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BIRCH HILLS TERRACE BLK 1 LT 5
Birch Hills Terrace Block 1 Lot 5 #050-141-07 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 2 of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211238 PID Number: 050-141-07 Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ®❑ Upgrade Name Kieth Muschinske ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound ❑ Other Site Address 18306 Tedrow Circle Phone Number of Bedrooms Soil Rating Total depth from original grade P4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Birch Hills Terrace 1 Lot 5 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES Toi Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field I Tank Line Ft2 Ft. Well i 100'+ 100'+ NAI NA 25'+ TANK p Septic ElS.T.E.P. El Holding El Other Manufacturer GREER Capacity 1250 Gal. Surface Water 1001+ 100'+ NA NA I Material Number of compartments i Lot Line 10'+ 10'+ i NA NA NA HDPE 2 Foundation 101+ 10'+ I NA NA LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer Whitters Enterprises PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Drainfield co/MT3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100.0 ft Inspection iectiom 7/13/21 Zed 7/15/21 3`d 08/10/21 4111 Location and description South East Corner Of House ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date . w,�P�� •:9 t [� TH 4�, ;t vee F' r'annar?e' Septic Syste �- 277 Approve_--, Date -2, Note: this approval does not include well permit requirements. K m --1 O h^^ -I 0O.,mi� -� CID mm00M -D-4 M O r o 01- x X rn '0 OCCrn O w c��zm> o {y r- O vl o r Z O= —I rA" ?"MOGn N O c :1 z r - o m � Co M m Z O U) O p z , O C m mg N rM mp D r - 0 L cn c m O � n �rm mI �1 in NOTES: RECORD DRAWINGS SEPTIC TANK I DRAWN I AJC I SITE PLAN 00 N vo i H t n� n a� N N xz y N O U,rn00p I O � C n I O I O � n �rm mI �1 in NOTES: RECORD DRAWINGS SEPTIC TANK I DRAWN I AJC I SITE PLAN -i C zrn 00 N n 41 N N U)rnK:A� O U,rn00p N m O C D N N 3� 0 cn 41 N y D 41lco O 41 to 0) CO > t.'', ;Uin N 0 U) Lo 41 m -i C zrn -i Z (n zovvi-M -0 �D7m A U) L0 U)rnK:A� N r!1 N m O C � N N 3� 0 cn UI y D O O 41 to 0) > t.'', ;Uin 0 U) Lo m m 0 fel U) j { c: Z 1 1 "1 i cf) Z -1 e I O > - { j X m f (A I { Z� O\ ( I n f c� N K_ f cn O iQ O I ' n z U) < - O rn rt ^ rZA O \ J,� m O _ r - n r D -0 lY . rn O Z A A s' \ I { n � I CA �f I� m ` > c { >, m -q / m / W v C) x / @0• 1( i O / m / j r O m I - � C ( 0 07 W 7 f O -Ai Z Z (n I lI 0-0 tai CP 3 -0 59 �< I( �O c �J�� l l to ti m i z O fi n �0 O m cn / �r J -D0 /J/ CO r I d —SP 00 PANNIGNE ENGLLC$�/C LC C.I. 1088) a��f.00a� REVISIONS DATE P.O. BOX 1807 PALI?ER, AI< 99648 � OF A(gdt� 08/11/2021 PHOME (907) 745-8200 FAX (907) 745-8201 ocP• '' A'•`Sf �!, ¢cel c BIRCH HILL TERRACE B1 L5 ,q*.*. KEITH MUSCHINSKE P"s SITE: 18306 TEDROW CIRCLE EAGLE RIVER, AK 99577 n l2: •Panriorie' CE 8149 4y 1" = 50' 3. NO 10-141-07 MIT NO. ISP211238 ET 1 OF 2 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program pOBox 1S0650 4moElmore Road Anchorage, Alaska 98519'805O Phone: (S0r)343'n8O4 Fax: (gO7)34o'rss7 On -Site Wastewater Disposal S�/she[D Permit Permit Number: DSP211238 Effective Date: Work Type: SepdoTenkUpgrade Expiration Date: Tax Code Number: 05014107000 Site Legal Address: BIRCH HILLS TERRACE 8LK 1 LT 5 80153 Site Mailing Address: 18306TEDRUVVC|R.Eagle River Owner K4USCH|NSKEKEITH D&PAULA J Lot Size ioSqFt Design Engineer: PANM0NEENGINEERING SERVICES Total Bedrooms: This permit is for the construction of: 0/25/2O21 6/25/2O22 [J Disposal Field Z Septic Tank [] Holding Tank E] Privy [] Private