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Home My WebLink AboutT12N R3W SEC 33 LT 40T! 2N, R3W, Section 33 Lot 40 #018-182-01 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SN00221 PIDNumber: 018-182-01 Nar~:Wastewater System: [] New X2[ Upgrade Roqer & Barbara DeLonqchamp AddreSs: 3430 E.142nd Ave. Anch., AK 99516 ABSORPTION FIELD Phone: I No. of Bedrooms: 345-8011 Five (5) i [] Deep Trench [~Shal[owTrench X~Bed []Mound [3Other Total Depth from original grade: LEGAL DESCRIPTION so, Rating: . 8 GPO/Sq. Ft. 1 . 5 Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 40 1 Ft. . 5 Ft. Township: I Range: I Section: Fill added above original grade: Gravel length: 12NI 3WI 33 1 Ft 60 ~ Ft. Number of lines: I Oistan~ between lines: WELL: [] New [] Upgrade Gravelwidth: 24 ' Ft. 4 . Ft. Clas~if Jcation (Private, A,B,C): Total Depth: cased To: Total absorption area: Pipe material: Existing Ft. Pt. 1 , 440 SO. Ft. ASTM D3034 PVC I Driller: Date Drilled: StaticWater Level: Installer: Date installed: Ft. Acreac~e S~;stems 7/12r13/00 SEPARATION DISTANCES ]~ Septic [] Holding [] S.T.E.P. To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank SewerLine~ Anchorage Tank 1 , 500 Matedah Number of Compartments: Wel~. .100' >100' N/A N/A i>25' Steel Two - s~rta0e ,100' >100' N/A N/A N/A LIFT STATION - N/A Water Lot Size in gallons:I Manufacturer: Line >5' >10' N/A N/A N/A I >5' >10' N/A N/A N/A "Pump on" leve, at: I "Pump off" level at: I High water alarm at: Foundation f Curtain None [~oted Dn Lot PumpMake&Model I Electrical lnspections performed by: Drain I Remarks: 2" Insulati'on Over Septic BENCH MARK Tank and Absorption Bed. Old Septic L°cati°nandDescripB°n:concrete S-lab in Pumped, Crushed and Abandoned in Bottom Floor Entry southwest Place. Corner 100.0 Fl, / ENGINEER'S SEAL Inspections performed by: H~A Dates: 1st 7/1 2/00 ~'~¢,~ 7/13/00 2nd Department of Health__and Human Services approval ;~: ~8~; ~;~; .... Reviewed and approved b / ~'/. J~n~-~ Date'-~_O_O '~*~'z-. .:, -¢, -- Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Page 2 of 3 Permit Number SW00221 142nd Avenue Centerline 33' Road Reservation C3 S2 C5 Family Room Five Bedroom House C2 PID No. 018-182-01 A B S1 41.0 73,2 S2 51.7 82.3 SV 79.8 105.8 M1 108.5 134.0 C5 138,7 164.5 C8 139.3 164.0 SCALE1"=40, Garage PLAN AS-BUILT Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650 - Anchorage, AK 99519-6650 - 34-3-4744 On-Site Wastewater Disposal System or Well Inspection Report Page 3 of 3 Permit Number SW00221 PID No. 018-182-01 93.5 96~2 nsulatic 500 Gal. Tank ~X~.93-3 21' I LEGEND: C - Cleanout S - Septic Vent SV - Flow Splitter Valve TH - Test Hole Location I 1' 26.7' 2 Insulak±on II Over Geotextile Fabr±c-' ~--Drainfield ~ 91R. o4c k~ fil. 0 29.1 ' 30.9' PROFILE AS-BUILT 1"= 10' 9.2.0 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 11, 2000 Expiration Date: Jul 11,2001 Permit Number: SW000221 Legal Description: T12N R3W SEC 33 LT 40 Design Engineer: 0014 Anderson Engineering Owner Name: Roger & Barbara DeLongchamp Owner Address: 3430 E. 142nd Ave. Anchorage, AK 99516-4001 ParcellD: 018-182-01 Site Address: 003430 142ND AVE E Lot Size: 108900 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: i__~ Disposal Field [] SepticTank [] Holding Tank ~ Privy Private Well ~, Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By:/ Date: July 7.2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0650 Su~e~: Lot 40, Section 33, T12N, R3W Se ptic System Design and Permit Application Impacts to Adjacent Properties Deaf' Onsite Services Engineer: The existing septic System on Lot 40. Section 33, T12N, R3W was apparently placed over 8 years ago without a permit. The house has recently been sold and it is necessary to obtain a Certificate of Health Authority Approval. Unfortunately, the certificate cannot be issued until the system is brought into compliance with the existing Municipal Ordinance. Recent investigation of the existing system indicates the steel septic tank placed eight years ago has corroded and is leaking. We are therefore requesting a permit be issued to place a new septic tank and to bring the existing system into corn pliance with. Municipal regulations. The attached Site Plan and backup documentation identify the location and configuration of the septic system and the parameters used inthe design. The wel location is also shown along with the 100' protective radius. No conflicts between the septic system or the well or wells on adjacent properties were noted. The test hole placed on the lot at the location of the absorption trenches revealed well graded sand and gravel with only a minor amount of silt. The percolation rate of the material was determined to be right at 2.5 minutes per inch. Absorption trenches placed 8 years ago are 5' wide with 6" of effective depth. According