HomeMy WebLinkAboutELMORE #2 BLK 8 LT 4Elmore #2 Block 8 Lot 4 #018-172-37 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT IV Permit Number: bSIQ PID Number: LW/ -147 ' �i Dwelling:IR Single Family (SF) ElDuplex (D) [IMultiple (SF and/or D) Project: F New ElUpgrade Name: r p L $ �c � ABSORPTION FIELD El Deep Trench El Shallow Trench Bed El Mound Address [ S6 D 1lav xv { u✓1 /1` V e' ❑ Other Phone Number of Bedrooms Soil RatingJ` Total depth from original grade ((/4 GPD/SF /r 0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade ©, �_Ft. Gravel depth beneath pipe 045— Ft. Subdivision Block Lot/tet Fill added above original grade ?j Ft. Gravel length `/ 3 7S Ft. ?/ -1 Township Range Section Gravel width ( �-Ft. Beds: Number of Lines Distance between lines S,D Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line �_7 D Ftp r Ft. Well i`/ (Q®`.� (�� /uOt TANK [:)Septic .T.E.P. ❑ Holding ❑ Other Manufacturer /I,, /I� C YV Capacity (2ri7 Gal. Surface Water (Ddf� �IIee tlfT Material Number of compartments � V Lot Line 20'f- 'Z J'1 -NA Foundation C, f �� ` LIFT STATION Manufacturer 1 _ n k, T'G Capacity ( Z S(� Gal. Curtain Drain /�) �J Remarks /,, k Pump on level at Pump off level at High water alarm at - .+ KDIVCi Pr � rS IYd//+ rf 30 (� Z -C 340 4 nR 60e$ t7htAJA ON in. in. in. ` //� rr-- A,b614 4ynuyelr J 61,e � VAt!` Pte. Pump make and model PS -2D Electrical Inspections performed by P"t'(i File -P(p(0 �Ikn �.' �- Yat ,S4w. *V? Yr he, PIPE MATERIAL Housetotank 30't I ankto - drainfield f"` + Installer /r I� 1-�i 1 A0e / A(A a ev,;O{•1 �.0 r Drainfield ' 0 - r)L CO/MT 30� If Inspector rn L n t kt n tY<0rj ltEr BENCH MARK (Assumed elevation) 3 ft Inspection , dates:3b / (3 Location and description P. 4m l „' a r it tj ri'4 J i COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF ���5r Conditional Approval: Date `p��•° Y. :49TH '•`+�? •..• . ..• �9� ICEL rdY EI't 9 Approved Date ��J�lly � lQ Inspection Reporf�_l-12.doc Permit No. OSP131225 Page 2 of 2 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: ELMORE #2 BLK 8, LOT 4 PID No.: 018-172-37 MARK A B FCO 11 8 c01 10 15 CO2 10 17 TCO 15 23 MH 27 29 22 MT2 23 7 MT3 50 41 MT4 55 40 I I I I 1 t 1 1 \ I / I / I I i 1 I• I 1 i \ f \U M U MT4/� ASBUILT i SCALE: 1"=30' \ — — — — — — — — 1W IITII ITV PACI-Ad FAIT \ I.R50 CALIPH S1E0. SIFP iAHF 11 0 ORG GRADE R33 Flu 1 ixwuirox / D'O ORG SP/GP 00 m,. 92 ♦♦ CM 1� 90 ♦I LOT PROPERTY ]AFL N. No. 0E z w J / PROPERTY ]AFL N. No. 0E 4 Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http:l/www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program Ment s �0 P Department **** VARIANCEIWAIVER REVIEW **** Waiver#: OSP141494 COSA#: Permit#:OSP131226 PID#: 018-172-37 Legal Description: Elmore #2. Block 8. Lot 4 Engineer: Mike N. Anderson Applicant: Ferenc Takacs Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the building foundation 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. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ........................................................ NOON .................. I Waiver is Granted: X Waiver is not Granted: Date: C Approved Name of Reviewer .........'................................................ Non ............... I Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue � ra 0 Anchorage, Alaska 99516 ( 4t 1.1 Phone 345-3377 Fax 345-1391 Nov 4, 2014 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Elmore 42 Subd. Blk 8, Lot 4, Waiver request To Whom it may concern: This is a request for a waiver of 5 feet between the leach field and the building foundation. The leach field is a bed system built at the same elevation as the footing elevation and doesn't pose any risk to the structural capacity of the foundation. Due to the well radius located on the south side of the property the bed needed to be closer than the 10 foot separation required by the MOA codes. The granting of this waiver will not impact any of the'surrounding neighbors. Please call me if you have any questions. Sincerel _ /k Michael N. Anderson, P.E. . �G o 1 r 0 M RIVERTON AVENUE S89050'47"W 212.00 0 � I / o IWel of M / Gravel / driveway 30.0 29' � L6 LOT 4 � N I I CO O LOT 3 8.0 N o = I L6 E I LOT 5 O LL �O 8.0 Z o I O t1_ OO O Z Septic Tank Septic vents 30.0 I O 30. Z I �c 1) W I � � IU W ° I LOT 10 SCALE: I"= 40' Jo 10' UTILITY EASEMENT N89056'17"E 212.00 LOT 9 1 1 LOT 8 '.4�.N\\\x1 OF , A�q`sf- �I *•°.49th f* �!00 ?% {. .a...J......:... Fred latka00 �� ^rF • 3255 - S I �Fp •° • .•.'gyp s I 1 �Ff5510NA�- `� id --t3 -14 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. PP Recer-f AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 4. BLOCK 8. ELMORE SUBDIVISION, SECOND ADDITION Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property tying adjacent thereto, that no improvements on the property tying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 10th day of October 12014. FRED WALATKA & ASSOCIATES BE(907-248-1666) Engineers and Surveyors Municipality of Anchorage Community Development Department - Development Services Division `. P.O. Box 196650 -Anchorage, Alaska 99519-6650 - 4700 Elmore Road j Info and Help: (907) 343-8211 —= INSPECTION: Voice: (907) 343-8300 Fax (907) 249-7777 Inspection Report - ElecFin APPLICATION NO. E12-1610 Subpermit of Master Permit: R12-1679 Permit Type: Electrical New Notes: Requested by: Ferenc Takacs 907,440 8021 Schedule Date:10/29/2014 Preference:AM_ Address of Project: 4830 RIVERTON AVE Inspection #• 329181 1 Parcel: 01817237000 Legal: ELMORE #2 BLK 81-T 4 G:3036 Description of Work: 1772 sq ft living, 780 sq ft garage / tb Contacts Owner TAKACS FERENC Inspector Comments: Inspector:6,S�j��G6ll Date: 6 0 Alaska state lata requires that a copy of this wcll lob_ be sent to the Department of Natural Resources within 45 days: fates arc accentable.(.AKstatutes3S.05.020.3S.V.035.?L0S.020. 46.1 5.020 and AK regulations I I AAC 91.140). DNR -'Division of Mining, Land and Water. 550 W'th Acenne. Suite 1020 Anchorage. Alk 99501- 3562 Phone(907)269-8639 and fax(907)269-S947 Within the City of Anchorage, it is required that a copy of the well log be seat to the appropriate city office within 60 days and that another copy of the well log be scut to the well%propclty owner within 30 days. Permit Number: 0SP131225 Date of issue: jLjy__3j :'2o1q Parcel Identification Number: Is well located at approved permit locatielf? (X) Yes or ( )NO STATE, OF ALASKA - DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER ' -" - -- - - WATERWELLLOG Drilling Started:10 /_0j_7013Completed:IU 0-2-01-3 cite: Borough: Subdivision: oLoclk I Lorproperty owner Nainc & Address: Ferenc Takacs Anchorage " Elmore#2 8 4 Site:4830 Riverton Ave 1513 Valarian St Anchorage, AK 99508 lcridian Township Range _Section %4 Of_%4 of _ �'14 of _ _ _ _�'A BOREHOLE DATA(from top of easing)Depth Drilling method: (X) Air rotary, { ) Cable too(, Other Material: Type, Color �; m wetness FroTo --- ... _-- � Well use: ( ) Public su ly, pp (X) DemeSI1C, O111C1' stickup 0 2 Depth of hole: 112 ti, Casing stickup: 2 ft Casing type: steelThickness: _.250_ inches gravel wet 2 15 Casing diameter: 6 inches Casing depth: _112_ ft ---" - Liner type: Diameter: _inches Depth: ft gravel w/ clay 15 25 Static water (from top of casing): 6()_ ft on _j0,'_Qj_:2013 Pumping level & yield: feet after hours at gpm Recovery rate: 10 gpm, Method of testing: airlift boulders 25 77 Developmentmcthod: airlift Duration: 1 hour clay W/ gravel 77 95 Well intake opening tape: (X) Open end. ( ) Open hole, Other Screened: Start: ft, Stopped wet clay w/ gravel 95 102 Screen type: Slovmcsh size: Perforated: Start: ft, Stopped: gravel w/ H2O 102 112 Start: ft, Stopped: ft Note: Grout qpe: _bentonite Volume Depth: from ground surface . to _ 20 ft — --- — Pump intake depth: _- _ ft Pump size: ftp. Brand name: Was well disinfected upon completion'? (X) Yes, ( ) No Mcthod of disinfection:.Calcium_HypochJ.arite..(C.hloripe)... Driller commentsi disclaimers: ......................... : I ............................................................................................................. ............. ................. -.......................... ............................. ...................... .................. - ......................................................................... .............. - Well driller name: .... K.Y.Ie.._................................................................ Company name:... Hefty Drilling Inc. Mailing address:... 3544 Akula Dr. city: Anchorage _ State: AK zip 99516 Phone number : ( 907 ) 345 _ 0593 faX:345-4700 Drillers signature: Alaska state lata requires that a copy of this wcll lob_ be sent to the Department of Natural Resources within 45 days: fates arc accentable.(.AKstatutes3S.05.020.3S.V.035.?L0S.020. 46.1 5.020 and AK regulations I I AAC 91.140). DNR -'Division of Mining, Land and Water. 550 W'th Acenne. Suite 1020 Anchorage. Alk 99501- 3562 Phone(907)269-8639 and fax(907)269-S947 Within the City of Anchorage, it is required that a copy of the well log be seat to the appropriate city office within 60 days and that another copy of the well log be scut to the well%propclty owner within 30 days. Permit Number: 0SP131225 Date of issue: jLjy__3j :'2o1q Parcel Identification Number: Is well located at approved permit locatielf? (X) Yes or ( )NO Development Services Department Building Safety Division On -Site Water & Wastewater Program oQA Gf BU 47 Elmore Road P.C.C Box 196650 Mark Begich Anchorage, AK 99507 Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number:-8W_Q&P i 645 Date of Issue: 1� 3 20 Parcel Identification Number: Legal Description Property Owner Name & Address: E��ore a gl t et 8 L 6{ y Fere- Tr, k/a C 3v - vcr kv, Ave - Pump Installation Date: Li ! )-.5 1 /1-( Pump Intake Depth Below Top of Well Casing: 9 () feet Pump Manufacturer's Name: G cXk I (i S Pump Model: 75r1✓h f2 AP 2u.( Pump Size N hp Pitless Adapter Burial Depth: %0 feet Pitless Adapter Manufacturer's Name: 6. /0 Pitless Adapter Installer: kct�c,-,, Well Disinfected Upon Completion? N Yes n No Method of Disinfection: I Comments: Pump Installer Name: —7k n"7 V Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. SCS Ref.