HomeMy WebLinkAboutSTELIOES LT 3Stelioes
Lot 3
#017-422-34
Municipality of Anchorage Page 1~o! _3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVlRONMEN'I'AL 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: SW980022 PtD Number: 017-422-34
Cindi Herman Wastewater System: [] New [] Upgrade
Add,esS: 12730 Cardinal Circle Anc., AK 3516 ABSORPTION FIELD
- Three
Phone: 561 -- 0505 NO. el Bedrooms: k~Deep Trench [] Shallow Trench ~ Bed ~ Mound O Other
· 6 GPD/S~ R 12 '
SteZ~oes 4 ' F~ 8 '
WELL: ~ New ~ Upgrade Gr~vel depth: 8 ' FL 1 --
C~ification (Private, A.B,C); Total Depth: Cased TO: Total sbsorphon area~ 9 6 Pipe material:
Private 485' FL 20' FL SO. Ft. ASTM D3034 PVC
Alpine Drilling 4/15/98 15' R. Whitters Exc. 11/4f5/98
Yield: Pump Set at: J Casing Height Abo~ Ground:
6
5
Ft.I 2' TANK
G
SEPARATION DISTANCES ~s~ptic ~ Holding ~ S.T.E.P.
From ~ank Field Statio~ Tank Sew~Linos Anchorage Tank 1 , 000
Well > 100 ' > 100 ' N/A N/A N/A ~aterial~tee1 Number of Compa~ments;
2
s.,~o. >~oo' >~00'. N/A N/A N/A LIFT STATION - U/A
Water
Lot > 5 ' > 10 ' N/A N/A N/A Sizein gallons: ~ Manulacturer:
Line
>5' >10' N/A N/A N/A "Pump on" level at: J"Pump cfr' level at:
Foundation
Cu~ain None )bserv 9d on 5ot Pump Make & Model J Electrical Inspections perlormed by:
Drain
Remarks: BENCH MARK
First Floor Slab
100.0 E~,
Inspections pedormed by: A. Harala Dates: 1st 11/4/98 ~'~
Department of Health and Human Services approval
PID No. 017-422-34
Permit Number SW980022
cARDINAL CIRCLE
Page 2 of 3
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PLAN AS-BUILT
SCALE 1" = 20'
Municipality of Anchorage Page 3 of 3
DEPARTMENT OF HEALTH AND HUMAN SI=RVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, AK 99519-6650 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW980022
PID No. 017-422-34
PROFILE AS-BUILT
HORIZONTAL SCALE 1" = 10'
NO VERTICAL SCALE
OF. W.ELL
· ,!iX) CATiON iSK ETcH :. '
~s ~w
M EA.SU,RED PROM:
DATA:
Yype and Color
FI ground surface
Depth
From To .
DATE OF C,0~LI:'I'
WELL
Depth of hol~:
Depth of c~siog:' ft
DEPTH TO STATIC WATER' LEVI:L: , ...
.._~drlL~f{ boloW ~top Of casing D.'g
ME'~HOD OF'DRILLING: ~ air r0t~ry [] cable.~ool' .'...';.'?
;domestic [] irr!gati0n .FI n~q~ltpn.. ;.,
~] public .:(~]'othet. ' · ' .:
CASING STICK,UPi. 'fL, Diem:
Casing tyi3e! ..
WELL INTAKE oPENING TYPE:' E~ open end ~..~
D perfernte~ ~,.open hole" · ".'.'.,
Depths of open~nQs: , ~ .to ..... ' [t'~'
' SCREEN TYPE Diem; ' i~.-,.-
Slot/Mesh Size: ' Length:
GRAVEL,PACK TYPE: ' "i.
Voiume used:: '
GROtJT TYPE;
Depth: f~'om ' ft to,
DEVELOPMENT METE( "' '
Duration: . ,
PUMPING ~.EVEL'AND YIELD: ' ': ' ' '
'. hfs Pumpln~
pUMP'iNTAKE DEPTH: . . ft HorsePowe/: ;,. .
