HomeMy WebLinkAboutLOMA ESTATES BLK 3 LT 2*oo,a,o -* bia w a) I Municipality of Anchorage Page I —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. -SW9603y3 PIDNumber: 020-092 Name: Pere!' lt Tc Tohn"rc,) Wastewater System: 19 New p Upgrade A02'lO0 CAinO0 k Ave An ch. hI< i9.srhs ABSORPTION FIELD Phone:No. *Z7/ - 6.53 j of Bedrooms: t? Deep Trench O Shallow Trench O Bed O Mound O Other LEGAL DESCRIPTION Soil Rating: 0. Total Depth from original grade: O GP01S Ft. Ufr • S, .F/ Lot: 2 Block: Subdivision: 3 1-O Depth to pipe bottom from original grade: Gravel depth beneath pipe net 45alafrl /,7 Ft Y.7 I Y.g Ft, Township: Range: Section: Fill added above onginal grade: Gravel length: / - a Ft. " s t S$ F Ft, WELL: 51 New ❑ Upgrade Gravel width: .2S'Numberollinea: 2 Distancebelweenlines: / Ft. Ft. Classification (Private, A.B.Cy Total Depth: Cased To: Total absorption area: Pipe material: F- 8/ o r", Prrvafc /ZZ Ft. 2 Ft, 106'3 so. Ft. 0-30TY .Aron- oaf Driller. AlpInlc Date Drilled: S/26/98 1 Sufic Water Level: 69 Installer. C4xc1ef Date Installed: I 5-//Y /9,9 Ft. n I Yield:Pump S Set.,: Casing Height Above Ground: 3 TANK GPM Ft. Ft. SEPARATION DISTANCES C2 Septic El Holding OS.T.E.P. To S•014 Absorption Lin Holding Pub4icrPrivate Manufacturer. Capacity in gallons: From Tank Field Station Tank Sewer Linn 4n Ch =e 77.f11- 1 /Z5-6 Weir 190' 19/' - - >roo1 Material: Number of Compartments: Waters > rte' > tool - - - LIFT STATION N.A LotSize - - In gallons: Manufacturer. Line 0' /21 - Foundation- "Pump on -level at: "Pump off" level at: High water etarm at: Curtain Pump Make d Model Electrical Inspections performed by: Drain - - - - - Remarks: S SPenn IA - ,tills BENCH MARK leg rr0 ✓ec! p/oJ I 7 . Va r ✓e /AJ�//i� Location and Description: O A4,t m O1T SF c(Fn SE d/iG L(y/n O �Gn of oCo In PI%rler (•p rn lis O� �L•I/�in I tamed Elevation: loo. O In SQ/ IO/ Scc /! MW tori O� «i- Z w/f ,nf <I rf �I/G i ENGINEER'S SEAL A©nWOR%' <•.r OF A( :F.. ��•. •.. •��N,j {E..•• I}4 t .••.G - I 1 n�ln <Am 11 �O.1 O� IUr✓♦ ,f /IGQuin lIDuJC /G fG /10n on lo/( ViorFc �oyle.l��2O�lf'r/' Gz il4Mep� �lar4l / /o /4. oC Surfzr�C 'r,4 Inspections performed by: F/a/%,- T�<�nFcp/ t-aDates:lst s/rY/99 2nd s//Y/99 ................. of .................... . THCOLD%L F. UOORE - Department of Health and Human Services approval .; ci:-3sa� Reviewed and approved by: "* Date: .. ••....... 71-013 (Reis. 11,11) MOA 25 ti4 PERMIT NO: SW980343 PID NO: 020-092-31 I PAGE 2 01-3 •4919 x SDC.".E F. MOORE U - 3569 R loo, m DIVERTER VALVE T L 59' TRENCH SEGMENT T W. 4.7' GRAVEL ALRLSC/RCCF J. 53' TRENCH SEGMENT_/ WITH 4.8' GRAVEL 1250 GALLON SEPTIC TANK 6" BUMP "H %I.o....F..� ,••• "F" "1" LOT 2 BLOCK 3 SWING TIES: FROM: COR. "A" COR. "B" TO: S.T. C.O. "D" 43' 72.5' S.T. C.O."E" 48' 80.5' DBL. C.O. "F" 52.5' 86.5' VALVE "G" 54.5' 89' TR. C.O."H" 48' 107.5' TR. M.T. "1" 51.5' 102' TR. C.O. "J" 77.5' 92 - 2'TR.C.O."K" TR. C.O. "K" 63' 117.5' TR. M.T. "L" 82.5' 110.5' TR. C.O. "M" 89' 109' _ F BEDROOM HOUSE O�2 .�4 ` �TBM R` •4919 x SDC.".E F. MOORE U - 3569 R loo, m DIVERTER VALVE T L 59' TRENCH SEGMENT T W. 4.7' GRAVEL ALRLSC/RCCF J. 53' TRENCH SEGMENT_/ WITH 4.8' GRAVEL 1250 GALLON SEPTIC TANK 6" BUMP "H %I.o....F..