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Home My WebLink AboutBIRCH ROAD ESTATES LT 6IPJ!!Ipap Ao� 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: OSP141487 Tax Code Number: 01549406000 Work Type: Septic Upgrade Permit Effective Dates: May 29, 2015 to May 28, 2016 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Subdivision: BIRCH ROAD ESTATES Site Legal Address: BIRCH ROAD ESTATES LT 6 G:2638 Owner/Address: NIELSEN PATRICIA K & JAN E 6161 MOOSE MEADOW LANE CIRCLE ANCHORAGE AK 995161739 Site Mailing Address: 6161 MOOSE MEADOW LANE CIR, Anchorage Lot Size in Sq Ft: 55669 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank 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. Special Provisions: 1. The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation test. The Engineer needs to do an additional percolation test prior to the construction of the septic field. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. AMC 15.65.060.6.3 2. The original well is to be decommissioned and a Well Decommissioning Log submitted with the Inspection Report. Received BI Issued By: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. V#9;__—f4V-f —0(9 Property owner(s) 'Sur, Al -f t 4 url Day phone Mailing address 1. Ito IA^rN 5 c. 7✓I ra J%� Gb a c� Site address 5 u1r v Legal description (Sub'd., Block & Lot) 9714- is— f Lt 1-10 5 w* * (n Legal description (Township, Range & Section) Lot Size SSV (v q(v q Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field Q�] Initial ❑ Single Family (SF) lyl (w/wo ADU) Septic Tank ❑ Upgrade ® Duplex F-1 (D) Holding Tank ❑ Renewal ❑ 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 further5�rtify that hi i�ccordance with applicable Municipal Codes. 180 2014 property owner or authorized agent) Permit/Rush Fees: Date of Payment: / Receipt Number: Ig Z `5 Permit No. C6 11A9 Permit App_.::- Waiver Fees: _ Date of Payment: Receipt Number: Waiver No. Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 Oct 28, 2014 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic system Legal: Birch Road Estates, Lot 6 To Whom it may concern: This is a request for a replacement septic on the above referenced lot which is failing. One new test hole was excavated at the north property line and showed silty sandy gravels for the entire 10 foot depth. Water was observed in the test hole at 7 feet during the excavation and after the 7 day monitoring period it was measured at 6 feet. The test whole was completed in 2006 and the water table was monitored throughout the seasonal high water period. The maximum water elevation observed during the past 8 years was 6 feet below grade. The perc rate was 12 minutes per inch which give us a total length of 117 feet for a simple 5 wide trench and 1.5 feet of effective depth. The lot slopes at about one percent to the north with no slopes greater than 25 percent within 100 feet of the site. The existing well was moved after the asbuilt was completed due to no water. My site plan is correct per my site visit. The creek located on the east side is over 200 feet from the proposed system with no impacts to this design. This new system will not impact any of the neighboring lots due to this design. Please call me if you have any questions. Sincerely / Michael N. Anderson, P.E. DESIGN CRITERIA: 4 BDRM X 150 = 600 GPD SOILS = 600/0.8 = 750 GPD 750 GA/5 X 0.78= 117' (1) TRENCH 2.0' DEEP 1.5' EFFECTIVE 5.0' WIDE 117' LONG - - ------ -- ROAD ROAD ESTA� / � C LOT 5i�" III MEADOW PROPOSED DRAINAGE FIELD I, G