Well R Water Storage All construction shall bninaccordance 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 (i8AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 1S.S5.Provide notification bycalling (9O7)343'7QO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Receive B� Issued By: / Ly /'�4/ uan*� Date: V-11 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-141-07 Property owner(s) Keith Muschinske Mailing address Site address 18306 Tedrow Circle Day phone Legal description (Sub'd., Block & Lot) Birch Hills Terrace Block 1 Lot 5 Legal description (Township, Range & Section) Lot Size 57,499 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (© all that apply) Absorption Field ❑ Septic Tank FK Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade FK 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: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. nature or property owner or authorized agent) Permit/Rush Fees: 0 9 o'` 5 _ Waiver Fees: Date of Payment: (o �,a0.2 1 Date of Payment: Receipt Number: 07 q 176 Receipt Number: Permit No. d S p a if 2 3 �1 Waiver No. Permit App__- : . _-..:c F13—'' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211238, Rebecca Carroll, 06/25/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211238, Rebecca Carroll, 06/25/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211238, Rebecca Carroll, 06/25/21 \ MUNICIPALITY OF ANCHORAGE 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME,/J�J t PHONE ❑NEW /�// V 2 wl UPGRADE MAILING ADDRESS S'da Ir 'Z - LEGAL LEGAL DESCRIPTION LOCATION NO.OF DR0OMS �5'/Z 7—/ z1 2zw o Y DISTANCE TO:�f We��O IAbsorpyo�re� Dwelling S r PER Tflp �/ ` Y n < Manufacturer ' �/jNG M �)e / >v N . of com rtruys W t- rn Liq. achy in allons �g IF HOMEMADE: Inside length Width Liquid depth q DISTANCE dOTO: Well I Dwelling I PERMIT NO. / Z ZH SA Manufac Material Liquid caps gallons O Foundation Nearest lot bne /PEHMIT NO. W = DISTANCE TO: lyln` \ u. Z No. of lines Length of each I Total length of lines Tre th Distance between lines F ? W - Inches f Top of We to finish grade Mat eneat Total effective absorption area p inches W Length Width �)rrfii \ PERMIT NO. / C F Type of crib Crib diamete Crib depth Total a absorption area W L W � DISTANCE TO: Buildingfoundation Nearest lot line J J Class / Depth Driller Distance to lot line PERMIT fib: \ W / ISTANCE TO: Building foundation Sewer line Septic tank Absorption area (s) \ I OTHER PIPE MATERIALS 7rlCNiC,1rALll! 7F !'T.frsnPA^E '! DEPT. CF HEA-TH & SOIL TEST RA G 'v /7• INSTALLE�� / SE I -C -I REMARKS REC =1VED OG/J 7flN✓ je&=rl-1ov1�0. kP. y ,. •.ti�,Fr!i j/ TJsit i^ ii V�9illii Ca APPROVED DATE LEGAL SRD 193X FY•1ALE RIVER ALASKA t�`7T r PH.B'J4-«S7D 72.013 (Rev. 3/78) �— C • to Cn FX e OLO Tlrlivu r� �� MU1q I C I F=•AL I TY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AY 99501 264-4720 O N— S I T E E3EWE R F} E R M I T PERMIT NO: 840714 UPGRADE DATE ISSUED: 08/22/84 APPLICANT: MARE: MAJOR LiC D /Q-P74� ADDRESS: SR #2 BOX 2945 EAGLE RIVER, AY. 99577 CONTACT PHONE: 265-6136 LEGAL DESCRIP: SUBDIVISION: BIRCH HILLS TERRACE LOT: 5 BLOCK: 1 SECTION: 12 TOWNSHIP: 14N RANGE: 2W LOT SIZE: 50000 (SQ.FT. OR ACRES) I certify that: 1. I am familiar with the requirements for on-site Sewers and wells as set forth by the Municipality of Anchorage (MDA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this.permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY.MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS -GUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL'WORY. MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED ---------- DATE: - $�,:i�/8Lr( --------------- ---- APPLICANT: MARY. MAJOR ISSUED BY CY--------- DATE: NICIPALITY OF ANCHORAGE i-) Hea and Environmental Protec )n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 ►�INSPECTION _ REPORT ON-SITESEWAGEDISPtOSA'(SS'+YOSTEM / C Ti– MAILING ADDRESS _S - t��i` �"YiJ 6 •,N/ /PHONE vgy_7 i939 LOCATION �uJSLLSA! `•�� LEGAL DESCRIPTIONL5---, L, /V'/// ,z.