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HomeMy WebLinkAboutINDIAN VALLEY ALASKA BLK 1 LT 9Indian Valley Alaska Block 1 Lot 9 #090-031-21 GREASER ANCHORAGE AREA BORLrJGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME " MAILING ADDRESS �� 43CA F�% LOCATION LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE FROM WELL Pp° C MANUFACTURER /� ' - MATERIAL INSIDE LENGTH INSIDE WIDTH 11 A /) NUMBER OF ��/ COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY/0C)J GALLONS. TILE DRAIN FIELD:r(�t DISTANCE FROM WELL TOTAL LENGTH FOUNDATION NEAREST LOT LINE OF LINES 1/44- NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH C'7IN TOTAL EFFECTIVE ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE (c IN ABOVE TILE IN WELL: TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE , TANK SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED 8Y• DIAGRAM OF SYSTEM SEWER LINE DEPTH PIPE MATERIAL J'-'•"- 3 t c. L. LOT SLOPE: REMARKS• Form EQ -032 DATEf'Cl • »' APPROVED G.A.A.B. ill": F" IL__ 1 '_B ' 131F-7 !==H IN IQ N N d H fR. q t! Gi �= DEPARTMENT OF HEFILTH AND ENVIRONMENTAL PROTECTION 251' E. TUDOR RD... AN•dCHCRFIGE. Ak::. 99507' 50 ' Co276-2221 --- 7L TOE: E.= F: rF' E : (F r 6 PERMIT NO. < 76843 ) APPLICANT CHARLES OLANDER LOCATION CSC:EANV1 E.W RD LEGAL. L9 B1 INDIAN VALLEY :SLIBD SRA BOX 8750 A:c9� Q511, LOT SIZE 65340 SQUARE ILIARE FEET TYPE OF SOIL AE:0RFT 1 ON SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = __ SOIL RATING (SQ FT/E:R)•= 85 THE REQI•.IIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E Arlt''"'E"ll =- :Ld-..l 9.__E P,9d.-o IFI=.— 22 H=am9 ."F EEIL_ il:.:AF fl-"-`F-IF_-N THE LENGTH DIMENSION I THE: LENGTH (IN FEET) OF THE: TRENCH OR DI='A I NF I EL.D. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE TANC:E E:E:TWEEN THE. SURFACE OF .THE (ROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GF:A'v'E:L BETWEEN THE OI_ITFAI_i.... P1PE. AND THE BOTTOM OF THE EXCAVATION (7:N'i FEET). - -- - - _ �__ �=_ d��� A_k :N: R° �' I':_� �. �•" _.�._ � w-=� B _ ih--e 9"-"� 8 =-" � "' __.= _. _. d_H d :H u - -H H_.FSHRI _A._ H...._w ); -: _;, 1-140 Y4 1_I a:::2 :-e Y PA " E n: H IF1 cH H "fi n : ' H:-:° ii i:: F =. IL=_ o `n BACKFILLING OF ANY SYSTEM WITHOUT FINFIL.. INSPECTION AND APPRO'VAL.. BY THIS DEPARTMENT WILL F -::E SUBjECT TO PROSECUTION!. t'1:tNII''IUt'i DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE I::1SPOSAL. SYSTEM I:; 100 FEET FOR A PRIVATE WEI_.I_. OR 200 FEET FOR FI PUBLIC WELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. a " Fn L_ 1 E: a F 1:_1 F_H_H �"-,� `-e° A--� @=-= d --w """A 1 °: : p..W I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FIF: ON -;ITE SEWERS AND WELLSS SET FORTH E:Y THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE c::ODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT I. F THE: RESIDENCE IS REMODELED TO INCLUDE MORE. THAN3 BEDROOMa SIGNED: APPLICANT CHARLES OLANDER ISSUED BY /241/2'.".21 __DATE"_. w GA YEH NTU REQ: CONSULTING GEOLOGIST BOX 476-M, STAR ROUTE A • ANCHORAGE, ALASKA 99507 • PHONE 344-7071 Date 1U/tfi �''' SOILS LOG �J Performed for iut�S \ °VW" (C \ \ie) Legal Description �c,4-i ` Depth (feet) Soil Descriation --2- -4- G -_6- o 4' ck, Total Depth ` 4- feet in (7U) Was groundwater encountered °\N---- ? What depth Depth to bedrock 7�C) I3ow determined 'vr Lu.ej4 Respectfull submitted, (I)i 10....ti Gary F. Player Consulting Geologist Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 090-031-21 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) KEITH JONES Day phone 242-6872 Mailing address Real Estate Agent Expiration Date: 