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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 32t Municipality of Anchorage page 1 of 3'-.' DEPARTMENT OF HEALTH AND HUMAN SERVICES 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, swA 70 3 0 3 PID Number. 01.113521 tuff` Larry Partusch Wastewater System:.* New <? Upgrade Aadr.:ti Ancchorage, AK liff 995021 ABSORPTION FIELD 344-5 6 7 8ITh r e e M Da p Trench G Shallow Troneo Q Sod 0 Mound Q Otter LEGAL DESCRIPTION SadPA#nlF 1 Tot/GO "f 6'°"°""'�°` ,2 -ape/ Ft. t.ue3 2 310=4 SubdNision: Sand Lake.No. 2 own m Pipe bown =aeiginal graft 7 Gravei d"d benwn pipe Ft g To`nslux pu+4r seesiorr Ru added above arigaW grade Gavei bngde 1 R. 30 WELL' ❑ New C3 Upgrade" GravNvwdit 4 Numbarotunee D oDom=. = pt. 1 - cLumficaoon (Pnvan. A.e.c): Toni oeam: cape TO: Tatn abovotion area: P 4W "Ou"tat PWSID No: 218539 Ps 90.9t.IASTM034 F810 ' Oramr Dam Ohflew Stabo Warar tleeb utm w . oat i um"= R rwaPump Setae cam HagaubMGfow= TANK GPiy Pt Pt SEPARATION DISTANCES M Sepde Q Holding G S.T.EP. To seam Aaeormm utt r- I . mmmdacaww. GaearY In gallons FMM Tena rwe swran r.+ S~Uu Anch .. Tank 11000 woo >100' >100' N/A N/A >10' mawlst NumowofCompannmmm sum >100' >100' N/A N/A 0001 LIFT STATION - N/A water Lot > 5 ' >10' N / A N / A >10' St:e m 4alu Manuhabrne One Foundation >51 >10' N / A N / A N / A "Pump on' lamed aL 'Pump oft la+ral ae . til;" waw aurin st . I curtain None on of Pump 6Up 3 MOM Eleeaiea! irrapeeumrs Perfarmed W.. Drain Remarks: BENCH MARK Location am oescriod= First Finished Floor Acwmed Eievanan 100 J. ENGIN SEAL OF A4 X-A 49 TH Inspections performed by. man ural a Dates: 1St? Q4a497 7...... . 2n / ? ttd //� ; MICHAEL E. ANDERSON , .s`g Department of Health and Human Services approval Ep . 4381-E ,. �s Reviewed and approved by / I Date: �N ' Z -ars m... sie+i rrow a Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LT 32, BLK 4 Sand Lake S/D, No. 2 PID No.: 01 11 3521 G C C LC 150' Well Radius See Waiver IV U F- a I cn v I_- > v � _ I + -9 13.0• cn N N N E ; U U2 boli 1,000 gal.i -1 septic to c 135.003 66.0• 3 BR Hse. o .. N N GRAVEL DRNE 0 LO 76.0' SPI Septic Pum. p, compartment 1 -- ------ PLAN AS–BLT —�— ------ Sp2 . 2 _ C Clean Out MT Monitor Tube 1 n o 201 .mom OF A4 4 ow ,Oft . — s � - - --- - - - - ---- - -- --- -- - -- --- M CHAEL E. ANJE9SON . - - - - - - - - --- — -- — - - - ----- - - . ��: 4331-E Permit No. - SW970303 Page 3 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 le Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report s - 0 - --- — -- — --- --- - -- ^0 -- -- r5c,,' geotextile fabric ---- --- -- - -- ---- ='2'- - -\ — - ELEVATION AS -BLT septic _ ock_ 1 0" — — - -- — - - - Ado, - - �. CHAELLMIDEM13014 g-. ----------- 4381-E-- ----- -- ------- ------------------- 1-1 W It < L- I ( MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970303 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:PARTUSCH LARRY OWNER ADDRESS:8308 SEACLIFF STREET ANCHORAGE, ALASKA 99502 PARCEL ID:01113521 LEGAL DESCRIPTION: SAND LAKE #2 BLK 4 LT 32 LOT SIZE: 6750 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: k c� - 9 -T_� I 1 ljctrr, PAGE 1 OF 1 DATE ISSUED: 9/09/97 EXPIRATION DATE: 9/09/98 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 (18AAC80). 3. THE ENGINEER 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: RECEIVED BY: m4aL.4.ct ElNL'4c"_n DATE: C?ltl A� ISSUED BY: ' C DATE: _ 9 9 s August 19, 1997 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 32, Block 4, Sand Lake Subdivision No. 2 Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: We hereby apply for a permit to install a new septic system on Lot 32, Block 4, Sand Lake Subdivision No. 2. The attached site plan and backup documentation identify the location, size and components of the new septic system proposed to serve the bedroom home to be constructed on the