Loading...
HomeMy WebLinkAboutPOLLARD LT 2Pollard Lot 2 #051-261-41 e Municipality of Anchorage Page 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 PID Number:/ - Permit Number: Name: �c,�/GIST � susA� Pay-�AR� Wastewater System: 1 New D Upgrade Address: P. 0 800 ABSORPTION FIELD Phone:No. '7000 of Bedrooms: C Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound C1Other LEGAL DESCRIPTION Soil Rating: 0,9 Total Depth from original grade: GPD/Sq. Ft. Lot: Block: Subdivision: 0Ft. Depth to pipe bottom from original grade: Gravel depth beneath pipe Ft. a p L.LA R 6�t,Sw i , _ [v __�. Township: / Range: Section: Fill added above nriginal grade: Gravel length: �� Ft. � o ©— . C?. Ft. Gravel width: Number of lines: Distance between lines: I WELL: ® New D Upgrade 3 Ft. / — Ft. Classification (Private, A,B,C): Total Depth: Cased To: area: Total absorption area: Pipe material: STM �3ojc� 8/U P?ld/1'TE Ft. Ft. /S(D46 SO. Ft. Driller: Date Drilled: Static Water Level: . Installer: r Date installed: s L L L v )r Yield:Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES 9 Septic D Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer:Capacity wU T in gallons: From Tank Field Station Tank Sewer Lines A C RA E' /JF// WelF /00 f /00/f — �S f Material: STEEL Number of Compartments: 12 Surfa e /00f /00 ri LIFT STATION LotWat I Size in gallons: Manufacturer: Line q1 /o' "Pump on" level at: "Pu p7 level at: High water alarm at: Foundation `� */ / ��'/ Curtain / ✓C �i/vw / Pump Make -M el I Electrical Inspections performed by: Drain /JG BENCH MARK Remarks: 116 I A> 41VV - - Location and Description: S�/)ArvrAk-� 1�41-0 !.o l J 7/t 11, /'R .t%uV %&M :77 7-04 vF c0wC C7c- ASE kidici- WV" ff-4 TtC Syj 7-&ol r S' nF Ce Cc 1-,e/c14C boX Assumed Elevation: Lo r o0 ENGl OF I..... tti `;% s de S ENGINEERING 17034 Eagle River Loop Road, No. 404 0 . b Dates:1st /Q-/� /S �,^'•- .:...., ...<...<.,. o Inspections performed : P p Y -t' « ..... ... ..: ...... 2ndlol�� /& ' 98 fr,...:. ?, 1 ROBERT C. COWAN,@ rla 32 E 10114-915, �C 4%% CE • Fi8U 1 \. N Department of Health and Human Services approval •,, ,•'••ri Reviewed and approved by: ��2"� Date: 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW980393 PAGE 2 OF 3 Municipalit of Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 *Anchorage, Alaska 99519-6650 • Tele hone) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 2, POLLARD S/D LEGAL T15N R1 W SEC. 20 E2SW4SE4SW4 P.I.D. NO. 051-261-06 NEW WELL Fly rop I � I h�p�SSF p A C co, �4 ,n/ \� F 100' WELL RADIUS NEW 1250 GAL. SEPTIC TANK r, FCO I z I� B I� Lu I� I� 1• Iw I ui INSULATION I m )ER DRIVE LOT 1 I J w IF-- \I'0 I TH#2• C'0 NEW TRENC4—ALT.— TH#1• SITE — z , GRAVEL DRIVE (Lor a • _ TH#3 r- I EI. BOX 1• � I �� T �'• ROBERT C. COWAN CE - 8801 LOT 2 LOT 1 ��'�F� �.............. • ''` PERMIT NO. SW980393 PAGE _ 3 OF 3 MunicipaUt of Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Tele hone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 2, POLLARD S/D LEGAL T15N R1 W SEC. 20 E2SW4SE4SW4 P.I.D. NO. 051-261-06 STI 972 112.9' FINAL GRADE NEW DBL2 — 91.5 145.0 106.2' 1250 GAL 105.9' S.T. CO2 = 105.4' CO3 = 103.4' CO2 MT2 CO3 MTI FINAL GRADE 30' 20' 15' 10' TOE OF SLOPE 2' ROADBED �ZIU_ 25% SR CO2 = 99.4' CO3 = 99.3' EDGE OF SEWER ROCK MT2 = 93.2' MT1 = 93.4' NO WATER FOUND 84.8' B.O.H. i • • r'l1. O qj 4 ROBERT C. COWAN it,L? des �g •., CE -8801 kkk tZ'R�e�. ' yip A B C FCO 9.5' 19,0' — C01 — 36.0' 76.0' ST1 — 78.5 134.0 ST2 — 87.0 141 .0 D8L1 — 90.0 144.0 CO2 — 109.0 147.5 MT1 — 109.0 147.5 CO3 MT2 114.5' 178.5.5 STI 972 112.9' FINAL GRADE NEW DBL2 — 91.5 145.0 106.2' 1250 GAL 105.9' S.T. CO2 = 105.4' CO3 = 103.4' CO2 MT2 CO3 MTI FINAL GRADE 30' 20' 15' 10' TOE OF SLOPE 