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Home My WebLink AboutEKLUND #1 BLK 2 LT 4Eklund # 1 Block 2 Lot 4 #050-531-09 Mdntclpality DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O.' Box 196650 * 'Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Sile WasleWaler Disposal System and/or Well Inspection Report D,~ell ~.~,~ Waslewater System: ~New D Upgrade · ~'~770]10 ~ ~rr? ~ 9q~ ABSORPTION FIELD Ph~,: ~e~--~7 ~7 No. of B~r.m,:~ ~Oeep,rench ~ShMIowT,ench OBed ~Mound ~Olher LEGAL DESCRIPTION 5.11, w. ~t.~l/~ IO-,-99 ¢~ ~ TANK SEPARATION DISTANCES ~s~,~ ~,o,~.0 ~ s.~.~.,. .~ ...,~ ~..,. ~., ~,. - Remarks: ~¢~¢~;e.E~ ~"R BENCH MARK S · S ENGINEERING '..." ...'.',."' ' .... t,: ........ '~' ' "~' mspecuons perlormeo Dy:. , -, ..... De,aliment ~t Health au~ Human uerwces approvm-- PERMIT NO. SW990081 PAGE 2 OF 3 M u nicip, o_ti .'g y_o..¢ Ancho~oge DEPARTMENT OF HEALIH AND HUMAN SERVICES ENVlRONHENTAL SERVICES DIVISION P.D. Box 196650 eAnchor~ge, Atosk~ 9951g-6650·Tetephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 2, EKLUND #1 P.I.D. ~o. 050-531-09 PERMIT NO, SW990081 PAGE -,% OF' ,.~ Municip. atit__y_. _oR .A.n_c h.o.mgg.e . DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 eAnchop~ge, Alaska 99519-6650®Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 2, EKLUND #1 P.I.D. NO. 050-551-09 ST1 ST2 ~- 85.5' FINAL GRADE .2" INSULATION ~n ~'~ 1000 GALLON 1% , ~.u POLYETHYLENE I ~-80.5 MT1 --69.1 MT2=69.0' COl =80.2' 02=79.8' · NO WATER FOUND 61.0' B.O.H. A B FCO 26.0' 58.0' ST1 52.0' 66.5' ST2 56.0' 70.5' DBL1 58.5' 75.0' OBL2 59.5' 74.0' C01 90.5' 97.5' MT1 92.0' 101.5' C02 118.0' MT2 115.0' 1 Municipality of Anchorage Page 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: ~"L~ c~ ~ 00-'¢~ / PID Number: O~'~2 '- ~-~ I -- O Ci Name: O~:~.O,~L.~,~/[ ~O,~/~[~ WastewaterSystem: ~New ~Upgrade Addr~¢~ ~7~ ~0 /~ ~;~/ ~ 9¢~77 ABSORPTION FIELD Phone:~Z~r~ JNo. of Bedrooms:~ ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION Soil Rating: O, ~ GPD/Sq. Fi. Total Depth from original gr~de~, Lot: ~ Block~~LSUbdiv~i°n:~ ~ ~ Depth to pipe bottom from original~grade: Ft. Gravel depth beneath pipe ~ ~' Ft. Township: IRange, ISection: Filladdedab°ve°riginalgradr:' Ft. Gravellengt.: ~' Ft. Number of lines: ~ Distance between lines: WELL: ~ New B Upgrade Gravel width: ~, ~ Ft. I ' Ft. C,assification (Prate, A,B,C,: To~a~e~th: Cased TO: Total absorption area: Pipe material: Dril,ler: DateDrgled: StaticWaterLevel: Installer: . , Date installed: ~ 0 Yield: Pump Set il: Casing Height Above Ground: ~O ~.J Ft.J ~ Ft. TANK SEPARATION DISTANCES ~Septic g Holding g S.T.E.P. TO Septic Absorption Lilt Holding 'ublic/Private Manufacturer: caP~CltY in gall°ns: I From Tank Field Statlo, ,snk Sewer Lines Well- JOO'J- i~,+ Materiah ~¢¢ / Number of Compa.ments: s,,,o~ ~ LIFT STATION Foundation ~O+~1 [; ]~ ~ J"Pumpon"levelat:~le~wateralarmat: Remarks: ~6DE5/CW~ ~ Do~ BENCHMARK o..tio. Assumed Elevation; ]O~ Ft. ENGI~EAL inspections performed by:~bmv, r:~.sk.~S~ DA~s: 1st I0-~-~ "..................... Department of Health and Human 8e~ices apProvm .~,, -*%,.., ........ .." ~' Reviewed and approved by:~fi_ ~:/ ~. ~ Date: / I-I ~ '~/¢ '~'",k~,~--"u'~;~'~' 72~)13 [Rev. 9/91) MOA 25 PERMIT NO. SW990081 PACE 2 OF 3 Municip, atil oF anchor(~Qe DEPARTMENT OF HEA~_THAND HUHAN SERVICES ENVIRONMENTAL SEIRVlCES DIVISION P.O. Box 196650 OAnchorage, A[osk~ 99519-6650 o Te[epHone: 343 4744 ON-SITE WASTEWATER DISPOSAl SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 2, EKLUND #1 P.I.D. NO. 050--531--09 ~,~~~~LOT 5 LOT 6 ~ ~.