lot. The lots in this subdivision are very narrow and little area exists for the systems. The lot will be served by a Class C Water System with the well located as shown on the Area Map. ADEC has issued a waiver of the normal protective radius from 150' to 100' to the well. The system also falls within the 150' radius of the Class C Well to the North. A waiver has been issued by ADEC allowing this encorachment. A copy of the waivers and the certificate to construct the Class C Well are attached f o r your review. The testhole placed in the area of the proposed absorption trench revealed well graded sands with a percolation rate of less than 1 minute per inch. No groundwater was noted during excavation nor during the ensuing monitoring period. We are therefore proposing placement of a 20' long by 10' effective depth deep absorption trench for disposal of septic effluent. The material encountered in the test hole is a well graded sand with a much larger than 51% component passing the No. 4 Sieve. A sand liner is therefore unnecessary in this case. A study of wells in the area indicates a low level of nitrate content in the water. The ground surface of the lot slopes from west to east at a grade ranging from 1% to 4%. The surface of the ground in the area of the new trench is fairly flat. No conflicts were noted between the new trench and any wells Lot 32, Block 4, Sand Lake No. 2 August 19, 1997 Page Two in the area with the protective radii as modified by ADEC. If the system is constructed as designed the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the area. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. m 1 Sincerely, t 3 - Michael E. Anderson, P.E. Attachments \ 1 � 1 r c 0 1 I EXISTING BUILE / { 4 e /y J U 'orf rTi / 177 / a a/o / � ROPO N ! (I WVVPOtF - -1 _ tL Q r Ul / L, W a II I I .ANCHOR tip 1J I W •, WALL SIDEWALK / i EXISTING E 309 I LOT 22 LOT 31 LOT 21 W Z V �N \ I/ALTERNATE. SITE W H e � x 1 - TH NO. 1 o i I THREE BEDROOM HOME SITE PLAN SCALE 1" = 20' SEACLIFF STREET LOT 20 150' PROTECTIVE RADIUS SEE WAIVER LOT 33 MONITOR TUBE 0 zo' Eel IN 20' LONG X 10' EFFECTIVE DEPTH .ABSORPTION TRENCH 1,000 GALLON SEPTIC TANK FOUNDATION CLEANOUT THREE BEDROOM HOME SYSTEM PLAN NO SCALE LOT 32, BLOCK 4, SAND LAKE SUBDIVISION N0. 2 DESIGN FACTORS: Three Bedroom Home Perc. Rate: LT 1 Min./Inch Application Rate: 1.2 GPD/SF SYSTEM REQUIREMENTS: Deep Trench. System 1,000 Gallon Septic Tank 10' Drainfield Rock 3 Bedrooms X 150 GPD / 1.2 GPD/SF = 375 SF of Absorption Area 375 SF/20 SF/LF (Absorption Area) _ 18.75 LF Trench Length Therefore: Construct a Deep Absorption Trench With One Lateral 20' in Length with 10' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed at 3.5' Below the Original Ground Surface. NOTE: r, �0 i /�aTuruc. _. $Au LLL r -0a Gr7-Gxrr cE Faarvc. 'bma,aFtGW ROW,- TYPICAL oup. TYPICAL DEEP TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 3' of Cover over Septic System. rr s ` 4 Municipality of Anchorage _` DEPARTMENT OF HEALTH 8t HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Spiny /ell Homes DATE PERFORMED: O/ t�� LEGAL DESCRIPTION: �— 3 Z T Township, Range, Section: DEPTH �•� San C_ -� StJ ,p� . SLOPE - - - - A4o. z1 17 1 - Depth to Water 2- 9 3- 9;53;57v 4- 467 13. 3 , Z�;, o 6- 7 o• _ o 8- z 9- • a 10- 1011 11- 12- 1213 13 14 15 16 .a. 17 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? nein to wstar mer Aw mm=q? V,/ I gw- oa, $ / 3 ■■■■©R■■■■ Net Time Depth to Water Net Drop . �e��aae�ee>•eee�eaaeaeee��t� . O to 9;53;57v .'75 ReadingDate Gross Time Net Time Depth to Water Net Drop I) . O to 9;53;57v .'75 13. 