HomeMy WebLinkAboutRABBIT CREEK BLK 1 LT 5Rabbit Creek
Block 1
Lot 5
#017-063-44
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: OSP141320
Tax Code Number: 01706344000
Work Type: WellSeptic None
Permit Effective Dates: August 19, 2014 to August 19, 2015
Design Engineer: ANDERSON CONSTRUCTION & ENG'G
Subdivision: RABBIT CREEK
Site Legal Address: RABBIT CREEK BILK 1 LT 5 G:2939
Owner/Address: PERRY TAYLOR L
324 KRANE DRIVE ANCHORAGE AK 995041083
Site Mailing Address: 6701 Our Own LN, Anchorage
This permit is for the construction of:
Y Disposal Field N Septic Tank N Holding Tank
All construction must be in accordance with:
Lot Size in Sq Ft: 46000
Total Bedrooms: 4
N Privy Y Private Well N Water Storage
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.
A
and heated
Special Provisions:
The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation
test. The Engineer needs to do an additional percolation test prior to the construction of the septic
field. Please submit stamped and signed results with the As -built Inspection Report. If the results
require a design change, construction of the system will stop pending On -Site review and
approval. AMC 15.65.060.B.3
Received By: —.� %A
Issued By:
Date: 2S /fid
Date: g �7
MUNICIPALITY OF
Community Development Department
Development Services Division ce*-j7
On -Site Water & Wastewater Program
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I. D. P- �f
Property owner(s) i a 1. (t7✓
Mailing address 3211 �rC rryK�
Site addresswo) r9 L.A,-) ✓t
Legal description (Sub'd., Block & Lot)
Day phone
Legal description (Township, Range & Section)
Lot Size 4 (o O o n Sq. Ft. Number of Bedrooms 41
L
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
Initial IX, Single Family (SF) ❑
(w/wo ADU)
Upgrade ❑ Duplex (D). ❑
El Renewal ❑ Multiple Dwellings ❑
SuENI
�A(SF and/or D)
Ef-El AUG 11 2014!'
THIS APPLICATION INCLUDES AVM. ANCE /WAIVER REQL 3 FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or
Perm /gush Fees: �// �/it141
Date f Payment:
Receipt Number:
Permit No.
Permit App_-1-12.doc
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
Aug. 11; 2014
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: Rabbit Creek S/D, Blk 1, Lot 5, Change Order Request OSP 131237
To Whom it may concern:
This is a request for a revised septic plan on the above referenced lot. The owner decided to flip the house
to the other side of the lot for a better driveway. A new test hole was excavated to 14 feet revealing the
same silty gravels found on TH#1 from the previous design but water was observed at 14 feet. The perc
rate was 12 minutes per inch and the water level raised to 11 feet during the 7 day waiting period. A second
test hole will be completed before excavation of the system to verify the soils outside the test hole radius. A
simple deep trench has been designed for the primary and secondary systems.
The lot slopes to the south at about 30 to 35 percent then flattens out at the bottom of the lot. The new
system will be constructed on the flat area per the site plan. The contours on the site plan are two foot
typical. No open water or well existing with 100 feet of this new proposed design. This new system will
not impact any of the neighboring properties due to the large lot sizes and good soils.
Please call me if you have any questions.
Sincerely' 4
Michael N. Anderson, P.E.