-,, SEPTIC TANK: DISTANCE/� /,,``NUMBER OF FROM WELL /" //'1 MANUFACTUREDcc Ut�G=MATERIAL •�IeZCOMPARTMENTS_ �. INSIDE LENGTH)) •` INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY_eGALLONS. TII F V'AIf�CI 2 A r' TOTAL LENGTH DISTANCE FROM WELL �� FOUNDATION�C.O NEARESST LOT LINE 'A0 ? OF LINE �Si # of Lines DISTANCE BE �TWEEN LINES -"_}—TRENCH WIDTFY� IN. TOTAL EFFECTIVE /Q ABSORPTION AREA SO. FT. LENGTH OF EACH LINE �y / DEPTH OF FILTER / / /- DEPTH: TOP OF TILE TO FINISH GRADE C/I _ MATERIAL BENEATH TILE _6_i_ ABOVE TILE S¢.�IN. SEEPAGE PIT: DIAMETER_ORWIDTH_ LENGTH_, DEPTH ' I Log Crib _Rings_ Crib Size:DIAMETER _DEPTH_ DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT, Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: C,t, k Pei # of Bedrooms: 3 i Installer: �� Remarks: 1. it1 _J _(_.1_ 7tis ,/ DATE ' APPROVE %�1 fN MlJt� T C I F'F�L 1 TY iuF F- r4KZ:Hu�r=1GEE /1; DEPARTMENT OF _HLTH AND ENVIRUNMENTHL Pf ECTION 9- 3 L 825 'L' . TREE1. ANCHORAGE, HF:. 995. •"`� 219-2511 co r-4 1 -t"t:E -%s F:wl✓F�: r-1`km 1 -r PERMIT NU. c 7785U �-a �1 111s2. HNF'LICAN I SWANK CONSIUCTIUN S. R. BX. 2951 E. R. 9957 J 694 9 39 LUCHIIUN I�URUW CR. LLUHL LS b1 BIRCH HILLS TERR. LOT SI -t Saaaaa SwuAK FEET TYNE OF SUIL HUSURBTIUN SYSTEM TRENCH MAXIMUM NUMBER OF BEDRUUMS = 4 SOIL RHTING (SLI F'TlBR)= b5 1HE REUU1RIU SILL OF THE SUIL FIBSURPIIUFJ Ltit=11"1'H= 1" LEr4l3-1"H= 2 SYSTEM IS: 1HE LENGTH DIMENSION 15 THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DLPIH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GRUUNU HFJD THE BU11011 OF THE EXCHVRIIUN (IN FEET). THERE 1S NU SET WIDTH FOR TRENCHES. 'EHE URHVEL DEPTH I5 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE B011UM OF THE EXCAVATION (IFJ FEET). Fd:E_UU 1 FrEEL7 "1-""K1 Gam= 1�`.. �4' U"L_LCj"_-5 F'Hl=.F<F=1LiE tom' L""i- cjFs`t' I cir•a H PACKAGE PLHNI MAY BE INSTHLLED AT THE PERMITTEE'S OPTION SUBJECI TO THE FULLUWINU CONDITIONS: 1. EITHER H CLHSS 1- UR 11' NSF HPPRUVED-PL'HFJI-MHY-BE"INSIHLL"ED.-` - 2. H CUNT'1T4000S`MHIF4IEF4HF4[JE-HUREEMENT" IS- REUUIREV.-" -I-H-MAIN]ENHNUE ' HGKEEMIFJI"'1S FJUI-Y.tl'1-I.URREFJI-YOU"MHY-bF"REWU1Rtl)-IU-EFJLHRGE-IHE�Sll1L"--- HL'.SURPIlUFI-SYSItTI-HFJDTUR-YUU-MHY-BE SUI3JECI- IU-PRUSEtiUT1UFJ.- - --- bHCKF1LL-ING_UF _HNY-SYSTEM-W1lHUUI-F1NHL'1NSPt-C:IIUN HN0"HPPROVHL"_bY-1H15_ - UEPHW I MEN I - WILL "bt -SUBJ EC1--I U-PHUSECU 1 IUFl-- '_MINIMUM~D1SlHNCf-bt1WEEN-H-WELL"HFJD_HNY-UN=S111'_SEWHGE-UISPUSHUSYSI EM 15 100 FEE I-I=UR-H.PPIVHIt-4JELC_UR -2UU-FU=1-FUR -H-PUbL'IC"WE'LL'.-' UIHER KtUUlRtf9EN1S MHY-HPPLV: ` SYEL'1F-1CH1ZUN5"HN13-CUF751F?UCTIUF7-61HGRHMS"ARE- HVH1LHSLE- 1U _INSURE-PRUPE-R'-INS-IHLLHf'ITJ J."— 1` CER I ITV I HH 1' "1 I_HM_FHMILIHR-WITH �IHE RthlUIRtT1EFJIS F"UR"UN=Slit SEWERS HFJD-WILL"S'HS`57=1'"-"-� - FUR I H -bY -1 HE-MUN I C.'IYHC1l Y UF-HNCHORHGE..- �:-1`LJ1Ll-1TJ51HLL'-IHt 54'S1ET7-IPI-ii['CURI)flFJCE-GTITH"`IHt'CUUE3: "`-"'��.� 3: .1"UNDtRS1HFJt3`1HH1-lHt"UFJ=SITE"��E1•Jtl'i'54'S�TTT-MN'�'f?E4TUIRE 1NLHRGE,tFJI--I1 1HE- - RESIDtNCE IS 1 LMUDEL.ED-TU-INCLUDE_MURE- 4_4-EEL5RuOF1S` HF'PLICHNI---154Hf1Y.