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Q � d J 'C V d L b O .� 0.0 J N s =0 :O CC O O� I v _ Q..4. ek � �t Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .5c~' ~7o¥/~ PIDNumber: Or.C- ~"// -o! Name: ~ ~o~ Wastewater System: ~ New ~ Upgrade Address: ~o ~. ~ ~ ~'~7~ ~, ~ ~=~ ABSORPTION FIELD Phone: 7~ ~ - ( ~ ~ No. of ~drooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTI ON Soil Rating: Total Depth from original grade: ~' ~ GPD/Sq. Ft. Lot: ~ Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe -- ~ ~, ~ Ft. ~' ~ Ft. Township: Range: Section: Fill added above original grade: Gravel [engtm / -- ~ Ft. ~ ~ Ft. Number of lines: Distance be~een lines: WELL: ~ New ~ Upgrade Gravel width: ~'~' Ft. I -- Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: F Date Drilled: Static Water Level: Installer: , Date installed: Yield: Pump Set at: Casing Height Above Ground: ~ GPM Ft. a.~ Ft. TANK SEPARATION DISTANCES = Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Privatel Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~O~ ~ ~ J Material: Number of Compa~ments: Wel~ I~' 1~7~ - _ ~ ~' ~1 Sudace Water ~' > ~'~ - _ _ LIFT STATION - Lot Size in gallons: ~ Manufacturer: Line ~ 2 ' ~ ~1 - - I Foundation ~ ~ ~ ~' ~ , - - - "Pump on" level at: J "Pump off" level at: High water alarm at: CudainDrain -- - -- Pump Mak~ & Model Electrical Inspections pedormed by: Remarks: ~/~o~ o~ b~¢¢ /~oF ~/¢o¢ BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Inspections pedormed by: ~/~f~ ~4. Woe Dates: 1st R//%/¢W , ,. · · ¢ 'L. %..OL,...: Department of Heal~ and Human Se~ices approval .,' .:. c:-:~..', ,- .,.-. Reviewed and approved by: Date: -~ -¢~ "' ~¢~ 72-013 (Rev. 9/91) MOA 25 PERMIT NO: SW970412 PID NO: 01549101 56' LONG SOIL ABS. TR. W. 9.2' GVL BELOW PIPE "E 1250 GAL. SEPTIC -- TANK T.H. /. ,T.H. #2 LOT 3 LUND S/D 4-BEDROOM HOUSE JNDER CONSTRUCTION PAGE 2 OF 3 SWING TIES: FROM: COR. "A" COR. "B" TO: S.T.C.O. "E" 66.5' 49.5' S.T.C.O. "F" 73' 68' DBL. C.O. "G" 77' 60' TR. M.T."H" 103' 64.5' TR. C.O. 'T' 124.5' 79.5' LOT 3, LUND SID SEPTIC SYSTEM INSTALLATION AS-BUILT INSPECTION REPORT PLAN VIEW FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 SCALE: 1" = 30' DRAWN BY TFM SEPTEMBER, 1998 PERMIT NO: SW970412 PAGE 3 OF 3 PID NO: 01549101 4'+ SOIL COVER 3'+ SOIL COVER 1250 GALLON SEPTIC TANK INV. 94.8' 56' LONG SOIL ABS. TRENCH 2' SE_W~ ER GVL. BELOW PIPE BOTTOM EXCAVATION ELEV. LOT 3, LUND SlD SEPTIC SYSTEM INSTALLATION AS-BUILT INSPECTION REPORT - PROFILE FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 NOT TO SCALE DRAWN BY TFM SEPTEMBER, 1998 FLATTOP TECHNICAL SERVICES CIVIL & ENVIRONMENTAL ENGINEERING THEODORE F. MOORE, P.E. PH: (907) 345-1355 ENERGY CONSERVATION & ANALYSIS 14530 ECHO ST. ANCHORAGE. ALASKA 99516 September 24, 1998 M.O.A DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: Because of a field design change during the installation of the new wastewater disposal system on Lot 3 of Lund S/D, the location of the septic tank was moved to the southwest end of the trench. The discharge line was plumbed directly into the end ofthe56-foot long horizontal distribution pipe. Only a~er the fact did we realize that this creates a distribution lateral a little longer than the 50 feet called