1 1 "l ( 3 INDIAN VALLEY S$bT BLOCK 1, LOT 9 220 BORETIDE ROAD, INDIAN, AK, 99540 2. TYPE OF DWELLING: • n 220 BORETIDE ROAD, INDIAN, AK, 99540 Single Family (w/wo ADU) Duplex Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well . Individual On-site 1. Individual Water Storage n Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System n Public Sewer ❑ Received by: COSA to be released to the engin€er. unless otherwise requested by the engineer. Date: COSA Fee $ Lig() .10 Date of Payment Receipt Number COSA # giic113 QW13It170 Waivor Fee i 3 60 . cJ Date of Payment 9/111/8 Receipt Number Waiver# oSP(313�1y 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: 111 conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 fife of all wells and septic systems depend on the local soils condition, groundwater revels 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report 15 for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor wolf it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. �� WA ANS Conditional approval forbedrooms, with the following stipulations::1_.Y3vi :21 0 V0 r -C.AR b)t Date 9 l l v ,13 oo600p�4 Off•'• VA Qn _ f fav �rness 7 CE -7953 fop pro fess\on°o O0000�� `QPtk,•{tOF t C6 ii///. `= ON-SITE ��'�, By: Original Certificate Date: - / cj -/ 3 The Mr icip- rty 'An ¶rage Deveiop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatafions 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11/05) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Atoss ka Legal Description: INDIAN VALLEY S/D; BLOCK 1, LOT 9 Parcel ID: 090-031-21 A. WELL DATA *PER TED MOORE, P.E. HAA (10/11/93). **ASSUMED BASED UPON SURROUNDING WELL LOGS. ***COULD NOT REMOVE WELL CAP DURING FLOW TEST. PRODUCTION RATE IS CALCULATED. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed 1976 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth *^'87 ft.Cased to **40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/5/2013 Static water level ft ***UNKNOWN ft Well production g.p.m. ***3.91+ g.p.m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.5bl mg./L. Collected by: Arsenic: tilt) ug./L. Date of sample: 9/5/2013 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed GEG, Ltd. 10/20/1976 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO Date of pumping 9/29/2012 Pumper C. ABSORPTION FIELD DATA Date installed 10/20/1976 Soil rating (g.p.d./ftior(/bdrm) 85 Length 24 ft. Width High water alarm (Y/N) N/A MCDONALDS PUMPING *BELOW EXISTING GRADE 4 ft. System type TRENCH Gravel below pipe 6 ft. Total depth *12.3 ft. Eff. absorption area 288 ft2 Monitoring tube YES Date of adequacy test 9/5/2013 Results (Pass/Fail) PASS Fluid depth in absorption field before test**DRY in. Water added 600 gal. Depression over field NO For 3 bedrooms New depth *DRY in. Elapsed Time: — min. Final fluid depth *DRY in. Absorption rate >= 450+ g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **MONITORING TUBE ONLY EXTENDS 56" INTO 72" EFFECTIVE. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at . wa er alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic tank/lift station on lot Absorption field on lot Public sewer main 100'+ N/A Sewer /septic service line 25'+ On adjacent lots On adjacent lots *1001+ *1001+ Public sewer manhole/cleanout Holding tank N/A N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 51+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line **5'+ Building foundation 101+ Water main N/A Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *DISTANCE TO UNDOCUMENTED SEPTIC SYSTEM ON LOT TO NORTH COULD NOT BE VERIFIED. ONLY ONE STANDPIPE PRESENT. **SEE ATTACHED WAIVER REQUEST. G. ENGINEER'S CERTIFICATION 1 certify that 1 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 Printed1/N me Date 9% , to/'i (Rev. 11105) JEFFREY A. GARNESS v0 VA y �ness CE— 3 .