HomeMy WebLinkAboutTHOMSON LT 8Thomson
Lot 8
#067 - 041 - 08
Municipality of Anchorage
Community Development Department
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141073 PID Number: 067-041-08
Page 1 of 3
• (907) 343-7904
1 New ❑ Upgrade
Name:
Joel & Deborah Webb
ABSORPTION FIELD
Address
P.O. Box 770414 Eagle River, AK 99577
0 Deep Trench 1
❑ Other
Shallow Trench ■
Bed ❑ Mound
Phone
Number of Bedrooms
4
Soil Rating
1.2 GPD/SF
Total depth from original grade
9 Ft,
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Gravel depth beneath pipe
Subdivision Block Lot
Thomson
6 Ft.
3Ft.
8
Fill added above original grade
Gravel length
Township Range Section
0-1 Ft.
58 Ft.
Gravel width
Beds: Number o Lines
Distance between lines
SEPARATION DISTANCES
5Ft.
Ft.
To
From
Septic
Tank
Absorption
Field
Lift station
Holding
Tank
Sewer
Line
Total absorption area
580 Fiz
Number of trenches
One
Dist. between trenches
Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK I] Septic ❑ S.T.E.P. • Holding ■ Other
Manufacturer
Capacity
Surface water
>100'
>100'
• N/A
N/A
Anchorage Tank
1,250Ga1.
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
Steel
'Two
Foundation
>5'
>10'
N/A
N/A
NA
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
Ga1J
Remarks -
Pump on level at
Pump off level at
High water alarm at -11
in
in.
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank D3034 Tank to 03034
drainfreld
Dean Construction and Development
Drainfield F810 cO/MT D3034
Inspector J Berkram
BENCH MARK (Assumed elevation) 100.0ft
Inspection 1:i 4/30/14 m
dates: z 5/1/14
Location and description
3" 5/2/14 4"
Lower Level Finished Floor.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date
+�9J[l F ,
�l•o... 4 to
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Approved es ski A t4% %et. Date /O'2 -/-/V
10
# % tMICHAEL E. ANDERSON : c Or
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25' DRAINAGE ESMT.
/ \ 15' TELE. ESMT.
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP141073 PID No. 067-041-08
Page 3 of 3
1
U
97.6
N Nee,
CO
Existing Finished
Ground
250 Gallon 1� J
Septic Tank \ !
92.35
Finished Grade
97.0
2.2
Existing Grade
Geotextile Fabric
91.0
Dra infield. Rock
91.0
82.0
No Groundwater `
58' (Trench Length)
PROFILE AS -BUILT
No Scale
88.0
ear. F X14 a
et: 4•
' 49th c'� rt
sti
•
0.
MICHAEL E. ANDERSON
No. CE -4381
Municipality of Anchorage
Community Development Department
On -Site Water & Wastewater Program
4700 Elmore St. P.O. Box 196650 Anchorage, AK 99507-6650 www.muni.org/onsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW OSP141073
Date of Issue 4-17-14
Parcel Identification Number: 06704108000
Legal Description
Thompson Lot 8
Property Owner Name & Address
Joel Webb PO BOX 770414, Eagle River, AK 99577
Pump Installation Date: 7-19-14
Pump Intake Depth Below Top of Well Casing: 372 feet
Pump manufacturer's Name: Grundfos
Pump Model: 5SQE15-450
Pump Size: 1.5 hp
Pitless Adapter Burial Depth: 12 feet
Pitless Adapter Installer: Dean's Construction
Disinfected Upon Completion?
yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments: Pitless Manufacturer: Martinson
Pump Installers Name: Cole Sullivan—Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Well
Disinfected Upon Completion?