DESIGN CRITERIA: U\
MOUND OVER
(THJ3) (TH#1) N
GRADE
4 BDRM X 150 = 600 GPD ORG ORG
SOILS = 600/0.8 = 750 GPD 1 D 1.0
FILTER FABRIC
750 GA/10 = 75'
0 PIPE
-1.0
TRENCH GM GM
SEWER ROCK
,(1)
S
EFFECTIVE -fir
0.0' WIDE 1 S�
75' LONG 14 161
H20011' JUNE 2014 H2O012' MAY 2013
SEPTIC FIELD SECTION
J
SEQUOIAESTATES
SEOUOW';E
BLOCK 1 1, LOT 16
BLOC K 1.§L�11S�
—
'/
—'PROPERTY LINE_
PROPOSED WELL
100' RADIUS
------ \ 20' UTILITY EASEMENT
RABBIT CRERK
( / 1 BLOCK 1, LOT 5`'
PROPOSED HOUSE
e
S I ; / •}:err,
\ RABBIT CREEK / •;,�...,
\ BLOCK 1, LOT 6
P�,���� �A
I SEPTI({
\ RABBIT CREEK
_,
PROPOSED DRAINFIELD � BLOCK 1, LOT
—OU R OWN LAN E
_—�_ — __ __ _ T
__ —— __ _--_
\\\\RABBIT CREEK ISEPTIC'/'//
RABBIT CREEK
BLACK 2, LOT 7A
/ BLOCK 2, LOT 5A \
I
I
/ \
•
SEPTIC I i 1
Septic Design Prepared for
TAYLOR PERRY
...,,,`•>•IIII
..............
�.�P.
: C9 ♦♦
RABBIT CREEK, BLOCK 1, LOT 5.r
Anchorage, Alaska
% ,,.. 494-L
N. ANDERSON,-1
Michael N. Anderson, P.E.
DATE: 8/6/2014♦'.MICHAEL
4661 NATRONA DRIVE
DRAWN: DJR
♦♦�� No. CE 9469
♦♦ •., '��
ANCHORAGE, ALASKA 99516
SCALE: V=100'0♦+���♦I,�SS`�
;
345-3377/FAX: 345-1391
i��
...... ....
7
- ----------
--------
SEQUOIA ESTATT�
--r
---------------
IA
E050TAIE8
(
LOT lb-
- -
) K 1
--------------
---------- --------
LRY
ENT
--- ----- - - - - - -
EXISTING 100,
WELL RADIUS
-A ........
..
PROPERTY LINE'— PROPOSED HOUSE
111
---- -- ------- - --
40 -
t
-A � ------- ---- -
S\-----------
-----------
OLD TH#1 & 2
GALL . .....
TANK 2' CONTOURS TYP
C-------
7
--- - -------
CO
1x\ ........ ..
SEPTIC ---- ......
I - - - - - -
0
BBITtREEK RABBrJ CRE RABBIT CREEK
B& LOCK BLOCK 1 LOT
1, LOT 6 5 4
1 X
1/fHL3
7 ......... .
PROPOSED DRAINFIEL RTY LINE -- ------ ------ --- -
!t ler e� V2 T�Lfliicild prq Ole! ko
j tory, j -OUR OWN L A N E
-------- — — — — — -----
---- — — -----------
-------Septic
Septic Design Prepared for
TAYLOR PERRY
..........
RABBIT CREEK, BLOCK 1, LOT 5
Anchorage, Alaska0
49T
...... . ...... .......... ....... I .....
r...........
'-..MICHAEL N. A DERSON..'
Michael N. Anderson P.E.
DATE: 8/6/2014
4661 NATRONA DRIVE
DRAWN: DJR
No. CE 9469
ANCHORAGE, ALASKA 99516
........... ...
345-3377 / FAX: 345-1391
SCALE: 1 11=50'
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci. anchorage.ak. us
(907) 343-7904
r.49TH Pq ..*
';....,4 ............
Solis Log - Percolation Test N
Performed For: Tai; ( ye (2zwN Date Performed:
/ /�
Legal Description: ��r'V�CPl Township, Range, Section:
Slope
L,/�y �rntae
LGrg � fZnnk s +
11
.-r �3m aF
15-
16-
17-
18-
19-1
COMMENTS
5-16-
17-
18-
19-
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
y
Gross Time
5
L
IF YES, AT WHAT DEPTH?
Net Drop
Depth to Water After
( 0
P
Monitoring?
([ E
Data:
% 711
'. K Yi............
MICHAEL N. ANDERSON :e
CE -9469 :•.,
z
D vir --S.,O`n. Y kY4 Kl.i.-
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1q
oM;H
It
Z, 97.