to current design criteria the trenches would have to total 62.5' in length to meet regulations. The trenches total nearly 80' in length exceed requirements. New cleanouts and monitor tubes will be placed and the distribution pipi~)g will be replaced to assure they are level. A Zabel flow splitter will also be placed to assure even distribution to each trench. The distribution piping's currently only 1.5' below the ground surface so insulation will be placed and additional fill to prevent freezing and to meet minimum criteria. The existing concrete seotic tank will be uncovered and inspected for continued use. If unacceptable, a new 1,500 gallon tank will be placed and the concrete tank abandoned. The ground surface on the ot slopes from north to south at a very slight grade. It also slopes from east to west at a 1% grade. The trenches are currently placed parallel to [he contour lines along the westerly portion of the lot. Grading will be accomplished once the system is completed so drainage is away from the trench and septic tank but in the direction of the current drainage pattern. No surface water will accumulate in the Lot 40, Section 33, TI2N, R3W July 7, 2000 Page Two trench area. If the system ~s constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments MEMORANDUM DATE: July 10, 2000 TO: FROM: Dan Roth Mike Anderson, P.E. SUBJECT: Lot 40, Section 33, T12N, F~3W Septic System Upgrade Permit Additional probing of the existing absorption system on the referenced lot has revealed it is a 24' wide x 60' long bed instead of 2 - 5' wide absorption trenches. The bed has 6" of d rainfield rock beneath the d~stribution pipe. but is out of level. Our intention is to regrade the bed using drainfield rock, place cleanouts and monitor tubes. place geotextile fabric over the bed and then place 2" of direct bury insulation over the entire bed to assure minimum cover. Both the existing 500-gallon concrete septic tank and steel septic tank will be abandoned. A new 1,500-gallon tank will then be installed Post tank cieanouts will be placed and the entire system will then conform to the current Municioal ordinance. Attached is a new site plan indicating the location of the bed and detailing the work to be accomplished. A cross section of the bed is also provided for your use It is our understanding the permit for the system can now be issued With the submission of this new information Please let me know if further information is required. SCOPE OF WORK: 1. Verify Foundation Cleanout. 2. Abandon Concrete Septic Tank in Pl~ce. 3. Remove and Dispose Existing Septic Tank. 4. Place New 1,500 Gallon Septic Tank According to Plan. 5. Place 2 Post Tank Cleanouts. 6. Place Cleanouts & Monitor Tubes in Existing Bed. 7, Regrade Existing Absorption Bed. 8. Place 2" Insulation Where Necessary. 142nd Avenue * Garag~ Tanks (TO B~[~: ...... · Abandoned) .~ew: ~5~0 9allon ' ' ' LAN' egraded and Ins l:fied SCALE f' = 40' -- NOTE: Locations Not Exact. LOT 40, SECTION 33, T12N, R3W DESIGN FACTORS: 5 Bedroom Home Perc. Rate: 2.5 Min./Inch Application Rate: .8 GPD/SF SYSTEM REQUIREMENTS: Shallow Bed System '1,500 Gallon STEP Tank 1' Total Drainfield Rock 5 Bedrooms X 150 GPD / .8 App. Factor = 937.5 Square Feet 937.5 SF/24 LF (Width of Bed) = 39 LF Length of Bed Therefore: The Existing Absorption Bed is 24' Wide X 60' Long and Therefore 21' Longer Than Required By Design Criteria. Relevel Existing Bed, Place Geotextile Fabric and 2" of Direct Bury Insulation. Provide a Minimum of 2' of Cover to Prevent Freezing. 2' 6II 2 ' Minimum Cover 2" Direct Bury Insulation Drain~ Rock ~ ' ' ~ '~ 3' 6' 6' 6' 3' 4" Pvc NOTE: SHALLOW BED DETAIL (NO SCALE) Grade Area to Drain Away. Maintain 6' Separation From Bedrock. Provide 4' of Cover or 2" Insulation and 2' Cover. Maintain 4' Separation From Groundwater. Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LO6 - PERCOLATION TEST Performed For: Barbara & Roger DeLongchamp Legal Description: Lot 40. Section 33. T12N. R3W SLOPE North OG/OL TESTHOLE NO. '1 GW Date Performed: SITE PLAN See Site Plan South Wa~ Groundwater Encountered? No If Yes, What Depth? 1 Depth to Water After Monitoring None 11 Date: 717100 S L 0 P E 1%-2% 12 13 14 15 16 17 18 Bottom of Hole Reading Date Gross Net Depth To Net Time Time Water Drop 1 7/6/00 4:00 3/8" 2 4:05 10 2-1/2" 2-1/8" 3 4:06 1/2" 4 4:11 10 2-1/2" 2" 5 4:12 1/2" 6 4:17 10 2-1/2" 2" 21 Perc. Rate: 2.5 Min./Inch Perc. Hole Diameter: 8" Test Run Between 4 Ft. and 5 Ft. Comments: Testhole Presoaked Prior to Percolation Test. Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 7/6/00 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 40, SECTION 33, T12N, R3W GENERAL: The scope of this project includes the verification of the existing 500 gallon concrete septic tank for continued use. It also includes the removal and disposal of an existing steel septic tank of unknown volume. Work will then include the procurement and placement of a new 1,250 gallon septic tank at the location shown on the Site Plan. New post tank cleanouts are required and the existing 5' wide x .5' effective depth absorption trenches must be regraded. New cleanouts are required along with monitor tubes in the existing trenches. A Zabel flow divider must be placed to assure even effluent flow to each trench. Insulation must then be placed over the septic tanks and absorption trenches to prevent freezing during winter conditions. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION The new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown on the plans. If the existing concrete tank is found to be unusable a 1,500 gallon tank will be required. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to 3revent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a mimmum of 12 inches above final grade. Lot 40, Section 33, T12N, R3W July 7, 2000 Page 2 of 3 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: The drainfleld shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfie.ld rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. A minimum 2' of accepting soil is required below the drainfield reck for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). · Lot 40, Section 33, T12N, R3W July 7, 2000 Page 3 of 3 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the ~lacement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Sewer/VVell Permit Application P.I.D. No. 018-'182-01 Single Family Dwelling Property Owner Name: Roger and Barbara DeLongchamp Mailing Address: 3430. 142n~ Avenue Anchorage, AK 99516 Legal Description: Lot Size: Lot 40, Section 33, T12N, R3W .Square Feet Number of Bedrooms: Five (5) Day Phone 345-8011 Inspections will be conducted by: X Approved Engineering Firm __ Municipality (permit fee included) Does your house contain any of the following: Hot Tub, Swimming Pool, Therapy Pool, Jacuzzi, Or Water Softener Unit? No If yes, which one? This Application is For: Sewer Only __ Sewer and Well __ Sewer Upgrade XXX Well Only__ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and in accordance with applicable Municipal Codes. Fees: Receipt # Engineer Permit Cf MEMORANDUM DATE: July 24, 2000 TO: FROM: Jeff Poet Mike Anderson, P.E. SUBJECT: Lot 40, Section 33, T12N, R3W Certificate of Health Authority Approval Additional improvements have been completed to the well located on the subject property to brin,g, it into compliance with current codes. The well head has been raised approximately 8 above the Vault floor to prevent contaminant intrusion. The top of the welt is now more than 1' above the ground surface outside the vault, n addition, all w~ring in the vault has been encased in conduit. The casing depth of the well was also verified to be greater than 40'. The static water evel was drawn down to 71.5' and allowed to recover. No inflow of water into the casing could be heard indicating no perforations in the well above that level. We are therefore convinced the casing is-more than 40' below the ground surface and probably much deeper. The aforementioned modifications and information should make the property eligible for a Certificate of Health Authority Approval. Please let me know if you have additional questions or concerns. July 17, 2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0260 Attention: Onsite Services Engineer Subject: Lot 40, Section 33, T12N, R3W Well Inspection Dear Onsite Services Engineer: The well on Lot 40, Section 33, T12N, R3W was probably constructed when the house was. built in 1962. No well log can be found so information is limited to the recollection of the previous owner. He has stated the well is approximately 180' deep and cased to the bottom. This has never been verified, but seems Iogi~c~, based on the inspection of the well. Originally the well was covered by an indi~i~lual well house, but now is covered by the walkway between the different areas of the house. The well head is approximately 10' below the walkway surface. It is enclosed in an insulated concrete vault with a concrete floor. The well head rises above the floor approximately 1'. The water line exits the well head and flows to the pressure tank. The seal on the well will prevent any contamination from entering the well We were unable to remove the seal to determine the static water level, but it is thought to be fairly shallow. The controller fo~ the well and the pressure tank are also enclosed in the concrete vault with the controller approximately 3' from the well head. Wire from the well head to the controller is not enclosed in conduit, but is not exposed to the outside elements and not subject to corrosion. The covered walkway has been constructed such that the