-CUF4SIUL I-lUFr--- 1 _ -75SUID-f34'_______-- -V3._U GARY PLAYER VENTURES y CONSULTING GEOLOGIST BOX 476•M. STAR ROUTE A - ANCHORAGE. ALASKA 99507 - PHONE 344.7071 SOILS LOG Performed for W Sig�"� Date 'S /-7 Location L04 Rik I J g(Yc A^ (411(.S Soil Type Water Level Remarks 0 2 4 - - 6- - G �,�/�•, - 6W w $ �cnA P -Ns 10 - - o. 12 - 14 - 16 - - 18 - 20 Total Depth of Excavation !�' Material at Total Depth Groundwater Bedrock t. Reached Not Reached Depth, if Reached Depth, if Reached Classification Method visual --------- p n . ( )'Sieve Analysis � 1\/ ( ) Gary F. Player, Consulting Geologist by ;T ` A & L DRILLING COMPANY �� o BOX 97, EAGLE RIVER, ALASKA 99677 • TELEPHONE 994-26w OWNER OF LAND /y%AK/C M 09JoQS DEPTH OF WELL ADDRESS 909 F 467H cT qwc W TATIC LEVEL OF WATER FT. LEGAL DESCRIPTION L S 4, < I bikc N Hg 3 7FL�itf"""-DRAW DOWN FT. DATE • Started q/7/77 Ended `1/f/77 GALS. PER HR 1 SD PERMIT NUMBER '7777 KIND OF CASING G s O t7 KIND OF FORMATION: From O Ft. to P Ft. Oue,< . From Ft. to Ft. From a Ft. t02.C_Ft. SF -je V- l/l rvcc From Ft. to Ft. From Ft. to -u- Ft. C4fe Y-6401VE4 From Ft. to Ft. FromlLFt. to 1 °I r Ft. 5-,5.j0 4 C4Av EC From Ft. to Ft From12 1 Ft. to19 -2, Ft. Cc+py 41e4-1Fc 'f From Ft. to Ft From II f? Ft. to I S % Ft. CLJ4 r cf 6124✓E L From Ft. to Ft. From/,73 Ft. to -2—D) Ft. eF0410c /< From Ft. to Ft. From 2 21 Ft. to Ft. 0,74 &e. f- t.l) P✓A,Cj Z. From Ft. to Ft. From330 Ft. toa�_Ft. IiED,Pac K SDlio From Ft. to Ft. From �_Ft. to 2ir� Ft. F3c'/Rxk' FXA--ruecn i°From Ft. to Ft. From 2155Ft. to;) 96 Ft. RFn4w-(' $ac. o From Ft. to Ft. From a 9 Ft. to 31.) Ft. 14f.0 R e c K r QAc T tQ E Ft. to Ft. From Ft. to Ft. /y�From ?Jf?4 : L �.vSeSr o) ia� prom Ft. to Ft. From31AFt.to 3J2 Ft, 4 From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: PVMP peri<r0 3/0 tfX., T.r o: Cl-9("JC t DRILLERSNAME r -i u r-.1 I Cl I F$'mL I I - Ne U F= Fi"C - H l_''� 1=113 E DEPARTMENT OF EALTH AND ENVIRONMENTAL F� iECTION 825 'L' STREET, ANCHORAGE, AY,. 995+1 279-2511 LJELLL FsEf2r'1 I T PERMIT NO. C 77776 ) APPLICANT MARY, A MAJOR 909 E 46TH CT ANCH 99503 2763698 LOCATION TEDROW CIRCLE LEGAL LOT 5 EL 1 BIRCH HILLS TERRACE LOT SIZE 56000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS qND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. INSTALLATION. PERM I T' EXP I FSE' [7ECEME�ER 31 . 1S4�7 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED: APPLICANT MARK A MAJOR ISSUED BY����LL�,------DATETIA _ �L V3. 0 ` p R ^t� E C i � Lc e � �c r L �., `7 u��=`+ G ice. e."-.. .._.__..._----"----..�,�.-.T-.. .....,.-----�'-^yr,.--..-� :.......-,.-.. .-.-^.�-,•-amu = ..,� r.-^^-�,-^'.'-,^�.. -'�::. Development Services Department ` `` r "�Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-141-07 1. GENERAL INFORMATION Expiration Date: 3 _Z UZ3 Complete legal description Birch Hills Terrace Block 1 Lot 5 Location (site address) 18306 Tedrow Circle Current property owner(s) Keith MUschinske Mailing address Real estate agent 2. TYPE OF DWELLING: Fx_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ED Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System R Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $550 Date of Payment OZZA1 Receipt Number 0785 q 6-- COSA # 05 62.11 L-1 9 9 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 riles 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for _�_ bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date A TH .. :� 'fever F`•:. .