�It
.Zr �rr
Ort
ZrStr
PERCOLATION RATE -e, (minutesfinch) PERC HOLE DIAMETER Y
TEST RUN BETWEEN 3 FT AND FT
Sto, [ 7 4...n.c. 2 [ k' 2 V 0'#.ou4 (ta
PERFORMED BY: t�dh(..�. I CERTIFY THAT THIS TEST W S
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: L W
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:
OSP131237
Tax Code Number:
01706344000
Work Type:
WellSeptic
Permit Effective Dates: August 08, 2013 to August 08, 2014
Design Engineer:
ANDERSON CONSTRUCTION & ENG'G
Subdivision:
RABBIT CREEK
Site Legal Address:
RABBIT CREEK BLK 1 LT 5 G:2939
Owner/Address:
PERRY TAYLOR L
324 KRANE DRIVE ANCHORAGE AK 995041083
Site Mailing Address: 6701 OUR OWN LN, Anchorage Lot Size in Sq Ft: 46000
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field N 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.
Special Provisions: The Inspection Report will not be approved without confirmation that the fill has
been added to the slope.
Special Provisions:
The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation
test. The Engineer needs to do an additional percolation test prior to the construction of the septic
field. Please submit stamped and signed results with the As -built Inspection Report. If the results
require a design change, construction of the system will stop pending On -Site review and
approval. AMC 15.65.060.6.3
Received By:
Issued By:
1/
Municipality of Ancho
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
hftp://www.muni.or-q/Onsite
Development Services Division
On -Site Water and Wastewater Prouram
went s
�o F
y r
e art e
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP131269 COSA#: Permit#:OSP131237
PID#: 017-063-44
Legal Description: Rabbit Creek Block 1 Lot 5
Engineer: Mike N. Anderson
Applicant: Taylor Perry
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the excessive slope has been approved. The approved separation distance is 0.0 feet.
This waiver approval applies to the proposed 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 nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
....... ............................................................ ........... I
Waiver is Granted: X Waiver is not Granted:
Date: / Approved by:
Name of Reviewe
........................................................... .................1
Rae#: 166336 Amount: $200.00 Date Paid: 818113
**** VARIANCEMAIVER REVIEW ****
m
p
m
nt
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP131269 COSA#: Permit#:OSP131237
PID#: 017-063-44
Legal Description: Rabbit Creek Block 1 Lot 5
Engineer: Mike N. Anderson
Applicant: Taylor Perry
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the excessive slope has been approved. The approved separation distance is 0.0 feet.
This waiver approval applies to the proposed 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 nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
....... ............................................................ ........... I
Waiver is Granted: X Waiver is not Granted:
Date: / Approved by:
Name of Reviewe
........................................................... .................1
Rae#: 166336 Amount: $200.00 Date Paid: 818113
**** VARIANCEMAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
rz �.+�., r ; ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. (9f % — U & [F�j v
Property owner(s) T- ct y ll(pr V' T P v y Day phone —r
Mailing address 3 7J 4 K rar,G pe t v'e'
Site address
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section)
Lot Size q to a o o Sq. Ft.
APPLICATION IS FOR:
(® all that apply)
h b, +=
Number of Bedrooms L4
APPLICATION IS AN: TYPE OF DWELLING:
Absorption Field
q
Initial Single Family (SF) [9
(w/wo ADU)
Septic Tank
ElUpgrade
❑ Duplex (D) F-1Holding
Tank
F-1Renewal
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well 5
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: o z nil
Date of Payment:
Receipt Number:
Permit No. OL is /a 1�_3
Permit App_.; :
Waiver Fees: -P- 00
Date of Payment: Zoll -2:,
Receipt Number: ��6✓3�
Waiver No. Oa P / 31 Z
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
July 25, 2013
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: Rabbit Creek S/D, Blk 1, Lot 5
To Whom it may concern:
This is a request for a septic and well permit on the above referenced lot. A test hole was excavated to 18
feet revealing silty gravel for the entire 18 foot depth. The perc rate was 9 minutes per inch with no water
observed during excavation but after the 7 day waiting period it was measured at 12 feet. A simple deep
trench has been designed for the primary and secondary.