for in DHHS's internal guidelines. It would be difficult and expensive to change the configuration at this time. In actuality, the trench was conservatively designed with respect to the measured perc rates, and better than expected soils were encountered during the construction of the trench. Thus, there is more than the minimum necessary effective soil absorption trench within 50 feet of the beginning of the trench. We are confident that this trench will function satisfactorily as constructed. Because of this, we are requesting your approval of the configuration, as installed. Thank you for your consideration of this request. Sincerely, Ted Moore, P.E. From : ALPINE DRILL 907 545 0202 Au9.28.1998 05:56 AM PO1 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES LOCATION OF WELL 5 ~ C~.~ ,.,~.~ -- WATER WELL RECORD BOROUOH 6UBDIVI&ION LOT SLOCK SECTION QTRB aEC¥10N TOWN~HIP RANGE MERIOIAN ON CE LOCATIONISK~CH: i ~ ' '~" WELL OWNER: ~ ~ ~ ~ DEPTHS M~SURED FROM~asing top ~ground *urface DATE OF COMPL~ION Depth of hole: ~ ft 80REHO/E DATA: Depth Depth of casing~ft ~ / Material Type and Color F;om To "' DE~H TO STATIC WATER L~EL: ' ~ ~ . ft bel0w~ top of casing  METHOD OF DRILLING: ~ir rotery ~ cable tool GRAVEL PACK TYPE: Volume used: Depth to top: Depth: from ft to fl Mur]icipailty o~ A.cl ~rage PUMPING LWEL AND YIELD; Dept. Health & Human ~ervices ~)~ ft efto¢ ~ , ,,hfs oumping ~O opm PUMP INTAKE DEPTH: __ ft Horsapower: WELL DtSlNFE~ED UPON COMPL~ION~ ~ES ~ NO CONTI:~XCTQR INFORM&Ti~iN:. · REMARK&: ' '~'"~L. tt, DNR/DIVISION OF MINING & WATER MGMT ~;gnatu¢e of Authorized Respresent~e 3601 C St, Suite 800 ANCHORAGE AK 99503-5935 Phone IB07)269-8639, Fax 1907)562-1384 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970412 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:JERRY JOST OWNER ADDRESS:6550 E ll2TH AVE DATE ISSUED:12/15/97 EXPIRATION DATE:12/15/98 PARCEL ID:01549101 LEGAL DESCRIPTION: LUND LT 3 LOT SIZE: 49513 (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: 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 (18AACS0). 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: RECEIVED BY: DATE: DATE: CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 December 2, 1997 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: ., The purpose of this letter is to provide the required design narrative in support of our application for a permit to construct wastewater disposal facilities on Lot 3, Lund s/d, located at 6550 East 112th Avenue. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 2. As can be seen from the soil log, the native material beloTM 6 feet is a somewhat silty sand a measured perc rate of 4 minutes per inch. Because the soils in the proposed construction area are quite variable, we have chosen to design the soil absorption system using a conservative application rate of 0.6 gpd/sq, ft. Accordingly, this proposed 4- bedroom residence requires a total absorption area of(4 x 150)/0.6 = 1000 square feet. The proposed 56 foot long soil absorption trench with an effective gravel depth of 9 feet has a total absorption area of 1008 square feet. The topography of the lot in the area of the proposed construction can best be characterized as a gentle swale sloping downwards towards