# 1144266001 Client Name Residential Testing -Cash Account Project Name/# Outside Faucet Client Sample ID Outside Faucet Matrix Drinking Water Sample Remarks: Parameter Metals by ICP/MS At Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E. Coli Total Coliform Results LOQ Collected Date/Time 09/03/2014 4:00 ND 5.00 0.465 0.100 Negative I Negative I Printed Date/Time 09/09/2014 13:19 Collected Date/Time 09/03/2014 4:00 Received Date/Time 09/03/2014 16:20 Technical Director Stephen C. Ede Allowable Prep Analysis Units Method Container ID Limits Date Date [nit ug/L EP200.8 C (<10) 09/04/14 09/05/14 CDE mg/L SM21450ONO3-F B (40) 100mL SM219223B A 100mL SM219223B A 09/04/14 NLL 09/03/14 MEV 09/03/14 MEV On -Site Water & Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131225 Tax Code Number: 01817237000 Work Type: WellSeptic Permit Effective Dates: July 31, 2013 to July 31, 2014 Design Engineer: ANDERSON CONSTRUCTION & ENG'G Subdivision: ELMORE #2 Site Legal Address: ELMORE #2 BILK 8 LT 4 G:3036 Owner/Address: TAKACS FERENC 1513 VALARIAN ST ANCHORAGE AK 995083067 Site Mailing Address: 4830 RIVERTON AVE, Anchorage Lot Size in Sq Ft: 41474 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N Water Storage 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 (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By By: AAXDate: `7 Date: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel l.D.l4JR- 172-4 Property owner(s) F-rz rit c 1 u lccet-S Day phone `70q- Ll Ll 0 904 Mailing address Site address q01200 � OCIWk" A_Ue . Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size ill q?- y 5q. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field ® Initial [c] Single Family (SF) ADU) Septic Tank ® Upgrade El(w/wo Duplex (D)_ El Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well [� Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owper or authorized agent) Permit/Rush Fees: Date ofPay mmit: '71;Lg I13 Receipt Number: W Permit No. M 12 1 31aa5 Permit App_-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. On -Site Water & Wastewater System Permit Permit Number: OSP121154 Tax Code Number: 01817237000 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Work Type: WellSeptic Initial Permit Effective Dates: August 01, 2012 to August 01, 2013 Design Engineer: ANDERSON CONSTRUCTION & ENG'G Subdivision: ELMORE #2 Site Legal Address: ELMORE #2 BLK 8 LT 4 G:3036 Owner/Address: TAKACS FERENC 1513 VALARIAN ST ANCHORAGE AK 995083067 Site Mailing Address: 4830 RIVERTON AVE, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 41474 Total Bedrooms: 3 N Privy Y Private Well N Water Storage 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 (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either. A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued g— (-2oPt2 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel 1. D. Ot i — f 7 2 - Property Property owner(s) pt Day phone Mailing address Site address Legal descriptio Legal description (Township, Range & Section) Lot Size / q %K Sq. Ft. Number of Bedrooms 13 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial C Absorption Field 19 Septic Tank rK Upgrade ❑ Holding Tank ❑ Renewal ❑ Privy ❑ Private Well X Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. property owner or autnorizea agent) PermiURush Fees: 7 ?7 Date of Payment: to Receipt Number: /�Ta(Llcl Permit No. GA8uildingl0n SiteTorms\Client FormsTermit App_010411.doo Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 1/11) Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 June 21, 2012 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Elmore #2 Subd. Blk 8, Lot 4 To Whom it may concern: This is a request for a