HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 5 LT 9Riverview Estates
Lot 9
Block 5
#050-792-26
Municipality of Anchorage Page ~__ of ~-~
DEPARTMENT OF HEALTH AND HUMAN SEF{VICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater DiSposal System and/or Well Inspection Report
=~ame: (- , Wastewaler System: ~ New [] Upgrade
Phone: ~_ ~"777., [No. of Bedrooms:~ D Deep Trench ~ShallowTrench DBed DMound DOther
Total Depth from original grad :
Number of lines: ~ Distance between lines:
WELL: ~ New [~ Upgrade Gravelwidth:
~lassification (Private, A,8,C)' Total Depth: Cased To: Total absorplion area: Pipe material:
Driller:
SEPARATION DISTANCES ~Septic D Holding ~ S.T.E.P.
Ma ufaoturerk Capacity in gallons:
~ '-- f~th / Number of Oomparlment,:~
Surface
Foundation ~7' ~ /, "Pump on" level at:/~level at: ] High water alarm at:
Remarks: 9ENCH MARK
ENGINEER'S SEAL
nspect OhS performed by ~- m,,,,, a~,~ka ~¢s~ Dates. 1st
Department of Health and Human Services approval
72-013 (Rev, 9/91} MOA 25
PI~RMIT NO 5W990269 PAGE 2 OP 3
Hunicip, cRi~ oF .A.n_c h.o ? a 9,e'
DEPARTMENT OF HEA~_TH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,I], Box 196650 eAncho~ege, Alesl<~ 99519-6650eTdephone: 343-4744
ON-SITE WAST[--WATER DISPOSAl_ SYSTEH AND/OR WELL. INSPECTION REPORT
LEGAL LOT 9, BLOCK 5, RIVERVIEW ESTATES P.I.D. NO.
NEW 1000 GALLDN ~
&THt~B
SEPTIC TANK
.... TBM :ri
EX~SNNG
3 BEDRBBN
HOUSE G~4VCL
LO? 1
050-792-26
SCALP,: l" = 40'
PERMIT NO SW990269 PAGE 3 OF 3
Municip. o, Li-I~ oF .A, nE h.o p o, 9.e'
DEPARTMENT OF HEA~TH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P~. Box 196650 OAnchor'cge, A~csl<(l 99519-66500 Telephone: 343-4744
ON-SITE WASTEWATER DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT
LOT 9, BLOCK 5, RIVERVIEW ESTATES P.I.D. NO. 050-792--26
97.6'
FINAL GRADE
? fflNSU~ATION
r~',Z;. ,;'/,.'
93.3'~
NEW 1000 GAL.
POLY. TANK
'~'x-~ 93.0,
C01
MT1 C02
C01 94.0'
C02 95.3'
GRADE
A B
FCO 1.5' 22.0'
S~T1 20.5' 56.0'
ST2 24.0' .39.5'
D__BL1 .30.5' 46.0~-
D__BL2 .31.5' 47.0
C01 43.5 57.5'
MT1 44.0' 58.0'
C02 69.0' 68.5'
M---T2 67.0' 67.0':--
INSULATION
002 = 91 9'
MT] := 88.8 MT2 88.9' '/
· ,
WATER FOUND ® ~n '.~ --~ "~,~;~,,~ ~ '
I
I
ROBERT C. COWAN, P.E.
WELL INSPECTION
& FLOWTEST
SITE pLANS
Municipality of Anchorage
Department of Health & Human Services
PO Box 196650
Anchorage, Al( 99519
Attn: Jefi' Poet
Reference: Lot 9, Block 5, Riverviexv Estates
Dear Mr. Poet,
This letter will certif~ that the test hole locations on the original design (site plan)were
located according to an as built sm'vey done by Robert Johnson. The discrepancy
between the test hole locations on the as built and the original design document is the
result of the locations on the as built survey being in error.
During coustruction the trenches were placed near the test holes as they existed in the
field.
Sin~er~
· Shafer, P.F..
If you require additional information, please contact us at 694-2979.