� ,••• "F" "1" PERMIT NO: SW980343 PAGE 3 OF 3 PID NO: 020-092-31 N 59' TRENCH SEGMENT WITH 4.7' GRAVEL 2'+ SOIL COVER 7' INSULATION 7' INS. + 2'+ SOIL COVER INV. 1250 GALLON I 93.9' SEPTIC TANK LINV. V, BUMP 93.T INV. ' ;� 92.4' INV. 90.0' BOT. ELEV.' 87.7' BOT. ELEV. 85.2' 53' TRENCH SEGMENT T.H. #1 WITH 4.8' GRAVEL BOT. ELEV. 79.2' WATER AT 82.5' 5/19/99 ¢,wwwwr�y ISTwZV �y�e r ............s.»s �y 1.7smcC:2 F.ImooRE • !J Cc -35b9 O g14q�eaaeo I LOT 2, BLOCK 3, LOMA ESTATES SEPTIC SYSTEM INSTALLATION AS -BUILT CROSS-SECTION I FLATTOP TECI RVICAL SERVICES NOT TO SCALE 14530 ECHO STREET DRAWN BY TFM ANCHORAGE. ALASKA995I6 OCTOBER, 1999 Mayor Municipality of Anchorage Department of Health and Human Services 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 hap:Awww.ci.anchorage.ak.us Permit Numher: #SW 980343 Date of Issue: 9-4-98 Parcel Identification Numb Date Started: 5-25-99 Date Completed: 5-26-99 Is well located at approved permit location? Legal Description; Loma Estates B1k3 Lot 2 Property Owner Name & Address: Peterambelpy Johnson.r•T� 2400 Chinook Ave Anchorage, Ak 99516 Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Method of Drilling ®air rotary Q cable tool Casing type: steel Stick-up 0 2 Gravelly silt 2 23 Wall Thickness: 025 inches Diameter: 6 inches Depth: 121 feet slty gravel P3 Y9 Liner Type: gravel 29 63 silty gravel 63 74 gravel 74 88 gravelly silt 88 101 Diameter: inches Depth feet Casing stickup above ground: 2 feet Static water level (from ground level): Pumping level: 120 feet after 2 hoursum in 5 P P F _ gPm 9 feet Sandy silty gravel and water 101 105 Recovery Rate: 5 gpm gravelly silt 105 112 Method of Testing: airlift bedrock 112 124 Well Intake Opening Type: ® Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ® Perforations Start12 feet Stopped !? feet Grout Type: bentonite#8 I Volume: 2bes Depth: Start 0 feet Stopped ?-feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: clorox Comments: RECEIVED Well Driller: Alpine Drilling & Enterprises P.O. Box 110496 1 JUL 9 1999 Anchorage, Ak 99511 AKO.. Municipality ul M;,, norage DePL Health & Human Services Attention: The we 9WIprewidea-wet leg-te-thejweperty-ewnerwitkin3A-days of completion and the property /IW.I Rr 111. Nall /1rI11M Oban IIrII\IIIiP a WPIC 1I. In III. npP t nr17.olll, k tillman IZ. /ArO \Vl h;n %In (t9VC nfrr.mnt.I1I1A MUNICIPALITY OF ANCHORAGE Department or Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW980343 Legal Description: LOMA ESTATES BLK 3 LT 2 Design Engineer. 0019 Flattop Technical Services Owner Name: PETER & JAY JOHNSON Date Issued: 04,1998 Expiration Date: Sep 04,1999 Parcel ID: 020-092-31 Site Address: 005201 TAURUS CIR Lot Size: 44375 SO. FT. Owner Address: 2400 CHINOOK AVENUE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516 - This permit is for the construction of: Q Disposal Field ❑✓ Septic Tank ❑ Holding Tank E] Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. 3. 4. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only). From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. Received By: Issued By: B. Covered, sealed, and heated to prevent freezing. M Date: 91 15e9R Date: 1-4 —98 _ YL_ATTO.P TECHNICAL SERVICES.., CIVn.6 ENVIRONMENTAL Eti CLNEERLNC • ENERGY CONSERVATION Q ANALYSLS I THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345.1355 ANCHORAGE, ALASKA 99516 August 20, 1998 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to construct wastewater disposal facilities on Lot 2, Block 3, Loma Estates, located at 5201 Taurus Circle. Soils logs, pert test results, a site plan, design drawings and specifications are'enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material between 1.5 and 15 feet below ground level is a silty sandy gravel with