WELL..DIS!NFECTED' UPON COMPLETION?'
. ~ .0ON~RAC OR INFQF~I~IATION: REMARKS: ; .
...: :.' ,.: ~onzeo Hesp~entatlvo Dbte . , · 3601 C St, SUite 800 .' . . '
,, · · ANCHORAGE AK'99503-6935- . ' ..'
~. : , " : Phone {907}269-~639,Fax {907)56.2-13B4.. .~.
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:SW980022
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:HERMAN CINDI A
OWNER ADDRESS:12730 CARDINAL CIRCLE
ANCHORAGE, AK 99516
DATE ISSUED: 2/25/98
EXPIRATION DATE: 2/25/99
PARCEL ID:01742234
LEGAL DESCRIPTION:
STELIOES LT 3
LOT SIZE: 34920 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
THE ATTACHED APPROVED DESIGN.
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).
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)
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
THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE:
DATE:
OP TECHNICAL S
CIVH~ & ENVIRONMENTAl, ENGINEERING · ENERGY CONSERVATION & ANALYSIS
TIIEODORE F, MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
February 10, 1998
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for
a permit to construct wastewater disposal facilities on Lot 3, Stelioes S/D, located at 12730 Cardinal
Court. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your
review.
The proposed system will be constructed in tile vicinity of test hole # 1. As can be seen from tile soil
log, the native material between 2' and 18.25' below ground level is a silty gravel with a measured perc
rate of 16 minutes per inch. Using the soil application rate of 0.6 gpd/sq, fi. specified in the wastewater
ordinance, this 3 bedroom residence requires a total absorption area of (3 x 150)/0.6 = 750 square feet.
The proposed 55 foot long trench design with 8 feet of effective gravel depth has a total absorption area
of 880 square feet.
The topography of the lot in the area of the proposed construction slopes downward towards the
south at 5 - i0%. Driveway construction for the house on Lot 2 to the west has resulted in the creation
of a 6 foot high cut bank along the west property line, and construction of Talisman Road resulted in the
creation of a 15 foot high cut bank with the top beginning near the south property line. The site for the
proposed soil absorption trench will be within approximately 15 feet of the top of the cut bank along the
west property line and within approximately 30 feet of the top of the cut bank along the south property
line. Due to the depth of the proposed trench below the existing ground level, there is virtually no
possibility that effluent in the proposed trench could daylight through either of these cut banks, and
therefore your concurrence in the proposed location is requested. The site for the proposed replacement
trench will be further fi'om either of these cutbanks.
The proposed project will have no significant impact on present or future water supply and
wastewater disposal systems serving adjacent properties, nor will it have any significant impact on
reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have
any questions on this submittal.
Sincerely,
Ted Moore, P.E.
TRACTA
LOT 6
LOT 2
STELIOES
S/D
O
SEPTIC
SYSTEM
5O%
R 100'
®
EXIST,
WELL
, ' × WELL
HSE
SEPTIC
'% ~. . ' SYSTEM
R 100' '% ~ -' o o
WELL % / ~ LOT 4
% /' ~ STELIOES
,REPL TR. / % /
~ '~-. ~ ~ INSTALL1000 GAL ~
'1 ' T'~7~L'~- ~ SEPTIC TANK ~
, o~, T.H. =
I,'" ~ ~. ~' X SOIL ABSORPTION TRENCH
] ~ ' .'" W. 8' SEWER GVL ~ELOW PIPE
TALISMAN ROAD
~ LOT 3, STELIOES S/D
PROP, WELL AND SEPTIC SYSTEM
EXIST,
WELL SITE PLAN
LOT 3 ~I~ATTOP T~C~C~ Sgg~CgS 1 INCH = 50 FEET
TALISMAN 14530 ACCO STEgg~ DRAWN BY TFM
", HEIGHTS S/D ~C~{O~Og, ~AS~ 995 ]6 FEBRUARY, 1998
,, NOTE: THIS IS NOT A SURVEYED P~T.