17034 NORTH EAGLE RIVER LOOP ° SUITE204 ° EAGLE RIVER, ALASKA 99577
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
DOG Go, dba
,'SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGtAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND ~/g O 7"~'d.C, ~ 8..J [' /
DEPTH
ADDRESS ~ D ~O~ ~O~J 0 E~
LEGAL DESCRIPTION__~¢ ¢ /~% ff
PERMIT NUMBER ~&~ Date of Issue
TAX INDENTIFICATION NUMBER n¢~- ~&- ~ &
Is well located at approved permit location? ~ ~ No
Method of Drilling: ~aW ~ cable tool
Depth of well:
Casing Type ~Wall Thickness ~ ¢ ~O inches
Diameter ~ // inches, depth ~/ feet
Liner Type: _ ~O ~¢
Casing Stickup Above Ground: ~, feet
Static Water Level (from ground level): ~ feet
Pumping level: feet after hrs. pumping gpm
Recover Rate: .~,~ gpm
Method of Testing:
WeLl Intake Opening Type: ~ Open End ~ Hole
~ Screened; Sta~ feet Stopped feet
~ PeRorations Sta~ Ce~ Stopped feet
Grout Type:. 8 ¢~;0~ ~¢ ~u me /
Depth; from ~ feet, to ~ feet
Pump Intake Depth: feet
Pump Size hp Brand Name
Well Disinfected Upon Completion? t~es ~J No
Method of Disinfection: (~//x ~/,,*J,"-' ~'"O //'¢~"'l/J ·
Comments:
BORE HOLE DATA
Drille¢8 Name
ATTENTION: it is the responsibility of the property owner to submit a copy of the well Icg to the proper authority, Municipality
of Anchorage: Dep. artment of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation,
MUNICIPALITY OF ANCNORAGE
Department of Health and Human Services
On-Site Services Program
8251. Street, Room 502
P.O. Box 196650, Anchorage, AK 995'19-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Aug 10. 1999
Expiration Date: Aug 09, 2000
Permit Number: SW990269
Legal Description: RIVER VIEW ES'rATES BLK 5 LT
Design Engineer: 0003 S & S Engineering
Owner Name: Disotell Construction
Owner Address: PO Box 770210
Eagle River, AK 99577-0000
Parcel ID: 050-792-26
Site Address:
Lot Size: 52509 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic'rank [] 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:
Date:
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELLINSPECTION
& FLOW I'E8¥
SOILTEST
CIVIL ENGINEERS
(907) 694-2979
. FAX (907) 694-1211
July 30, 1999
MUNICIPALITY OF ANCHORAGE
Department of Health and Hnman Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 9, Block 5, Riverview Estates S/D
Request you issue a permit to install a well and septic system to serve the proposed
three bedroom dwelling on the referenced property.
Two test holes were excavated and percolation tests performed. The approximate
locations of the test holes m'e located on the attached site plan.
At the time of excavation, 7-7-99, water was found at 9 feet. After seven days of
ground water monitoring, water was found at 9 feet.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the
adjacent properties.
If you re/~ddiTal information, please contact us.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577
Municipality of Aftcherage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE
LEGAL DESCRmT,ON: ~._o~ .~ ~- ~'V4 ~.,~ (~(~¥ownship, Range, Section:
SLOPE
10 WAS GROUND WATER
ENCOUNTERED?
12
13
14¸
15-
16
17¸
18-
lg-
SITE PLAN
IF YES. AT WHAT
DEPTH?
I~onlloring? -~ ,¢ )
Gross Net Depth to Net
Reading Date Time Time Water Drop
_ ~ .r'-'~. ~-- ~U~M-
2o- ~ 6
ERCOLATION RATE (minutes/tach) PERC HOLE DIAMETER
'
PERFORMED BY: ~// .~~.~ ,~'1~'~ .... CERTIFY THAT THIS TEST WAS PERFORMED IN
72-008 (Rev. 4~85)
Municipality el Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' StreeL Anchorage, Alaska 99502-0850
SOILS LOG -- PERCOLATION TEST
SEAl_)
LEO^L DESC.i.T,ON: L:I F 5'~~:~ ~.~<TOW.Sh~p, .ange,
3
4
5
9
10
11
13
14
15-
16-
18-
19-
20-
COMMENTS
SLOPE
PERFORMED BY: / /
/
ENCOUNTERED?