NE SEPTIC r/ I i I / I EXISTING WELL BIRCH ROAD I LOT 6 I WELL i 1 — 100' RADIUS �� DONNAHUE LOT I Septic Design Prepared for JAN AND TRISH NIELSON BIRCH ROAD ESTATES, LOT 6 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 345-3377/ FAX: (907) 345-1391 SCALE: 5.0' 10 SEPTIC FIELD SECTION UND OVER 1DE FABRIC f PIPE 0 0 36" ROCK A BUBBLING BROOK I�-1 A LOT 7 4 BEDROOM�'A V\ HOUSE 5/18/2015 DJR V=100, PROPERTY LINE L LEXISTING WELL I`...) TO BE % 1I Y DECOMMISESIONED ` PER CO %- BUBBLING BROOK � LOT 1 I I _ I 5/18/2015 DJR V=100, /j -------------- °-------------------- ------ --- J �� r -- r —I— \ I� 'j SEPTIC {, �\ �� « BIR@H ROAD ESTATF�Y ' 0T 5 , APPROX LOC. OF i %\\It` ,•/ / CREEK j _ �. EASEMENT 100' CREEK EDGE OF� SETBACK CREEK PROPERTY LINE L yELL I r y$ FOOT • / CONTOURS �, ? �V • i\ i� _ `SSS--. BIRCH ESTATES \ • �I \ J Lo \\ \II .` TH#� i n • PROPOSED _ --� DRAINAGE FIELD TH#2 TO BE DONE PRIOR TO CONSTRUCTION Y o$,� .. ' . nit LID \ •� ,� •- f REMOVE OLD 1250 TANK \ AND REPLACE W/ NEW ? 1500 GALLON STEP TANK I -MOOSE ME&DOW *E EXISTING SEPTIC _. ,____ 1 �"\ \\ - PROPERTY LINE // DONAHUE t LOT 1 �� l \ { DONAHUE i LOT 2 (��- Septic Design Prepared for W,��\��1 OF .•'�E q y♦ JAN AND TRISH NIELSON :�C- ' ' ♦0 BIRCH ROAD ESTATES, LOT 6Aff :`•♦i� Anchorage, Alaska 49TH ...:...., 0..00 t ............... ♦� :MICHAEL N. ANDERSON! ♦♦�i': Micha« el N. Anderson, P.G. DATE: 5118/2015 NATRONA AVERAGE, ALASKA 99516 Zo94601 ♦ r•DRAWN:DJR ♦ �.• • ♦♦♦♦��1"";��• (907) 3405 3377 / 907) 345-1391 SCALE: 1 "=50' Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 ww w. ci . a n c h o rag e. a k. u s (907) 343-7904 Soils Log - Percolation Test Performed For:/'It t l L U h Date Park [[ Legal Description: VI rCh t -74" V- 4_ Township, Range, Section: _al a 4'g ; e7t 891/4.a' C-11?r01.'eC 5 p/ G" P 14- 15- 16- 17- 18- 19 - COMMENTS OF ............. MICHAEL N. ANDERSON ; C�l i'. CE - 9469 v Site Plan lot V_ -S,ter kwd. 1y4a Reading Date WAS GROUND WATER 9- Depth to Water ENCOUNTERED? yrs 1 O- G ttl b IF YES, AT WHAT DEPTH? r S 366ra (®/' Depth to Water After O / 11- (•{.n (,� Monitoring? E � E 12- L" Date:td •L77, gf 14- 15- 16- 17- 18- 19 - COMMENTS OF ............. MICHAEL N. ANDERSON ; C�l i'. CE - 9469 v Site Plan lot V_ -S,ter kwd. 1y4a Reading Date Gross Time Net Time Depth to Water Net Drop G ttl b 31,Vv 366ra (®/' Ze 5-111 L" 2s" Gn 2 S.r t PERCOLATION RATE 42W (mmuteaAwh) T€.ST RUN BETWEEN Z FT AND PERC HOLE DIAMETER to PERFORMED BY: t+r " I CERTIFY THAT THIS TEST WA PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / Z swam Iwaim ALa+ of 5 FA m..a OtfACT) nrorr unla •T..10f . slwl un+a ■n.a+ i flPPiPDX/MHT of tha �tCCC:UT&,S� drawing G K y.; s;;o•Nn on this rerr' it le 21+ AMC• /i 9/N En AN(e +;It) C p1i S l7S�M�NT E I 3; 3 � I ^Ni 2 IK �+ N A% 0 AL lv UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONS7RUC ION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL 7RANSAC71CN ONLY AND ASSUUES FWANaAL LIABILITY ONLY FOR THE COST OF THE SURVEY. USM DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. AT SURVEY TYPE SYMBOLS ❑ FOUNOAMW IMT ❑ FlNu sNucn,FE A IIMr SEr AR Z"=ZF DRAINAGE •i:.`i ASPHALT El PIDT PUN ... As-euRT ... IA1 SVRxY ... 7oPomwlrc O FOUND�REBAR 'e-'a a w000 FENCE CONCRETE ® ASSUMED ELEV. .;c—,K " METAL FENCE ® WOOD DECK PLOT PLANS h LOT SURVEYS NOTE. IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERVASE NOTED. SURVEY CERTIF1CAn0N r��\ILS - Prepared by PLOT PUN•t.•+ r -\` Robert E. Johns, Jr. & Assoc. n..sr .Luh u.. ++,.,. MY•�^rY ....