailing Address
(d) Real Estate Company and Agent /~,~-
Telephone
Address
Telephone
(e) Mail the HAA to the following address: (or check here F"Xl, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family [] Number of bedrooms 3'
3. WATER SUPPLY
Individual Well ~ Community [] Public []
.Note: If community well system, must have written confirmation from the State Department Of Environmental
Conservation attesting to th legality and StatuE. ' ' ' :
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 legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th~s
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 flies 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.
NameofFirm i~(¢zC'-'tt~t~ 7-~c/1~[¢c4f ~'¢ru't'c~,~ Telephone
Address Iflf$'30 E¢~o (~/./ tZlr~ c/4of'~¢~., .,4P'c
Date D~c / ~
6. DHHS APPROVAL
Approved for .'~
Approved ~
bedrooms by ~-~~' ~Date /~ -~-/~
Disapproved Conditional
Terms of Conditional Approval
The 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 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.
72~25 (Rev. 7/88)Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: ~..~J.
A. WELL DATA
Well Classification
Well Log Present (Y/N) N Date Completed
Total Depth~ 'he ' Cased to · "/'¢ ° Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N)
I? 7~ Yield · ~ "/'5",,~/~,,
Static Water Level U q'
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
Pump Set At ~'
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
N
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
~' ¢, ~,, ~'~'c~¢,") ; On Adjoining Lots N, ~.
Ikl,/~, ; On Adjoining Lots I~t, A..
To Nearest Public Sewer Cleanout/Manhole 3'5"
Water Sample Collected by ~'?'~{'/'~/~ ~'¢cb _('o,¢ ;Date
WaterSampleTestResults ~~ - ~o~ ~c~ l~
B. SEPTIC/HOLDING TANK DA~,~,
Date Installed Size No. of Compartments
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)
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
To Buiiding Foundation
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments (./'¢¢~ ~,,~ r~ E'o~/~'c/"~ /~ AcC/~-,c~..(
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutback (if present)
D. LIFT STATION N, ,~-,
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical'Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level'at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and H~,A.~b~li~i'~l~e~ffect
inspection,
Signed __~~
Company I=(~/
Date Dec
Receipt No.
Date of Payment /~ -~) - ~ 0 Waiver Fee:$
Amount: $ / ~¢ [)C~ Date of Payment
72-028 (Rev. 7/88) Back Page 2 of 2
the date of this
Engineer's Seal
FLATTOP TECHNICAL SERVICES
14530 Echo St., Anchorage, AK
Ph, (907) 345-1355
Legal 'Description:.
Street'Address: 620
ADEQUACY TEST DATA SHEET
99516
Client Name:. /-LoYD
Test Date:.
Initial Conditions:
Float #1 in set
Float #2 in' set--
Float #3 .in set--
Float #4 in set
Water added' through:
TeSted By:
" b,t,o, " pipe w, " fluid
" b,t,o, "pipe w, " fluid
" b.t.o,. " pipe w, ".fluid
" b,t.o, " pipe w, " fluid
'"'~CTION TiME H20 METE[ NET, GAL WEL'L FLUID LEVEL
TAKEN ' LEVEL
CT~T II',~o _ ~75& ----Q ............... 91
11:2o ,. ~g 816 60 ~
~-. ~o tiff 27? ~23 ~8
3 :/o ffq~oy. 7Yf
esured ..... y~ ~ s,v~ ~e~
~/~ Adequate for ..~ Bdrms
Unit Absorption Capacity =
Average Absorption Rate
Surge Capacity
Adequate for
Bdrms
%, CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907)562-2343
FEDERAL TAX I.D. #92-0040440
ANALYSIS REPORT BY SAI~LZ for ?fork Order ~ 30464
Date Report Printed; DEC 3 90 @ 10:30
Client Sample ID:L3 E4 TURPIII ~1; GARAGE uTILITY
?~VSID :UA
Collected NOV 29 90 ~ 11:30 lye.
R~eeived NOV 29 90 ~ 1~:20 hrs,
Preser¥~d with :AS REQUIRED
Client {lame ' ~LATTOP TECHNICAL SRV
Client Acer : FLAIYO?
P.O.U !IORE RECEIVED
Req ~
O~dored By TED ~OORE
Analysis Co]npletod :NOV 30 90 Send Reports co
IJFLATTOP TECHNICAL SRV
Labor~tozy ~upez¥1~o% :~TEPREN C. EDE
Chsmlab Ref ~: 905031 Lab S;npl ID: I ~atrl×: WATER
Allowable
?arametex Tooted gemlIt Unit8 }~ethod Limit~
NiTRATE-I~ ND[O,IO~ )~g/1 EPA ~53.2 lO
Sample ROUTIRE SAIdPLE,
Remarks: SAI~LE COLLECTED BY CHRIS.
1 ~ests Poz£ozmed See Special Instructions Abovo UA-Unavailable
RD~ [tone Detected *' See Sample Remarks Above
NA= Not Ana3.¥zed LT=Le~s Than, G~:G~e~te~ Than
hi
50
ST*O+OO~O.T"I 7'
STA 7+69.61
MH TP-$
SEE
3O
x' +~
'bi