Certified Drilling Log
DOC CO o6a
OSP BILL & COLE
�► ULLIVAN WATER WELLS
AtilleR0. Box 670269, Chugiak, AK 99567
OWNER OF LAND: Joel Webb
ADDRESS: PO Box 770414 Eagle River, AK 99577
LEGAL DESCRIPTION
DATE: 5/6/14
Thomson Lot 8
PERMIT NUMBER: OSP 141073 DATE OF ISSUE:
TAX IDENTIFICATION NUMBER 06704108000
4/17/14
Is well located at approved permit location: MYes
Method of Drilling: Mair rotary cable tool
Depth of Well: 380'
No
Casing Type: steel
Diameter: 6
Liner type none
Wall thickness
inches, depth
.250 inches
104 feet
Static Water Level: 90
Recovery Rate 4.5
Method of Testing air
gpm
feet
n gph
Well Intake Opening Type: 1 open end
Start feet
Start feet
n Screened
❑ Perforations
Grout Type: Bentonite chips
Depth: from 0 feet, to 40 feet
Well Disinfected Upon Completion: yes no
Method of Disinfection: Chlorine 50ppm
wopen hole
Stopped
Stopped
Volume: 751bs
Comments:
Bore Hole Data
Depth
From To
0
2
2
4
4
21
21
56
56
80
80
91
91
115
115
135
135
139
139
248
248
252
252
304
304
380
688-2759
Casing stickup
overburden
Sand & gravel w/ clay
Tight sand & gravel
Hardpan
Hardpan w/ clay
Bedrock yellow
Bedrock gray
Bedrock yellow
Bedrock gray
Bedrock yellow
Bedrock gray w/ quartz
Bedrock gray s/ fractures
Water progressive
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
MatSu Borough: Department of Environmental Conservation.
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: OSP141073
Tax Code Number: 06704108000
Work Type: WellSeptic Initial
Permit Effective Dates: April 17, 2014 to April 17, 2015
Design Engineer: ANDERSON ENGINEERING
Subdivision: THOMSON
Site Legal Address: THOMSON LT 8 G:0363
Owner/Address:
WEBB JOEL M & DEBORAH S
PO BOX 770414 EAGLE RIVER AK 995770414
Site Mailing Address:
Lot Size in Sq Ft: 40918
Total Bedrooms: 4
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 By:
Issued By:
Municipality of Anchorage
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 S (907) 343-7904 • Fax (907) 343-7997
http://www.mu n Lora/0 ns i t e
Development Services Division
On -Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP141074 COSA#:
PID#: 067-041-08
Legal Description: Thomson, Lot 8
Engineer: Anderson Engineering
Applicant: Joel & Deborah Webb
Permit#: OSP141073
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the 25% or greater slope has been approved. The approved separation distance is 15 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 non -objection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
Waiver is Granted:
Date:
X
Waiver is not Granted:
Approved b
ame of Reviewer
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Phone: 907-343-7904
Fax` O 10
y7:
ON-SITE SEWER/WELL PERMIT APPLICATION
APR 1 4 2014
Parcel I.D. 067-041,84'
Property owner(s) Joel & Deborah Webb Day phone 250-8290
Mailing address P.O. Box 770414 Eagle River, AK 99577
Site address White Spruce Drive Eagle River, AK 99577
Legal description (Sub'd., Block & Lot) Thomson, Lot
Legal description (Township, Range & Section)
Lot Size 40,918 Sq. Ft. Number of Bedrooms Four (4)
APPLICATION IS FOR:
(® all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
APPLICATION IS AN:
Initial
— Upgrade
El
RenewalEl
0
El
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D)
MultiEl
ple Dwellings
(SF and/or D)
nein"�
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
IS (WAN
('Dis tance !
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Slope to Absorption Trench
(Signature of property owner or authorized agent)
Permit/Rush Fees: 9-B7
Date of Payment: c-// LIO
Receipt Number: Cana
Permit No. 05Pit 1/07,3
Permit App_9-1-12.doc
Waiver Fees: 2!5
Date of Payment: Lilt tili
Receipt Number: 6420 .a7
Waiver No. QSPj`t /O9
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
April 12, 2014
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 8, Thomson Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 8, Thomson Subdivision intends to construct a new four-bedroom
home on the lot. We are therefore requesting a permit be issued for the construction of
a new well and septic system to accommodate the home. The attached Site Plan and
backup documentation identify the location and configuration of the proposed well and
septic system along with the alternate site. Also identified on the plans are the existing
wells and septic systems on surrounding lots. No conflicts exist between the proposed
septic system and well or septic systems and wells on adjacent lots. Drainage contours
are shown on the site plan showing the grade and direction of flow on the lot. The
drainage pattern will not be changed as a result of this project.
Two test holes were placed on the lot in the area of the absorption trench and alternate
site. The logs indicate silty gravel (GM) with sand in the zone specified for the
absorption trench. The percolation rate of the soil was determined to be 4 to 5 minutes
per inch. No groundwater was found during the placement of the test holes and none
has been noted during the monitoring period. An application rate of 1.2 gallons per day
per square foot was used in the design of the absorption system. We are proposing to
place a new 1,250 -gallon septic tank and a 58' long by 5' wide by 3' effective depth
absorption trench to treat and dispose of the effluent generated in the house. The
elevation of the distribution line in the absorption trench will be 6' below the surface and
the total depth will be 9'. A minimum of 3' of fill or 2" of insulation and 2' of fill will be
placed over the absorption trench and 4' over the septic tank.