The lot slopes to the south at about 30 to 35 percent with fill from the house excavation being used to flatten
the slope downhill from the system. The contours on the site plan are four foot typical. This new system
will not impact any of the neighboring properties due to the large lot sizes and good soils.
Please call me if you have any questions.
Sincer
Michael N. Anderson, P.E.
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
Aug 5, 2013
Municipalities of Anchorage
Departments of I3ealth and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: Rabbit Creek S/D, Blk 1, Lot 5, Review comments dated 7-29-13
To Whom it may concern:
The contours are 2 feet not 4 feet as stated on the original site plan, therefore the driveway will be less than
10%, this has been stated on the 50 scale site plan.
The design criteria of 7 feet has been revised the 100 scale sheet.
The slope cross section has been included in this submittal showing how the extra fill from the house
excavation will be used to flatten the front yard to below the 25% slope limit.
The tank has been moved away from the deck area the required 5 feet min.
Also two test holes were excavated during the original investigation but only the I" test hole was perced.
The water table was the concern not the soil perc. A new soil log has been added to this submittal showing
the same soils. If a secondary perc is necessary it will be done during construction.
We are also requesting a slope waiver of, feet to a slope of greater than 25 percent. The reasoning for the
waiver is the new fill will flatten the slope to within the 25 percent thus allowing the lot to be developed
within MOA guide Lines.
Please call me if you have any questions.
Sincerely,
Michael N. Anderson, P.E.
DESIGN CRITERIA:
MOUND OVER
(TH#1)
GRADE
4 BDRM X 150 = 600 GPD ORIS/--
1.0
SOILS = (300/0.8 750 GPD
FILTER FABRIC
750 GA/1 2 = 63'
4*0 PIPE
(1) TRENCH GM
SEWER ROCK
7.0' DEEP H20012' MAY 2013 —7.01
6.0EFFECTIVE
2.0' WIDE
63' LONG 16
SEPTIC FIELD SECTIO
SEQUOIA ESTATES
BLOCK 1, LOT 16
SEQUOIA tESFAT �'
BLOCK 1,XQT/lv
PROPOSED WELL
PROPERTY LINE77:z,,-
100- RADIUS
20'.. UTILITY EASEMENT
. . ......
.....
RABBIT CREE
BLOCK 1, -7 � - -
PROPOSED OUSE
WELL
RABBIT GREEK
BLOCK 1, LOT 6
. - - - , --
SEPTIPROPOSED
-----
15RX INFIELD BE I T K
RA CREEK
BLOCK 1, LOT 4
------ ------ ------ ------
0 U R OWN LAN E
- - - - - - - - - -
ISEFric'
BL\R ABBIT CREEK
PCK 2 LOT 7A
RABBIT CREEK
BLOCK 2, LOT 5A
I
_SE�PTICI
Septic Design Prepared for
TAYLOR PERRY
RABBIT CREEK, BLOCK 1, LOT 5
J
49TH
Anchorage, Alaska
iff
............... .... ....... ................. 0
100 ......... .... I ...... .......... ...
0.0C) MICHAEL
Michael N. Anderson, P.E.
DATE: 8/6/2013
4661 NATRONA DRIVE
DRAWN: DJR
No C mw
ANCHORAGE, ALASKA 99516
345-3377 /FAX: 345-1391
SCALE: 1 '.=1 00'
III
VA 1k
PROPERTY LINE
r SEPTIC
ti
_, tABBIC�EREEK
B 1, LOT 6
X '(
S%01A ESTATES
ELOCCK 1 :LOT 15.
7 ......1
PROPOSED WELL
100' RADIUS
PROPOSED HOUSE
\ �CO �'� 1250 GALLON
'� T INK
j`.