', ALL LOCATIONS SHOWN ARE APPROXIMATE.
1000 GALLON
SEPTIC TANK
55' LONG SOIL ABSORPTION TRENCH
DOUBLE
CLEANOUT
WITH 8' SEWER GRAVEL BELOW--~ ~ "A"
"~"A" --OUTER EDGE OF TRENCH EXCm-'~
PLAN VIEW
SCALE: 1" = 10'
CLEANOUT
MONITOR TUBE
3
1
-MOUND BACKFILL 12"
LTER FABRIC
0 PERF. DIST. PIPE
~--1/2" - 2 1/2" SEWER GRAVEL
SECTION "A - A"
SCALE: 1" = 5'
BOTTOM OF EXCAVATION
LOT 3, STELIOES S/D
SEPTIC SYSTEM INST.
PLAN AND CROSS-SECTION
FLATTOP TECHNICAl. SERVICES
14530 ECHO STI~EET
ANCHORAGE, AK, 99516
SCALE: AS SIIOWix!
DRAWN BY: TFM
FEBRUARY, 1998
Flattop Technical Servicee
14530 Echo Street, Anchorage, AK 99516
Pho,e (907) 345-1355
Lot 3, Stelioes S/D
12730 Cardinal Circle
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of installation ora 1000 gallon septic tank followed by a 55
foot long soil absorption trench with a total of 8.5 feet of sewer gravel.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform to Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessat3, utility locates, and to work around
any buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by
the construction.
1.6 Prior to the start of construction the property owner shall arrange for a surveyor to set survey
lath marking the location of the west property line at approximately 50 and l OO feet north of the
southwest property corner. To assist in positioning the well the surveyor shouhl also set lath at
the PC at the northwest end of the straight portion of the property line adjacent to Cardinal
Circle, as well as at pobtts along that property line $0 and l OO feet southeast of the PC.
2.0 Septic Tank:
2.1 The new 1000 gallon, 2 compartment septic tank shall be Municipally approved and shall be set
level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a
4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial
type, rigid insulation.
2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of i/4'" per foot, and the
waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot.
A cleanout shall be installed within, fi"feet of the building foundation, and a double cleanout shall be
installed within 5 feet downstream of the septic tank.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 55 foot long trench to a depth of
12 feet below original ground level in the vicinity of test hole #1.
3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked
to allow proper infiltration.
3.3 A total of 8.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with
the perforated distribution pipes laid level such that the pipe inverts are no less than 8.0 feet above the
bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing
the #200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A
minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less
than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the
gravel, in addition to the filter fabric.
3.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the
sm'rounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall he responsible for arranging to have
the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and
seed to promote rapid revegetation of all areas disturbed by the construction.
4.0 Inspections:
4.1 A minimum of 4 engineering inspections will be required during the course of the project: (i)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and
grading is complete. The septic tank requires one inspection after it is set level and the piping
connected, but prior to backfill. This inspection may be incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
ITEST HOLE
FLATTOP TECHNICAL SERVICI-'S
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: __Lot 3: Stelioes ,~JD
DATE PFRFORMED: ,lanuary4~, 1,qR&
PERFORMED FOR: ___Cindy. He[man_
DEPTH
(feet) Pt'
1
SM Reddish silty loam
5
GM/ML Gray silty gravel
6
Variable texture
Lensee of damp ML
7-
Lenses of dry GM
SLOPE
~%
'50%
SiTE PLAN
LOT 3
STELIOES S/D
T.H.