the northwest at 10%. The ultimate lot development includes a barn that will have a toilet and sink. Since the barn will probably be constructed too Iow to allow gravity flow into the septic tank, it will be necessary to utilize a sump pump installed in a polyethylene vault located underneath the barn, which will pump the wastewater through a 1.5" HDPE discharge line to the septic tank. The proposed project will have no significant impact on present Or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. L8, B6, SOUTH LAKEWOOD HILLS #1 LOT 3 ', LUND SlD ' WELL ) 112th AVENUE PROP. '700' BARN PROPOSED 56' TRENCH W. 9' GVL. LOT 2 LUND S/D PROPOSED 4BEDROOM HOUSE 100, LU 20% REPLACEMENT 'RENCH ~-'-- ?250 GAL. SEPTIC TANK P, ROP. WELL THIS TRACT HAS ~-~,~,~,~ OF ~/__~,,. NO DEVELOPMENT THEODOREF. MOORE ~ ~ --_ ~¢¢¢ L5A, BLK2, MACBETH S/D NOTE: WASTEWATER DISCHARGE FROM TOILET/SINK IN PROP. BARN TO SEPTIC TANK WILL REQUIRE INSTALLATION OF INTERIOR SUMP PUMP IN A SUBFLOOR VAULT AND A 1.5" HDPE LINE TO SEPTIC TANK HSE WELL HOUSE" WELL SYSTEM ,, PARCEL 26 D SECTION 23 T12N, R3W LOT 3, LUND S/D PROP.WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAOE, ALASKA 99516 1 INCH = 50 FEET DRAWN BY TFM NOVEMBER, 1997 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. C.O. M.T. 4" DIA. F-810 PIPE 56' LONG SOIL ABS. TRENCHl W. 9.0' GVL. BELOW DIST. PIPE PLAN VIEW SCALE: 1" = t0' - 0" 4" DIA. D-3034 PIPE DOUBLE CLEANOUT 1250 GALLON SEPTIC TANK SECTION "A - A" SCALE: 1" = 5' - 0" -- MONITOR TUBE OUND BACKFILL 12" ~rGINAL GROUND ~RIC 4" DIA. F-810 PERF PIPE --1/2"- 2 1/2" SEWER GRAVEL OTTOM OF EXCAVATION LOT 3, LUND S/D SEPTIC SYSTEM INSTALLATION PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICES SCALE: AS SHOWN 14530 ECHO STREET DRAWN BY: TFM ANCHORAGE, AK, 99516 DECEMBER, 1997 Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (907) 345-1355 Lot 3, Lund S/D 6550 East 112th Avenue Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installing a 1250 gallon septic tank followed by a 56 foot long soil absorption trench containing a total of 9.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The new 1250 gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation, 2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 56 foot long trench to a depth of 12 feet below the existing ground level in the vicinity of test hole #2. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 9.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 9.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. ITEST HOLE LEGALDESCRIPTION: DATE PERFORMED: PERFORMEDFOR: DEPTH-- (fe~) FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Lot 3. Lund S/D November 17, 1997 Jerry Jost Pt. SM Sandy loam GM Silty sandy gravel Variable, cleaner above 5' Siltier between 5' and 6' ML/SM Damp sandy silt Small seep of trapped water SLOPE Depth to Groundwater Date No groundwater 11/17/97 Monitor tube dry 12/2/97 SITE PLAN LOT 3 LUND SID J I I I : PROP: 00~ , .! ! :WELL: 15%: : : coz Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 11/17 12" Presoak Add water & start 11:47:30 23 1/2 #1 11:52:30 5 18 1/8 5 3/8 Add water 11:53 23 3/8 #2 11:58 5 18 1/8 5 1/4 Add water 11:58:30 23 5/8 #3 12:03:30 5 19 7/8 3 7/8 at12.5' GM Silty sandy gravel rounded