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HomeMy WebLinkAboutBIRCH NORTH ESTATES LT 4Birch North Estates Lot 4 #015-501-35 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water 8 Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • htip.,ftww.muni.orglonsite a (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131369 PID Number: 015-501-35 ❑ New ®Upgrade Name:RODGER HUNTER ABSORPTION FIELD ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address: 10510 BIRCH ROAD, ANCHORAGE, AK, 99507 ❑ Other Phone: No. of Bedrooms: soil Rating: Total Depth from original grede: (907) 346-4567 4 0.8 GPD/Sq. Ft. 11.5 MAX Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: 3.5 MAX F. Gravel depth beneath pipe: 8.0 F. Subdivision: Block: Lot: BIRCH NORTH ESTATES — 4 FII added above original grade: Gavel length: SEE DWG. F. 50 F!. Township: — Range: — Section: — Gmvei width: 3eds Number of lines Distance between lines 2.5 Ft. — Ft. SEPARATION DISTANCES Total absorption qumber of trenches: Dist. between trenches: To From Septic Absorption Lift Holding Public/Privo Tank Field Station Tank Sewer Linea 800 SO. Ft. 1 — R Well 100'+ 100'+ — — 25'+ TANK ■ Septic ❑ S.T.E.P. DHolding ❑Other Manufacturer: capacity: Surface Water 100'+ 100'+ — — ANCHORAGE TANK 1250 Gal. Lot Line 5'+ 10'+ — _ N/A Malarial: STEEL Number of compartments: 2 Foundation 5'+ 10'+ — — LIFT STATION Curtain Drain NONE KNOWN Manufeclurer: c Gal. Remarks: OLD TANK ABANDONED PER UPC 'Pump on• level at: ump off' le High water W. ou 2013 DRAINFIELD MUST BE TESTED FOR ANY FUTURE Pump Make & Electrical Inspections performed by: 4 BEDROOM COSA APPROVAL. OLD 1987 DRAINFIELD PIPE MATERIAL IS ONLY SIZED FOR 3 BEDROOMS. House to tank EXISTING Tank to D3034 drainfield Installer NORTHERN EXCAVATION Drainfield D3034 CO MT D3034 Inspector GEG, Ltd. BENCHMARK (Assumed elevation) 92.25 FL Inspection Location and Deecrtption: Dates: 1 st 10/11/13 2nd 10/12/13 3rd — 4th — BOTTOM OF TANK (ST1) Community Development Department Approval EN61NEER88EILL 00600 0�0 .•........ 9Soo Conditional approval: Date: ovoo� fr 9 H Op p ....... ....... .......... .N QO ••,J fr ness. 0 E -7953r vO v4� Approved: Date: Lo iag"/3 aap.0,a, rofession o �4Oo004�0 PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: - OSP131369 015-501-35 A B ST1 138.42 147.75 ST2 146.15 155.12 DBL1 148.05 156.90 DBL2 149.06 157.84 FD 149.91 158.56 C01 155.17 157.27 MT1 155.75 157.58 CO2154.08 149.22 MT2 152.71 147.86 / / INGRESS -EGRESS / EASEMENT GARNESS ENGINEERING GROUP, Ltd_ CONSULTANTS & GENERAL CONTRACTORS I E. NOM ROOD, Wn 101 r AN "O F, M 99W7 r F E (907)331-8119 • FM (907)339 MO • 11E9 M: ��r.9emewrgi9aarlrq.cam PREPARED FOR: PHONE NUMBER: RODGER HUNTER 907-346-4567 LEGAL DESCRIPTION: BIRCH NORTH ESTATES S/D; LOT 4 TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC UPGRADE ,R99. alms) PAGE NUMBER: 2 OF 3 A.J.G. 10/22/2013 NEW 1250 GALLON ., SEPTIC TANK •,�, :.•�; •• �000� �•� �•:� GENERAL LOCATION FDOF I WATER SERVICE yeti e 100' WELL RADIUS UNE CO 1 11 \ 1` 1 II CG,`��i---- MTI A 11 \ SCO EBISTING HOUSE B OLD TRENCH 11TH#1 CONNECTEDS SITE II MT2 � � � / CO2 RESERVE SITE NEW TRENCH 50' LONG I If GARNESS ENGINEERING GROUP, Ltd_ CONSULTANTS & GENERAL CONTRACTORS I E. NOM ROOD, Wn 101 r AN "O F, M 99W7 r F E (907)331-8119 • FM (907)339 MO • 11E9 M: ��r.9emewrgi9aarlrq.cam PREPARED FOR: PHONE NUMBER: RODGER HUNTER 907-346-4567 LEGAL DESCRIPTION: BIRCH NORTH ESTATES S/D; LOT 4 TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC UPGRADE ,R99. alms) PAGE NUMBER: 2 OF 3 A.J.G. 10/22/2013 I PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMB -ER: OSP131369 015-501-35 TH#1 TOP OF TANK AT INLET = 97.13 INVERT OF BUNG AT INLET = 96.49 ORIGINAL GRAI ® HIGHEST POINT = 96S FINAL GRADE = 102.18-102.98 Lill NEW 1250 GALLON SEPTIC TANK RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 79.42 (TESTHOLE DRY) FINAL GRADE _ 97.46-97.64 \FILTER FABRIC _RT OF PIPE = 93.42 - BOTTOM OF TRENCH = 85.42 - TOP OF TANK AT OUTLET = 97.09 INVERT OF BUNG AT OUTLET = 96.35 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS . . . 3'!01 E. RIGOR 204➢, SURE 101 • 4NCHOR40E, M 99507 • P NE (907)317-8119 • FM (907)338-3218 � 8'E691E: wr.9arnnlenginexNgxom a . PREPARED FOR: PHONE NUMBER: PAGE NUMBER: '..J ff ROGER HUNTER 907-346-4567 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: QA 9s BIRCH NORTH ESTATES S/D; LOT 4 A.J.G. V4 e e TYPE OF WORK: DATE. 4004 PROFILE AS—BUILT DRAWING OF SEPTIC UPGRADE 10/22/2013 (Rev. UIM5) .. . Gar ess, .7 �s ►a..`��A�oo On -Site Wastewater Disposal 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: OSP131369 Tax Code Number: 01550135000 Work Type: Septic Permit Effective Dates: October 11, 2013 to October 11, 2014 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: BIRCH NORTH ESTATES Site Legal Address: BIRCH NORTH ESTATES LT 4 G:2537 Owner/Address: HUNTER RODGER W PO BOX 233031 ANCHORAGE AK 995233031 Site Mailing Address: 10510 BIRCH RD, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank to/Ilia z : 30 Lot Size in Sq Ft: 48658 Total Bedrooms: 4 N Privy N 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. 1. If the existing 3 bedroom system is not decommissioned but a diverter valve is used, a note must be made on the Inspection Report stating that only the system designed for 4 bedrooms shall be tested for any future COSAs. 2. The location of the water line is to be determined prior to final as -built. Received LtJ/3 l � �/ Issued By: ,�L� .�:- � tip_ Date: � % MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 015-501-35 Property owner(s) ROGER HUNTER Day phone 346-4567 Mailing address 10510 BIRCH ROAD, ANCHORAGE, AK 99516 Site address 10510 BIRCH ROAD, ANCHORAGE, AK, 99516 Legal description (Sub'd, Block & Lot ) BIRCH NORTH ESTATES S/D; LOT 4 Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ® Single Family (SF) Absorption Field ® Upgrade ❑ (w/wo ADU) Septic Tank ® Renewal Duplex (D) F-1❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: V 530 Waiver Fees: Date of Payment:TL3/ Date of Payment: Receipt Number: 0 2246 Receipt Number. Permit No. 6SPI313(a9 Waiver No. (Rev. 09/12) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS October 2, 2013 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 (907)343-7904 Ref: Proposed Septic System for Birch North Estates S/D; Lot 4 To whom it may concern: The existing four (4) bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. We are proposing to install anew 1250 gallon septic tank and a deep trench type drainfield. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. TRENCH DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100+ feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawings, the average topography in the area of the proposed drainfield is relatively flat. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questOns, please contact us at 337-6179. Thank you for your assistance. .E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com 1 100' WELL RADIUS \ _ PROPOSED SEPTA SYSTEM T12N, R3W, SECTION 15, LOT 2 64251 SANDY ACRES LOT 3 / 1L, 1100' WELL RADIIU I N � 1 \ S ALE: \\ / 1 = 1nn' / I I I I I Q 0 I � BIRCH NORTH ESTATES S/D; LOT 2 = BIRCH NORTH ESTATES S/D; LOT 3 « U (OWNED BY SUBJECT PROPERTY OWNER) `W m SERVED BY PUBLIC LyP�P�� I W Im WATER AND A PRIVATE SEPTIC r--------- / r--GRESS—EGRESSI\ / EASEMENT c SPRING FOREST, .: Ys SPRING FOREST, '"'TR• 1100 WE RA [US I i LOT 1, BLOCK 2 SERVED BY PUBLIC WATER AND A PRIVATE SEPTIC SYSTEM AMANDA PLACE S/D;'LOT 4 VDA PLACE S/D; LOT 3 RADIUS I 1 /WEST TREE ROAD I I I GARNESS ENGINEERING GROUP, Ltd. p c0:" CONSULTANTS & GENERAL CONTRACTORS O........ .. ... ......: ... 