2' ROADBED �ZIU_ 25% SR CO2 = 99.4' CO3 = 99.3' EDGE OF SEWER ROCK MT2 = 93.2' MT1 = 93.4' NO WATER FOUND 84.8' B.O.H. i • • r'l1. O qj 4 ROBERT C. COWAN it,L? des �g •., CE -8801 kkk tZ'R�e�. ' yip A B C FCO 9.5' 19,0' — C01 — 36.0' 76.0' ST1 — 78.5 134.0 ST2 — 87.0 141 .0 D8L1 — 90.0 144.0 CO2 — 109.0 147.5 MT1 — 109.0 147.5 CO3 MT2 114.5' T r r t if i b � , itltug i[ag II SULLIVAN WATER L �lrl ER • Y ELLS P.O. BOX 6to212.CNOGIAK.ALASKA 99567 V TELEPHONE 688.2759 r OWNER OF LAND _ `2�nQ_ DEPTH OF tti't Ll 00 _ ADDRESS � �-� �� � ST.AT1C LEVEL 0 WATER FT. N 1 rC 1. ; c� S •u �i 3 DRAW DO N FT. LEGAL DESCRIKIO f DATE . Started Ended GALS. PER ITR PERMIT NUMBER KIND OF CASING ( - KIND OF FORMATION, From— Ft- to—Ft- Fram Ftomp p._Ft. toFt.� L �% JSz < From Ft, to Ft- From__Ft. to�S2—fit. FromFt. to�Ft. From, ---.Ft. to� Ft. From, Ft. to Ft. .._....... From—_—Ft. to I't• — From Ft- to Ft — From-- Ft. to Ft. From _Ft. to_Ft.� --� From- Ft. to—Ft• — From. Ft. to�Ft. Ftom. Ft. to Ft. From—_Ft- to Ft. .-.. From-- Ft. to Ft. From. --.-Ft, to -ft, MISCL. INFORMATION: G !� c. Q .7 !' ToT r°oig Fog 4r" From—Ft. From Ft, to_— Ft. Froin Ft- to Ft- Fran Ft. to_.Ft. -- From__Ft. to_ Ft. From t t From t' o -Fi From— Dept. rom— Dept. Health & t-iuman Services From Ft, -- From Fj. to_ Ft. From Ft- to Ft. From Ft. to Ft DRILLER'S NAME 20"d VVOV9V V9V V7VoStL 889 51"l31-1 c13.L V I•I N V A I-1-1(15 Wd 8S £0 Q3I.1 8c—L0—o:aa MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 625 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW980393 Legal Description: T1 5N R1 W SEC 20 E2SW4SE4SW4 Design Engineer: 0003 S & S Engineering Owner Name: Dwight Pollard / Linda Frank Owner Address: PO Box 770628 Eagle River , AK 99577-0628 nc>u,y1 ")Pcy--� �� It �Cn-r�IN Date Issued: Oct 02, 1998 Expiration Date: Oct 02, 1999 Parcel ID: 051-261-06 Site Address: 020509 LAUGHLIN ST Lot Size: 217800 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 'This permit is for the construction of: [V] Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 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 ). 4. 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. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. 1. Ensure the required separation distances are met between all surface waters & the septic system. 2. Prior to the final approval of the As -Built inspection report, the existing house, septic system and well must be properly decomissioned as shown on the design. 3. The well log must be turned in for the As -Built inspection report to be approved. This is a renewal of permit SW970062 Received By: Issued By: ❑�❑ ��❑ ❑ ❑%❑oma, Z ��- Date: Date: �� `0 10 0 2. Depan.r ent of S eaiah and 11.1un inn Services 825 1" Street Rick DAystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650 Nla yor htip, wrrrv.ci.anchoraye.ah.us 343-4744 April 17, 1998 Susan Amanda Pollard Dwight Dufresne PO Box 770628 Eagle Eiver, Alaska 99577 0628 Subject: T15N R1W Section 20 EZ SA SE -4 SW4 Permit #SW970062, PID 1051-261-06 The subject permit, issued April 16 1997 by this office for a single family well and/or on-site wastewater system, has expired as of April 16, 1998. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Since ly, Jam s% Cross, P.E. Pro ram Manager On-site Services enc: Copy of Permit cc: S & S Engineering Moo COW PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 1966501 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON—SITE WELL AND WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970062 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:DWIGHT & SUSAN POLLARD OWNER ADDRESS:P.O. BOX 770628 EAGLE RIVER, AK. 99577 PARCEL ID:05126106 LEGAL DESCRIPTION: T15N R1W SEC 20 E2SW4SE4SW4 LOT SIZE: 217800 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 4/16/97 EXPIRATION DATE: 4/16/98 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: IZkC?wR 0 Sr�a�'liwfia;.