�+ a. a r..w ave.. n..� .w •r i , ,.''�•, ♦ ..�P,.••' ♦ Professional Land Surveyors ^^' aaw : rveiw r r "" wt van 542 E 12 AVE. r AV • • J,% ANCHORAGE, ALASKA 99501 It :4 Sole: ++ Rao. Lot S.F. RK Plot Flo Na FOUNDATION AS-SULLY/~r/5... l bM< L Jwa !- MrY 1Ml .. Z = SO Doe. Sun•y.d: Dralol eK Checked t+Y a•�' 1 .... r.ev.a r•AI .. ar wwa.• ., M a u.Ie"7 ur /.. • ..•.r 1••• r, f �..,... .�„.. ,,, . •••i• R T Ns 2-14-96 REJ MLJ Date Dram: 2-14-96 CHd w.o. 96010 .:�.�.:.�... ...+. ♦ i R �1p'Q'• RNAL STRUCTURE As-BUILT 4121 ;: �°L! 2 95-076 clI �-M r ~I ♦♦`��p ol..awnd�oo��•+ OT 66�Yt BIRCH ROAD ESTATES 11C e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST 1 �k ;NiAr+A4C4a •.d.r ::�.t rFi.l.�.skw,5 a++9{.3, 3 ��: F mvsan {L t'iVnnonm CIw 4 81414 w''+` PERFORMED FOR: a tA 1`•l iQ I r---LSott O�� DATE PERf,'ARMED: LEGAL DESCRIPTION:_ Rb LWTTownship, Range, Section: DEPTHSLOPE SITE PLAN (FEET) 6 Le g 1 p CL cnZ4An►ii c,S 2 3- 4- 5- 6- 456 CSM 7 8- 9- 10- 11 91011 sbj� 12- 13- 14- 15- 16- 17- 18- 19— c 213141516171819 SILTY 6;,RAgaxS c e S A arnS . WAS GROUND WATER ENCOUNTERED? b S IF YES, AT WHAT L DEPTH? 0 P E Depth to Water Alter Monitoring? Date: L!M&2nf5 Depth to Time Water 20 -{ il_ll PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT )OMMENTS S-- 1400 —T--tt) U C---QIJ=,e SorL 5 SL%,wL mtA—&h?%A t 1,4s PERFORMED BY: ,LCERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 17-''20 --95 72-008 (Rev. 4/85) J WATER WELL RECORD STATE OF ALASKA njr \\k J\)� 1 q ('� DEPARTMENT OF NATURAL RESOURES ✓——1-�—ao Division of Geological O Geophysical Surveys LOCATION OF WELL (Please complete either la, Ib or Ic.) Drilling Permit No. Loi Borough Subtli vis ionA. D.L, No. L/al Block Ib. I/a glrs. Section Na. Township Range N� g E� Meridian _ —af_of —ol_ S❑ Ic. OIS TANCE AND DIRECTION FROM R040 INTERSECTIONS 3. OWNER OF WELL: cjr I Q'S ori Sire¢t Adtlress and Area of Well Locollon 2. WELL LOG M aherlal Type Address: M.q-nJo t) 4-Rhe�C/A_ FS ur faecle� q. WELL DEPTH: (final) /9e 5. DATE OF COMPLETION Tap Bottom ft. S S 6. Coble to K1 Rotary Driven C)Dog ElAuger 0Jetted Bored C3 Other �! 7, USE Do -attic [2 PublicSupply❑ Industry Irrigation (j Repharge 13 Cammallcal Test Well Other: S 8. CA NG: j,] threaded N Welded bs diem. in, to � ft. Depth Weight__Ibs./fl. dlom.—In to_ Depth $Ilckup If. 9, FINIS H�jO F�WELI: Type: dryae,..--C j:) Diameter: r Slot/Mesh Slrs: Length: Set belween ft and it BaCkfillinq Gravel Dock / 10, STATIC WATER LEVEL:6 S t I. 0 Above or C] Below land surface Dote Equipment used; .,, %y. -rte 11. PUMPING LEVEL below land surface and YIELD ft. after hrs, pum Ding _ g. D. m, —ft. at101_hire. pumping_ _ I. p.m 12 -GROUTING Well Grouted: Yes No Material: C] Neat Cement 0 Other: Ia. PUMP: (if available) HP Length of Drop Pipe fl• capacity g. P.m. Sub.. 0 Jet [3 Centrifical 13 Other Iq. RE MARKS: p "0 r�/ I / 16. WATER WELL I�uurvn ry4RUitMIpE RTI FIC AT ION: 3540 AKULA DRIVE I6. Water Temperature _ Tn10 W01 wp55p5�4r�0f�pwy mtYVI rV�Ory`g�' R1Vlar^y{lypiian and Inis 'apart is :rue Ip IM1e best of NN11 JJ��7�(Vj Y knowledge and belief; 4 q -] 1ui � Name �., , / / Con tract L¢ense Number ... _..___.