701 E NOOK ROAM. SI117 101 , ANOOML M 9950 , PRONE (907)331-6119 , FM (907)339-3216 • WE95RE www.9vmw n9ln dM.c PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ........ .••••: ROGER HUNTER 907-346-45671 OF 3 Q� '.J Gar ess.- m� LEGAL DESCRIPTION: DRAWN BY: BIRCH NORTH ESTATES S/D; LOT 4 A.J.G.olp Oro '' rp •}11' f3 0°0 TYPE OF WORK: DATE. V044p0 ess, oo SITE PLAN FOR SEPTIC UPGRADE 10/1/2013 n., vuu11 c SPRING FOREST, w"I LOT 1, BLOCK 1 SERVED BY PUBLIC dI WATER AND A PRIVATE 1 `ul SEPTIC SYSTEM GARNESS ENGINEERING GROUP, Ltd. p c0:" CONSULTANTS & GENERAL CONTRACTORS O........ .. ... ......: ... 701 E NOOK ROAM. SI117 101 , ANOOML M 9950 , PRONE (907)331-6119 , FM (907)339-3216 • WE95RE www.9vmw n9ln dM.c PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ........ .••••: ROGER HUNTER 907-346-45671 OF 3 Q� '.J Gar ess.- m� LEGAL DESCRIPTION: DRAWN BY: BIRCH NORTH ESTATES S/D; LOT 4 A.J.G.olp Oro '' rp •}11' f3 0°0 TYPE OF WORK: DATE. V044p0 ess, oo SITE PLAN FOR SEPTIC UPGRADE 10/1/2013 n., vuu11 DESIGN CRITERIA: ULU, Ltd. HAS A 7 PAGE SPECIFICATION CONTRACTOR SHALL HAVE SOUTH NUMBER OF BEDROOMS: 4 LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER LOT LINE AND 100' WELL RADIUS GALLONS PER DAY (GPD): 600 CONTACT GEG. BY PROCEEDING FORWARD FLAGGED BY A REGISTERED PERCOLATION RATE/S: 2.96 & 9.23 MIN/IN WITH THIS INSTALLATION, THE ENGINEER, PROFESSIONAL LAND SURVEYOR PROPOSED APPLICATION RATE: 0.8 GPD/FT° WELL DRILLER, CONTRACTOR AND MINIMUM DRAINFIELD SQ.FT.: 750 PROPERTY OWNER AGREE THAT THEY PRIOR TO CONSTRUCTION HAVE READ THESE SPECIFICATIONS AND DRAINFIELD DESIGN: AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. MAXIMUM DEPTH: 11.5' — — — WIDTH: 2.5' LENGTH: 50' / M.O.A. APPROVED SAND FILTER: N/A EFFECTIVE: 8' REDUCTION FACTOR: �P N/A ACTUAL SQ.FT.: 800 FINGRESS—EGRESS EASEMENT E PROPOSED —�0 SCOP DOUBLE CLEANOUTS EXISTING 1000 GALLON TANK TO BE REMOVED INSTALL FLOW AND REPLACED WITH A _ DIVERTER NEW 12511GALLON �:' r!•': SEPTIC TANK 100' WELL RADIUS CO M 11 1, \\ `•FCO ^.•. y;: �:. EXISTING 4 �l .;... BHOUSEM EXISTING I1 TH#1 1 \ DRAINFIELD TO BE `1 \ CONNECTED UA SITE 11 1, RESERVE DRAINFIE RESERVE / 11 MT (4 BEDROOM) u CO PROPOSED DRAINFIELD / GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS. 3X11 E. NWR ROAD. SUiE 101 • MMOWA, M 99507 . F NE (907)337-81'!9 * FM (907)]]8-3248 • W WM-..w.g...m fnwdN, m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ROGER HUNTER 907-346/4567 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: BIRCH NORTH ESTATES S/D; LOT 4 1 A.J.G. OF WORK: UAIL: DESIGN OF PROPOSED SEPTIC UPGRADE 1 10/1/2013 peau. Ulm) o `v.......... _ysp0o 4 T .... .... 6a .. ....... f A. Gar ss 4/ cpJ-,O,& -S (Rev. 01105) GARNESS ENGINEERING GROUP, Ltd. C0NSULTANTS & GENERAL CONTRACTORS SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: BIRCH NORTH ESTATES S/D; LOT 4 PERFORMED FOR: ROGER HUNTER DATE: 9/23/2013 DEPTH tEPTH= ORGANICS TEST HOLE 1 UPPER BENCH 1 7 8 9 10 11—r„� ��, SP (FINE SAND) 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 9/23/2013 SOIL CLASSIFICATIONS 4:15 10/.x/2013 6” - 2 4:45 30 2 3/8" 3 5/8" 3 4:45 - 6" TH#1 4 GW 30 ORG 3 1/4- 5 SITE PLAN I GM AMANDA PLACE S/D; 40T 4 1 100' Ll 6 5:45 30 2 3/4" 3 1/4" R;.: GP ML 3 GM CL 4 GC OL SW MH 5 so SP CH ...• •: . ol SM OH .•. ••.• •m• c •i •••` _ SC 7 8 9 10 11—r„� ��, SP (FINE SAND) 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 9/23/2013 DRY 9/28/2013 4:15 10/.x/2013 6” - DATE READING 1 1 i F INGRESS -EGRESS EASEMENT NET TIME (MINUTES) ! sz' NET DROP (INCHES) 9/28/2013 1 4:15 1100' WE'RA [US 6” - 2 4:45 30 2 3/8" 3 5/8" 3 4:45 - 6" TH#1 4 5:15 30 2 3/4" 3 1/4- 5 SITE PLAN I - AMANDA PLACE S/D; 40T 4 1 100' Ll DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 9/28/2013 1 4:15 - 6” - 2 4:45 30 2 3/8" 3 5/8" 3 4:45 - 6" - 4 5:15 30 2 3/4" 3 1/4- 5 5:15 - 6" - 6 5:45 30 2 3/4" 3 1/4" 19 PERCOLATION RATE 9.23 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3.0 FT. AND 4.