� i)iS"YgN(rs /I.Rr /VIE7 PRIOR TO FINAL APPROVAL OF THE ASBUILT/INSPECTION REPORT, THE EXISTING HOUSE, SEPTIC SYSTEM, AND WELL MUST BE PROPERLY ABAND&JED AS SHOWN ON THE DESIGN. DATE: DATE:�- ilG� Si,i7Li HCI V'/i4-7�=.�5 /a/VC)�Sr_;<'7/c. SySC,r=iv1i RECEIVED ISSUED BY: s&S� �ineeRrnq February 23, 1997 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX (907) 694-1211 HEALTH AUTHORITY MUNICIPALITY OF ANCHORAGE APPROVALS Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 SEWER& WATER MAIN EXTENSIONS REFERENCE: East 1/2; SW 1/4; SE 1/4; SW 1/4; Sec 20; T15N; R1W S.M. SEWER&WATER Request you issue a permit to drill a well and install a INSPECTION septic system to serve the proposed four bedroom house on the referenced property. Test holes were excavated and percolation tests performed. ENGINEERING STUDIES The approximate location of the test holes are located on AND REPORTS the attached site plan. At the time of excavation no water was encountered in the test holes and after seven day ground water monitoring, the WELL INSPECTION monitoring tubes within the test holes were found to be &FLOW TEST dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. SITE PLANS We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. ROAD DESIGN There are no points of contamination within the proposed well radius which can be seen on the attached site plan. SOIL TEST If: you require additional information, please contact us. Sincerely, PERCOLATION TEST Robert C. Cowan, P.E. RCC/gk STRUCTURAL& MECHANICAL Enclosure INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 60' SCALE SITE PLAN DESIGN ls6oll i Tr 'oo. BOO No/ z TOP OE CUT BANK ___---.\ DVI0 ZS� r m m>,< Dec F- A z m -x w z o mpg �N j 1C <C Zm i O D D mr 7 y N ?OmmE—w> �oDA Dv, ,,K<w 1111Rl m 0 - O Obvi )puyjQ Aj!jv-ch3Iu lw 2� � o zA r mmyr'lmmm Cn Z LL�' JJy-/ m OZ D N O sz pm00 nD MR M m1: ->m = ::E QG Y Z Z y Z O O , Dmf aOD= �\ r0 n ii I I ii 25 //�� 13 `�j zOm v �0 m mom m m x t J 1 \y0 ! T /`fit ed �l NOS TvM. o�xvy `d 1 Q?O mo Z` [r" -uZ Vo o$m i NiJ U7 I-� Oo D n H 11 a -`7 HCl 1-y 1 z Ito �T'm rel O n m co II K mo mjso oomz r'l —{ II O II m m p m z rte' OD o O IVO W i (Jl -O O la 1 co ! F- IV ' 0) N N W r -i LNC p1 ,O N Q -,0-7 I Ul�m� m9 rm*1 b 3 p� alp -ri N m 01 vi C = i1 00 C) U) `.�. 70 _ n a a Fr] 0 I 1� ls6oll i Tr 'oo. BOO No/ z Z m pc �� yc 0 A "'ice a „C � o O N d� p 01 1 ----0 -- O\y0 4 / =4 oz m POSSIBLE 33' ON LINE EASEMENT fmoo O A W O A O � Z T m> ZD o OCy y Z1–� � N m nom O mm ymm jom 0 0 z 0 o0-iy ONO DVI0 ZS� m>,< Dec F- A z m -x w z o mpg �N j 1C <C Zm i O D D mr 7 y N ?OmmE—w> �oDA Dv, ,,K<w 1111Rl m 0 z O m y O :o fF- 2� rm zA r mmyr'lmmm 0 Z m OZ D N O pm00 nD m1: ->m = ::E 0 0 0 Z Z y Z O O , n 3 0 X11 r0 n ii I I ii 25 Z m pc �� yc 0 A "'ice a „C � o O N d� p 01 1 ----0 -- O\y0 4 / =4 oz m POSSIBLE 33' ON LINE EASEMENT fmoo O A W O A O � Z T m> ZD o OCy y Z1–� � N m nom O mm ymm jom 0 0 z 0 O N o0-iy ONO DVI0 ZS� m>,< Dec F- A z m -x w z o mpg �N j 1C <C Zm i O D D mr 7 y N ?OmmE—w> �oDA Dv, ,,K<w m 0 z O m y > 2� cO-ZDA zA r mmyr'lmmm Z m OZ D N O pm00 nD m1: ->m = ::E 0 0 0 Z Z y Z O O O N N. 1'. S, PROFILE SCALE r- 16' DEEP 14% O r M TH #3:E n 8 rllr- Z DEEP > 0 i D N z r O Frl z O � zm D -i n 0 rT m z Frl x D o v r X ;u c� o m 00 D \\ C7 00 rrj m n LA � FEZ m MIN. COVER W/ INSULATION m 6' EFFECTIVE A N ---10' DEEP \� Q00 E_T M #1 & 2 \ V m �n o x N z p � N O C O i m m m '0 OF Municipality of Anchorage All C9\.' DEPARTMENT OF HEALTH & HUMAN SERVICES % ' "7 }�,•P� 825 "t_" Street, Anchorage, Alaska 99502-0650 j>•"t,-•,.