�rir iore Conditional approval for bedrooms, with the following st %i�t�Ar�����(/ OF,/�r�� `sJ ON-.SlT �o WATER AICD rn -V'' AT ER z /JJ AN `7 B 1 Original Certificate Date: S? -2—d 2 The 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Birch Hills Terrace Block 1 Lot 5 If more than 1 septic system on lot: COSA Checklist # 1 of A. WELL DATA ❑® Well log is filed with Onsite'(Or attached) Date drilled r Total depth 320 // ft Cased to UUNNKI/ ft ❑ Sanitary edl is functioning correctly ❑ Wires are properly protected Casingh fight (above ground) LINK in Date o flow test for COSA N/A Static waevel begtnning-ofiiesf= Parcel ID: 050-141-07 Structure served by this system 1 Well production at time of test N/A/%gpm Water storage tank volume N/A f gallons Well disinfected for coliform, test? ❑ Yes Q No ❑ Coliform bacteria is Negative Nitrate mg/L 6 Nitrate less than MRL (ND) Arsenic ug/El Arsenic less than MRL (ND) Collected by // Date of Sample Commdnts Well Not In Use, Lot Now Supplied By Public Water Main B. TANK DATA Age of tank(s) <1 years Tank type/material HDPE Measured operating fluid level in septic tank NEW FIM] Standpipes/foundation cleanout per record drawing Date of pumping NEW TANK D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) Fil ALL standpipes present per record drawing Total measured depth from grade 10.0 ft (max) Measured depth to pipe invert from grade 4.0 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes goCe of effective. If not, state depth into effecti❑® Code -required sr 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 G. LIFT STATION ❑ Required maintenance completed Age of lift station N/A years Lift station material N/A Comments: Adequacy test date .°'`°Z' Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed timq 95 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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 > 100' 0 Yes if No Community Sewer Manhole/Cleanout > 100' Fv� Yes if No ft [V Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' [El Yes if No Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' 7 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No 0 Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft Fv� Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 1771 Yes if No ft Surface Water > 100' ft ft ft ft ft Q✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Fv� Yes if No ft Private Wells > 100' Yes if No. Water Main > 10' 0 Yes if No ft Community Wells > 200' Fv� Yes if No _ Water Service Line > 10' Z 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' E Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft . Private Wells > 100' B Yes if No Water Service Line > 10' Fv� Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MDA COSA guidelines in effect on this date. 2l tz, COSA Checklist yellow sheet of A�,,sfi � a ,gib- . I y I_ ven F. Pannone ft ft ft ft IdNO(55330&dill(, }aaj ul aIoas 02 9t 0 ZL •Sl'?N 'awi aouaj jo Alepunoq a 6uiLppelse job jo uo!iorulsuoo ............................. jo} pasn aq luawnoop snq pfnogs saouelswnano ou japun lefd plooaj 0141 uo madde ou op go!gm i f u0!13ulsal Io 'slueuanoo 'stuawasea lue jo eouals!xa eql au!wjalap of Jaumo a141 jo llipq!sucdsal 1 • • • ! aq{ s! p •leanal lew lams llepunoq luanbasgns a 1e141 seioeinooeu! hue of loafgns s! pue /arms ,'- '� ,Uepunoq a alnlpsuoo lou scop luawnoop s!14I •lams 014110 M!) ayi 1e suo!1!puoo pue sluawanaadw! Olq!s!n sluasadai lams a14I •spiepue)S uo!leool 96e6Uo1q SIdSV 0141 qi!m sagdwoo 6avns siyl Jc lett >y...... 30- m O m \\0'6 \ 1N3W3AVd 30 3,903 \ \ \ ,0F _ „ I aleDs �adO�1 dOO7 a3AILI 37,9V3 3 •j:)ijjsia Supooab @Seaogauy '{,L -696I -ON Meld uo paseq sf juawn:)op sigl -E JanoD aflda5 („t •Aluo'aisuigasnw gl!a>l aoj jpq-se ue }o asodind agj joj sAanjnS jafjuoi j Aq pajean sf Muawnaop