� �•[._ e Dale: Copy Di,, mulion: WHITE-Sla la OGGS, PINK - Driller, CANARY• --�"�'--------. C u s tam a r F Q C 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 SYSTEM PERMIT PERMIT NUMBER:SW980156 DATE ISSUED: 6/08/98 DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE: 6/08/99 OWNER NAME:NIELSEN SAN E & PATRICIA K OWNER ADDRESS:6161 MOOSE MEADOW LANE CIR ANCHORAGE, ALASKA 99516 PARCEL ID:01549406 LEGAL DESCRIPTION: BIRCH ROAD ESTATES IT 6 LOT SIZE: 55699 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: 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 (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: RECEIVEDBY. /,,-'' DATE: �Z C(%-I�j0(� ISSUED BY: C/�'YW{// tJ• DATE: / - / a .iinr.a ar•n 0 /00 . -/• L, "ROOF O / 25 L -s AVA earn er,•.rx 1 �-- 34 0 ^ t 91 J o I ` S DEr�a/c. L1p — /t�1 h ^t SCFJLG 62 b� 43 -V I at `� CRrEi� ,I L i i Q- a n "1 / V au,Q twu / m • N m ON o �! SO.00 Dh \\�h2a Au /,s✓� .�{ } �.x�s res 08 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE LJ Loy slRwy SURVEY TYPE ❑ FOUNDATION AS-wLT SYMBOLS • SET RESAR ASPHALT SETAR DRAINAGE ❑ FINAL STRUCTURI: AS -BUILT P PLAN ... 1=1T ... LDT 91RWLY ... ION ASAPHY FOUND �--8$ WOOD FENCE..: CONCRETE ® ASSUMED EIEV. 31 X X• METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS. DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WMICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.- ALL DISTANCES ARE RECORD UNLESS OTHERWaISE NOTED. SURVEY CERTIFICATION.+,r++++��,, Prepared by IF b� Robert E. Johns, Jr. & Assoc. PLOT PLAN -°>-°h�' p >-^� �••-�E, • ��P,.•^ �� Professional Land Surveyors ' n.,. ww w.mwr r a n. re aaw.. w •n..a ., w .+a w as aw e.w a mr Nww.ap aw amu.a a e.•viaa. naw e.n - � ,:' Ar •' �� ♦� 842 E. 12 AVE ANCHORAGE ALASKA 99501 Scala: 1 �' = 5 0 ' Rea. Lot S.F. SSG 9 Rx. Plat F700 Na 77-1,Q9 "w'Y•"w '" �0L Fg1NDAT10N AS Mr 0... ..... •• • -BUILT Dal* Sures 2%_27-95 Dram by REJ Checked b MLJY .. .... ... ... ;.•. .,/ •, Md ;.'ROB '�• �♦ Ar Dat* Dram; trld: W.O. FINAL STRUCTURE AS -BUILT P a� �j:'ir's 41 —S ••'��• 7-95 26 95-076 Logcd Ds•ar tbn: IP •mer•'••••'••.........•••Apo ''•• .++��•• LOT 6, BIRCH ROAD ESTATES sww Municipality of Anchorage Page I of 72-013 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number:6%9 sc oz K7 PID Number: o/ 5 - K%4 - 06 Name: Wastewater System: QRNew El Upgrade Address: - ABSORPTION FIELD Phone: 56 1— zSN4 No. of Bedrooms: y ❑Deep Trench Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: O • R GPD/So. Ft. 3 ! Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe NiA Q31Rc 2 T /.S Ft. /.O Ft. Township: Range: Section: Fill added above original grade: Gravel length: O Ft. e /3Ft. WELL: ;9 New ❑Upgrade Gravel width: Numberoflines: Distance between lines: 1 Ft. 1 3 -- Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area:Pipe material: i2tvA E 303 Ft. Z3? Ft. ASO SO. Ft. 3034 Driller: Date Drilled: Static Water Level: Installer: Dateinstalled: t2 -?--4.i RPM�ART QILtI /ti 4074 10/z3/ ZZIF Ft. MI Anela So N A # t-ta-46 Yield:Pump Set at: Casing Height Above Ground: o TANK GPM Z- 4 8 Ft. 3 Ft. SEPARATION DISTANCES VSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Litt HoldingPublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Linea IJC T NL JZ S_d Welt, t /o2s .t/! N Material: Number of Compartments: yo surface Water l 0-S /110 105 LIFT STATION LotO t t Size in gallons: Manufacturer: Line /0' O ZQ Foundation /p 16 0' _„• "Pump on" level at: "P 'level at: High water alarm at: CurtainNl ll A NIA Pump M odel Electrical Inspections performed by: Drain Remarks:. BENCH MARK Z"Tzt , TTo ov Location and Description: Tt¢+z'Ft 6". t t z ceL Fie aN'e'1`�e Cf1 — c ¢ OVr�'Y2..T k '7` L e-fN40 Assumed Elevation: T 'i�ec-rTo,vS CLtom- GwQIC M .SOON ' 13!% Efi*AF.AL S•2•PA N i� T x TI t / _ ' vim,. 