cobbles cleanerthan upper G~ PERCOLATION RATE 2 (minutes/inch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN 8.5 FTAND 9,0 FT COMMENTS: While generally quite permeable, the soil composition varied significantly throughout the test hole. Since the stratum where the perc test was conducted was somewhat cleaner than typical, I recommend using 0.6 gpd/sq, ft. for a design application rate. PERFORMED BY FLATrOPTECHNICALSERVICES. I _~"~' ~ CERTIFYTHATTHISTESTWASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: TEST HOLE # 2 FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST SLOPE LEGAL DESCRIPTION: Lot 3. Lurid SID DATE PERFORMED: November 17:1997 PERFORMED FOR: Jerry Jost DEPTH Pt. (feet) 1 SM Sandy loam GP Coarse, silty sandy gravel Densely packed, many cobbles SM/ML Dense silty sand Hard digging SP/SM Gravelly, somewhat silty sand Variable, lenses of clean SP Soft digging Depth to Groundwater Date No ~roundwater 11/17/97 Monitor tube dry 12/2/97 SITE PLAN LOT 3 LUND S/D I I I I : : PROPi 00/O[ ~~ 0 : : 00'~i: : ~: WELL: O/o. ~H~ 1 PERCOLATION RATE 4 (minutes/inch) PERC HOLE DIAMETER 8 TEST RUN BETWEEN 9.0 FTAND 9.5 FT COMMENTS: The soil below 6' appeared quite uniform throughout the remainder of the test hole. however it became variable on either side of the test hole where benches were dua for the Derc test. Deso te the rapid roeasured Derc rate recommend usino 0.6 ODd/SO. E. for desion. PERFORMED BY FLA'ITOPTECHNICALSERVICES. I ,~'~..~.~' '~..~,-~_ CERTIFYTHATTHISTESTWASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ! ~--/ ..~/~ "~ Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 11/17 12" Presoak Star~ 1:36:10 23 #1 1:41:10 5 21 15/16 1 7/16 Add water 1:41:30 23 5/8 ~r2 1:46:30 5 22 0/16 1 5/8 Add water 1:47 23 5/§ #3 1:52 5 22 0/16 1 5/8 Parcel I.D. # 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 ~ l..,c- - ,/91 - ~.'1 ~ haa# GENERAL INFORMATION Complete legal deSCription Location (site address 0¢ directions) Property owner Mailing address Lending agency Mailing address Agent /q,/L Address Day phone ,5-2 ;~ -o~'-/g.5- V ' Day phone ..~-~'~? - '7 7_?( Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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 (Rev. 1/91) Front MOA#21 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. Name of Firm Address / Engineer's signature Phone DHHS SIGNATURE ~ Approved for F0 G'I~ Disapproved. Conditional approval for bedrooms. Date bedrooms, with the following stipulations: Additional Comments By: ~//'//~~ /-~/, ~~ Date 7- 3 0 - ? ? The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. /2-025(Rev. 1/91} Back MOA#21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES~ ~I./~ ~! ~ Environmenta Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A, WELL DATA Well type ~r,t ~' ~/"E Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist ~. c~/~ ¢~' _C/.D Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed 5" / ?- / / ~ ~' Cased to ~ Z / FROM WELL LOG ,~/~t / ~,~ Date of test Static water level Well production WATER SAMPLE RESULTS: g.p.m. Coliform 0 col/too m.E Nitrate Date of sample: '7 / ~/22.~ '7 ! ?-- 7 / 9 ~ B. SEPTIC/HOLDING TANK DATA Cas ng he ght (above ground) Wires properly Protected (Y/N) AT INSPECTION g.p.m. Date installed ~/15'-/~,E Tanksize IZST~,?