sfgl .Z :)fldaS (Si 1IT-0 snufw/snld We e sa a oa c 7 sauil Aj.ladoid of suofsuawfp •Aan.fns sfgj Oupedaid jo jsw agj paaoxa f M p d f3 v jou pegs AalUnS sfgj jol Ajgfgefl aqM 'aauaPfj9au ssoaO .foj Oupdaax3 'Z fejsapad •dal Vv sa30A_I IDaauaD pua&7 ,68'19C M„OO,89.69N VI7 1N3W3SV3 Alnun ,06 3� N (n O a6e.1e01e0 C PaUoellt/ 4lm asnoH awejd pooh} UolS C % D � a6on0 nio-IPal 90086 X � �c ` �j •bS 0ZC,£ uois1nipgnS aoelral S1#H goalgx ,"'fS; I G 40019 `9107 / x o h 15 1 ' C = I k i i .6 o -< ' -< y o - i i rn x CHHS S �$£� 6C Z° m K w k m w01 ' m z G 9107 w I / w Vt x �37 co O 8S 8�e 40s 5,/j °J' o is k_ 737 ' v 9107 •Og Municipality of Anchorage .. Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 n n , ,n Anchorage, AK 99519-6650 (/Yvf//{Viy)_Gl www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-141-07 1. GENERAL INFORMATION Complete legal description Birch Hills Terrace Block 1 Lot 5 L, UttZAI k 14/ 1/0 y COSA a (A 04M Expiration Date: — l — 0 Location (site add(ess) 18306 Tedrow Circle Current Property owner(s) Mark A Maior and Karen D Major. Day phone 1)(27694-2817 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 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 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by requirededen fproheesiotranal civil engineer registered in the State of Alaska. Certificates of On -Site Systems App are title (except between spouses) for properties served by a single-family on-sfte wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site 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 shows thatprocedures the on-site watersupplyand/or asd In the tewatter disposof On -Site al systetems m Is (aral Guidelines e) safe, functional and or this application, 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 Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 102954 Anchorage AK 99510 Engineer's Printed Name Steven R. Pannone P.E. Date 12/24/2008 Engineers Comments: In conducting an adequacy lest,) attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water •••••gagOF a levels that may fluctuate during the year, and the water usage of the family being served by the system. •• 71csc conditions are outside the control of the evaluator of this system. All systems eventually fail and : �J�/d ���� aaa♦e♦ satisfactory test results do not guarantee future performance of the system, nor do the Y they +f f 49 r„♦ there are no hidden defects or encroachments. PES an therefore not provide any warranty for future � -- performance nor give any estimate of how long the system will continue to meet the operational � _ _ .�.. requirements of the MOA DSD. The content of this report is for the sole benctit of the owner listed tK��Steven R� var+oo�e: above. Any reliance upon or use of this report by any other person or party is not authorized nor will it •i•� r'D No 'E 8149 =' confer any legal right whatsoever. 5. DSD SIGNATURE• it �• ataaaaa��t•�,••. Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ^"aW H 11et1LS: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: — 3 -to g tn.,.. ,, Municipality of Anchorage Development Services Department = n 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: Birch Hills Terrace Block 1 Lot 5 Parcel ID: A. WELL DATA Well type If A, B. or C provide PWSID N Date completed _ Sanitary seal (YM) _ �asina es perly protected (Y!N) Total depth ft. d to ft. height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft ft. Well production g.p.m. g.p.m. :WATER SAMPLE LTS:liform colonies/100 mL Nitrate mg/L Other bacteria colonte 100 mL enic: _ ug/I Date of