6TtUi Com. ht.t� @o Tit Ae-t- y' -N Inspections performed by: Dates: 1st tz-I S -4s Q 3 11- 91 2nd t - 1z-46 w start R. Punrcne l Department of Heal#L and Human Services approval,8�©� — Reviewed and approved by: Date: —6- 72-013 (Rev. MI) MOA 25 AS -BUILT WASTEWATER ABSORPf Lot 6, Block 1 BfrQh Little Campbell Creek 100' Creek Set New 4 Bedroom House — 1250 gallon Septic Tani O 1% D_Nv= Way Mr. Jan Nelson 6161 Moose Meadow Lane Anchorage, AK 99516 (907) 561-2544 :ON SYSTEM Road Estates Well 3 a 200' to Nelghb Well New System See Sheet 3/6 z� TH 4II 150' to �d neighboring well Deslont Perc. Rate of 13 min/Inch 4 Bedroom House . 750 SF of Absorption Required Use 5 Wide Trench, 135' Long Total Depth Is 3,5'' STEVEN R. PANNONE, P.,E, P. O, BOX 142025 ANCHORAGE, ALASKA 99514 274-0308, 272-8218 Fax ATE, 3-8-96 1 AS -BUILT l '- AS -BUILT DETAILS WASTEWATER ABSORPTION SYSTEM Lot 6, Btock 1 Birch Rd Est. New 4 Bedroom House 31 Installed a Clean-out i Monitor tube, Typical at each V EC i FC1 oo C1 C2 � TC2 1 T2 EM o' � 1250 gallon ; o Septic Tank A to I I TH I i A%' 49TH n R. f CE 81 0 TH 5 0 Mr. Jan Nelson 6161 Moose Meadow Lane Anchorage, AK 99516 (907) 561-2544 35 LF 0 TH 4 Flow mfg'd New System J 0 W To Prop, Line STEVEN R. Pl P. 0. BOX 142 ANCHORAGE, JNONE, P.E. 25 _ASKA 99514 -8218 FAX AS -BUILT Swing -Tie Table A-FC1= 13,5' C-FC1= 7.5' A-FC2= 12.0' C-FC2= 6.6' A -TCI= 10.7' C -TCI= 6.6` A-TC2= 9.0' C-TC2= 12,0' A -PTI= 10.7' C -PTI= 15,2' A-PT2= 122' C-PT2= 15.8' A -NC = 53,0' B -NC = 70.7' A -NM = 58.0' B -NM = 67,0' A -EC = 73.8' 13 -EC = 29.8' A -EM = 65.3' B -EM = 41,3' A -WC = 97.3 B -WC = 105,7' A-WM = 77,0' B-WM = 76,3' I i A%' 49TH n R. f CE 81 0 TH 5 0 Mr. Jan Nelson 6161 Moose Meadow Lane Anchorage, AK 99516 (907) 561-2544 35 LF 0 TH 4 Flow mfg'd New System J 0 W To Prop, Line STEVEN R. Pl P. 0. BOX 142 ANCHORAGE, JNONE, P.E. 25 _ASKA 99514 -8218 FAX AS -BUILT O i�•'41 9TNh...h°...,... ............ f .......................... d. .Steven R. Pannone: No. CE 8149 AS -BUILT DETAILS WASTEWATER ABSORPTION SYSTEM a N 0 Lot 6, Block 1 Birch Rd Est. a inaNV3l3 a s °s 3Hnl YOJ.mowt °r' Y a _ a m nu NaUY d� 0 oim ° d 4 Z 0 H U LJ V) Mr. Jan Neilson (907) 561-2544 4- 3am NOIINON Sam mimaN e 1nONV3l3 w 1nONV310 inaW3l3 a a �+ as it 5 N inONV3l3 [ 1nONV3l3 [ inaw3l3 NOI1VONnOi 0 C r f Y ++ �a R i J {a w N +° as 41 ; U ya Y UY z c t- uw ZW z�0 y� LL' lL O STEVEN :Ri PANNONE, P,E, P. O. BOX 142025 ANCHORAGE, ALASKA 99514 274-0308 ate. a-8-96 AS -BUILT i NTS RECEIVED Ma":['P�&MU 1UM1111LID(D TU4440 1201 Ramona St. 99515 ANCHORAGE A1V`#Achorage 344-7714 Dept. Health & Human Services *A Franklin Electric pumptec will be installed & shut the pump down for 12 minutes on overpumping of Well. Pump pumps at 8gpm. 303 feet. SIX INCH WATER WELL DRILLED ----------OUT iTO THE DEPTH OF DRILLED AT THE RATE OF $24.00 PER FOOT. Steel casing - seated out to 237 ft. 346-3311 PROPERTY OWNER Jan & Trish Nielsen P.O. Box 112429 Anchorage AK 99511 LOCATION OF WELL SITE Lt. Blk. Sub. DRILLER Bernie Claus of RAMPART DRILLING WORKS. WELL LOG: 0 - 191 Coarse gravel with rpvpral smaii honiaera 35% clay material. 19 - 65' A silty coarse gravel. 45% blue clay. 65 — 135' Hardpan. A cemented gravel. 135 — 159' A wet silty gravel with 20% brown clay. 160 — 163' A water yield of almost 2 gpm with 30 feet of water standing after a two hour wait. This water was very silty. 163 - 1711 Wet sandy clay with a small amount of water at 1711. Not useable. 171 - 190' Silty wet clay with 25% fine gravel. A minimal amount of water at 190 feet. Very poor quality. 