a measured pert rate of 15 minutes per inch. Using a slightly conservative soil application rate of 0.6 gpd/sq. ft., this proposed 4 -bedroom residence requires a total absorption area of (4 x 150)/0.6; 1000 square feet. The proposed parallel 56 -foot long soil absorption trenches with effective gravel depths of 4.5 feet have a total absorption area of 1008 square feet. The topography of the lot in the area of the proposed construction slopes down towards the southeast at approximately 15%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space -surface and subsurface, or on drainage. I Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Z—.4C X. Ted Moore, P.E. UNSUBDIVIDED NO SEPTIC WITHIN 100' OF PROP. WELL ---- oc EXISTING SEPTIC SYST LOT 2 ; 0 0 PROPOSED BLOCK 3 WELL SITE RESERVE AREA ' R 700, ; HSE. SEPTIC RESERVE AREA LOT 3 R 100' ------ -_ - EXISTING / kPROPOSEDf 3 #2 : SFpT%C WELL 4 BEDROO HOUSE 1250 GALLON T. H. SEPTIC TANK -----�---------- WELL—�� J HOUSE I ,I 2 PARALLEL 56' LONG o SOIL ABS. TRENCHES of . 4.5' SEWER GVL , \F LOT 8 NO WELL WITHIN \ \ 100' OF PROP. SYST.\ \ LOT 9 P,�E OF.q<,��', Aw��. 4 n '� ; 9 9 .. 1 THEODORE/.MOORE S� CE -3589 �: of 6�1 pro/ef 5t v%' 4 LOT 1 LOT 1 BLOCK 1 L -,,_4" D-3034 PVC WASTE LINE FROM HOUSE INSTALL1250 SEPTIC TANK DOUBLE C.O. "A" 4" ASTM F-810 58 PERF. DIST. PIPE b_______________________________________„__________________________O. CONSTRUCT 2 PARALLEL 56' LONG SOIL ABS. TRENCHES WITH - IT M.T. CONSTRUCT &- -SUMP" 4.5' SEWER GVL. BELOW PIPE IN 4" PVC INTERCONNECT b_________________________________►________________________________cl PLAN VIEW J „A„ SCALE: 1" = 10' TUBE BACKFILL 6" 3 1 2'SOIL COVE 6" "BU `2" RIGID INSULATION 4" PERF. DIST. PIPE W) v FILTER FABRIC 1R" - 2 12" GRAVEL OF EXCAVATION SECTION "A - A" SCALE: 1" = 5' • ....... o C2 ...........Y:::.... p �• THEODORE F. MOORH i CE - 3589 •;' j ''6p •'•.....••• ��•CAr �nfe+s%o LOT 2, BLK. 3, LOMA ESTATES PROPOSED SEPTIC SYSTEM PLAN AND CROSS-SECTION FLATTOP TE•CINCALSERVICES SCALE:ASSIIOWN 14530 ECHO STREET DRAWN BY: TFM ANCI IORAGE, AK, 99516 AUGUST, 1998 Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (901) 345.1355 Lot 2, Block 3, Loma Estates 5201 Taurus Circle Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installation of a 1250 gallon septic tank which discharges into 2 parallel 56 foot long soil absorption trenches with a total of 5 feet of sewer gravel in each. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements; unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish gri ding after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed byithe construction. 2.0 Septic Tank: 2.1 The new 1250 gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 4 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by constructing 2 parallel trenches to a total depth of 6.5 feet below ground level. The axes of the trenches shall follow the natural contour of the land. 3.2 The bottoms of the excavations shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 5.0 feet of approved sewer gravel shall be placed in the bottoms of the excavations with the perforated distribution pipes laid level such that the pipe inverts are no less than 4.5 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the 4200 sieve. The non -perforated pipe connecting the two trenches shall be constructed with a 6 -inch "bump" located at the edge of the upper trench to ensure that the upper trench fills completely before effluent overflows into the lower trench. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than' the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping, connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 1 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 TEST HOLE # 1 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 2 Block 3 Loma Estates DATE PERFORMED: September 22, 1997 PERFORMED FOR: P tecJohnso- SLOPE � 49 .«...................... i THEODOREF.MOORE i t f'•,� CE - 3589 1 ..-*'••00.00•• ; w �C 11Q Pf.fes.10"i� PERFORMED BY FLATTOP TECHNICAL SERVICES. Iry�,, �„_4-+� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 612-o 1$I' FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 TEST HOLE # 2 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 2, Block 3 Loma Estates DATE PERFORMED: September 22, 1997 PERFORMED FOR: _PCter Johnson DEPTH SLOPE (feet) Pt 1 Ash SM Reddish sandy loam 2 3 iiil:Tlii!:!iu q GM/SM Gray silly sandy graveVsilty gravelly 5 Similar to T.H. #1, but less gravel or ii Ei:i[igej in upper portion of the stratum. 6 iciEij!!!iiuei 8 1!:!i: l iill!:�i!. . 10— ' �:,!'.Ii1: Material becomes denser !v!iiii and smears more 11 — j iliIN: below 10' !11;I { :11:::1:. 72 ii'!ii� ��"!i 13 ii_!;rnpa!I;i i!3Ei!i!IiEj? Date 15 116- 6171819 ;:;:14—. n:u!!k!i! ?jF iii:i!iii!i::::: :..,..,; .., B.H /22197 912Zre7 816/98 17— Is- soak 19— Depth to Groundwater Date No gmundwater Vyater-M-EB.G e Ne riZ- " R. Q. L /22197 912Zre7 816/98 ! soak r CO •• :� * ;- 49 D! .«................... .T-4 : e i THEODOMVIWOORE �P'.CE-3589 Vii•, '1A $*. .a 1e Qro., .. longe SITE PLAN 3% W 10% Date Reading Clock Net Time Time (minutes) Percometer Reading Net Drop (Inches) ! soak —273/8 1 Add water & start # — 2 �2 1318 /4 Add water # dd_wate 2_32:15 23715 12:37:30 23/8 2111/ 231/2 ! 1 #3 2:42-30 TT3/ Add water 2:43 231/2 . 1 94 _8 1 20 PERCOLATION RATE 3 (minutes/Inch) PERC HOLE DIAMETER 16 TESTRUNSETWEEN 5.0 FTAND 5.5 FT COMMENTS: The material encountered in this pert test hole was sandier and cleaner than typical of majority of the stratum. Recommend using more conservative rate measured in T.H. #1 for design purposes. PERFORMED BY FLATTOP TECHNICAL SERVICES. I /'4i.....` CERTIFY THAT THIS TEST WAS PERFORMEC ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: October 23, 1997 MUNICIPALITY OF ANCHORAGE • '• DEPARTMENT OF HEALTH 3 HUMAN SERVICES Division of Environmental Services us 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. # O Z o- 0 9 2- 3/ I HAA # 1. GENERAL INFORMATION Complete legal description 1-01- 2-, 61uc4- 3, A&a oc P=r/— Location (site address or directions) S2h/ %aur"Y CLc/e S Property y owner Pe�� To%ntoDay phone 27r -6539 Mailing address 4veAue Lending agency Day phone Mailing address Agent N• h. Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water .7-11,-m NOTE: If community wet/ system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site f 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. n-M(ftv.ini) F, t MoAni S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 - Ela"o4! Tech"ca/ See cep Phone Address /HS -3a 5c,ho Sf� f}nc�iu�cxyp f}k 99s -le' �T Engineer's signature :7, ' l" �- 'r 210-4— Date 7, /999 %YSTH s • � ;• 1 F. 6. DHHS SIGNATURE Approved for F UP bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments M Date 11— /0 - q9 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-M Mn W) 6. MOAm RECEIVED Municipality of Anchorage OCT 08 1999 DEPARTMENT OF HEALTH & HUMAN SERWQ5&vmr OF ANCHUOM