HomeMy WebLinkAboutGRAHAM LT 12 raham
Lot 12
#012-181-18
oAre - 7-10-70
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MUNICIPALITY OF ANCHORAGE
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Development Services DepartmentUS j
Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 012-181-18 Expiration Date: O+"-1
1. GENERAL INFORMATION
Complete legal description Lot 12 Graham Subd.
Location (site address) 7316 Brache Circle, Anchorage Alaska 99518
Current property owner(s) Dylan Bales Day phone 907-727-3974
Mailing address 4530 Macalister Drive, Anchorage Alaska 99502
Real estate agent Ralph Matukkonis Day phone 907-350-6446
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2. TYPE OF DWELLING: �� `v RUSH! , `
❑ Single Family (w/wo ADU) gAf a
❑ Duplex '7s JUL 3 1019
❑ Multiple Dwellings (Single Family and/or Duplex) 4.
ti
3. NUMBER OF BEDROOMS: 4 ii
01
6 6 L g 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well E Private Septic ❑
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer E
•
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 650 -t- 3 t:) &Sh = 0 O - Waiver Fee $
Date of Payment 7/ Ii g' - Date of Payment
Receipt Number OD�_r 6 Receipt Number
COSA# O5^ to lR8\ 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. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm Rodney P. Kinney Associates, Inc. Phone 907-694-2332
Address 16515 Centerfield Drive, Eagle River Alaska 99577
Engineer's Printed Name Rodney Kinney Date July 3, 2019
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6. DSD SIGNATURE 'a . .. • •
_
1.a
System #1 Approved for _bedroomsLI 02
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Rodn P. Kinney,Jr,
System #2 Approved for bedrooms CE 7955 . •�`""�
049
Disapproved 'Vii*a7.'.!,`'•V'�6Or
Conditional approval for bedrooms, with the following stipt.t111111111 h1:
tkoIN? OF f!' Cyr(.
ON-SITE ir''
WATER AND
--"A WASTEWATER s
PROGRAM �-s.i?"-
""�T SERNI \\N
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By: S ‘4../\. 6 1/ Original Certificate Date: - "-�
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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
COSA Checklist
Legal Description: Lot 12, Graham Subd. Parcel ID: 012-181-18
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA NO WELL LOG AVAIL.
❑Well log is filed with Onsite (or attached) Well production at time of test 5 gpm
Date drilled UNK Water storage tank volume 33.4 gallons
Total depth 80 ft Well disinfected for coliform test? ❑Yes ❑U No
Cased to 80 ft Coliform bacteria is Negative
❑■ Sanitary seal is functioning correctly Nitrate mg/L 0 Nitrate less than MRL (ND)
❑U Wires are properly protected Arsenic 11.3 ug/L ❑Arsenic less than MRL(ND)
Casing height(above ground) 31 in. Collected by Rod Kinney
Date of flow test for COSA 6-21-19 Date of Sample 6-21-19
Static water level at beginning of test 33.5 ft.
Comments Static water level measured from top of casing
B. TANK DATA N/A C. LIFT STATION N/A
Age of tank(s) years ❑ Required maintenance completed
Tank type/material Age of lift station years
Measured operating fluid level in septic tank Lift station material
❑ Standpipes/foundation cleanout per record drawing Comments:
Date of pumping .
D. ABSORPTION FIELD DATA N/A
Which system tested (date installed) Adequacy test.date
❑ ALL standpipes present per record drawing Results 0 Pass For bedrooms
Total measured depth from grade ft(max) Fluid depth prior to test in
Measured depth to pipe invert from grade ft(min) Water added gal
❑ N/A—pressurized field New depth in
❑ Monitor tubes go to bottom of effective. If not, state Elapsed time min
depth into effective
1=1 Code-required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
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' Community Sewer Manhole/Cleanout > 100'
❑Yes if No ft N/A 0 Yes if No ft
Neighboring Tank > 100' E Yes if No ft Private Sewer/Septic Line > 25' IT Yes if No ft
Absorption Field on Lot > 100' ❑Yes if No ft N/A Holding Tank > 100' 0 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment> 50' ❑✓ Yes if No ft
0 Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required) N/A
Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' 111 Yes if No ft
Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft
Water Main > 10' ❑ 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) N/A
Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below
Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft
Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft
Surface Water > 100' ❑ Yes if No ft
F. ENGINEER'S COMMENTS
.rte ,rF AO
G. ENGINEER'S CERTIFICATION -4� . �•*: -
pi �. 1
I certify that I have determined through field inspections and review P '. 4 r r H r"l1 • : '1
of Municipal records that the above systems are in conformance with 0•••• •• ••• alr
MOA COSA guidelines in effect on this date. � 04
.. ... .; ;.:...