IF YES, AT WHAT
DEPTH? ~"~ ~
D~plh t~ Waler Alter
Moniloring? "~ ' ~- ~"~/~_~..~ a I~L~ (~
SITE PLAN
Reading Date Dross Net Depth to Net
Time Time Water Drop
RCOLATION RATE ~'~ '" [minules/inch} PERC HOLE DIAMETER
¢: FTAND ~ FT
RUN BETWEEN
NICIPAL GUIDELINES IN ~FECT ON THIS [DATE.
L.
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 9, Block 5, Riverview Estates
July 30, 1999
GENERAL:
The scope of this project includes the installation of a 1000 gallon polyethylene Premier
septic tank and leaehfield trench for the proposed three bedroom house located on the
ret'erenced property.
Construction shall be in accordance with the approved site plan and design drawings,
Municipal pe~xnit with any special provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary underground utility
locates.
Unless specifically agreed otherwise, the property owner shall be responsible for final
grading areas subsequently depressed fi'om soil settling.
Contractors installing wastewater disposal systems must be certified by the Municipal
Health Departmant for system installations. Owners installing their own systems must
also receive prior approval from the Municipal Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer. Construction
shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
All standpipes on the septic tank shall extend a minimum of 12 inches above final
grade.
Page 2
Lot 9, Block 5, Riverview Estates
July 30, 1999
Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts shall
be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in
line, shall be to clean toward the leachfield. The second cleanout shall be to clean
toward the septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCI-I/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock)
placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt ban'ier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
from the bottom of the trench to the invert of the distribution pipe. This is equivalent to
the effective depth of the gravel as noted on the design.
Backfill over the final gravel layer must net be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent the formation of a
depression after settling.
Page 3
Lot 9, Block 5, Riverview Estates
July 30, 1999
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
T.T_yp e of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
Insulation shall be at least 2" thick extruded direct burial polyst3a'ene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco,
or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform
to cun'ent M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of t~'ee (3) inspections required during the installation of
the wastewater disposal system. These inspections will occur as follows:
Page 4
Lot 9, Block 5, Riverview Estates
July 30, 1999
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting
engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a
pre-construction meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineering shall be the owner's representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precantions incident to this project.
CONTRACTOR/INSTALLER
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L..'r'OhlS C 0 I',]::::;T I':..'
../ Department
0(P~ 825
~pplicant:
LOcation:
264-4720
* * HANDWRITTEN PERMIT ~ * *
WELL AND/~t~-~N-SITE SEWER PERMIT
~ Mailing Address:
Phone Number:
MUNICIPALITY OF ANCHORAGE
? Health and Environmental rotection
~ Street, Anchorage, AK. 99501
T.~pe of Soil Absorption System
Trench: ~' Drainfield:
Maximum Number of Bedrooms: ~
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br) ~'[~ /~--
DEPTH
The Required Size of
LENGTH ~ ~
the Soil Absorption System Is:
!
GRAVEL DEPTH ~.I~' WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC CH%k-DCd~D~) TANK SIZE TM /~Og GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED ~ ~ *
Backfilling of any system without final inspection and approval by this department~
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
(2)
(3)
Signe~:
set forth by the Municipality of Anchorage.
I will install the system in accordance with codes.
I understand that the en-site sewer system may require enSlaVement if
the residence is remodeled to i nslude more ty
Issued by:~_~,~f/~
SWP/024(1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, AncEorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
/~ SOILS LOG
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
2
3-
4-
5-
7
8
9
SLOPE
DATE PERFORMED:
SITE PLAN
10
11
12
13
14-
15-
16-
17
18
19
20
COMMENTS
72-008 (6/79)
WAS GROUND WATER S
ENCOUNTERED? ~/~.> L
0
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE /~",~r . (minutes/inch)
TEST RUN BETWEEN FT AND -- FT
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE! OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENE[RAt. INFORMATION
Complete legal description
Lot 9,
Block 5,~Riverview Estates
Location (site address or directions)
NHN Falling Water Drive
'Property owner Disotell
Mailing address .PO Rn~ 77021
Lending agency
Mailin. g address
Agent
Address
C .~ ~Disotell
onstructiQn/uar±
Day phone 694-5797
Eagla Rivar: AK 09577
Day ~hone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
3
XXX
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE" OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA~21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Engineer's signature
s ~, s ~NGINEERING
17034 Eagle River Loop Raad No. 204
Phone
Date I /1"1/ <~ o
DHHS SIGNATURE
Ap. proved for ~-~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with thee following stipulations:
Additional Comments
The Municipality of Anchorage Department of'Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
Lega Description:
A. WELL DATA
Well type /~?