••..<• 4 SOILS LOG - PERCOLATION TEST ROBERT C, COWAN�Fj[ C M1-Ct-t3UU1 O �1 /�..,� � tip `_ •, �, ' (> ao PERFORMED FOR: JS �t�Pc DATE PERFORMED: ?���•-''.(`a,�' C LEGAL DESCRIPTION: Jam-. z� Tt �14..� Township, Range, Section: D,EW7-0 F— Ily 1 SUt I ,I 15 rz IA 5 vi 114 SLOPE SITE PLAN 1 v 2 3 4 � v � r 5 SJwI� SILT 6 �J 7 8 g v. 14 i5 p ,jL 51617 15- 16- 17 18- 19 20 COMMENTS S WAS GROUND WATER ENCOUNTERED? I S IF YES, AT WHAT I% L DEPTH? A O P E Depth to Water�le< Monitoring?1 J_`(�•IIDale: Reading Date Gross Time Net Time Depth to Water Net Drop c 1 --1 -7- 2 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: S & S ENGINEERING���� 7 CERTIFYTHA THIS TEST WAS PERFORMED IN 17034 age Iver oop oa , l ) / ACCORDANCE WITH A�h��EFdI�IrA1d546nC99.5+7gi U I DELI N ES IN EFFECT ON THIS DATE. DATE: J 3 lei _ 72-008 tRev. 4/85) Municipality of Anchorage ,� 0 DEPARTMENT OF HEALTH 8t HUMAN SERVICES /'qt! 825 "L" Street, Anchorage, Alaska 99502-0650 s f, r ........ :.:....� SOILS LOG — PERCOLATION TESTr.,,,,; V. ROBERT C. COWAN d & cv PERFORMED FOR:`�G�Arr-,' �b1��t�C�—t7 DATE PERFORMED:_ LEGAL DESCRIPTION: Ste, Za I Tl�j ti t Q-1 Township, Range, Section: P -F UH (may 11IL rj �f `Sp4 �/E 5`� ir•I SLOPE SITE PLAN 1 , 2 � N 3 4 5 LI Lw 6 7 , 8 9 l 10 ° 11 12 .r 13 14 51617 15- 16- 17 18 19 20 COMMENTS WAS GROUND WATER Depth to Net Water Drop ENCOUNTERED? I� S IF YES, AT WHATL WHAT' ry L' DEPTH? �- E Depth to Water After Monitoring? � Dale: Reading Date Gross Net Time Time Depth to Net Water Drop fn1� t I F— PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER c TEST RUN BETWEEN FT AND —7_ FT & S ENGINEERING — PERFORMED BY: ale Rtver Loop RoW�CERTIFY THAT S TEST WAS PERFORMED IN ACCORDANCE WITH-iAet t3f 4' RND'14TUNtCIP'AL GUIDELINES IN EFFECT ON THIS DATE. DATE: iZ Al! 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOC — PERCOLATION TEST ., .,.... . ROB[ --RT C. COWAN t c- ! uSArS C� l L rd �, PERFORMED FOR: AaRii DATE PERFORM LEGAL DESCRIPTION: !�t:L. Zo tTisjh4 KI W PTH 6Af't• t/Z. ,e SLJ �4 5E Iy A 3 4- 6 6 7 rb . 1 11 6- 12 13 14-0 c 16 17 m III OR.CaAIIJtC,r, RE -C I V ED APR 1 199 i Municipality Of Anchorage Dept. Health & 1-iuman Services �/LLGHT �IL"r Ar1� Cobkttr�S Township, Rancie, Section: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE NO SITE PLAN CE 8801 3•ti't- � It',✓eM L Depth to Waler er Monitoring? Date:3''T�`q� 20 PERCOLATION RATE (mmutesimch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS V09— 4ti -q- I't 'nCeE t>( Soit1� V)bej Moj T9Jt—,n) ti IS t�dl 0 P E NINE C ■ 1■■10:0 OMNI ■NMNN■■ No 3•ti't- � It',✓eM L Depth to Waler er Monitoring? Date:3''T�`q� 20 PERCOLATION RATE (mmutesimch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS V09— 4ti -q- I't 'nCeE t>( Soit1� V)bej Moj T9Jt—,n) ti IS t�dl 0 P E PERFORMED BY: 17034 Bag's River Loop Read 9 • 1204 1/.,1t40 L-- L 'v` -"'C S ERTIFY THAT/ THIS T ST WAS PERFORMED IN ACCORDANCE WITH ACLag;OAWVA��t lI M�G7UIDELINES IN EFFECT ON THIS DATE. DATE: 3/ 31 '11_I _ 72-008 (Rev. 4/85) C PERFORMED BY: 17034 Bag's River Loop Read 9 • 1204 1/.,1t40 L-- L 'v` -"'C S ERTIFY THAT/ THIS T ST WAS PERFORMED IN ACCORDANCE WITH ACLag;OAWVA��t lI M�G7UIDELINES IN EFFECT ON THIS DATE. DATE: 3/ 31 '11_I _ 72-008 (Rev. 4/85) inq ROBERT C. COWAN, RE. ROBERTA. SHAFER, P.E. KA ON-SITE WASTEWATER DISPOSAL SYSTEM CIVIL ENGINEERS CONSTRUCTION PRACTICES (sol) 94- FAX (9007)7) 6 694-1211 and MATERIAL SPECIFICATIONS HEALTHAUTHORITY APPROVALS REFERENCE: Eastl/2; SWI/4; SEI/4; SWI/4; Sec 2.0; T15N; R1W S.M. February 24, 1997 GENERAL: 1. The scope of this project includes the installation of SEWER&WATER a 1250 gallon septic tank and a leachfeild trench to MAIN EXTENSIONS serve -the proposed four bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned completely. The existing leachfield is to be SEWER&WATER abandoned completely. INSPECTION 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with special provisions or conditions, and all ENGany AND IREPORTS NEERING STUDIES applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any WELL INSPECTION necessary underground utility locates. & FLOW TEST 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. SITE PLANS 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing -their own ROAD DESIGN systems must also receive prior approval from the Municipal Health Department. SOILTEST SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include PERCOLATION two 4" cleanouts for pumping access. TEST 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. STRUCTURAL& 3. All standpipes on the septic tank shall extend a MECHANICAL minimum of 12 inches above final grade. INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two East1/2; SW1/4; SE1/4; SW1/4; Sec 20; T15N; R1W S.M. February 24, 1997 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TREHCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and -the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three East1/2; SW1/4; SE1/4; SW1/4; Sec 20; T15N; R1W S.M. February 24, 1997 5. Backfill over -the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation 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: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever applies. Page Four Eastl/2; SWI/4; SE1/4; SWI/4; Sec 20; T15N; R1W S.M. February 24, 1997 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with -the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five East1/2; SW1/4; SEI/4; SWI/4; Sec 20; T15N; R1W S.M. February 24, 1997 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage / Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street b P.O. Box 196650 rF Anchorage, AK 99519.6650 www.munl.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING^' Parcell.D. Q��.o`Z(e(^ T1 COSA# UiPf)0c 3 v 1. GENERAL INFORMATION Expiration Date: %" 1 3 — o Complete legal description Location (site address) Current Property owners) Mailing address Lending agency Mailing address Real Estate Agent Mailing address POLLARD SUBDIVISION: LOT 2. 20509 LAUGHLIN STREET • CHUGIAK AK 99567 SUSAN POLLARD Dayphone 440-7257 (AGENT) C/o RANEY HARDMAN w/ REMAX PROPERTIES Day phone RANEY HARDMAN w/ REMAX PROPERTIES .Day phone 440-7257 16600 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal andlor water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 obtained from the Municipality of Anchorage riles 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance ofthe system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for _q__ bedrooms. Disapproved. Conditional approval for Attachments: COSA Checidist Septic System Advisory Well Flow Advisory Nitrate Advisory 337-6179 Date ///11 rL bedrooms, with the filowing stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other WATER AND • IT ! :-WASiEWATE, PROGRAM By: Original Certificate Date: 3 d 'P_ .,M, Municipality of Anchorage Development Services Department Buikiing Safety Division On-Sse Water b Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519 -WW www.muni.ory/onske (907)343.79D4 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: POLLARD SUBDIVISION: LOT 2. Parcel ID: 051'1 CI _}1 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Date completed 6/1997 Sanitary seal (Y/N) YES Total depth 100 ft. Cased to 60 ft. FROM WELL LOG Date of test 6/1997 Static water level 5 ft, Well production 25 g.p.m. WATER SAMPLE RESULTS: Coliform 0 oolonies/100 ml. Arsenic: ND ug./L. B. SEPTICIHOLDING TANK DATA Nitrate 3.45 