sample: _ Collected by: _ B. SEPTIC/HOLDING TANK DATA Tank Type/Material steel Date In 911611984 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) y Foundation cleanout (YIN) y Depression over tank (YIN) P High water alarm (Y/N) na Date of pumping JQI2008. Pumper is Septic Pumpers C. ABSORPTION FIELD DATA - Date installed 712111976 Soil rating (g.p.d.e or te/bdrm)140_ System type lignch Length 40 ft. Width 3 ft. Gravel below pipe .61t. Total depth 10 ft. Eff. absorption area 480 fe Monitoring tube y Depression over field r Date of adequacy test 1212312008 Results (Pass/Fail)a� ss For 4 bedrooms Fluid depth in absorption field before test rl yr in. Water added600 gal. New depthdU in. Elapsed Time: Lo min. Final fluid depth Sf in. Absorption rate >= 600 9•p•d• Any rejuvenation treatment (past 12 mo.) (Y/N &type) n If yes, give date b D.LIFT STATION Date installed `Pump on" level at E. SEPARATION DISTANCES (Y/N) =rump off' level at _ in. Hig'wh ater alarm le Cycles tested Meets alarm & circuit DISTANCES FROM WELL ON LOT TO: Septic tank/lift station Absorption field on lot Public sewer main Sewer/septi ice line containment areas On adjacent lots Holding tank at in. Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line t 0 4- Absorption field 5 + Water main 100+ Water service line 25+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 100+ Water Service line 25+ • Surface water 100+ Driveway, parking/vehicle storage 50+ Curtain drain 50♦ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION .••�• pF �aaae �•.tp� F ............. rei I certify that l have determined through field inspections and�i` "'+9eee review o/ Municipal records that the above systems are In rr 4 conformance with MOA COSA guidelines in effect on this date. •'"" " r....... ....._... „ ..�— Engineer's Printed Name Steven R. Pannone P.E. oM, S1even R. Ponnonej ♦ s, No. CE 8149 f i Date22tf ei�. (� e_ .............�•�' psi COSA Fee $(� Date of Payment I r— 0 9_ Receipt Number_ (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number MUNICIPALANCHORAGE DEPARTMENT OF HEALTH 8 HUMAN SERVICES 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 Parcel l.D.# Ir) e-n—ILIX—n, HAA# 0Qq-Qr)1_)L0 1. GENERAL INFORMATION Complete legal description Lot 5; Block 1; Birch Hills Terrace Subdivision Location (site address or directions) 18306 Tedrow Circle Property owner Mark Major Day phone 256-6136 wk Mailing address 18306 Tedrow Circle, Eagle River Alaska 99577 694-2817 hat Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-M(A r.U91) Front MOARt 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 furtherverify 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 S & S F.NGINFFRINC.. Phone 17034 Eagle River Loop Road NO. Address FaUle River, Alaska 99577 Engineer's signature Date t'p-`�2 '• L°x •°c...��9 AV RODE; J.HAFER d E d S cq ter.. o ?�'�•.. ..•�' aim 6. DHHS SIGNATURE FESSI �Ro x Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 2-r -/Z 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. 72o= IR«. i,on BKk MOA 121 Municipality of Anchorage Auk Department of Health &Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lct 5 �l.K �t�u % Parcel I.D. Tom. ala A. WELL DATA Well type 'FeAJATF If A, B, or C, attach ADEC letter. ADEC water system number r11A Log present &N) Date completed I - B-71 Driller A i k- t>aL. I,L.. A Lt Total depth s Cased to to Casing height 12 Sanitary seal &N) Wires properly protected CDN) FROM WELL LOG AT INSPECTION o dz Date of test -8-77 1-'+-3-9�. m D Static water level VK 213 rn o Weft flow 2.S g.p.m. o m �O N Pump level 'tet