well and septic permit. A test hole was excavated in the November of 2011, then the water table was monitored through the spring of 2012 high water table. As stated in the soils log the highest measured water table was at 5 feet below grade. The soils are excellent in the top 5 or 6 feet then change to silty sandy gravel below 8 feet. The perc rate is 2 minutes therefore a small bed system has been designed with an application rate of 0.8 gpd/sf. None of the neighboring properties will be impacted by this installation since most are vacant and large with plenty of separation distance from each other. The slope at the site, is very flat to the west. No cut banks or slopes over 25 percent existing with 200 feet of the proposed installation. Please call me if you have any questions. Sincerely _l Michael N. Anderson, P.E. DESIGN CRITERIA: (TH#1) 3 BDRM X 150 = 450 GPD -o.s SOILS = 450/0.8 = 562 GPD 562 GA/15 = 38' (1) BED O.5' DEEP H2O 0-5.0 0.5' EFFECTIVE 15' WIDE -e'0 38' LONG -10.0 I — 11 NATI I AVE 15.0' OVER I PIPE ROCK I I I I T— I I I I i I I w l w l `\ PROPOSED 1Do' WELL JI V Ems_ ` i EXISTING 100' \ ,�{' 'WELL RADIUS — I _ PROPOSED HOUSE PROPOSED SEPTIC TANK PROPOSED DRAINFIELD SEPTIC) VACANT l I, I 1 `\\ LOTLl I l II I II !I — R I V VACANT LOT VACANT LOT I H \ A — E A S T 1 4 5TV E _ Septic Design Prepared for FENEC TAKACS ELMORE #2, BLOCK 8, LOT 4 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4661 NATRONA AVE. DRAWN: ANCHORAGE, ALASKA 99516 345-3377 / FAX: 345-1391 SCALE: �X? 49TX+ -0 (1-1 ;MICHAEL N. 6/18/2012 11� No. C�� II I I II II, -- i --- ----- — — — — -----I r VACANT I l LOT VACANT Ili 11 LOT I� PROPERTY UNE — RADIl1S — R I V VACANT LOT VACANT LOT I H \ A — E A S T 1 4 5TV E _ Septic Design Prepared for FENEC TAKACS ELMORE #2, BLOCK 8, LOT 4 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4661 NATRONA AVE. DRAWN: ANCHORAGE, ALASKA 99516 345-3377 / FAX: 345-1391 SCALE: �X? 49TX+ -0 (1-1 ;MICHAEL N. 6/18/2012 11� No. C�� RIVERT10N AVE — FLAT 1' CONTOURS PROPOSED L- WELL RADIUS MUST STAKED BY LICENSED / 10, -----� MT t r PROPERTY LINE - EASEMENT 'I i \ 10' UTILriY, EASEMENT / l / 1 Septic Design Prepared for FENEC TAKACS ELMORE #2, BLOCK 8, LOT 4 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4661 NATRONA AVE. DRAWN: ANCHORAGE, ALASKA 99516 345-3377 / FAX: 345-1391 SCALE: NEIGHB RADIUS I I' i \ it \ I , \ I -_---------h-- I -NEW 1,250 GALLON STEP TANK I f—FLAT I •\ I \ I\ I I WELL ELMORE f2 BLOCK 8, LOT 8 — — — — — — — — — —— ELMORE #2 BLOCK 8, LOT 9 i 0.��49 ...... 6/18/2012 MICHAEL N. RSON .i No. C ,9 69°' Municipality of Anchorage Development Services Department Building Safety Division ye On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchorage. ak.us (907)343-7904 OF, is 49TH •r MICHAEL N. ANDERSON .yam CE9/169 �• Soils Log - Percolation Test f Performed For: /' e c n t .,Ter k"? �j Date Performed: Legal Description: 1we e G tt.L l 2 (�'f, I., 4 Township, Range, Section: "Cl ahtz 4. P/C" P 9- 10. 17- 12- Date � N1 S" WAS GROUND WATER J� ENCOUNTERED? e p yyf IF YES, AT WHAT DEPTH? L Depth to Water After / P v it Monitoring? E 14 U Date: Net Time 1 1 1 1 1 1 1 COMMENTS Z Site Plan 4... k in. - H 1.,& ".� Reading Date Gross Time Net Time Depth to Water Net Drop r 24S ; p, r✓mi % A 5 - PERCOLATION RATE L (mlWeMrch) PERC HOLE DIAMETER (O TEST RUN BETWEEN 7- FT AND'Tj FT PERFORMED BY: m, he,Q,,, tL Qd 4 v n 1 CERTIFY THAT THIS TEST AS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 4-;/1(