#1
66
~#2
TALISMAN ROAD
Depth to Groundwater Date
No qroundwater 1/28/98
~itnr tube,~L-y 2/4/98
COMMENTS:
Date Reading Clock Net Time Percometer Net Drop
Time (minutes) Reading (inches)
1/28 12" Pre-soak __ 27 3/8 _
Add water & star[ 2:13:30 23 1/2
#1 2:33:30 .2L 22 1/4 1 1/_4
Add~v_ater 2:34 23 1/2
#2 2:54 2~0~ 22 1/4 1 1/4
Add water 2;54:30 23 1/2
#3 3:14:30 2~0~ 22 I/4 1 1/4
PERCOLATION RATF 16 (minutes/inch) PI=.RC HOLE DIAMETER 6"
TEST RUN BE'RNEEN 7.0 FTAND 7.5 FT
Design soil absorption sy_stem on basis of 0.6 gpd/sq._ft. _______
PERFORMED BY FLA'Fi'OP TECHNICAL SERVICES. I~'¢~"'...¢.~,,.(~' '~"¥~-. CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
ITEST HOLE #2
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH
(feet)
1
2
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 3, Stelioes S/D
,January. 28;Jg_g&
Cindy Herman
Pt.
SM Reddish silty loam
GM/ML Gray silty gravel
Variable texture
Lenses of damp ML
Lenses of dry GM
SLOPE
5O%
~., .~ e
THEODORE F. MOORE
SITE PLAN
LOT 3
STELIOES S/D
T.H.
#1
66
~#2
TALISMAN ROAD
Depth to Groundwater Date
_ No groundwater 1/28/98
~lonitor tube dry_ 2/4/98
0%
B.H. (Bedrock)
Date l Reading
1~/ 12" Pre*soak
Add '¢~ter~& start
Add water
Clock Net Time Net Drop
Time (minutes) (inches)
J_1;21
11:31;30
t1:32
Reading
23 1/2
5 22 1/8
2,3 9/16
5 22 1/8
23 7/16
5 _~21/16
1 3/8
1 7/16
I 3/8
PERCOLATION RATE 4 (minutes/inch) PERC HOLE DIAMETP'R __~,,
TEST RUN BETWEEN 6.75 FTAND~_25_... FT
COMMENTS: This perc test was conducted near the southwest side of the test hole. An earlier perc test conducted on Jan. 28 near the
northwest side of the test hole at approx, the same depth perced at a rate slower than 60 min./in. Recommend 0.6 gpd/sq, ft. for avg.
PERFORMED BY FLA'FFOPTECHNICALSERVICES. I ,~"...¢.,~~ CERTIFYTHATTHISTESTWASPEREORMEDIN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~- /i'D /' ~8
Scmplin9
LOG OF TEST BOHING
'tole No ~
ewit!_~m g. Lounsbur. g ( Associat~ Sheet ] of ~
DESCRIPTION
Soil type, cold6 texture,
e$1irneted particle slze~
sampler driving notes~
depths c/fculal/on Iost~
holes cn drilling eose~
bits used, etc.
Vegetation:
,I
{m~{mmmmmmmmmmmmmmmmmmmm{m~m~~{m{{
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
017-422-34 HAA# ~-~J~O
1. GENERAL. INFORMATION
Complete legal description
Lot 3, Stelioes Subdivision-
Location (site address or directions) Talisman Road and Cardinal
Property owner _~tarm~ gan ¢.on~-rllrtt~i.r~n Day phone
1720 E. 59th Avenue Anchorage, AK 99507
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
~Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTI=:
Three (3)
XXX
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
I lng 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.
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 structu re 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 Anderson Engineerinq
Address P.O. Box 240773 Anchoraqe,
Engineer's signature ~ ~' ~
Phone 522-7773
AK 99524
Date 4/11/2000
DHHS SIGNATURE
A?proved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Sen/ices (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 DH HS 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.