190 - 215' Hardpan. Again, about two gpm of water yield showing at 215 ft. No pressure behind the water aquifer, & with a very low static level. About 35 feet only, ever, after standing overnight. 215 — 237' A silty wet gravel with 45% blue clay. Water seeping thru slowly. 237 — 3031 . Bedrock. A sedimentary type rock. Water finally showing at 295 ft. Water coming out of a porous type rock showing 3 1/2 gallons per minute. Long duration pumping (over three steady hours) production drops to 180 gallons per hour. Static level is 75 feet off bottom in two hours, & should come up about 30% higher overnight. (Static water level.) One horsepower submersible pump should be installed five feet off bottom. ($1,500.00 paid initially on Well.) COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. No setup or mobilization cost on this well. $24.00 per ft. x 300 ft. WRITE CHECK PAYABLE.TO RAMPART DRILLING WORKS FOR THE SUM OF 5+700.00 The one horse Pump will overpump the well for fast recovery. See note above.* THANK YOU VERY MUCH. NO chart or well sea�o/t pit -Less adapter installe Total cost: $7,200.00 ��T1@'C`C (As'tl�l BER O M RILLING WORKS DATE October 23, 1995 j* 4o'7`3 it 6 )a...) 9 7b6. � �13 SSED �yppagi�<ti This Wel �ESio ul��Re EcPe epi ecRin°Ln@ WiULUr �Sstk We W111Ado °so Aat°minimal cost. /\A'c)'4 copy PAGE 1 OF 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:SW950247 DATE ISSUED: 8/29/95 DESIGN ENGINEER:STEVEN R.PANNONE EXPIRATION DATE: 8/29/96 OWNER NAME:NIELSEN JAN E & PATRICIA K OWNER ADDRESS:6161 MOOSE MEADOW LANE CIR 0 TILT rvtta f FI PARCEL ID:01549406 LEGAL DESCRIPTION: BIRCH ROAD ESTATES LT 6 LOT SIZE: 55669 (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 (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) v4 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: REVISED 12/01/95. PRIOR TO CONSTRUCTION, PERFORM ADDITIONAL SOIL TESTS TO CONFIRM 0.8 GPD SOIL RATING THROUGHOUT LOCATION OF PROPOSED DRAINFIELD. SUBMIT SOIL LOGS AND PERCOLATION DATA WITH ASBUILT DRAWINGS. Tniu'+Tir (Anp" Dp-(VEl" REVISED 12/01/95. RECEIVED B ISSUED BY: DATE:_ DATE • .22-1 — qS- 1 Steven R. Pannone, P.E. Consulting Engineer P.O. Box 142025 Anchorage, Alaska, 99514 (907)274-0308 (907)272-8218 Fax November 30, 1995 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 All. Mr. Jim Williams Subject: Lot 6, Block 1 Birch Road Estates Permit Application Dear Mr. Williams, A permit was issued to construct an onsite septic system for this property. The design needed to be modified due to the encountering of ground water during the installation. Attached is a redesigned septic system that will meet your departments requirements and serve the property. The design calls for a five -wide trench with one foot of effective depth. The trench will be 135 feet long, and will be broken into three legs. Two legs will be fifty feet long, the third leg will be 35 feet long. An effort was made to design three equal length legs. Due to space constraints this was not possible. Each leg will have a monitor tube installed at the end to assist in monitoring this system. A flow splitter, similar to the ones manufactured by Orenco Systems will be installed were the legs join to provide for even distribution of the effluent. Water was measured in the test hole monitor tube at depth 7 feet by you. The design will maintain four foot vertical separation from this water depth. Relocating the new system to this location will not impact the surrounding properties. The original location has been designated as the reserve area for this lot. I would request an immediate issuance of a permit to install this system. Cold weather is freezing the ground. Further delays will make installation of this system this year impractical. Please contact me immediately if there is a problem. Sincerely, ,•; EYE € , ��. _ �d �.i01.10eP0su.