3 , Z�;, o i -5 I `� 20 � 1 d PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER l� TEST RUN BETWEEN FT AND LD FT COMMENTS Testhole presoaked prior to fiPat MatPri a l annrnintarcr7 in fc--; f ln1 p well graded sand. More than 51% of material vasses No 4 Sieve. PERFORMED BY: 1 RTIFY THAT T IISS TPT�7WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE �rl ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 32, BLOCK 4, SAND LAKE SUBDIVISION NO. 2 GENERAL: 1. The scope of this project includes the procurement and installation of a new 1,000 gallon septic tank. It also includes the construction of a new 20' long by 10' effective depth deep absorption trench. The distribution pipe in the trench to be placed 3.5' below the existing ground surface. Due to the small size of the lot it is imperative that a I I separation distances from existing and proposed wells be carefully measured prior to construction. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,000 gallon septic tank must be procured from an approved source and installed at the location shown on the Site Plan. Lot 32, Block 4, Sand Lake No. 2 August 19, 1997 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Lot 32, Block 4, Sand Lake No. 2 August 19, 1997 Page Three 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 32, Block 4, Sand Lake No. 2 August 19, 1997 Page Four 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. 17 TONYKNOWLES, GOVERNOR ! oou J�t 7 ii J � DEPT. OF ENVIRONMENTAL CONSERVATION % ANCHORAGE/WESTERN PUBLIC SERVICE OFFICE 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 (907) 269-7505 July 23, 1997 Mr. Michael E. Anderson, P.E. Anderson Engineering P.O. Box 240773 Anchorage, AK 99524 RE: Lots 21, 22, 31, 32 Block 4 Sand Lake Subdivision No.2; Request For Waiver of Horizontal Separation Distance, Class "C" Well, and Stormwater Plan Review. AWPSA Project Nos. 9721 -WV -174-050, 9721 -DW -174-139, and 9721 -WW -133-331. Dear Mr. Anderson: This letter is in reference to the materials received in this office June 20, and 23, 1997, regarding a stormwater plan review, and a waiver request for a lesser horizontal separation distance between a proposed class "C" source well and supporting on-site wastewater disposal systems to serve the above referenced lots. The Department has completed its review of the submitted materials which included a cover letter, site plan, surrounding soils logs, surrounding well logs and a history of water quality sampling in this area. Based upon a review of the submitted information the Department has the following comments concerning approval or nonobjection of this project: Stormwater Plan Review: From the information submitted a limited amount of fill material was to be removed for development of the above referenced lots. A verbal nonobjection was given to Mr. Randy Ross with the Municipality of Anchorage, Department of Public Works Project Management and Engineering to issue the fill permit. This nonobjection was based upon a review of the completed ADEC stormwater pollution prevention and plan review checklist, and profiles of the developed lots which indicated appropriate best management practices for the treatment and management of stormwater runoff. Horizontal Separation Waivers: After reviewing the submitted information it appears that the minimum separation distances proposed between the new class "C" well and supporting wastewater disposal systems should present minimal threat of contamination. However, the density of surrounding on-site Approval to Construct section verifying this Department's approval. This approval does not imply the granting of additional authorizations nor does it obligate any other state, federal, or local regulatory agency to grant required authorizations. Thank you for your cooperation with this Department. If there are any further questions regarding the above, please do not hesitate to call. Sincerely, ,�W -4-- Michael Lu, E.I.T. Environmental Engineer MLU/ph g:NwdoVnlukHoW.ltr attachment cc: Randy Ross, MOA/DPW/Project Management & Engineering STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT Plans for the