HomeMy WebLinkAboutMARYLAND LT 1Mar'yland
Lot !
#015-082-24
· Municipality of Anchorage Page /' of
DEPARTMENT OF HEALTH AND HUMAN SERVI'CES
ENVIRONMENTAL SERVICES DIVISION
P.O. BOX 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report_~. .
Permit Number: ~1 ~",~t~L¢~\'-~Lr~ PID Number: /E~ ~/-"~-("~?~.-~'b\
Name: ~/~ ~/~ ~X~ Wastewater System: ~ew ~ 'Upgrade
Address: ~ 7~/ ~¢~Y/~ e~,~ ~. ABSORPTION FIELD
Phone: ~ "~¢~/C)~ N°.°fBedr°°ms:
_~ ~eepTrench ~ Shallow Trench ~ Bed ~ Mound ~ Othe~
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION ~ ~ ~/sq.~.
Lot: ~ Block:~,~'~ -¢~~ubdiv~i°n: Depth to pipe bottom from~ original,~ grade: Ft.Gravel depth beneath p~pe~ Ft.
Township: Range: Section: Fill added above origin~l,~grade: Gravel length:
Ft. '// Ft.
Number of lines: Distance between lines:
WELL: ~ew ~ Upgrade Gravel width: ~ Ft. / '~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: ~--~// ~ ~pe material: ~'~
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Yield: Pump Set at: ~ ~ Casing Height Above Ground:
~ ~ I ~'~.J /'~ ~'. TANK
SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P.
From Tank Field Station Tank Sewer Lines .~ ~ ~ ~
Well- /~Z~/ /~/~'~ ~ ~ ~ ~ Material: ~ Number of Compartments:~
Su~aCewater ~ ~ ~ ~ ~ LIFT STATION
Line
Foundation ~ ~ -~ ~/~ ~ .-- ~'wump on" level at:~ff' level at: High water alarm at:
Curtain ~ ~ ~.~ ~ ~ .~ ~ump~ Electricallnspectionspedormedby:
Dra~n
BENCH MARK
Remarks: ~,~>~ ~,~ ~ ~
I Assumed /,~¢~ ~,
Elevation;
ENGINEER'S SEAL
': :' "' ,'%
Inspections performed by: ' '*~ ¢'~ ~¢¢Dates: 1st ¢~/¢'~ ¢ ;' ' ": ''~'ru
Department of Heal~ and Human Services approval ~"', .,,"'~ ......................
Reviewed and approved by' Date' ~- /~ -¢7 ~'- :'~':~;:,,,:.- , : ..... ..
72-013 (Rev. 9/91) MOA 25
Permit No.
Poge
Municipolity of Anchoroge
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O, Box 196650~chorage, Alosko 99519-6650,. Telephone 543-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legol Description:
Lot 1, MarCand Subdivision
.0'1[ O~ ,§'Or S]I~JVA Hid3(] 1VI01
~ 01 ,~ S31;~¥A
,0'L
72-013 A (2/91) MOA 25
Permit No,
Page ~' of
Municipalit7 of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.0, Box 196650 · Anchorege, Alosko 99519-6650° Telephone 345-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Lot 1, Maryland Subdivision
PID No.:
72-013 A (2/91) MOA 25
/
/
/
DOC Co. dba
SULLIVAN WATER WELLS
*P.O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 688-2759
ADDRESS
LEGAL DESCRIPTION ~'~?-
DATE. Started Ended
PERMIT NUMBER
DEPTH OF.-.WELL / 0 /
· '~? 5'/0' ' .
STATIC LEVEL OF WATER F'r.
DRAW.DOWN FT.
GALS. PER HR ~ :'~ :3
K~ND OF CASING ~//
KIND OF FORMATION:
From ~ Ft. to '~ Ft.
From :~ Ft. to <~ Ft.
From ~r Ft. to ~ Ft.
From t,~' Ft. to .~<~' Ft.
From 3~'""Ft. to ~ ~ Et
From~Ft. to ~ Ft.
~ ~ ~t.
From. ~ Ft. to ]0
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
From~Ft. to__Ft.
From~Ft. to Ft._
From Ft. to Ft
From
From
From
From.