�•: r StevAn�noneP.E�.� Steven R. Pcnnwe CE•8149 DESIGN WASTEWATER ABS❑ Lot 6, Btock 1 Bir Little Campbell Creek 100' Creek Set i i �; 49THi _'s Steven R. Pannc New 4 Bedroom House 1250 gallon Septic Tank1 [❑N SYSTEM Road Estates 0 Ne Well J 200' to Neighboring we v U311"i Install aGenn-out 1. Monitortuhypicalnteachend Install Flow Sputter mfg'd by Clrenco or approved equil Solis will be verifiedPraposed during InstallationSystem TH 4IIn I 150, to neighboring well neighbor well qel �e Delve way 0 DeslAnl Perc. Rate of 13 rein/inch 4 Bedroom House 3a5' 750 SF of Absorption Required Use 5 Wide Trench, 135' Long 5' Total Depth Is 3,5' 1' PREPARED F❑RI STEVEN R. PANN❑NE, P.E. Mr. Jan Nelson P. ❑. BOX 142025 ANCHORAGE, ALASKA 99514 (907) 561-2544 274-0308, 272-8218 Fax ATEI 11-30-95 DESIGN ].=50' DESIGN DETAILS Lo-rtoiBLocK ( � l`Rck4'Qo/a� EST. 1n�v3ia 39n1 2W101MHI L Q � � a S a iD C „ sib i -9Y d Q d U yny A neo > C C O +1 ii d 4 38n1 tmmmm a LL Y d d a in C Cr i Ce N G {d N �4 Zl� O� Q Q aaoaaac ~ Y N Ld u I' U 30 J e u N 39n1 N01MON O 4 oaoaoaoa W maNV313 O O coca vi L) 4- i 3 1noNv3ia 1nowia irl[IW3'm --11 lfuw37a �pN N_ 1nONV310 NM1VNNn0d W� r d 9TH • ;.... a...... .... ................a.....' '••" .PREPARED FORT STEVEN R. PANNONE, P.E, f :Steven R Pannone;�j r No CE B14s ' �i Mr. Jan Nellsan P. 0. BOX 142025 /30,.•'Oi'�� ANCHORAGE, ALASKA 99514 �t............. 274-0308 +Is%% (907) 561-2544 a e 11-30-95 i NTS DESIGN RECEIVED Municipality of Anchorage ((��(('� '( e r DEPARTMENT OF HEALTH & HUMAN SER9JES 7 1995 825"L" Street. Anchorage, Alaska 99502-OqM;;y of Anchor SOILS LOG — PERCOLATidd +& Human S? PERFORMED FOR: A/ DATE // // q gIr5?`ut es LEGAL DESCRIPTION: L'h -f b ,r �i /6na/a Township, Range, Section: 1 2 3 4 5 6 7 8 9 10� 11 12 - 13- 14- 15- 16- 17 4- 15- 16-17 18 19 20 ZOMMENTS OA(r,4n/lLs 104-7- 12 iW 04--T 12a/ '-' Ljc,( PERFORMED BY: M 4 ✓n K 0,-/, /. ACCORDANCE WITH ALL STATE AND MUNICI ORMED1 \ SITE PLAN WASGROUNDWATER Afn — ENCOUNTERED? /yy S IF YES, AT WHAT L DEPTH? 0 Degh to Wats NAG��p�A& MaMonn07 I Dat PERCOLATION RATE - Z (mmutevmen) PERC HOLE DIAMETER 614 TEST RUN BETWEEN 5 FTAND FT 7 I CERTIFY T AT THIS TEST WAS PERFORMED IN GUIDELINES IN EFFECT ON THIS DATE. DATE MWAk A 5ig PERCOLATION RATE - Z (mmutevmen) PERC HOLE DIAMETER 614 TEST RUN BETWEEN 5 FTAND FT 7 I CERTIFY T AT THIS TEST WAS PERFORMED IN GUIDELINES IN EFFECT ON THIS DATE. DATE KLCEIVED NOV 2 2 1995 Municipality of Anchor4a,g$a�M��unictpallty of Anchor DEPARTMENT OF HEALTH & HUWfflSb4911Va%Hulnan Set 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 44th GARTH K. HOWLETT Cr _ A 'On PERFORMED FOR:r✓ P ISI 1 -e ` 4zY/ DATE PERFORMED: LEGAL DESCRIPTION: I c,' 0,,, k l'Li e54�jownshlp, Range, Section: DEPTH \ SLOPE SITE PLAN IF 60rt'+,('�1vYZr�1r rT1 -7-1 1 2 3 p�rC� a Gcu I j( 5 S, 4- 6- 7 -6 7 1 k+ n,0 &-, 11422V15 SS£S,,"-" E3 0 '01 16.4 11 WAS GROUND WATER /,� ENCOUNTERED? IF YES, AT WHAT 12 DEPTH? Depth to Waw Aller 13 Mwlllwng? 2 Rett I g*S 14 15 16 17 18 19 jl 20 L� PERCOLATION RATE _+L (minutes/inch) PERC HOLE DIAMETER I (TEST RUN BETWEEN �' 'r FT AND yi� FT :OMMENTS F!)U.nlL Wti%-<✓' a1�'�^Pr TN ne. 'h0 1H 1,IrO 6,W44--lMl -yrr I IA., 0C k' 41- r L C Pg Z -eGOt o In, 4-01,i,b1 �1x1^ A A �1 PERFORMED BY: 1 PA✓t 4f L otln I CERTIFY ,T/HAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7?