6 s;, Rodney . Kinney,Jr, :.Sr ;
3•.44 y CE 7955 .' .i�
1% 0p' C1�1 .6
COSA Checklist yellow sheet
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT (• 'vf c,'"� 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite �
Arsenic Advisory
Certificate of On-Site Systems Approval # OSC191281
Subdivision: Graham, Lot 12
A water sample revealed an arsenic concentration of 11.3 micrograms per liter
(ug/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/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. information on arsenic is available from the On-Site Water and
Wastewater Program website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.0. Box 196650* Anchorage,Alaska 99519-6650*www.muni.org
BRANchip-
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-: r,.. •'-'1•- ' 9 ^^^'"•'°'" - EXCLUSION NOTES: It is the owners' responsibility to determine LEGEND: SET FND
ORDERED sY: the existence of any easements, covenants, or restrictions 5/8"RB W/CAP® 5/8" RB 0
ID ',.--1_A NJ B A L E.S which do not dppeor on the recorded subdivision plat. NOTE 3.25' ALMON.O MONUMENT.
Under no circumstances should any data hereon be used for HUB & TACK .0Tippvg,Triaw
- construction or for establishing property lines.
. FENCE— X x
SURVEY CERTIFICATION: SLANA has conducted a OVERHANG .J
]� physical survey of this property as shown on this WOOD DECKS— I 1
SLANA ST �('�URVEYS j I Y . drawing and that the improvements situated there—CONCRETE— F ••
on are within the property lines and no encroach— ASPHALT—
ments exist other than noted. GRAVEL— (' I
A S— B U I L T O F: LEGAL DESCRIPTION: SEPTIC STANDPIPES- OS
LAND & CONSTRUCTION SURVEYORS WATER WELL-. Q
1200 E. 76th (fax) 929-3369 LOT 12
ANCHORAGE, ALASKA • 99503 (907) -562-6103
WORK ORDER NUMBER: DATE: . . SCALE: PLAT KAMM
JUNE 20, 2017 , -20 P-505 GRAHAM SUBDIVISION
SL-19—TSC NAIRN aCED Ira CM► K,�Aa=
MD. t. 2130 483/75
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal afl-[xed hereto and as of the validation date shown below, I vedfy that my ;nvestigation
based on procedures outlined in the Health Authority Approval Guidelines for 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 furlher verify that based on the
information obtained frern the Municipality of Anchorage files and from my investigation and inspection, the
on-sit, e water supply and/or wastewater disposal system is In compliance with all applicable Municipal and
State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm _Pannone Ena. Svc. Phone. 272-8218
Address .P.O. Box 102954, Anch, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date
· eaDnccrbtg analysis of the s~tcm in accordance with MOA DSD GuH,'lines & Rc~m/ntions. '[~c
[he test. and ~parafion d/stancez meazorcd to readily identifiable fcatore~. The opc~tional life of all .~,
~ells and septic systems depcad on thc local soil condifion, grouad~ate~levclsflmt~yfl~ ~ ~ 4
dor~ thc yea-, a~ the ~ ,saSe or the c~i~y ~ ~-~ I~ t~ s,/~c~. 1~ co~o.s ar~ ~...~C__~,.~..L- ', _........_~
outsi& the contm~ or the evalua~ of th/s system. Ali systems eventually fail and satis~ctory test ~~
I~d~. dcfccL~ or cacmach~c~ts. PES mm thcrc£orc not provi& a~y ,n~ramy for ~turc [~rform,~cc ~~"~ n""'~"'~~
nor g~ve any estimate of how long the system, w/ll continue t~ meet the operational requiremen, of thc
reliance uP°n °r use o f thisrelx~n, bY any olhcr pcrson or pmly is not authmized nor will it confer any -e.l¢~
6. DSD SIGNATURE ~., ·
/ Approved for
Disapproved.