rng,/L, Well Log (Y/N) YES Wires property protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 3/28/2006 6 ft. 5.9 g.p.m. Other bacteria 0 colonies/100 mi. Date of sample: 3/29/2006 Collected by: GEG. Ltd. TankType/Matenal STEEL Date installed 10/16-22/1998 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping 4/7/2006 Pumper JR's PUMPING C. ABSORPTION FIELD DATA Date installed 10/16-22/1998 Soil rating0j.p.d fIlbdnn) 00=8 System type TRENCH Length 63 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 010 ft. Elf. absorption area 756 ft' Monitoring tube YES Depres over field NO Date of adequacy test 3/28/2006 Results (Pass/Fall) PASS Forbedrooms Fluid depth in absorption field before test DRY in, Water added 2138gal. New depth 13 in. Elapsed Tkne: 1035 min. Final fluid depth DRY in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 3 type) NONE KNOWN If yes, give date - D. LIFT STATION Data installed 'Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot 100'+ Absorption field on kri 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100' Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lob 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water *100, Driveway, parkinglvehicle storage 10'+ Curtain drain 50'+ Wells on adjacent lots 100'+ F. COMMENTS *FROM EDGE OF CLEANOUT TO CENTER OF FROZEN/SNOW COVERED DITCHUNE. G. ENGINEER'S CERTIFICATION I car* that 1 have determined through lield insperdlons and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's ,Printed ame JEFFREY A. GARNESS Date 1 /mt/04 UU -� COSH Fee a �,� Date of Payment 1, t "Y Receipt Number '2 (Rev. 1IMS) Waiver Fee E Date of Payment Receipt Number SGS ReEM 1061484001 Client Name Gamess Engineering Group, Ltd. Project Name/p Pollard S/D Client Sample ID Pollard SID Lot 2 Slatris Drinking Water Sample Remarks: Parameter Meta18 by ICP/MS Arsenic Slaters Department Nitmic-N Microbiology Laboratory Total Coliform Results ND 3.45 0 All DateJrimes are Alaska Standard Time Printed Daterrime 04/102006 15:21 Collected Datefrime 03292006 7:45 Received Date/time 03292006 15:34 Technical Director Stephen C. Ede Allowable Prep Analysis Units Method Container ID Limits Date Date but 5.00 ug/L EP200.8 0.100 mg/L EPA 353.2 A (<=10) 04/03/06 04/05/06 SCL A (<=10) coUI00mL S%12092220 A (<=I) 0329/06 ALR 0329/06 DPT 04/10/2006 12:15 9073449821 JRs Pumping PO 90N 777411 raea River. AK 99571 (907) 694.6454 78IIIIn0lnfotm�tl0n ..._r, Game65 Engtneeretg Group 3701 E Tudor Road Suite 101 Anchorage, AK 99507 (907) 337.6179 Meagan & Krla ,1o4�tte Intolmtnlory_.J Caleb - Susan Pollard, home owner 20509 Laughlin Street Chuglak, AK 99557 (907)337-e179 952-5306 Caleb JRS SEPTIC Jeb oroapban: Unknown P.C. Number: Tem.. Net 30 StM.rap' Nlkote MW Boot. PAGE 01 Service Agreement Number. 019463 Order Date; 29 -Mar -2006 Service Date: 07 -Apr -2006 12:00 Technician: Dave eras soeao. N.ila 4.2 Old Glenn Hwy Tax 14: 0 Job Type Repent Map ortd: 61 Jan comma,%: lNew- last service unkmmn tNeed to Check dw - very bad d too steep, no way to :manuver. Need little truck — j• Needs to Do serviced by April Mn t Addluonol Localion Comments 049 : ■ %&� Big blue house on top of hill. Pipes located halfway up Ow on left. Steep dw, may need little truck. Gallons Planned: 0 9z-a-�� Gel. Actl � Hose Length: Double Tank: C Pump System; Baffles Inlet: O Baffles Outlet: Service Type oty Price Each Tax? Extension Actual Contra5lorJob 1 $115.00 No $115.00 1115 Cl"cc.k At orAy oat AtJc.i Ale, jeof tS ►tor. -.til NonTin•Ma Twat 7"obte Total Tex Total Grand Total Eeomead Curses: VISO $000 90.00 srrlisto ACI" Chwo": 1 1� Custom' agreea n ow term ea cardltlens prated On the bae4. TMS M A SINDINO AGREEMENT. ^ 11pneAr.e and Tib of Cuab Aepeeawtat! a