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ANDREW GRAY COMMENTS: PERK RESULTS WERE MEASURED TO WITHIN 1/16" PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 10 1 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: BIRCH NORTH ESTATES S/D; LOT 4 PERFORMED FOR: ROGER HUNTER DATE: 9/23/2013 DEPTH ORGANICS (fee1 t TEST HOLE #1 LOWER BENCH 7 8 9 10 11—r�;� ��'� SP (FINE SAND) 12 13 14 15 16 17 DEPTH TO GROUNDWATER DATE DRY SOIL CLASSIFICATIONS 9/28/2013 4:15 10/1/2013 6" — 2 4:25 10 2 1/4" 3 3/4- 3 4:25 — GW TH#1 ORG yam----� 10 GM 3 3/8- 5 SITE PLAN I — 3 1'-100' jI 6 G 10 ML 3 3/8- 7 4:45 — GM — CL q 10 2 5/8" 3 3/8" GC 4:55 OL 6" — 10 5:05 SW 2 5/8" MH 11 5:05 — �•• : SP 12 CH 10 ••: •••• 3 3/8- SM i OH SC 7 8 9 10 11—r�;� ��'� SP (FINE SAND) 12 13 14 15 16 17 DEPTH TO GROUNDWATER DATE DRY 9/23/2013 DRY 9/28/2013 4:15 10/1/2013 6" — DATE READING 1 I I r INGRESS -EGRESS EASEMENT NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 9/28/2013 1 4:15 100' WE • RA IUS 6" — 2 4:25 10 2 1/4" 3 3/4- 3 4:25 — 6" TH#1 4 yam----� 10 2 5/8" 3 3/8- 5 SITE PLAN I — AMANDA PLACE S/D; LOT 4 1'-100' jI DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 9/28/2013 1 4:15 — 6" — 2 4:25 10 2 1/4" 3 3/4- 3 4:25 — 6" — 4 4:35 10 2 5/8" 3 3/8- 5 4:35 — 6" — 6 4:45 10 2 5/8" 3 3/8- 7 4:45 — 6" — 8 4:55 10 2 5/8" 3 3/8" 9 4:55 — 6" — 10 5:05 10 2 5/8" 3 3/8- /8"11 11 5:05 — 6" — 12 5:15 10 2 5/8" 3 3/8- 19 PERCOLATION RATE 2.96 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6.0 FT. AND 7.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ANDREW GRAY COMMENTS: PERK RESULTS WERE MEASURED TO WITHIN 1/16" PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PR ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 1 ! MUNICIPALITY OF ANCHORAGE DE RTMENT OF HEALTH AND HUMAN SER ES S o 3 35 - Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Leroy Allrri e r DISTANCES Address TO SEPTIC ABSORPTION lOS/ a 13,rch Rao .. Anckor e, /4k 99S/r:; FROM TANK FIELD WELL Phone(s) Permit No, No. of Bedrooms WELL Ofj r 16,0 r 272 - lrg/ 670 262 3 LEGAL DESCRIPTION LOT LINE c(� r 30 Lot Block Subdivision N•A. Birch NorJA €s/u/e/ FOUNDATION20 r 16101 r Township, Range, Section yup T. 1GIJ SeC rs AS -BUILT DIAGRAM (Show location of well septic system property lines foundation TANKS ® SEPTIC ❑ HOLDING Manufacturer Capacity in gallons Gre,-/ /000 Material No. of Compartments Sfee ( 2 TYPE OF SYSTEM [Y TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade !r O v FT 0. O FT Fill added above original grade Gravel depth beneath pipe O FT 70 FT Gravel length _ Gravel width `IO FT /19 FT Total absorption area Distance between lines S60 SQ FT Nr A - FT Number of lines Soil rating Pipe material Splrct D-303 r/ 1 177 S perf I -'5 -SIO Installer �FIOS��I•%a Datelnstalled ,r Clcusr� Erccavai�in 10/23/87-rd/2Y/g7 WELLS EwsT�K� N PRIVATE ❑ OTHER (Identifv) Classification (A,B,C) Total Depth Cased to Eased FT Installei Date Installed. I REMARKS: ( I '-1V .';�`) _ rN40 1 water bodies, etc.l Cf/1 N n NN■■,M-00; 010 1119"■.�W�W■"© low INNo wo■milm sfin Cc�Ss ad � L.f�r?f rc� tCr! a.�ctn crsohe�. 'tale: r r'= foo r Inspections Performed by: Fk66%r Tecti Sccr Date: 10/23 - !o/Zy /67 certify that this inspection was performed according to all Municipal and State guidelines in effect on this date: f-51 /f 7 ,i Health Department Approval: 72-013 (3/85) Date:.&AZ47 ENGINEER'S SEAL .A, ty ^rY ` fin 4`3 f"' ra ��emeomm-ca—r/o .'maeo�e[eeo asa;aa eems sseeee emmpeeaoseo m rII,0D02'E P. 1vl0brlE MUNICIPALIlY OF ANCHORAGE Department of Health & Human Services 825 L SLreet, Anchorage, Alaska 905O1 343-4720 ON-SITE SEWER PERMIT Permit Number: 870262 Upgrade Date Issued: 10/02/87 Owner Name: LEROY ALLINGER Day Phone: Owner Address: 10510 BIRCH RD 272-3581 ' ANCHORAGE, AK 99516 Parcel Id: O15-103-35 Lot Legal: Subdivision: BIRCH NORTH ESTATES Lot: 4 Block: NA Section: 15 Township: 12N Range: 3W Lot Size 1.124A (sq.