Conditii)nal approval for __
4- bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Expiration Date:
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date:
Reissue Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage. AK 99519-6650
www.cLanchorage.ak.us
( 07) 343-7 04
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 12 Graham $/D
Parcel I.D.: 012-181-18
WELL DATA
Well type _P
Date completed
Total depth SO'"
If A. B. or C provide PWSID #
Sanitary seal Y_
Cased to I~0' It
FROM WELL LOG
Date of test
Static water level It
Well production g.p.m
Well Lng N
Wires pmpedy protected Y ~_,,..j_.
Casing height (above ground) 2.5 '~. '
AT INSPECTION
/4q002
34 ft
6,0 g.p.m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi Nitrate .227 mg/I
Date of sample: ~ Collected by: I,,aurlt Pprlnmle
Other bacteria 0 colonies/100 mi
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Date installed
Cleanouts
gal Number of Compartments
Depression over tank water alarm.
Date of pumping
C. ABSORPTION FIELD DATA
Date installed Soil rating
Length It W~tth
To~al depth 'It
Dale of adequacy test Results
Fluid depth in absorption field before~/'' in
Elapsed Time: _0 min ~Fin_al_~:id depth
Any rejuvenation treatmeTst 12 mo.) (Y/N & type)
(Rev. 11,~9g)
It
System type
Gravel below pipe It
Monitoring tube Depressio~ over field
For bedrooms
__ gal. New depth
Absorplion rate >=
If yes, give date
Iff.
gp.d.
D. LIFT STATION
Date installed
'Pump on' level at
Datum
Size in gallons.
In'Pump off" level at
Cycles tested
E. SEPARATION DISTANCES
in
Manhole/Access
High water alarm level at. In
Meets alarm & circuit requirements? ,,
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on Int,/~/h'~
Al~orption field on Int.
Public sewer main,
Sewer/septic service line
On adjacent Ints.
o. adjacent nts.
Public sewer manhole/cleaneut
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation . .~.mpe~ Absorption field
Water main ~service line Surface water.
Drainage /"/ Wells bn adjacent Ints
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water Service line
Curtain drain.
F. COMMENTS
,~ve#s on a(ljacent Ints.
Water main.
Driveway, parking/vehicle storage
G. ENGINEER'S CERTIFICATION
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name. Steven R. Pannone. P.E.
Date,
49 t...~-
Steven R. onnom
Fee S .' 7D
Date of Payment
Receipt Number ~' I ~) C) c~
(Rev. 11/99)
Waiver Fee $.
Date of Payment
Receipt Number
,~ ~nv~nmen~ll Servloee Inc.
GT&E
S L-npk R~Mrks:
0.~T7
Z,Q'r
O2OO
lnlt
To~l ~llfon'r, 0
~ol/IOOmL SMll 9222B
0~'04~02 K. AP
,rdlt-04-02 TLR. 01:25
P, 02
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It is the responsibility er the o~ner to determine
the existence of any easements, covenants, ~r.r~L
stricttons ~htch do not appear on the recor~ea sue-
division plat. Under no ctrc~nstances sheul¢ any
data hereon be used for construction or for estab-
lishing bounda~ or fence lines· The surveyor take~
r~nstbil, it¥ for the initial transaction only.
LOT ./~-~
T
· IHOWN
ANCHORAGE RECORDING DISTRICT r~
/~rP.U(ED eY: {2X2)WLJNG ~ ASSOCIATES. ' '
AHC.HORAGE~ ALASKA 9,9,501
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)
(c)
Property owner ~ ~ 0 h-,F'~'.,~/'¢/~,'":*2'' Telephone: (home)~'~' -J~g'C--~:CBusiness /cP'.,4
Mailing Address
Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address ~/7/
(e)
Telephone
Telephone
Mail the HAA to the following address: (or check here ~d for pick up.)