· From
Ft. to Ft.
Ft. to Ft
Ft. tb Ft.
Ft. to ' Ft~
Ft. to Ft
Ft. to__Ft
Ft. to Ft,
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,
From__.Ft. to__Ft.
From Ft. to Ft.
From Ft. to__.Ft.
,RECEIVED
.... ' 6 1996
I~{UV
Dept. Health & Human Services
MISCL. iNFORMATION:
DRILLER'S ~/~ME
II/I,O
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960170
DESIGN ENGINEER:DOUGLAS T. KENLEY, P.E.
OWNER NAME:MIKE WEITZ
OWNER ADDRESS:8701 JEWEL TERRACE CIRCLE
ANCHORAGE, AK. 99502
DATE ISSUED: 7/05/96
EXPIRATION DATE: 7/05/97
PARCEL ID:01508224
LEGAL DESCRIPTION:
MARYLAND LT 1
LOT SIZE: 54649 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0) .
~-, THE EN~GI~EER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR-'TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
D
Douglas T. Kenley, PE HCO1 Box 6034, Palmer, dlaska 99645 (907} 746-1073
June 21 1996
Municipality of Anchorage
Health & Human Services
On-site Services
Re:
Three-bedroom septic system design submittal
Lot 1 Maryland Subdivision, Anchorage, AK
Owner: Mr. Mike Weitz
On June 8, 1996, the above referenced 54,649 s.f. property was inspected in conjunction with soil
percolation tests being performed for application and approval to install an on-site wastewater disposal
system to support a three-bedroom residence.
The site is located to the South of Abbott Road at the northwest intersection of Homestead Trail and
Jollipan Court. The lot is flat with no significant changes in elevation. The site is moderately trees with
spruce and birch.
On-site observations and physical survey showed that there are no water wells or private wastewater
disposal systems within a 100-foot radius of the proposed system. No surface water was observed at the
time of the inspection and it appears that there would be no potential for contamination of adjacent water
wells or streams.
The proposed septic system has been designed to minimize impacts to adjacent properties. There is a
house located on the property to the no~th, on Lot 14 of the Nettleton Acres Subdivision and a house on a
200,454 s.f. lot to the South, both of which are on well and septic systems. Other adjacent and nearby
properties remain undeveloped. The proposed primary and replacement wastewater disposal sites do not
encroach upon any protective well radii nor will they preclude development of any other parcels. The
replacement site was located within the same test hole radius as the primary system.
A percolation test was performed at the site to assess the adequacy of the subsurface soils to
accommodate both the primary and secondary wastewater disposal systems. The result of this test is
attached to this report. The test site had adequate percolation to support the proposed three-bedroom
system. Subsurface soils were found to be gravel with sand overlain by 1.50-feet of surface organics.
The percolation rate for the test hole site was measured to be 13.7 minutes per inch.
If there should be any questions concerning this application please call me at 746-1073.
Sincerely,
Douglas T. Kelley, PE~
CE #8176
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~'~*~"~--~""
LEGAL DESCRIPTION:~/' ~'.,Z~'~*'~'~.'~'~'[..'2,~:~ ~ Township, Range, Section:
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
I
S
L
IF YES, AT WHAT ~ O
DEPTH? p
E
Depth Io Water After
MonitorinD? /'-'/'~'*~'"'~" Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
TEST RUN BETWEEN __
(minutes/inch) PERC HOLE DIAMETER
FT^ND FT
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFF T ON THIS DATE. ATE:
72-008 (Rev. 4/85}
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.0. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.a k.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 01~-082-24
1. GENERAL INFORMATION
· Complete legal description
HAA# ///k~lQ~ 7 7
Expiration Date:
MaryLand Lot 1
Location (site address or directions) 6741 Jollipan, Anchorage AK.
Cun'ent Property owner(s) Mike & Debble Weitz
Mailing address
Lending agency
Mailing address
Real Estate Agent Shaylene Ernisse
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: ;3
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class Well []
Public Water System []
I/~ /.2 - o2_
Day phone 346-4790
Day phone
Day phone ~ 7 3- 7 31 1
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system, DSD also issues HAAs upon request to homeowners. Certificates of Health
Authority Approval are valid far 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 procedures outlined in the Health Authority 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 vedfy 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 KND ENGINEERING
Phone (907) 696-6111
Address
Engineer s Printed Name
5. DSD SIGNATURE
f/' Approved for
Disapproved.