�2' CONTOURS TYP
#21 'N
T N
i
PROPOSED DRAINRELD t A ""
R_ RABBIT CREEK \ RABBIT CREEK `. `...
• i �HLOCK 7 LOT 5 BLOCK 1 LOT 4
—
OUR 0 W N LANE
-
- — — — — — — — — — — — — — — — — — — — — — — — — — —
Septic Design Prepared for
TAYLOR PERRY
RABBIT CREEK, BLOCK 1, LOT 5 x �t
49 TH°;
Anchorage, Alaska 0.......... .....................:.... 0
..........................................jy..
Michael N. Anderson, P.E. DATE: 8/6/2013 ♦.:,MICHAEL N. ANDERSON:
♦c
4661 NATRONA DRIVE ♦♦ No. E 69
ANCHORAGE, ALASKA 99516 DRAWN: DJR 1♦�� .:�
345-3377 / FAX: 345-1391 SCALE: 1"=50'
1 •
50.0' \\
12' DRNEWAY
ALL NEW SLOPE --------
-- _
TO BE VEGETATED 2
PROPOSED 6' TRENCH
EXISTING 35%
SLOPE
NEW FILL WILL BE
KEYED ANTO THE I4,
SLOPE caoss SECTION
12" OF FILL OVER
MIN. SLOPE
Septic Design Prepared for
TAYLOR PERRY
RABBIT CREEK, BLOCK 1, LOT 5
Anchorage, Alaska
Michael N. Anderson, P.E. DATE:
4661 NATRONA DRIVE DRAWN:
ANCHORAGE, ALASKA 99516
345-3377 / FAX: 345-1391 SCALE:
e 49TH
■, . .
0....., .................. ...............
8/6/2013 =.MICHAEL N. ANDERSON,:
�1�% ' No. 9 E 469
Performed For:
Legal Description:
11
12-
13-
1
1
1
1
1
COMMENTS
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchorage,ak.us
(907) 343-7904
�d10dD`\�
c OF A/�`►.
49TH I
• ..........�
............... 0
MICHAEL N. ANDERSON .,0C,0
CE -94669
/Soils Log -Percolation Test
(� C'4 t to J_P-?VV4 Date Performed:
K- cL C -U va (.v Township, Range, Section: _
Slope�
T�4 #-t
L9V C) or) r L S
C-7 M
SI �Ty
Gu FGC�
VZv j. k s
06 Nov,. > l'
hho(P/
WAS GROUND WATER
ENCOUNTERED? 1110
S
IF YES, AT WHAT DEPTH? L
Depth to Water After O
P
Monitoring? ( 7i E
Date: Zy /?
Site Plan
V/ P —e'JA6fl.ii�� y� 1r�vL "'.-
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
5-1!4
(0 //
3S/lv
(� r/
3 r (b
�"
3Tim
PERCOLATION RATE (rninut..11n.h) PERC HOLE DIAMETER Le
TEST RUN BETWEEN FT AND FT
PERFORMED BY: /✓(/ T ✓ Tt I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ? t/
Performed For:
Legal Description:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www aanchoragre,ak _us
(907) 343-7904
y •;v `'r
*' 49TH �•'�
;0 • MICHAEL N. ANDERSON .*%
CE -9469
f
S10 oils Log - Percolation Test 'l'FpP'l-,, ,;"k.�—
(/��TtZr Yf r /P 9 Y✓ t' Date Performed:
Y�-4717 t4"ti Township, Range, Section:
Slope
4-
5- /
6- CGvc;,ii
7 u? A Si
s -
WAS GROUND WATER (O
9-
ENCOUNTERED? Imo(
S
10-
IF YES, AT WHAT DEPTH? L
Depth to Water After D
11-
P
Monitoring? itE
12-
Date: to "
13-
17-
18-
19-
20 -
COMMENTS
Z
Site Plan
211
Reading Date Gross Time Net Time Depth to Water Net Drop
� •r r S t;
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
PERFORMED BY: [A � -4. 1 CERTIFY THAT THIS TEST S
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (O %