C. '"5 0 ro <_ N R 0 SEPARATION DISTANCES FROM WELL TO: Z Septic/holding tank on lot 1 �� 1 ; On adjacent lots Absorption field on lot Ivo ; On adjacent lots tppI+ Public sewer main 'SI P� Public sewer manhole/cleanout ^1�A Sewer service line 25 tr Petroleum tank WATER SAMPLE RESULTS: Coliform 0C O"/Iotl W%S Nitrate taD Other bacteria �e'� Date of sample: /1-�-`12- Collected by: S & S ENGINEERING 17034 Eagle Klver Loop Koad No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date Installed 19 $A' Tank size I LsC:� Compartments Z Cleanouts &N) T Foundation cleanout (9/N) Depression (Y6 tJ High water alarm (Y6 Alarm tested (Y/N) ^J/4 Date of pumping 1 - 22 -9't- Pumper S, Lis$ P 0 t. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1 O o 1 On adjacent lots t X01 Foundation 51 To property line to1� Absorptionfield '161 Watermain/service line to%4- Surface water/drainage 10 o 72-028(Rev.7/91) From CONTINUED ON BACK PAGE C. LIFT STATION , Date Installed Size In gallons Vent(Y/N) High water alarm level Meets MOA electrical "Pump on" level at Manufacturer Manhole/Access (Y/N) /Pump off" level at Cycles tested (STANCE FROM LIFT STATION TO: on lot On adjacent lots ' t Surface water D. ABSORPTION FIELD DATA Date Installed Soil rating �4d'System type _r(L"CA Lerigth 40„ Widtn '�1 Gravel thickness L; Total depth 101 Total absorption area 40e Cleanouts present O/N) Depression over field (Ycm Date of adequacy test 1 ^ Z -S 'q 7- Results (Z�ait) PAe, for -Foo CA) bedrooms Peroxide treatment (past 12 months) (Y49) nbAje tGn1o1)") If yes, give date %' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1001, On adjacent lots too 1+ Propertyline ►p 1+ To building foundation 101 To existing or abandoned system on lot �Ia On adjacent lots 301 Cutbank "� Water main/service line 1'014 - Surface water 1 ob I } Driveway, parking/vehicle storage area 401 Curtain drain E. ENGINEER'S CERTIFICATION _ 1 certify that/ have checked, verified, or conformed to all MOA and HAA guidelines in effect{l� date of this Inspection. F4� pF 4Z.,iy S & S ENGINEERINGv•t�•'••~ ••y•'•a 4rf�' 17034 Eagle River Loop Road N0i204 4-1 f�49L t%«a • % B Signature Eanle klver, Aiaska YY5// - �; ,•�•, Engineer's Name q io • •••N• , Date 12 1P ^t� ROG ••JJ.. MAFER .' y - .1- �� J' •a 0.8215 •. \ r✓ A �FESStO�.r� HAA Fee $ / %e Waiver Fee: $ Date of Payment l—,WVDate of Payment Receipt Number tzV _'�33 / l C�7�O) Receipt Number 72-026(R". W) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561.5301 ANALISIS RESULTS for INVOICE i 50495 Clealab Ref.1 92.0227 Sample 1 5 Matrix: NATER Client Sample ID : LS /1 DIICH HILLS TEM. S/D PNSID : Ul Collected : JAY 20 92 l 11:30 hrs. Received : JIM 20 92 4 14:70 hre. Preserved with : 13 RIQUIRED Analysis Completed : JIM 22 92 Laboratory Supervisor STEPHEN C. IDL Released By : �� Client Nana :S Z S ENGINEERING Client lcct :SNSENGP 11`04 : Iegl s Ordered :y :1. SHAPER Send Reports to: 1)3 E S ENGINEIIINC 2) POI :NONE RECEIVED .................................................................................................................................... Parameter Results Units Method Allowable Limits 11II1119-111 ND(0.10) mq/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED IT: BIT. Remarks. .................................................................................................................................... 1 Tests Performed Sao Special Instructions Above OA -Unavailable ND- Nona Detected " See Sample Remarks Above NI- Not Analysed IT -Lost Than. CI-Grestat Than AV'SGS Member of the SGS Group (SOCIM6 GAnArale de Surveillance)