List contact person and day phone number below:
2. TYPE OF /ir. /
Single-Family ~ Number of bedrooms
3. WATER SUPPLY~
Individual Well Il2' Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL/
On-site [] Public B~' Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
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Well Classification
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description: ~J~ ~t-~/~/zS.'~ ~/~.~
/
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) //~ Date Completed ~/'/'l ~ Yield
Total Depth (~69/~'~Cased to ~ '~/~ Depth of Grout, ing
Static Water Level ~O / Pump Set At 7~
Casing Height Above Ground '~ ~ / Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) ,~ Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /~//~- ;On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /fJ//~F ; On Adjoining Lots /("///~'
To Nearest Public Sewer Line //--~'~ / To Nearest Public Sewer Cleanout/Uanhole //~' :~ /
To Nearest Sewer Service Line on Lot '7~' '~
Water Sample Collected by ~/~-(~ ~/'~--¢-'J/"/ ;Date
Water Sample Test Results ~--~-~-~, ~' ~7Z'~'¢~-~'
/
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size
Standpipes (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/H(
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lak,
Comme
No. of Compartments
Air-tight Caps (Y/N) Foundation
Date Last P
or Drainage Course
; for
(Y/N)
Tank Permit(Y/N)
TANK:
D Uilding Foundation
isposal Field
72-026 (Rev. 7/88) Fronl Page I 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 Cour:
To Driveway, Parking Area, or Vehicle Storage
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present
Date of Last Adequacy
To Proper
; On Adjoini
Existing or Abandoned System on
Cutback (if present)
D. LIFT STA.'I'_J~N
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Le~ at
Tested for
Meets MOA~ectrical Codes (Y/N)
Comm/~
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Pe rmi/tt/ee
I certify
inspection/
Signed //~/~
Compa.Cy
Date
MOA No.
Bedroom~F~i~ Against HAA Request**
)/,/¢he~c.,b/d';,..~e'rified, or conformed to all MOA and
Receipt No. ¢'~-..-~
Date of Payment
Amount: $ //
72-026 (Rev. 7/88) Back
effect on the date of this
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
Engineer's Seal
FEDERAL TAX I.D. #92~0040440
ANALYSIS REPORT BY SAt~LE fo~ Wor:k Ozder B 30030
Date Repo~t Printed: NOV.!3 90 ~ 09;~?
Client Sa~ple ID:L12
?WSID :UA
Collected I~OV 9 90 @ 15:00 hrs.
Received NOV 9 90 @ 16:47 hrs.
Preserved with :AS REQUIRED
Client Name : CORWIN & ASSOC.
Client Acer : CORWINP
P.O.~ NONE RECEIVED
Ordered By B~UCE COR~I~
Analysis Completed :
I, ebo~ato~y Supe~¥~oz :STEPHEN C. EDE
Released ~y -
Send Repozts ~o:
1)CORWIN 6 ASSOC~
Special
Inst~uat:
Chemlab Re£ ~: 9Di?78 Lab Smpl ID: 4 Mat~xx: t~A?ER
Allowable
Pazamete~ Tested Result Units ~ethod gin'~ts
TOTAl COLIFOR~ SEE kTTACHED eoi/lO0 mi
/
/
!
Sample ROUTINE SAI~LE.
Remake: SAI~LE COLLECTED BY B,J,C.
I Te~t~ Peziozmed See Special instzuctions Above UA=Unavailable
ND= 5one Detected ~ See Sample Rem~k~ Above
NA: }lot Analyzed LT=Less Than, GT:Gzeatez Than
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INc.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
..... ~,~oz~ gEPORT BY SAMPLE for Work Order ~ 30030
' Date Repo~t Prlnted: NOV 13 90 @ 09:47
Client Sample ID:L12 GRAHA)4 S/D
PWSID :UA
Collected NOV 9 90 @ 15:00 l~s.
Received NOV 9 90 @ 16:47 his.
P~eseryed with ;kS REQUIRED
Client Name : CORWIN ~ ASSOC.
Client Acct: CORW!}IP
P.O.~ NONE RECEIVED
Req ~
Ordered By : BRUCE COR?IIN
Analysi~ Completed :NOV 12 90 Send Reports to:
),abozatory Supezvlso~ :~TEPHEN C, EDE i)COR['IlN & ASSOC.
Special
Instruct:
Chemlab Ref ~: 90~778 Lab Smpl ID: 3 ~atrix: ~';AT~R
Allowable
Parameter Tested Reeult Ur~t~ Method Lilni%S
NI~RA~E"N ND(0.10) mg/1 EP~ ~53.2 ' I0
Sample ROUTItlE
Remarks: SAMPLE COLLECTED BY B.J,C.
1 Tests Performed ' See Special Ins~xuct:ens Above UA=gnaYazlable
ND- None Detected ** See Sample Remarks ~boYe
NA- Not 'Analyzed LT-Less Than. G~G~ea~er Than