Log present ~/N)
Tota oeptll ,//~:~
Sanitary seal(~N)
Municipality of Anchorage
DFPARTMENT OF HEALTH & HUMAN SERVICe.9
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)
Health Authority Approval Checklist
~,,~ ~/~ ~ ~/~ Parcel LD,:
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to __
_ Casing height (above ground)
Wires properly protected~/N)
Date of test
Static water level
Well production
FROM WELL LOG
AT INSPECTION
WATER SAMPLE RESULTS:
Coliform
Date of sample: / //
/
Nitrate
0. -.¢ ¢ Other bacteria
Collected by: __ .%'y :'5
B. SEPTIC/HOLDING TANK DATA /'y/~--z..~
Date installed z~//~-/~_ Tank size _/(~:~/¢2~' Number of Compa~ments ..
FoundationcleanoutCN)_ ¢-~ Depression (Y~_ /~/~
Date of Pumping _ A/~ Pumper
c. AaSORPT~ONF.SLDDATA ~'~ ~5
Date installed ~/~/~ ~Seilratin~ (~or~/~drm)
/ ~./
konCh ~ .Width ~ _
Effectlve absorption area ~ :/¢¢ MonitorlngTubepresent~N)
Date of adequacy test. ~¢~ Results (Pass/Fail)_ ~5 For '~ .bed'ooms
Fluid depth in absorptien field before test (in,); Immediately
Fluid depth (ins) Minutes later: ..~~orption rate =. .g,p,d.
Peroxide treatmer~s~'months) (Y/N) If yes, give date
72-026 (Rev, 3/96)*
4~-- Cleanouts~N).
High water alarm (Y/N)
/
_ Total depth
D. LIFT STATION
Date installed I ~ / Size in gallons
Manhole/Access (Y/N) ,~,~,~/ "Pump on" level at*
High water alarm level at* *Datum
Cycles tested /
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ,¢,,,/
/
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ,/ '~- ~
Property line ~- -~ /
Absorption field
Water main/service line
Surface water/drainage
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line ~ Z-
Surface water / O0 /2-
Curtain drain
Building foundation '~ / / Water main/service line ,,/O ~-
Driveway. parking/vehicle storage area ,/4~) /¢--
,~A,/¢'b'b/ ]',,,J Wells on adjacent lots /~)~ / ,..~L
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records
in conformance with y~k~...~guideli~s in effect on this date.
Signature r'"~J
Engineer's Name
Date
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $ .
Date of Payment
Receipt Number
Ol-l?~O0 i8:22 FROI~-CTE £NVIRON~NTAL ~81B301 T-224 P.OI/04 F-84§
CT&E Environmental Sen/ices Inc.
Laboratory Division
200 W. Potter Drwe
Anchorage, AK 99518
Tel: (907) 562-2343
Fax (907) 561-5301
CT&E Reft ~: 1000193001 Client PO~: n/a
Chenl Name. S & S Engineering Prinme Date/'hme' 01/17100 16:00
Project Name: n/a ColleCled Date/Time: 01113/00 15 00
Client Sample ID L9 B5 Riverv~ew Recmved Date/Time'. 01/14/00 10 50
Mamx. Drinking Water Tecl~mcal D~rector. Stephen Eae
PWSID
n/a Released
Sample Re~arks:
Allowable Prep Ana[ys~s
Parame[er Results PQL Units Meth{3d Limits Date Dam
Total Cohform (MF) 0 col/lOO mi SM9222B 01114/g0 JDT
Nitrate 0.58 0.5 mg/L EPA 300 10.0 01/1,~/00 GCP