•' Leics 9,i3'•cci;1 'Oro f e ssio�000 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS September 10, 2013 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Lot Line Waiver for Indian Valley S/D; Block 1, Lot 9. To whom it may concern: During the course of our inspections, it was noted that the drainfield is approximately 8' from the south property line. We request that your department issue a 5 -foot lot line waiver from the south property line to the drainfield. I am unaware of any adverse impacts this waiver would have on adjacent w-lls or septic systems. If you have any questions, please contact us at 337- 6179. Thank you fyour assistance. iicer ly, !/ 1 , )'eff`eryJ.}Qi. ess, P.E., M.S. Pres 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 S Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Division On -Site Water and Wastewater Proqram **** VARIANCE/WAIVER REVIEW **** Waiver#: osp131344 COSA#: osc131470 Permit#: PID#: 090-031-21 Legal Description: Indian Valley Alaska B-1 L-9 Engineer: Garness Engineering Group Applicant: Keith Jones Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. M The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. n Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: 11-11-i3 Approved by: Na • =evifirer Rec#: 09707G Amount: $200.00 Date Paid: 9/11/13 **** VARIANCE/WAIVER REVIEW **** sy�W�x�a�b 9189-S1� r �P'' 'taW .yang •'. f o. N, r 04 iO ,mss• d �Nfra�diia 19.4 /rb/Oivr Imo f%/G ' a31Ya P -r,/ :3-VOS 'S3N11 AUC -0N008 SNIHSI18Y1S3 804 80 'S3N11 30N34 d0 NOIiOlai8N00 804 OSf 39 NCO:13H viva MN COWS S33NV1SWfl3a10 ON 83QN0 `iVld NOISIA I08119 03080038 3141 NO UV3ddv .1.014 oa HOIHM SNOIIOI81S38 aO `51NVN3AOO191N3W35V3 ANY 40 3ON31SIX3 314.1. 3N1{4183130 01 83NMO 3141 40 A111181SNO4S3a 3141 51 .1.1 '031VOIGNI SV .1.833X3 .1.91X3 S).N3WHOVOHON3 ON 1VI-LL ONV / :"Y -t d 'o7 )?*2r d'-Ss'i7YX.92 n/!'b/p,t2' 1A183d08d 039183530 SNIM0110d 3Hl03A3Aaf1S 3AVH 1 1VH1• A311833 A8383H 99517-989 ONIX2AlUQS QI1V`I 521VI00SSV 9 GUMS '31V0 SIHI 13S S83NH00 ON -rummy r l/L EIOZ-90-60 yam/ 3••• ' v 8 NI 0 • 0 O� • :.,'o C}• \•I •o0�'Li i^,s:�e`,sp i ".,4410•004 •v • L O� sand • 9Z I»LZ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & 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 I.D. # (°C2\\- C1cC) 1. GENERAL INFORMATION Complete legal description LOT 9, SLK 1 , INDIAM VALLEY HAA# VM9(21-)1n.�1 Location (site address or directions) Ocean vt tw (2 Act oC:^l ye on R) Property owner C NAR L E5 OL ANDER Day phone 243- 203g Mailing address 2901 V11.•1 ?oST AVE ANON. AK 995/7 Lending agency Day phone Mailing address Agent Sal11 N1ck ers-rn Co(crcvefl Address HloT�cdor Cfi Dr1��� �}ncho�x�e /k. 99508 Unless otherwise requested, HAA will be held for pickup. �n(i oan s` $a9ker Day phone S6/ —2 198 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 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 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. 72-025 (Rev. 1/91) Front MOA #21 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 FL >q TOP -T EC EI . SVCS . Phone 3L/S- l35S Address 530 ECHO .ST. /4r' CN , Ak 9g516 Engineer's signature ' — - J. - Date Oct /', /99? 6. DHHS SIGNATURE X Approved for bedrooms. Disapproved. By. g%ke", . .. Y•.4 .•. ..•Y..J....• .. THEODORE E. MOORE • �` "` CE - 3589•,•6 w'` It •• ........ '• PrzerastoIN ;fir t,011 A4 Conditional approval for bedrooms, with the following stipulations: Additional Comments Date li CAUTION 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. 72-025 (Rev. 1/91) Back MOA 421 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ) oT 1, I3Lk 9 INDIAN VA/A.61 Parcel I.D. A. Well Data Well type 1'RI VfjTE If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) N Date completed Driller U,I I< I, Total depth r 87 Cased to 7 4`0 Casing height 17-- Sanitary LSanitary seal (Y/N) i Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION MUNICIPALITY OF ANCHORAGE Date of test 2 4 9 CNVIRONMENTAL SERVICES DIVISION Static water level OCT 1 2 1993 Well flow g.p.m. } - 7 g.p.m. Pump levell > RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ids" To C.O. ; On adjacent lots 7 fly Absorption field on lot 1(S- ' ; On adjacent lots > /°J/ Public sewer main N, A. Public sewer manhole/cleanout N.rl• Sewer service line 2S- Petroleum tank WATER SAMPLE RESULTS: Coliform d cvl / t vo m i Date of sample: 9/214/93 Nitrate D. `l3 mq /-i Other bacteria 0 cc,/ //&or»e_ B. SEPTIC/HOLDING TANK DATA Date installed /a�7 6 Collected by: FL 4 riot' TECH SVCS Tank size /00 0 Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) 7 Depression (Y/N) N High water alarm (Y/N) fN •A. Alarm tested (Y/N) N A. Date of pumping 9 12i41"/ `9 3 Pumper L 5 A- A C S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot IDS FRon C.0 . On adjacent lots 7 I o 0 Foundation SD To property line 2O Absorption field S' Water main/service line /OS Surface water/drainage 7 /o o 72-026 (3193r Front OCUi L u 2Jf n r CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at - "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water - 8s FtVis Date installed /n / 7G Soil rating (GPD/Ft2) 1 - 8 GPD /Ft x System type "t- tZ t= NC H Length 2 L( Width Lf Gravel thickness io Total depth 12 Total absorption area 28 8 Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test I 0 1 I 1 `13 Results (pass/fail) PA SS for Bedrooms 1/2'i Water level in absorption field before test Q After test Peroxide treatment (past 12 months) (Y/N) NINE KraowN SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 115 - If yes, give date N ,A . r r On adjacent lots 71 OD Property line /O r To building foundation 60 To existing or abandoned system on lot N.A On adjacent lots 30 Cutbank Water main/service line 115 Surface water 7 /O0 Driveway, parking/vehicle storage area 60 Curtain drain No Ne o 1350Z ✓C D E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA. guidelines in effect on the date of this inspection, OF y yyt.� t.a°aras°.0v 10• s a a e s .eraraaea6aa as ,aerr 7� 1117:: 1 ea ora • a _ ' 1117°° THEODORE E. MOORE A. Date 07cc /1, - /992 & ` r ; °a CE %- 3589 .L° 4 , y. A 4I 4°°rasa.• .C;('4.A, Waiver Fee $ Signature - Engineer's Name Theoaeor. rtUoV^� HAA Fee$ AGO, od Date of Payment /D-/ Z <13 Receipt Number o2 S 3 / 61 O s 9 9) 72-026 (3/93)' Back Date of Payment Receipt Number NORTHERN: 3330 INDUSTRIAL AVENUF 2505 FAIRBANKS ST. Flattop Technical Services 14350 Echo Street Anchorage AK 99516 Attn: - I.ABORATORIES, INC. FAIRBANKS, ALASKA 99701 907-456-3116 ANCHORAGE, ALASKA 99503 907-277-8378 Report Date: 10/05/93 Date Arrived: 09/25/93 Date Sampled: 09/24/93 Time Sampled: 1200 Collected By: Chris !DL = Method Detection Limit Our Lab #: F128892 * Flag Definitions Location/Project: - B = Below Regulatory Min. Your Sample ID: Lt 9, Blk 1, Indian H =-Above Regulatory Max. Sample Matrix: Water Comments: Date Date Method Parameter Results ^ MDL Prepared Analyzed EPA 353.3 Nitrate -N y%1 0.43 0.05 10/04/93 iv- 4f401140- i Re orted By: amen H.)Johnson Vice=-Rr-esideni