Odn --TehV ACCO',W by J e oxfvir.0 Dale Acmind Fa yaw added cw"rat nee we oemp ; Amikin It < eee, Dicww. Vee and Maatar Ced prr.r...a ,, M phony Ane 30 DM acounts Wd be Wad eye'to cdlpusCns. $25.00 Fa AEF Chocks Returned. . )m: ASBUILT 9076944214 To:9073383246 m P.2/2 o� • hl • /.vA i3G v 'cr nl oa I HEREBY CERTIFY -THAT I HAVE SURVEYED THE FOLLOWING D•SCRISED PROPERTY, AND THAT NO ENC36A„HMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETEttRMINE THE EXISTENCE OF ANY EASEMENTS,DgvENANTS, OR RESTRICTIONS WHICH DO NOT CAR ON THE RECORDED SUBDI- VISION PLAT.VNDER NO CIRCUMSTANCES SHDULD ANY DATA HEREON BE USED FOR CONSTRUCTION 0= FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD 6 ASSOCIATES LAND SURVEYING 6 SCALES DATE, I 0. OF At P�. ' • gsrf � �;• TH� ••-•• •9 1 GRID: r • • FB: w..,. M.A. 3.....e . k , +e �, DRAWNi Alk \.p . C)M 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. # 051-261--6Er q L HAA #1 1. GENERAL INFORMATION Complete legal description i,T of 2 • Pollard and SID T15N R1W Sec 20 E2SW4SE4SW4 Location (site address or directions) 20509 Laughlin Drive Property owner Susie Pollard Day phone 276-4472 Mailing address Lending agency — Day phone Mailing address— Agent J,ynn ddressAgentJ,ynn Kile/ Target Real Estate Day phone 694-2388 Address 170934 North Eagle River Loop Road Unless otherwise requested, HAA will be held for pickup. t 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx 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. 72.025(R",1/91) Front MOAN21 - - 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 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 further verify 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. S & S ENGINEERING Name of Firm 17834 Eagle Diver loop Road No 204 Phone 6 Address Eagle River, Alaska 99577 9 s Engineer's signature 6. DHHS SIGNATURE Approved for /U �� bedrooms. Disapproved. Conditional approval for Additional Comments Date ) aJ 3 / 9 �_ �~ �E OF ACS 414 t 4 9th �;a rcuncHi t;.:L�WAN + � 4� CE -"8$01 bedrooms, with the following stipulations: %UTI( Date 2 " �� 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 pu rchasers of homes and their lending institutions in orderto 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 engineers work. 72-M (Rev,1M) Back MOA N21 RECEIVED Municipality of Anchorage DEC 0 4 1998 DEPARTMENT OF HEALTH &HUMAN SERVINICIPAUTr oFANCHo Environmental Services Division NVIRONMENTALSERVICESD 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34.3-4744 Health Authority Approval Checklist Legal Description: Loi ;L s / Parcel I.D.: o S'/ - a(o / L) G A. WELL DATA Well type _Pd I v 4 Y IL If A, B, or C, attach ADEC letter. ADEC water system number Log present &N) Y S Date completed _ 7 10", 00 r 1 -1 - Total depth Cased to 7V Casing height (above ground) a 4- — Sanitary seal &N) S _ Wires properly protected O)N) FROM WELL LOG AT INSPECTION �" (� -7 Date of test _ aL Static water level Well production _ 9-,57 g..m. / P 9.m.P WATER SAMPLE RESULTS: Coliform ° Nitrate 7 Other bacteria C' Date of sample: I) Il ej/ e1 Y Ia. /�,L / t y, Collected by: S & S ENGINEERING —IZU04 Eajlee River Loop Road No. 204 13. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 /16 Date installed�0 I °I `� Tank size _Ia- 15'_ o Number of Compartments _ Cleanouts A/N) "/� 1 Foundation cleanout e/N) Y f -S Depression (YAM High water alarm (YO Ivo _ Date of Pumping^'�� N h4✓ Pumper d - C. ABSORPTION FIELD DATA Date installed / o �� < R `� _ Soil rating g.p.d,/ft2 or ft2/bdrm) 0 • _System type It OV _ Length Cc 3 _Width 3 Gravel thickness below pipe —_ Total depth / o Effective absorption area .I S G F1 z Monitoring Tube present O/N) Y4 J Depression over field (Yo Date of adequacy test N/4 _ Results (Pass/Fail) For _� bedrooms Fluid depth in absorption field before test (in.); Immediately Fluid depth Peroxide 72-026 (Rev. 3/96)' (ins) Minutes 12 months) (Y/N) Absorption rate = ^ g.p.d. If yes, give date D. LIFT STATION Date installed _ Manhole/Access (Y/N) _ High water alarm level at* Size in gallons "Pump on" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 0 0 r Absorption field on lot I 150 –{ Public sewer main IV /n On adjacent lots On adjacent lots Public sewer manhole/cleanout off" level at* / 0 0 V /A i Sewer /septic service line a S 4 _ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: r Foundation ? 't _ Property line ! / Absorption field l $ — r Water main/service line ° /'� Surface water/drainage 1 00 Wells on adjacent lots _ o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line 1 ° Building foundation _ Jos, Water mainlservice ^a I ° Surface water 7 °0 Driveway, parking/vehicle storage area _ p r � Wells on adjacent lots /00 Curtain drain _� — F. ENGINEER'S CERTIFICATION -�'Tc I certify that t have determined thru field inspections and review of Municipal in conformance with M ` guidelines,effect on this date. Signature Engineer's Name _ /l o /30, ,i r Co w,q r✓ — Date 7/:a 3 HAA Fee $ Date of Payment s/� Receipt Number , Z `7 f J 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 44 I� OF �►R e•abovr� / � s are M��M..,YI, •r 1f Re.. /.II 302, r' Gr y+v L" tea -a6 VV: 18 I;NVIWNIlOiAI. HIN$ul I -H2 P.UI/tel F—u25 vironmental Serviees In6� 01 *�Cx inion a� 200 W. Fonar Orive )rinkin ter Analysis Report for Total Colifol-lri bacteria. Tt (907) 562 23431 B-1 605 READ t1VSTRUC2*IONS ON WERSE SWE BEFORE COIGN �TlN�G�SAMP4 Fix, (907)58, -53017rnn7 0 PUDLICWATFRSYSTFMI,D-4t K PRIVATE, WATER SYSTEM p send p Send lnvoieg SAMPLE DATE, F Day Ez Ygoor SAMPLE TYPE: %— Routine Ca Repeat Sample (for ruufiae Sam It With lab ref, no. 0 Special Purpast SAMPLE LOCATION 9 Comments: p Treated Water p Untreated Wetter Tithe Collected Colleetsd by i1,'D S' Analysts shows this PIarer SAMPLE to be: 7., Satisfactory p Unsatisfactory t7 Sample over 30 hours old, results may be unreliable o Sample Wo long to transit; sample Should not be over 48 hours old at extiminanon to indicate rtliable results. PIC' a send new sample via Sp Ltio I & ve Haid Date Received T Time Received Analyr►z ftaa Analytical Method, )24 etmbrww Filter a mtManlvc • Number of colonicSll Lab Ref. No. Result* Analyst E) 43 E •.gel E3 1 Jun Faxed Via ...• - Cl�i-e-int notified orunsatiafactory results: rh ord 5" With F�rd Date. ,.. __ Time BACTERIOLOGICAL WATER ANALYSIS RECORD MMO.MUG R"uh, TOW Catform F- Coo Membmat Filler- Direct Count Colaalerl100 ml Ver,fcatioo: LTIi DGf3 COLLFLHM Fecal Coilfortn Contirtnatlaa - Final Mcmpratie Filter Results Collform1100 ml Rtporttd Dy Date l �� �7 _ Tltoe L� hra TNTC -Teo N.NRO-a rc C'ient Pz I Memper of"tiii8 Grawp (Suciat0 GOnerata Ce SurvoiilonceJ —��( f ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, oHIO, AzOtIL16, CT&E Enviros,tniental Services Inc. Laboratory Division 200 W. Potter Drive Anchorage, AK 99518 TeL (907) 562-2343 Fax. -(907)561-5301 Chemt-ab Ref. #: 98.6818-1 Client PQ#: n1a Client Name: S&S Engineering Printed Date/Time: 11/27/98 07:00 Project Name: n/a Collected Date/Time: 11/19198 18:15 Client Sample ID: E1/2SW45ESk1/48ec20TI5NRI W Received Oate/Time: 11/20198 12:10 Matrix: Drinking Water Technical Director: Stephen Ede PWSID n/a Released By: Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Oate Date Init IQ r/�S iliH,oL ✓J- p —® Total Coliform (MP) 57-G4"0 Coli col/100 ml SM9222D 11/20/98 KAP Nitrate 2.87 0.1 rng/L EPA 300 10.0 11/20/98 GCP M/TO'd TBOST9SL06 39tiJ01-IONd IS3 381D sS:LO B66T-LZ-()ON