The ground surface on the lot in the area of the septic system slopes to the southwest
at a grade of 25%. This grade steepens to the southwest and a slope waiver is
required to allow the trench to be within 50' of a break in grade greater than 25%. The
Lot 8, Thomson Subdivision
April 12, 2014
Page Two
new trench will be constructed parallel with the contours of the slope as much as
possible in conformance with Municipal requirements. The new septic system will be
constructed a minimum of 100' from all wells and any surface water and 10' the
proposed and existing water services in the area.
If the system is constructed in accordance with our design 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 future.
3. The system, if constructed as designed, will have no adverse impact on reserve
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.
Sincerely,
Michael E. Anderson, P.E.
Attachments
7
/17
13 '`7,
MPI fRIADRNE
0
Existing
Well
0
Existing
Well
F
02'
2
Existing
Well®
Proposed
Well
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t.,n;MICHAEL E. ANDERSON
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SCALE 1" = 100
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LOT 8, THOMSON SUBDIVISION
DESIGN FACTORS:
Four Bedroom Home
Pero. Rate: 4-5 Min./Inch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,250 Gallon Septic Tank
3' Drainfield Rock
4 Bedrooms * 150 GPD/Bedroom = 600 SF Absorption Area
600 SF/1.2 GPD/SF/5 SF (Width) *.58 (Red. Factor)= 58 LF Trench Length
THEREFORE: Construct a 58' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 6' Below Original Ground Surface. Total Depth to be
9' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over
Septic Tank.
5'6"
5'
Geotextile Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION -
(NO SCALE) ����..••• ,...
NOTE: Grade Area Over Trench to Drain Away. :+�
Minimum 6' Separation From Bedrock. •
49th
W ';
7....:..../�
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Private Wells in the Area. it m; MICHAEL E.ANDERSON
Minimum 100' Separation From Surface Water or Streams. %G%%. No. CE -4381r
weal»..*%t s'.
•
•
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: Loi 8, THOMSON SUBDIVISION
PERFORMED FOR: JOEL WEBB
DATE: 1/4/2014 PROJECT No •
PARCEL ID#:
4
at
OB/CG
TECHNICIAN- A. HARALA
TEST HOLE # 1
SILTY GRAVEL WITH SAND
GM
BOH
SLOPE
Ntl d 311S33S
WAS GROUND WATER ENCOUNTERED, No
IF YES Q WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING:
NONE
DATE OF MONITORING 1/21/14
0
0
,
���•��, •441
iji
• 49th
1114tjej Ea)
MICHAEL E. ANDERSON :a
Professional Engineers Stamp:
SITE PLAN
SEE SITE PLAN
SEE SITE PLAN
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
1/4
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
2:42
5.75"
2
3:12
30
12.25"
6.50"
3
3:13
5.81"
4
3:43
30
12.19"
6.38"
5
3:44
5.81"
6
4:14
30
12.19"
6.38"
PERCOLATION RATE: 4 7 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4 5 FT. and 5.5 FT.
COMMENTS' TEST HOLE PRE SOAKED PRIOR TO. TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 4/12/14
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:
PERFORMED FOR: JOEL WEBB
DATE- 1/4/2014
PARCEL ID#:
LOT 8, THOMSON SUBDIVISION
4
•
4 4
4
OB/00
PROJECT No
TECHNICIAN- A. HARALA
TEST HOLE # 2
SILTY GRAVEL WITH SAND
GM
BOH
WAS GROUND WATER ENCOUNTERED?
IF YES @ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING:
SLOPE
Nd1d 9119 99
NO
NONE
DATE OF MONITORING' 1/21/14
O
D
%•ts•••
744.44Oth 1 \»'
C
?MICHAEL E. ANDERSON �W, j
♦♦ f'•. NO. CE -4381 ',i
Professional Engineers Stamp:
SITE PLAN
SEE SITE PLAN
SEE SITE PLAN
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
1/4
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
3:08
4.50"
2
3:38
30
10.75"
6.25"
3
3:39
4.38"
4
4:09
30
10.63"
6.25"
5
4:12
4.44"
6
4:42
30
10.69"
6.25"
PERCOLATION RATE: 4 8 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4 5 FT, and 5.5 FT.