RECEIVED
Mu.,e,,.,i o,A.chor.,e . *PR
DEPARTMENT OF HEALTH & HUMAN SERVICESk~uN~¢~P^LiW oF ^,¢~1~
Environmental Services- Division ~tW~RONME~^L SE~WCE~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approw~l Checklist
Legal Description: _T.,of. 3: L~-.~I i (~R~ RuBd i Vi ~ inn
Parnell.D,: 017-422-34
If A, 13, or C, attach ADEC letter. ADEC water system number
Date completed 4 / 1 5 / 9 8
_ Cased to 2 0 ' Casing height (above ground)
¥ Wires 3roperly protected (Y/N)
AT iNSPECTION
A, WELL DATA
Well type Pz:±vate
Log present (Y/N)
Total depth 485 '
Sanitary seal (Y/N)
FROM WELL LOG
4/15/98
15'
6.5 g.p.m.
Nitrate
· 636 mg/ L Other bacteria
Collected by:__A, Harala
_ Tank size 1 , 0 0 0
Y
>2~
Y
Date of test
Static water level
Wel production
WATER SAMPLE RESULTS:
0
Coliform
Date of sample: _ .4/3/2000
B, SEPTIC/HOLDING TAN K DATA
Date installed 11 / 4 / 98
Foundation cteanout (WN)
Date of Pumping _
C. ABSORPTION FIELD DATA
Date installed 11 / 5 / 98 _
Length 56 ' Width
Effective absorption area 896
Number of Compartments 2 Cleanouts [Y/N) ....
Depression (Y/N) N High water alarm (Y/N). ~
· Pumper .._C.,~, _ - i ....
Soil rating (g.p.d./ft~ or ft~/bdrm)_ · 6
3 ' Gravel thickness below pipe
Monitoring Tube present (Y/N) ¥ _
Date of adequacy test _New Consk. Results (Pass/Fail)
N
g.p.m.
__ Immediately after.
Absorption rate = ..
If yes, give date
Fluid depth in absorption field before test (in.); __.
Fluid depth (ins) Minutes later:.
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
Y
Sy,,~tem type .Deep T]:enc_h
8 ' _Total depth 12 '
Depression over field (Y/N) N
For .bedrooms
gal. water added (in.):
~.p.d.
D. LIFT STATION - None on Lot
Date installed
Manhole/Access (Y/N)
High water alarm level at* *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot > 100 '
Absorption field on lot > 100 '
Public sewer main N/A
Sewer/septic service line > 2 5 '
Size in gallons
"Pump on" level at*
"Pump off" level at*
N/A
On adjacent lots > 100 '
On adjacent lots > 100 '
Public sewer manhole/cleanout
Lift station N/A
>100'
Absorption field > 5 '
Wells on adjacent lots
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5 ' Property line >,5 '
Water main/service line > 1 0 ~ Surface water/drainage > 1 0 0 '
SEPARATION DISTANOE FROM ABSORPTION FIELD ON LOT TO:
Property line > 1 0 ' Building foundation > 1 0 '
Surface water > 100 '
Curtain drain None Noted on Lot
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
Engineer's Name Michael E. Anderson, P.E.
Date 4/11/2000~
Water main/service line > 1 0 '
Driveway, parking/vehicle storage area > 2 5 '
Wells on adjacent lots > 100 '
HAA Fee 8. ~-~ ~ / ~--'D
Date of Payment /7~/,/F/~-~
Receipt Number '--~- ~ ~ ~'~-- (~ L~)
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
04-10-00 08:37 FROM'-¢TE ENVIRONBENTAL
~t~. CT&E EnvironmentalSe, vices Inc.
5615301
%167 P.02/03 F"284
CT&E Ref.# 100142300l
Client Name Anderson Engineering
Project Namcm L3 Stehnes Subd.
Client Sample ID L3 STehoes Subd.
Matrix Dnnking Water
Ordered By
PWSID o
Client PO~
Printmd Date/Time 04/09/2000 21 59
Collected Date;rime 04/03/2000 13:10
Received Date/Time 04/03/2000 16:40
Technical Director Stephen C. Ede
Sample Remarks:
m,636 0.500 ~g/g EPA 3ofl.m (~lm) om/mm/tim
To~L coliform
0 cot/lOOmL sM18 92228 04/Om/dO
KAp
Received Time Apr,lO, 7:39AM