{L. or acres) Max Bedrooms: This Permit: 3 Total Capacity: 3 SEWER SYSTEMSx Listed below are the options available to you in designing your sewer system. Choose the option that best fits your site. TRENCH Depth to Pipe Bottom (ft): 6.0 Gravel Depth ({t): 7.0 Total Depth (ft): 13.0 Gravel Width ({t): 2.5 Gravel Length ({t): 38.O Gravel Volume (cubic yds): 26.4 Soil Rating Used (sq [t/brm): 177 LIFT STATION: if a lift station is installed, a high water alarm must be connected to the residence. SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). PROPERLY ABANDON EXISTING CESSPOOL,, I CERTIFY THAT: 1. I am familiar with the requirements for on-siLe sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations,, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms. I also understand that the capacity of the total system is 3 bedrooms and any enlargement will require an additional permit. Signed: DATE: (Owner) LEROY ALLINGER ' Issued By: DATE: ��' �c7�� �y________-_____________________ _ ..... ..... ..... __ ® SOI LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ® PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Lea R'i Y A !I rn cq a r- DATE PERFORMED: P I tSS 18 7 LEGAL DESCRIPTION: l- or q 10 13 1 ri c H noR rH C -S TNT ES (-r. H. 4ir i DEPTH SLOPE SITE PLAN rt 1 SP 15row 1, fly Sand W, SoMO organs rnakriaf 2 3 4 $ M / P1 1. trr•rar St f ly Sano( Drx, Some S.'weml'«9 5 �/ 6- 7 sjjfy Sano 8 (jeool"sr Nas S(/> e 9aS 0,� •fir 10 -• rn061 frnCf llmvScA6 11 12 13 14J I SP 15 S P WAS GROUND WATER S ENCOUNTERED? N L below to' f �f:d IF YES, AT WHAT A�Ce o E DEPTH? uertfraat 912y/07 16 OF At +�oe►wt Ar 18 i C.0; 4.91H / ......................2 THEODORE F. MOORE Reading Date Gross Time Net Time (l`ti„) Depth to Water Net (•�• Drop `�-n) Presoet `TEST (:'SS Prr 7 s T (� Wr I ,,;010SO(O' RUN BETWEEN 7 \w; + 20 9 t2:2 Pt7 3 Seo(r'o+oop —yxr.f^ czW cg?�utrc 6 cxreoc- -riliS 1 lc, ked wtt- � oL fi"cnch YY' 1-A% A 2: yr 10 2 SI 1/2 23 7/16 r 'Ile #$ 2 DATE: 918V.97 t 0 2 2/!6 7/B 6 oc to 23 --sk 13 /16 l:07 2y 8 �p to 23 '/Y 7/S • • S t: 2& to 23 rpt T/f 20 a ' ••. CE - 3589 •' w~'P •••• •• • \ RCOLATION RATE 4e ••.••.• �o l2 (minutes/inch) 17S' 0 '18df `TEST 7 s T (� Wr I ,,;010SO(O' RUN BETWEEN 7 \w; FT AND FT COMMENTS 3 Seo(r'o+oop —yxr.f^ czW cg?�utrc Fes' W eu&xorPha.) cxreoc- -riliS Can be accon. lc, ked wtt- � oL fi"cnch YY' 1-A% riC�t�vnrinq 6 �o�avc! bekv 7 rrj lar PERFORMED BY: )=!'Q�/ Techluca! Svcf CERTIFIED BY: �T—c�rtn DATE: 918V.97 72-008 (6/79) ® SOILS LOG MUNICIPALITY OF ANCHORAGE El • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST \\ 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /GAI(rn {�" DATE PERFORMED: 9/ �s'I67 LEGAL DESCRIPTION: L.o-r W, O(RcH 1g0RrH EFS747'gr aN #t2� DEPTH SLOPE SITE PLAN P i- 1 S P Br CvA scram w, ,S'oms 2 3 4 $ r-1 l�r c. S. f >tr 'ra"Of 5- rex y 6 7 8 Sr?/sP 9 10 SllcS-ley Sano( 11 6�'°"%/ Dr%� WAS GROUND WATER S ENCOUNTERED? N L O 12 f3ecom my �.er� Absence c -F N:o E �t � P Sand IF YES, AT WHAT Ile r.1Aed p',.a 13 DEPTH? rj8 (aw /O' 14 15 FS 6 +ev.+ar►a r e ..�10FAt 17 Q M. �'� • �......... `' 18 0 �49TH 19 71 `.i.....+/...ss / •. THEODORE F. MOORE Reading Date Gross Net Depth to Net Time Time Water Drop ..... d .....q 20 CE - 3589w a �'�/� ••• •'•I OLATION RATE (minutes/inch) 4qro",,* TEST RUN BETWEEN . FT AND FT COMMENTS See p�.rC .c 7` GQa1�cc cerlc� oees,art rcco,".-'u+daAr ,V on /ocf r T. H• -# ( fir, PERFORMED BY: F&41-2O/e 7et-44rcai S'erV;CSW CERTIFIED BY: DATE: 9/2'//67 72-008 (6/79) Flattop Technical Services 14530 Echo Street Anchorage, AIaska 995ip, c.ar 1 1.oT 6-46A L.oT 3 (NO PWC-11Irv6) 297 all �-oT Ytoo we 1. I CV A C �4 N t" b `p l/q� �? pQaPosQd' JW S(FOP rrc r hSr T. H. o3' r GISSS pooS w4 �i HouSLw G` (V Ac A M r) �, a7" yN ANAN PA PLACE S6.O PO E LIA 1� uA T/on! The Ian oC rn -Me vcc in i by of *e proe oseo( sep tic SyrPeo) s to/7-vs 16 *e west erf 2-3 RF -SORT E +qeA: Av,Or Ir 000 pZ of S«.thti to /ani( CS p rIg cna I p (-v rerer-L a rent, (too, XIS -0) 4 T HA;' OrW •• .............