-nOA (Rm 4,851 -�I e Municipality of Anchorage, DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 ti SOILS LOG — PERCOLATION TEST PERFORMED FOR: -t1AA,7 DATE PER LEGAL DESCRIPTION: L. Sec4 Rn Township, Range, Section: DEPTH SLOPE SITE PLAN 1 2 3 C�RAy 9-c '^-/ SI L -r- 4 4 5 6 7 8 9 WAS GROUND WATER 10 ENCOUNTERED? Ya.S 11 S IF YES, AT WHAT L DEPTH? 7Z O 12 e 13 Depth la Water Atter Monitoring? 9- gate: P-24�4s 14 15 16 17 18 19 20 PERCOLATION RATE tminutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT'' JJ COMMENTS T�S'T Flo t /a --Co V rna I FY QO f L a T235T YO C M . �?l- PERFORMED BY: ,L—`"may CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Water PERCOLATION RATE tminutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT'' JJ COMMENTS T�S'T Flo t /a --Co V rna I FY QO f L a T235T YO C M . �?l- PERFORMED BY: ,L—`"may CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) s� a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST S - PERFORMED FOR: a P to r`I I C—LSoty DATE PERFORMED .Y 1--11.1-. I Steven IL Pannono CE -8149 LEGAL DESCRIPTION: L.� ,"l2 ! tic f4 2b La-rTownship, Range, Section: DEPTH T�STpIO C L S' SLOPE SITE PLAN (FEET) ITI-1--1 ' 1 OQ I ca(,ANtcS 2 3 4- 5 6 Gm 7 8 9- 10 11 Q;bkll, 12- 13- 14- 15- 16- 17- 18- 19- 20- WAS 21314151617181920 SILTY GS2Jr`v¢cS w/TWo.ce- sA'anS WAS GROUND WATER ENCOUNTERED? 11 (b IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Dale: !Z'7* -YS PERCOLATION RATE Immtemm,h) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT :OMMENTS QST HOC'ZOeL 5 CIA ,uw 13R1AC .1� ¢f�.��J TES'"'r 140 C L' - PERFORMED PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I2--20 -9S 72-008 (Rev. 4185) ffi MOUNIAS SMONJO WGWN d S W r � i t a 4 H10 I $ Lin ry n d d d3It,v d° n i s IIP if 7 I Ty ;t� 'Zigl Fi °W 02 O 'Lt C Permit No. Municipality of Anchorage Page _/_A 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 per/ �rN Legal B LRC 66 160" FS iA-T.r:F_-�;: PID No.: 72-013 A (Rev. 9/91) MOA 25 Y.em. Z� e z�2o0 FLow PIviD" J J ,. LO a -o /Zoo' 64 °o T � Al o ��oP® e r �1` @'SSEAL s 60 Ct 8841 i ttr�P?OfE8S14�P= 72-013 A (Rev. 9/91) MOA 25 Y.em. ter,. �F iMunicipality of Anchorage $T ote: DEPARTMENT OF HEALTH & HUMAN SERVICES %y 825 "L" Street, Anchorage, Alaska 99502-0650 JAMES M. WRiGH SOILS LOG — PERCOLATION TEST CE 8841 PERFORMED FOR 'Pt /-G % fiv t I C -- LEGAL DESCRIPTION: L Pi17— F �p VV 3 4 �P S Township, 6 � 8 9 10 11 12 13 14 15 16 17 16 19 20 'OMMENTS SLOPE _— DATE PER FORM Section: SITE AP %-%8G>/i WAS GROUND WATER D is ENCOUNTERED? -ve.5 PERCOLATION RATE , �' (mmutevinch) PPEER-C HOLE DIAMETER TEST RUN BETWEEN /s �FT AND 2-J FT PERFORMED BY: gf"/w e -Y /W. WC�I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE IN a r, Municipality of Anchorage DEPARTMENT OF HEALTH 8& HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR plr-i,4oa� LEGAL DESCRIPTION: L E' 7" C, DEPTH c- 1 2 3 4 5 jcp-) 6 9 10 11 1 n 60?D/h 12 13 14 1s 16 17 18 19 20 ZOMMENTS .LL DAT SLOPE PLAN WASGROUND WATER ENCOUNTERED? v e -S_ s IF YES, AT WHAT L DEPTH? O P E OepN in Waer After Mndenng? 6Hatt o PERCOLATION RATE 2 � t> (mmuteamchl PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 2� �FT K PERFORMED BY: Z4 I CERTIFY TH T TH TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: - ON ME PERCOLATION RATE 2 � t> (mmuteamchl PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 2� �FT K PERFORMED BY: Z4 I CERTIFY TH T TH TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: -