construction or modification of Lois 210221 31, 32 $X Sand Lake ,Su b4i �, dI2 9721-Pw- i?Y- aq public water system located in Qnc t6v4Ag0 Alaska, submitted in accordance with 18 AAC 80.100 by A%Aet,o_%% y_wty1rc 1r� have been reviewed and are Q approved. ❑ conditionally approved (see attached conditions). B��Lj � �✓ii-paww.t ( r reiwep64 TITLE r J..._. DA/E If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by Date C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY TITLE 18-0407 (Rev. 11183) DATE DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEERIMUNI-BOROUGH (Complete Section C) 4. GOLDENROD - MUNI -BOROUGH (Complete Section A) 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. # 01 1 1 3521 HAA # 1. GENERAL INFORMATION Complete legal description T.K~f: ~2,. Rlnek 4; T.ak~ .~,hrtivi.qi~n Nh. 2 Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Agent Address Spin~ll ~nm~ Day phone 344-567R 9210 Vanguard Drive Anchorage, AK 99507 Day phone Day phone · Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well xxx Public water NOTE: 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 Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 (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. Ifurtherverifythatbased 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's signature Date 3/22/98 DHHS SIGNATURE Approved for ~-~¢.~'~- Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments ''5- By: 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. 72~325 (Rev. 1/91) Back MOA Municipality of Anchorage ~'~ DEPARTMENT OF HEALTH & HUMAN SERVICESR ~' {~ E I V E Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 34~¢{7~4~ 1998 Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human 8err/ce8 Legal Description: Lot A. WELL DATA Well type C Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 Date of sample: '~/1 2/9R B. SEPTIC/HOLDING TANK DATA Date installed 10 / 8 / 97 Foundation cleanout (Y/N) Date of Pumping New C. ABSORPTION FIELD DATA Date installed I 0 / R / 9 ? Length 3 0 ' Width 32, Block 4, Sand Lake #2 ParcelI.D.: 01113521 If A, B, or C, attach ADEC letter. ADEC water system number 21 8 5 3 9 Date completed Cased to FROM WELL LOG g.p.m. Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Nitrate Non De~-P_c.t Other bacteria 0 Collected by: Alan Harala Tank size 1 , 0 0 0 Number of Com 3artments 2 Cleanouts (Y/N).__ Y Depression (Y/N) N High water alarm (Y/N) N Pumper Construction g.p.m. Effective absorption area 540 SF Monitoring Tube present (Y/N) Y Date of adequacy test ew n t Results (Pass/Fail) Pass Fluid depth in absorption field before test (in.); Immediately after Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* System type Deep Trench Total depth 1 6 ' __ Depression over field (Y/N) N For 3 bedrooms __ gal. water added (in.): Absorption rate = If yes, give date g.p.d. Soil rating (g.p.d./ft2 or ft2/bdrm) 1 . 2 4 ' Gravel thickness below p~pe 9 ' Y D. LIFT STATION - Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES F. Size in gallons "Pump on" level at* *Datum - Public Water On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station None on Lot "Pump off" level at* are SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation > 5 ' Property line > 5 ' Water main/service line > 10 ' Surface wateddrainage > 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line > 10 ' Building foundation > 10 ' System Absorption field > 5 ' Wells on adjacent lots > 100 ' Water main/service line Surface water > 100 ' Curtain drain None on Lot ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that. in conformance with MOA HAA guidelines in effect on this date. ,~,~'~ Driveway, parking/vehicle storage area > ,50 ' Wells on adjacent lots > 100 ' Signature Engineer's Name Michael E...nd ...... , P.E. Date 3/23/98 HAA Fee $ ~C"x'% Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number