~I Number of Compartments ~. Cleanouts(Y/N) ~ V Foundation cleanout ~) ~ Depression ~/N) H High water alarm ~/N) N, ~, Date o~ ~g~,,~ , ~ ~. ~',::~ ~ ~ Pumper N, ~. /~;O ~ ~' " ., . C. ABrUPTly,FIELD DATA D~'~talma ~//5-/~ ~ Soil rming (g L~-bgtN; ~$ ~ ~ W~dth ~, ~ Gravel thickness below pipe ~, ~' To~l depth ~ z' i ~ ~ o Monitoring Tube present ~) ~ Depression over field ~) ~ EffeCtive abso~fion area ~ ' Date of adequacy test H, $, (n~ Resul~ (PasCall) r~ For q bedrooms Fluid depth in abso~tion field before test (in,); O Immediately after gal. water added (in.): Absorption rate = ;> o",~ g.p.d. f yes, give date ~, ~ Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (y/N) 72-026 (Rev. 3/96)* N Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line D. LIFT STATION /q, ,~. Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump on" level at* *Datum On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /'/~" Property line 'C ?-' Absorption field Water main/service line ~. 10' Surface water/drainage ~ ~oo' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '~ ?-' Building foundation $'7 ' Surface water ~ (oo' Curtain drain Ne,,)¢ ~ ee',~ "Pump off" level at* R ENGINEER'S CERTIFICATION IQ' Water main/service line Driveway, parking/vehicle storage area ~,' . Wells on adjacent lots '~' (~' ~ ' I certify that I have determined thru field inspections and review of Municipal records tha,~Jll~l~J~ms are in conformance with MOA HAA guidelines in effect on this date. Signature ~ ~ ~ . Date ~/v ~P, I~e~ - , -. · , · HAAFee $ '~d~ o= Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ~T~=- CT&E Environmental Services Inc. CT&E Ref.# 993282002 Client Name Flattop Technical Srv. Project Name/# N/A Client Sample ID Lot 3 Lund S/D Matrix Drinking Water Ordered By PWSID Client PO# Pre-Paid Colis/NO3 Printed Date/Time 07/12/99 13:51 Collected Date/Time 07/08/99 13:00 Received Date/Time 07/08/99 14:50 Technical Director: Stephen C. Ede Released ~ ~ Sample Remarks: Parameter Resutts PQL Units Method Attowabte Prep Anatysis Limits Date Date Init Total Coliform TNTC OB/lO0 ML Nitrate-N 0.500 U 0.500 mg/L SM18 9222B 07/08/99 rAP EPA 300.0 10 max 07/08/99 07/08/99 SCL CT&E EnvironmenTal Services Inc. ..= .......... mmm~mmmmtym~n~m~ ~'m,~"--'~'_'~--~--"'"~'eL~ ~ ~boram~ Division r~~ = ............ 200 ~V PoTter AK 99516-1605 Tel' {~.,07l 562-2343 Drinkin'-' Wamr Analysis Report for Tomt Coliform Bacteria .ql:. ID /'~.','£R{ ('TiO.%.¥ ti), Ri.'I '1; R~'E E/DE BEFORE COLLECTING $..t.tIPLE Pa~ { )071 561 xFER 5~.~1E~i I.D.w Month Day Year SAMPLE TYPE' D Treated Water I~ Routin~ 0 Repeat Sampl~ [for routine sample ~ Uncreated Water with lab ref. uo. _ ---) O Speci~] Purpose TI~ Coll~ SAMPLE LOCATION Collated By S~mple o~¢r 30 Y, oam old, ~s~l[s m~y Sample too long ,n T~nsa; s~pic ~houtd to 1nd;cate ,~ti~le ~ults, Pit,sc s~d new sample via's~ial dclive~ m~d. ~maJ~ycical Method: ~ Membram: Filter · m MMO-MUG ' Number of colonies~ 100 mi. Lqh Ret. No, R~ulI* ~ns m A.D.~-C- A.sC~ F0k~ Jun Date: ,,-- Time Client notified of un~atisfactor~ Fhontd .%~0#~ with BAcTERIOLOGIC,~L wATER ANALYSIS IU~CORD · E. Coli Colooi~'lO0 mi . COLIFIRM Time Coli~orm/lO0 mi . ~ ~ Member o! me ~iG5 GrouP ~$ociem Gone~mo Oe Sur~,,~c~'l ,,, ~