20441 Ptarmigan Blvd., Eagle River, AK 99577
1-
Kenneth M. Duffus Date '7/7~/"'/c-~o
,., ... t,
¢ ~ ·
~ bedrooms. ~1 ~'~'/;? ......... ':', ~"';
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer s Report
Other
Odginal Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety D~v]sion
On-Site Water & Wastewater Program
4'/'00 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-665O
www.ci.anchorege.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Maryland Lot 1
A. WELl, DATA
Well type_~ If A, B, or C provide PWSID #
Date completed 7122102 Sanitary seal (Y/N)y
Total depth 101 It. Cased to 40+ ft.
FROM WELL LOG
Date of test 8 1 9 6
Static water level 4 7 f.
Well production 7 g.p.m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. Nitrate 0.~-~0 mg./I.
Arsenic: ,q~k mg./I. Date of sample: 7122/02
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material ~ Date installed 813 011 9 g 6
Tank size 1000 gal
Foundation cleanout (Y/N) y
Date of pumping 7~22~02
Parcel ID: 016-082-24
Well Log (Y/N) Y
Wires property protected (Y/N) y
Casing height (above ground) 2'+
AT INSPECTION
7/22102
38 ft.
5.4 2 g.p.m.
Other bacteria O colonies/100 mi.
Collected by: KND Engineering
Number of Compartments2 Cleanouts (Y/N) Y
. Depression over tank (Y/N) r,I High water alarm (Y/N)
Pumper MCDONALD
C. ABSORPTION FIELD DATA
Date installed 8/30,~0~¢;6 Soil rating
Length 41 ft. Width ~l
(g.p.d./ff2 or ft2/bclrm) 0.8
fi. Gravel below pipe ?
System type DEEP TRENCH
Total depth 10.3 fl. Eft. absorption area 574 ~ Monitoring tube Y
Date of adequacy test 7/22/02 Results (Pass/Fail) PASS For ~
Fluid depth in absorption field before test NONE in. Water added450 gal.
Elapsed Time: 15 min. Final fluid depth NONE in. Absorption rate
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Depression over field N
_ bedrooms
New depth NONE in.
>= 450+ g.p.d.
N If yes, give data
O. UFT STATION
Date installed
Pump on level at in.
Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main
Property line 10'+
Water Service line 10'+
Curtain drain 50'+
F. COMMENTS
Size in gallons
Pump off level at
Cycles tested
Manhole/Access (Y/N)
in. High water alarm level at
Meets alarm & circuit requirements?.
On adjacent lots 1 0 0' +
On adjacent lots 1 0 0' +
Public sewer manhole/cleanout 1 0 0' +
Sewer/septic service line 25'+ Holding tank I 0 0' +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line [; ' ~- Absorption field
Water main 10'+ Water service line 1 0 ' + Surface water
Wells on adjacent Iot~ 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 1 0 ' + Water main I 0 ' +
Surface water 100'+
Wells on adjacent lots I 0 0 ' +
+
100'+
in.
Drtveway. paddng/vehids storage 2 6 ' +
G. ENGINEER S CERTIFICATION
m~ew of Mu~ci~l m~s that ~e a~m s~tems am in
=n~ance ~ MOA ~ guidelines in eftsoon ~,s date.
Engineers ~nted Name Kenneth M. Duffus
HAA Fee $ ~'7~' "'
Date of Payment
Receipt Number
(Rev. '~2/Ol)
Waiver Fee $
Date of Payment
Receipt Number
CT&E Environmental Services Inc.
CT&E Ref.#
Client Name
Project NameHt
Client Sample ID
Matrix
Ordered By
PWSID
Sample Remarks:
1024519001
KND Engineering
Mar/land Lot I
Maryland Lot I
Drinking Water
0
All Dates/Times ark Alaska Standard Time
Printed Date/Time 07/26/2002 13:29
Collected Date/Time 07/22/2002 14:45
Received DategFIme 07/22/2002 15:45
~&te~s Depa~t~eat
Ni~ate-N
0.200 U
rQL
Units Me.od
Allowable Prep Analysis
L/mits Date Date Init
0.200 mg/L EPA 300.0 (<l 0) 07/22/02 JDT
llic~obiolo!~/ Laborato~-y
Total Coliform
col/100mL SMI$ 9222B
(<1) 07/22/02 Ir. Ap
N ?cJ"4 1
s
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.