�.• THEODORE F. AAOORE ; CE - 3589AF n ^► i LI S 17- 1= P G, A N 1_ dT Y S/ R C H !NORTH E57 -A7 -ES scAl.E: I"= too' PhrEF' 912y/87 pUIN 6Y: TF1/ NOTE : T h �r 'is n C a sur -,eyed P f«�. All /oc4�-wns are ct frroximet�-e . .11ing Co. {.+i' y * F r ,�' %i'�'. ; , Driller owner Looati addre road / /j /.- r' Of Range, ab seption, i;/ IT own; r USGS No. Area •. , � . 3 t: .... IIse of we11 D /1r1 E? or distance from main Size of oasing Depth of hole 77 7 feet Cased to _feet- Statio water level „,feet (above)(below) land surface. Finish df well (check one) Open and , Soreen ( ); Perforated ( ). Describe screen or perforations we11 . pumping test at gallons per hour mina for „� ,�hou:•a with V I feet of drawdown from static level ?,emarks we 11 Lo Depth in feet from five details of formations pens rate , size of material, color, round surface and hardness. d to .... to to XP e L(2 r 2S to 1 f � 1' ¢",�'r / Z. -9 5 OV41V to... q tom_ / Y to to Z OIL ..r.w.�..... t0 to _..,.._..... to ,............. ..___... to to to to to to .- Municipality of Anchorage` On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-501-35 Expiration Date: ' J 1. GENERAL INFORMATION Complete legal description BIRCH NORTH ESTATES; LOT 4 Location (site address) 10510 BIRCH ROAD *ANCHORAGE, AK Current Property owner(s) RODGER HUNTER Day phone 346-4567 Mailing address 10510 BIRCH ROAD *ANCHORAGE, AK Real Estate Agent JOHN BLAINE Day phone 229-8050 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. 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 ❑ Received by COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Tv Date of Payment Receipt Number G 3 9 t 92 COSA # 66C 1316W Date: Waiver Fee $ Date of Paymen 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. /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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. 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, UD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the 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. 6. DSD SIGNATURE Phone 337-6179 Date 10 S 13 System #1 Approved for bedrooms. System #2 Approved for `O(Ftt(/fife/ bedrooms. QJ�� �C/yyp/iii' Disapproved. "'r ON-SITE WATER AND Conditional approval for bedrooms, with the following stipulations: 0 WASTEWATER Zz PROGRAM Original Certificate Date: n 13 The Mdni*3lity orA,gdi%rage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. 7. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flaw Advisory Other IR— 114xi 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: BIRCH NORTH ESTATES; LOT 4 A. WELL DATA Well type PRIVATE Parcel I D: 015-501-35 If A, B, or C provide PWSID# N/A Well Log (Y/N) Date completed PRE -1962 Sanitary seal (Y/N) YES Total depth 117 ft. Cased to 117 ft. FROM WELL LOG Date of test PRE -1962 Static water level 77 ft. Well production 8 g,p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate ND mg./L. "* Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 9/12/13 ft. 5.50 g.p.m. Collected by: GEG. Ltd. Arsenic: 5.65 ug./L. Date of sample: 9/13/13 & 10/7/13 B. SEPTIC/HOLDING TANK DATA *FCO LOCATED 35' FROM HOUSE. FCO LOCATION HAS BEEN PREVIOUSLY APPROVED BY MOA. Tank Type/Material SEPTIC/STEEL Date installed 10/11-12/13 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping NEW Pumper — C. ABSORPTION FIELD DATA Date installed 10/11-12/13 Soil rating (g.p.d./ft`or '/bdrm 0.8 System type TRENCH Length 50 ft. Width 2.5 ft. Gravel below pipe 8.0 ft. Total depth *12.04+ft. Eff. absorption area 800 ft2 Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test = in. Water added =gal. New depth =in. Elapsed Time: = min. Final fluid depth = in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump ofr Level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAM station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ Public sewer manholetcleanout Holding tank Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING 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 lots 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, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ 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. Engineers Printed Name JEFFREY A. GARNESS Date 10 / -Zs )a (Rev. 11ros) I esniui r I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT.. UNDER NO CIRCUMSTANCES SHOUI.D ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE= - DATE• / p Q iv S a* ra GRID= ..... _ f' .... Dusm MerF Sward FBi Ls-a�v 8 DRAWN= y i,t'+X' 3'•vWY mj�1�X,9t tli r'sic k Y,x••uk.em+• `" -e, 'M­ > � �h if-a' -Address. 4t IY,.FCi Y 4t Tl+y r �x-r '•1 i { .�?f 49ti"i � � y �1 '• Unless otherwise requested, HAA will be held for pickup + f fit - ,exp r 4 .iae tiny F: I 1 I 1 � F i j•. iFi ��i A+ryM f'I-i '� - ! , � 1 2-,,.. NUMBER-. 00: BEDROOMS:Ti 3 4 a1r y&t,Jr,.w, t p tip+ 3 ATYPE OFUWAT1ER_�S� UPPLYr} }� #' H�� ( t(� > J�Individual well ✓ y rn Y} v, k1 .:H S b/�d. 6iX,X�pc 1 ,d.•p9T i� 9 a ' 0 0 H '+154ti "g a t" 33 qg�' ..lt� F i u r s+ it t iI M b0 Yi 'i+n c.+,qw 9ddtli'rYt X�ro { 0 3' f to r faa n H7.. ff r1<,�° r aXy x s rk y r� �'ionlnlUnity W@ll X N C �•. •: ( 1-. WS«a ut r �YWa;u rrM�.+'31 a:1f-wdp� Public mater.-, rn a y,7 yl y 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 . >;,�1 t%d9 ... ,.:. ..-.. .S. .. ..... Baa. ..,.,..r n.. ... _.. _ .. ,. '...,. � -• j..... ... .. s .ik ti�` 1.... :. ,Ft '�i 1 r•. ;Individual on-site r - Yrvii 3-, 4'Fiofdx o # ti t Y + a t, -r 7 t +r7 R:"i i R r F- } ce •••+, a * wy,Mirnt9'tank(^sry• }� , k �r' n �� f ► �; F+'WnmRYfAf»"i�rCYc+.ttYo.VW'J.9'1'. ..-fit Ai..:1 .., q . _... . .. E ?I.t .1+.. e�+l v. .Ya ��� 1 to dT.#iCommunity,on-site , 9 �M- 714'. %-1-- dY}� 'Public sewer, >+ I JJJ) 11 NOTE. If communitywastewater system, provide written confirmationffrom State ADEC "attesting to the legality and status of system. 72-MS (Rev,' 1/91) Front MOA 021 ;. i. .> .r .,w.. .'"m';; •. '."+P! a�F ;;. - k•..M.,Ftit - ,.s....- div i£.� .p,}+4.,.�p , r c •r'•.. Y. .... . •„- Z • ':3i 'r'k', � C h 1 p iM1 y i 9 L" `Additional Comments ``�` (-� � rrr7 .ti ta, Fs .. : r iR , .r_�s ���� awx .,t • - !- r CAUTION f i The MuriEeipality` Anchorage Department of Health and HumanSen ices (DHHS) issues Health Authority Approva[ CeMfUites based only upon the representations given in 'paragraph 5 above by an independent profess(bnal engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and th •t .. , r • g. conduct inspectionsanal(tor� order to satisfy certain federal and state requirements. Employees of DHHS do not yzedata before a certificate is issued. The Municipality .of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (Rev. 1/91) Beck MOA 021 • ` 6. SIGNATURE�� �� `�• t .'..DHHS Approved or ;bedrooms. M1 7in!'� :' -.: i}I^. �' v � ' b • tl ^i Y � n: 3 :Y f $ R. Disapproved Conditional approval, for . < bedrooms, ;with the following stipulations to t• -:, ,<. , ,N# �1 4P ;4.�..i�•'� 'i, i �p, -'#�` .. ,x 2.: a'1'7i� t. :.4 fi �f "I ✓i:. a`�Ynk:: w'�, f � ;. i. .> .r .,w.. .'"m';; •. '."+P! a�F ;;. - k•..M.,Ftit - ,.s....- div i£.� .p,}+4.,.�p , r c •r'•.. Y. .... . •„- Z • ':3i 'r'k', � C h 1 p iM1 y i 9 L" `Additional Comments ``�` (-� � rrr7 .ti ta, Fs .. : r iR , .r_�s ���� awx .,t • - !