COMMENTS' TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 4/12/14
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
April 12, 2014
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 8 Thomson Subdivision
Absorption Trench to Slope Waiver
Dear Onsite Services Engineer:
Lot 8, Thomson Subdivision has limited area for construction of a septic system due to
steep slopes to the southwest. The developer of the lot has located the house on the
flattest area of the lot further reducing the area available. We have located an area
with acceptable soils for the primary and alternate septic sites. The 25% slope when
extended from 2' above the distribution line in the absorption trench does not daylight
for a distance of 35'. We are therefore applying for a waiver allowing placement of the
absorption trench at the location shown. The soil encountered in the test holes is clean
well graded sand (SM/SW) which is very good for the absorption of septic effluent.
Most of the effluent absorption will be down with little or no migration of effluent to occur
toward the steep slope.
Sincerely,
Michael E. Anderson, P.E.
• pMICHAEL E. ANDERSON j
i
•1 f�•. No. CE -4381 ���
Attachment
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5' 10' 15' 20' 25' 30' 35' 40' 4
-, THOMSON SUBDIVISION
•
* LOT 8
SLOPE ASSESSMENT
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Parcel I.D. 067-041-08
1.
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 P
Certificate of On -Site Systems Approval OS g//
Expiration Date: / ' 2- I 1 ✓�
GENERAL INFORMATION
Complete legal description Thomson, Lot 8
Location (site address) White Spruce Drive Eagle River, AK 99577
Current Property owner(s) Joel & Deborah Webb Day phone 273-1018
P.O. Box 770414 Eagle River, AK 99577
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
a Single Family (w/wo ADU)
0 Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Four
UBMITTAL
on- 202014
TYPE OF; WASTEWATER DISPOSAL:
Individual •
Holding Tank
0
Community
0
Public Sewer
WaiverNariance request for: Distance:
Received by: art 2L a...411,-1
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
/O -2Z -/!G
COSAFee $ (°41) gill( =
Date of Payment lof 2,11'{ V 4"
Receipt Number OBJ) -G
05C14 64 co
COSA#
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. 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 Certificate of On -Site Systems 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 verify that based on the information
obtaind`tfrom 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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
AZ.
__ System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
By:
`.bate 10J1 't%
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• Ag -m1 : '.Y
32
f al tl 1.�` J 'IL
';
,S r•MICR/ L,Ef� ANDERSON: k• -•O J: CE='r981 : m
'#?e ., to_-iV,tC
bedrooms, with the following stipulations:
-,,‘,/<•(
-\ (,OF y, oe"
o(;
` = ON-S1TE
-Z WAMR AND
.5:0 WASToNATER o^
PROGRAM
0 -et Original Certificate Date: / 0 '02-1— �7
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
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7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_( f- L c
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Thomson, Lot 8
A. WELL DATA
Well type Private
Date completed 5/6/14
Total depth 380 ft
Date of test
Static water level 90 ft
Well production 4.5 g.p.m.
If A, B, or C provide PWSID #
Sanitary seal (Y/N)
Cased to 104 ft
FROM WELL LOG
5/6/14
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate
Arsenic NO ug/L Date of sample
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 gal.
.846 mg/L
10/6/14
Number of Compartments
Parcel ID: 067-041-08
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >18 in.
AT INSPECTION
ft.
g.p.m.
Collected by: Anderson Engrg.
Date installed 4/30/14
2 Cleanouts(Y/N)
Foundation cleanout (Y/N) Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping New Const. Pumper
C. ABSORPTION FIELD DATA
Date installed 5/1/14
Length 58 ft.
Soil rating (g.p.d./ft2 or ftZ/bdrm) 1.2 GPD/SF System type 5' Wide
ft. Gravel below pipe 3 ft.
Width 5
Total depth 9-10 ft. Eff. absorption area 580 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Const. Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
Elapsed Time: min.
N
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off' level at in.
Datum Cycles tested
No Add On Manhole - Gravity Flow to Absorption Trench.
E. SEPARATION DISTANCES
WELL ON LOTTO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main N/A
Sewer /septic service line >25'
Animal containment areas >50'
Manhole/Access (Y/N)
High water alarm level at in.
Meets alar & circuit requirements?
On adjacent lots
>100'
On adjacent lots >100
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas >1001
N/A
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5 Absorption field >
Water main >10 Water service line >10 Surface water >100
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10'Building foundation >10 Water main N/A
Water Service line
>10'
Curtain drain None NotedWells on adjacent lots >100'
Surface water
>100' - Driveway, parking/vehicle storage >10'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 10/19/14
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