HAA #
NOV 0 6 1996
R CEI ED
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Day phone
e
Unless otherwise requested, HAA will be held'for pickup.
NUMBER OF BEDROOMS: .~
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community'on-site
NOTE:
Public sewer
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
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 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 inspection.
Name of Firm
Address
Engineer's signature
DHHS SIGNATURE
'~'. Approved for T-~'J~-~~-~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
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~I
Legal Description:
DEPARTMENT OF HEALTH & HUMAN SERVIC
Environmental Services Division
825 L Street, Room 502 * Anchorage, Alaska 99501 * (907)
Health Authority Approval Checklist
~o~- / ,'~-'"~.~'/~yz-z.~x.~',~:~ Parcel I.D.:
A. WELL DATA
Well type
Log present (Y/N) ~/'
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date
completed
Cased to / dj / ,,~/ Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform ~
g.p.m.
AT INSPECTION
Nitrate ~/~' Other bacteria
g.p.m.
Date of sample:
B. SEPTIC/HOLDING TANK DATA
installed/~'~'~,,~/¢~Tank size /~) Number of Compartments
Date
Foundation cieanout (Y/N) ~/" Depression (Y/N)
Collected by:
__ Cleanouts (Y/N) ~'
High water alarm (Y/N) ~,~
Date of Pumping '~ Pumper
C. ABSORPTION FIELD DATA
Date installed ,'~¢~ /~,/¢¢,g; Soil rating (g.p.d./fF or fF/bdrm) ~' ¢
Length ~///-T/ Width ~-~ '~'~/' Gravel thickness below pipe
Effective absorption area ~ Monitoring Tube present (Y/N) ,Y
Date of adequacy test ,~'~-z4.~ ~'~',~'~'~?'Results (Pass/Fail) For
Fluid depth in absorption field before test (in.);
Fluid dept~~ ~~~~I~1~
PeroxFd'~-atment (past 12 months) (Y/N) If yes, give date
System type '~-~,,~"~'~'
~-,,z-~, Total depth
__ Depression over field (Y/N)
Absorption rate = g.p.d.
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N)
High water alarm level at*
Cye~
"Pump on" level at* /L,~/./~-
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
~'A-'?
Lift station
/O
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ¢ ,z-.,- Property line ~;~-/c_~ Absorption field
Water main/service line ~4~'~/z'v~Surface wateddrainage ,'c/,:'x~'~
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line
Surface water
Curtain drain
Building foundation ,-'~,-¢-/'":-/- Water main/service line ~ ¢ "~'-'~"
Driveway, parking/vehicle storage area ,'~'~
,..~.,...,,o~4.~ ~ ~¢'x'/.¢;r' Wells on adjacentlots
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records
in conforman, ce with MOA HAA guidelines in effect on this date. ,_,~,
Signature '_~ '¢.--'~'
Engineer's Name
Date [I · ;~-. ~
HAAFee $ ~--¢~' ~
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev, 3/96)*
CT&E ReL#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSJD
Sample Remarks;
17:01 CTgE ESI ANCHORAGE * 987 248 5774
CT&E Environmental Services Inc,
965559001
Douglas Kenlcy P.E,
L1 Maryland S/D
Water
Drinking Wate~
Client PO#
Printed Date/Time 11/04/96 16:16
Collected Date/Thne 10/30/96 10:30
Received Date/Time 10/30/96 11:00
Technical Director: Stephen C. Ede
Released By
Perameter
N)tre~e-N
Total Coliform
Ree~[ts
0.100 U
o
PeL Units Method
ALLo~abte Prep
LJndts Date
0.100 mg/k SH18 4500-NOgF 10 max
0 col/lOOmL $M18 9222B
Analysis
Date ln{t
ll/01/g6 EMB
10/30/96 TAV