- r CAUTION f i The MuriEeipality` Anchorage Department of Health and HumanSen ices (DHHS) issues Health Authority Approva[ CeMfUites based only upon the representations given in 'paragraph 5 above by an independent profess(bnal engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and th •t .. , r • g. conduct inspectionsanal(tor� order to satisfy certain federal and state requirements. Employees of DHHS do not yzedata before a certificate is issued. The Municipality .of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (Rev. 1/91) Beck MOA 021 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.of `/, (3rrch lyerM Esf Parcel I.D. A. Well Data Well type Pyf If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y (At Date completed eet� 196 a Driller Fast / Scuef �d Total depth 117' Cased to I 1-r I Casing height it" Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y rn FROM WELL LOG AT INSPECTION o Z Date of test 19 6 2 K! 2G l 9s- 20 Static water level -77 nT'� N c (T) rn Well flow R g.p.m. `I. 2 g.p.m. D C rn Nz Pump levell 4 `J' o 7 R N SEPARATION DISTANCES FROM WELL TO: z Septic/holding tank on lot 10,91 ; On adjacent lots > tool Absorption field on lot I GO r ; On adjacent lots > too ` Public sewer main > 1 G0' Public sewer manhole/cleanout > 1 oc ` Sewer service line > ss-, Petroleum tank K/ 017e Seel? WATER SAMPLE RESULTS: Coliform O col /too "-e Nitrate < o. I mi /t Other bacteria noo e- V v Date of sample: 6 l 2 0 / ?S` . 6/ Z6 / 9s- Collected by: r F moo,,,, B. SEPTIC/HOLDING TANK DATA Date installed 10/21 / 6 7 Tank size 1 000 g of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N. A. Alarm tested (Y/N) N. A. Date of pumping t / Z 1 / 9s- Pumper A t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10,91 On adjacent lots > ladFoundation 1 !to To property line '-I0 Absorption field 55' Water main/service line > 2S' t Surface water/drainage > I 00' 72-026(3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION &/ A. Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed 1 U / 2 y / 8 7 Soil rating (GPD/Ft2) 177 ):2'16drM System type 7'rcn Ch Length 410f Width t. 8 , Gravel thickness Total absorption area 564 Q' Cleanout present (Y/N) Y "7 Total depth 13 Depression over field (Y/N) Date of adequacy test 6 / Zo /95 Results (pass/fail) Parr for 3 Bedrooms Water level in absorption field before test 61 to After test 78 of Peroxide treatment (past 12 months) (Y/N) IV If yes, give date N A. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 160' On adjacent lots > 100' Property line 301 To building foundation I GO ` To existing or abandoned system on lot On adjacent lots 7 30 ' Cutbank IV. A. i0a' Water main/service line > 23 ' Surface water > too' Driveway, parking/vehicle storage area > 100 Curtain drain N On e s e en E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect Signature TJCc T 7k4m Engineer's Name-PleoA,-e F P-tao►-- DateTu (flo 19 9S' HAA Fee $ 3 40 If-, Date of Payment / /�P/i�5 Receipt Number //0 e�69 6�( 6 If 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number inspection. ►/seas**s**ss*+*s*amaE I V V 0 THEODORE F. ;at�o>rE c' l4�MY,mee -eM 4,v AIL CT&E Environmental Services Inc. PFAVAVA CT&E Ref.# 95.2506-3 Matrix WATER Client Sample ID L4 BIRCH NORTH EST - NORTH HOSE BIB Client Name FLATTOP TECHNICAL SRV WORK Order 15680 Ordered By TED MOORE Printed Date 06/23/95 @ 16:40 hrs. Project Name Collected Date 06/20/95 @ 14:00 hrs. Project# Received Date 06/20/95 @ 15:00 hrs. PWSID UA Technical Director STEPHEN C. EDE Released Sample Remarks: SAMPLE COLLECTED BY: T.F. MOORE. QC Allowable Ext. Anal Parameter Results Qual -------------------------•------------------------------------------------------------------------------------------- Units Method Limits Date Date Init Nitrate-N 0.10 U mg/L EPA 353.2 10. 06/21/95 OAA * See Special Instructions Above UA = Unavailable n** See Sample Remarks Above NA = Not Analyzed "U = Undetected, Reported value is the practical quantification limit. LT = Less Than -�D = Secondary dilution. GT - Greater Than