Environmental Services Division eoggor#AEMAI SERvmCU av 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 I Health Authority Approval Checklist Legal Description: l o t 2, (3 / k 3, L t, s+ a C -t h6 J49i Parcel I.D.: O 2 0- 0 9 2- 3/ A. WELL DATA weti type Prr ke If A. B, or C, attach ADEC letter. ADEC water system number Log present (YM) Y Date completed .5"/ Z6 /9 9 Total depth r 2 2 ' Cased to / 2 r ' Casing height (above ground) 3 f F Sanitary seal (Y/N) Yrl Wires property protected (YIN) Y i FROM WELL LOG AT INSPECTION Date of test S/ 2 6 / 9 9 Static water level '49' Well production S g.p.m. I g.p.m. WATER SAMPLE RESULTS: CoiMorm D cal /r a u ^X Nitrate 'a./Y 71-e Other bacteria Nom i rc�r fro( Date of sample: lO /Y /99 Collected by: Ftaflvp TccA le -1c B. SEP710HOLDINO TANK DATA Date installed S / / Y / 99 Tank sizeI?Svgal Number of Compartments 2 gearwuts (Y N) Y Foundation cleanout (Y/N) Y Depression (YIN) N High water alarm (Y/N) N•A. Date of Pumping N.A. (-,veto) Pumper N. A. C. ABSORPTION FIELD DATA Date Installed S/ / Y / 99 Soil rating (g.p.dAF or fF/bdrrn) � System" Tome-cA 6 ' Length S9�+S3 � S Width Z. Gravel thickness below pipe _Y•7N�8' . Total depth s Effective absorption area 1063 0' Monitoring Tube present ( "--r— Depression over field (YM) N Date of adequacy test N.A. (N.w) Results (Pass/Fam For `Y I bedrooms Fluid depth in absorption field before test On.); O Imrneclately after_ gal. water added pn.�: Fluid depth (Ins) Minutes later. Absorption rate = Goa g.p.d. Percxkle tntatrnent (past 12 months) (Y/N) N It yes, give date N• A. i 72-026 (Rev. 3196)• D. LIFT STATION N• A Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level ar "Pump air level at' High water alar level at' 'Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 190, On adjacent lots > too Absorption field on lot 19 / On adjacentkrts > Iuo ' Public sewer main N• A Public sewer manhole/deanout N• 14. Sewer /septic service line > 2 S" Lift station N• .4. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 3 8 ' Property line YO' Absorption field /5" Water main/sennee fine > s' ' Surface water/drainage > 100 ' Wells on adjacent Its SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property fine 1 Z Building foundation 511r' Water mairdservim line > re Surface water > t u O ' Driveway, paAdngNehide storage area 2 ' Curtain drain W&A e s e on Wells on adjacent lots IIS' F. ENGINEER'S CERTIFICATION 1 cattily that I have determined Mru held inspeclYons and review of MunkW records Mem are in conformance with MOA HAA guidelines in effect on Mis date. hop ••••• • • ••.'qs Signature 'l�-- f,.:` i ►..M ........E,�ti�*,� Engineer's Name 7h eo a/6,Y r 1 -too -e d MOORE Date 7, /99� bi �E-35C7 F HAA Fees ' oa "s` • Waiver Fee $ Date of Payment l 9 Date of Payment Receipt Number D�r�`�/ D/ Receipt Number 72-M (Rev. 3M)• DCT -07-99 17:54 FROM -CTE ENVIRONKNTAI Lt�CTtE Environmental Services Inc. �riirrrrr��rirrriir� CT&E Rrf.X Client Name Project Name/a Client Sample W Matrix Ordered By PWSID 995428002 Flattop Technical Srv. N/A Lot 2, Blk 3, Loma Est Driakiag Water 5615301 T-705 V Client PDX Pre -Paid Colu/1 mated Date/Time 10/07/99 16!03 CoUected Date/CUne 10/04/99 14:30 Received DateMme 10/04/99 16:55 Teclialcal Director: Steppes C. Ede Rrleaw 3anllne KcaLugs. I Atto a0te Prep Anatrsis PeraaKter Results POL Units McTMOU Lim fta Oate Date Init Totat totitorm 0 tot/100ML 9118 92228 10/04/99 /DT ■itroto-k 2.14 0.500 94A IPA 300.0 10 eaa 10/04/99 10/04/99 SCL