roof can be removed if it is ever necessary to remove the pump from the well. A flow test..performed on the well indicated it is capable of producing 4.7 gallons of water over a sustained period. Water quality tests indicated no coliform or other bacteria and an undetectable amount of nitrates. Based on the water quality the well is obviously protected from contamination. The well has been in place since 1962 and has continued to provide satisfactory service since that time. We therefore recommend the well be approved in its'present condition. ~ Sincerely, Michael E. Anderson,P.E. Well Head 10' + Above Vault Floor, Wiring in Conduit Well Head After Being Raised Above Vault Floor Bed Prior to Backfill Placement Bed Reconstruction With Insulation and Geotextile Fabric Septic Tank in Foreground, Bed in Background Bed After Reconstruction, Backfilling and Landscaping Lot 40, Section 33, T12N, R3W Well and Septic System Inspection - 7/2000 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services OmSite Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01 8-1 82-01 1. GENERAL INFORMATION Complete legal description Expiration Date: Lot 40, Section 33, T12N, R3W Location (site address or directions) 3430 E. 142nd Avenue Current Property owner(s) Roger & Barbara DeLongcharap Day phone 345-8011 Mailing address 3430 E. 142nd Ave. Anchorage, AK 99516 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: Five TYPE OF WATER SUPPLY: Individual Well ~ Individual Water Storage [] Community Class Well [] Public Water System [] (8) TYPE OF WASTEWATER DISPOSAL: Individual On-site x~ Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Cedificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 fRev 01,00)' 5. STATEMENT OF INSPECTION BY ENGINEER As cedified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 522-7773 Engineer's Printed Name Michael E. Anderson, P.E. DHHS SIGNATURE J Approved for .:/-- bedrooms. Disapproved. Conditional approval for Date 7/14/00 bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: -~ - ~- ~- ~ o Reissue Date: 025 ~Rev 01 %-JMunicipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak,us dUI. 17 (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot A. WELL DATA Well type p_rivate Date completed · Unkn°wnsanitary seal Total depth Unknownft Cased to > 40 ' ft FROM WELL LOG Date of test Unknown Static water level ft Well production g.p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi Date of sample: 7/1 2/00 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/12/00 Tank size 1,500 Cleanouts ¥ Foundation cleanout ¥ Date of pumping New Construction C. ABSORPTION FIELD DATA 40, Section 33, T12N, R3W IfA, B, crC provide PWSID #__ ¥ Nitrate .5 mg/I Collected by: MEA Parcel I.D.: 018-1 82-01 Well Log. N Wires properly protected __ Casing height (above ground) > 24 AT INSPECTION 6/15/00 See Letterff ~ ~ 4.7 g.p.m Other bacteria 0 colonies/100 mi gal Depression over tank . N Pumper N/A Number of Compartments 2 __ High water alarm N Date installed 7/1 2/00 Soil rating (g.p.d./ft2 or ft2/bdrm) . 8 Length 60 ft Width 24 ft Gravel below pipe -5 ft Total depth ~ ft Effe(;6ve absorption are¢, 440fF Monitoring tube ¥ ' Date of adequacy test ~ew Const. Results (Pass/Fail) Pass Fluid depth in absorption field before test 0 in Elapsed Time: 0 min Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type Shallow Bed __ Depression over field M For 5 bedrooms Wateradded >750 gal. Newdepth. 0 0 in Absorption rate >= 750 N If yes, give date __ Y in. irl. g.p.d. 72-026 (Rev. 01/00)* D. LIFT STATION - M/A Date installed "Pump on" level at __ in Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: F. Septic tank/lift station on lot > 100 ' Absorption field on lot Public sewer main M/A Sewer/septic service line > 25 ' >100' in Size in gallons __ "Pump off" level at Cycles tested Water Service line > 10 ' Curtain drain None Noted COMMENTS Manhole/Access High water alarm level at __ in Meets alarm & circuit requirements On adjacent lots > 100 ' On adjacent lots > 100 ' Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation > 5 ' Property line > 5 ' Absorption field > 5 ' Water main N/~ Water service line > 10 ' Surface water > 100 ' Drainage . > 100 ' Wells on adjacent lots > 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD QN LOT TO: Property line > 10 ' Building foundation > 10 ' Water main N/A Surface water > 100 ' Driveway, parking/vehicle storage Wells on adjacent lots > 100 ' The well was probably completed in 1962 when the hous( 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 HAA guidelines in effect on this date. >50' Engineer's Printed Name Michael E. Anderson, P.E.':t:'~'F'"~""."~ Date 7/14/00 .'-~ HAA Fee $ ~P~ ,Z¢-7) Date of Payment ~'~//'~/dn~ Receipt Number ¢ ,/ O ~-C'7~, ~/~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)*