~,,,.;~ PERMIT NO, SW990081 ...... H_u n_ic ip. 9 I.i t;. y_o. F' .A.n_c h.o..r' .a g.e.. DEPAhHIVff-N/ uI- Ht::AL/H ANI.) HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION · P.D. Box 196650 ~.,Anchoroge, Atask~ 99519-6650 e TelelDhone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LECAL LOT 4, BLOCK 2, EKLUND #1 P.LD. NO. 050-5,51-09 //,,,--FINAL NEW 1000 GAL SEPTIC TANK GRADE FINAL GRADEy MTl=69.1'J MT2=69.0' NO C01=80.2' C02=79.8' · WATER FOUND 61.0' B.O.H. by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND .d/.~',9'7-LC:'Z/~ ~o,aJ ,[7"" BORE HOLE DATA DEPTH ADDRESS ;0 ~'~ 'l.~ ,~. "770¢,~[(~ /'~.. From To LEGAL DESCRIPTION .F~'/,~J~J,~ ,'7'~F- / /.~&~'c,,) ~ ~'~ Z,-,7'" 4 ,-.2 4 PERMIT NUMBER c:~/,_~,9~// Date of lssue ~'"'~ fi- ~'~ 4 TAXINDENTIFICATIONNUMBER~_~- :~?/- O<~ Is well located at approved permit location? ~"~s [~ No -~'_'~' ~ ~" Method of Drilling: ~ rotary [~l cable tool Depth of we,: /'// Casing Type .(~',,:&. Wall Thickness , .,.....fl5''i~ inches Diameter ~ /! inches, depth /4/ feet /42 Liner Type: Casing Stickup Above Ground: o~. feet Static Water Level (from ground level): ~ · feet Pumping levek__feet after__hrs, pumping gpm Recover Rate: ~'~) gpm Method of Testing: .~ / ~ Well Intake Opening Type: ~:;~n End I~1 Open Hole ~]] Screened; Start feet Stopped feet [~ Perforations Start feet Stepped feet Grout Type: 15F,,, 7~,,~, 7'£ dhQ'~olume / ~"0 Depth: from ~) feet, to ~ --' feet Pump Intake Depth: feet Pump Size .hp Brand Name Well Disinfected Upon Completion? ~"~es [~ No Method of Disinfection: ~"~Z o ~/~ ~ _,~"O ~y~,.~ ~ Comments: Driller's Name ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. 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 /WATER SUPPLY PERMIT Initial Date Issued: May 04, 1999 Expiration Date: May 03, 2000 Permit Number: SW99008'1 Legal Description: EKLUND#1 BLK 2 LT 4 Design Engineer: 0003 S & S Engineering Owner Name: Disotell Construction Owner Address: PO Box 770210 Eagle River, AK 99577-0000 Parcel ID: 050-531-09 Site Address: Lot Size: 46332 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] 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 ( 18AACS0 ). 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 Date: ROBERT C. COWAN, P.E. lei, 1999 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 SEWER&WATER INSPECT[ON ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 4, Block 2, Eklund Subdivison Request you issue a permit to install a septic system to serve the four bedroom dwelling on the referenced property Two test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation 1/19/99 water was not found. After seven days of ground water monitoring the monitoring tube was dry. 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 require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/rdp Enclosure 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 ° EAGLE RIVER, ALASKA 99577 1:" = 60' SCALE SITE PLAN DESIGN PROPOSED 4 BEDROOM HOUSE z PERFORMED FOR: Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ..~. ROBERT C. COWAN /~//~/~wnship, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 17 18 19 20 SLOPE SITE PLAN //o IF YES, AT WHAT /~/(~ pO DEPTH? E Deplh to Water Alter ,.,~, ~ Monitoring? ~/ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE z~'-- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' Fl' AND ~"~FT COMMENTS PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN I/U~q Eagle kiver Loop Road No. 2~ ~ ' V" / / ACCORDANCE WITH~R~ GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ I~ ~ ~ 72-008 (Rev. 4/~) Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ' ~'~ '/AZ n Section LEGAL DESCRIPTION:: /~/~/~ ~'/~/z~//dd'/ ,/Townshil~LRo~Ege, ' : SITEPLAN 4- 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Waler AftpL. _ ~ M0.itori.g? /~'F Date: /'~l" J')? COMMENTS Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE .~-._._._._._._._~_:' (minutes/inch) PERC HOLE DIAMETER TEST RUN BE'rWEEN ~'~ FTAND ~FT PERFORMED BY: I CERTIFY THAT THIS~EST WAS PERFORMED IN 17034 Eagle giver Loop Road No. 204 ' - ' / / ACCORDANCE WIT~'~t~JjJ~wT~Jas~tlill~/~'JJ~. GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 {Rev. 4/85) S~t. TEST ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS ROBERT C. COWAN, P.E. CML ENGINEERS (907) 694-2979 FAX (907) 694-121 REFERENCE: Lot 4, Block 2, Eklund Subdivision February 12, 1999 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench for the proposed four bedroom house located on the.referenced property. Construction shall be in accordance with the approved site plan and 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 any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department 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. 17034 NORTH EAGLE RIVER LOOP · SUffE 204 ,, EAGLE RIVER. ALASKA 99577 Page 2 Lot4, Block 2, Eklund S/D Feb 12,1999 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 I0 fl[. 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 TRENCH/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 (roffed-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 barrier 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 not 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 Lot4, Block 2, Eklund S/D Feb 12,1999 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_vp. e of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 0tDPE) 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 polystyrene {Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, 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/t200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot4, Block 2, Eklund S/D Feb 12,1999 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, eleanouts, 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 owners 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 act~ 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 precautions incident to this project. CONTRACTOR/INSTALLER Municipality 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 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-531-09 1. GENERAL INFORMATION Complete legal description HAA# Expiration Date: Location (site address or .directions) Lot 4, Block 2, Eklund #1 Subdivision NHN Upper Kogru Drive Current Property owner(s) Carl Disotell Construction Dayphone 694-5797 Mailing address PO Box 770210, Ea~le River.. AK 99577 Lending agency Day phone Mailing address 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: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] 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 !ransfer 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. Certificates 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. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the 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. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone ,~? G ~f - % :) ? ;/ Eagle River,-.~Jaska 9~)577 Address Engineer's Printed Name Robert C. Cowan bedrooms, with the following stipulations. DHHS SIGNATURE ),~ Approved for '~ bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: Reissue Date: Municipality of Anchorage R E C E ! V DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division NOV 0 1 2000 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 MUNICIPALITY OF ANCHORAGE Health Authority Approval Checklist ENVIRONMENTAL SERVICES DtVIS{ON Legal Description: L"/J~ ¢~-' ~L.,J~o '¢~'-'1 A. WELL DATA Well type Log present {~'_N) Total depth Sanitary seal'N) Cased to FROM WELL LOG Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed /O /5/1 Casing height (above ground) Wires properly protected~N) AT INSPECTION g.p.m. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~) Nitrate Date of sample: O. ~o 5- Other bacteria Collected by: '~ ~/-'~ ~-'~'-'-J~/,,..i ~,~,..~ B. SEPTIC/HOLDING TANK DATA Date installed I~,,'-~'~ci~l Tanksize /¢Oo Number of Compartments 2. Cleanouts~/N)~ Foundation cleanout ~N) ~ Depression (~Y~ fO High water alarm (Y/N) '~.~ Date of Pumping C. ABSORPTION FIELD DATA Date installed /Z~ Length_ ~-~'/" Width Effective absorption area Date of adequacy test f3~ i&~,¢ ~ ,J Soil rating (g.p.d./ft2 or ft2/bdrm) ~ ~ Gravel thickness below pipe Monitoring Tube present~)~N) '/ ._.,-,~.~ Results (Pass/Fail) System type ~/_F~ ?~/~,J¢/./ 7 t Total depth /¢~ / Depression over field (Y/..~ ~-) For _~--~-- bedrooms Fluid depth in absorption field before test (in.); '-""--Immediately after '-'"~jal. water added (in.): Fluid depth -------"' (ins) Minutes later: /-" Absorption rate = ~-~ g.p.d. Peroxide treatment (past 12 months) (Y/N) -'"-'--- If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level.~at.*~ ........................ ~"l~ump off" level at* '-'---' Nigh water alarm level at" ................ Datum Cyeles~t~'~' ................... E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot i L.,~o 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 ~.-.-, ~,F Absorption field 5~ Water main/service line Ir,, ~ Surface water/drainage ~ ¢'c,' ~ ~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line \o '~'' Building foundation. ~o i~-.- Water main/service line Surface water i¢o '~ ~'' Driveway, parking/vehicle storage area /~' Curtain drain ~t,.~)¢.. ~c-~,.~/./ Wells on adjacent lots '~ ".;"~'~' ~ ~ F. ENGINEER'S CERTIFICATION I certif that I have determined thru field inspections and review of Municipal recor~C{t~¢~.~.,,~b/~ ~Jf~tems/,._., are ~n conformance w~th~OA HAA gu~del~es ~n effect on th~s date. Date /I/i /oo ',, CE-SS 1, ,,' HAA Fee $ r'~ ~. Date of Payment __,,/4 Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number NOU-01-2000 09:19 $&S ENGINEERING 90'7 694 1211 P.02/03 ZJ~ G'T&E Environmental Seruices Inc. C]L'&E Ref.# 100~;726001 Client Name S & $ {~zl~ince~§ Project N~me/~ ~ B2 ~dund ~1 CHen~ Sampl~ ID ~ B2 ~uud ~ M~i~ D~nk~g ~a~ O~re~ By Sar~plu p. ematks: Niuratc-N Client Frint~d Date/Time 10/3]/2000 10:08 CoUected Dn're/'Time 10/~6/2000 ~ Dat~imc 10~?/2000 Technic{ Diree~r Szephen C- Ede PQL Units ALLoa~bie Prep 0.505 0,500 mg?L EPA 300.0 10~ax 10/27/00 SCL Total Coliform coVlOOm.L SM] 8 9222B 10,~7/00 JDT NOU-01-2000 09:20 S~S ENGINEERING 90? 094 1211 P.03/03 iO-z1-11Q I0:A1 I:ROkI-CIE ENV' ON~NTAL SS15301 T-I]8 p.OZ/02 F-302 E CT.E Eh, imnmente, Se~vi--s Inc. 2~ W. P~er ~mg Water An~ysi~ Repo~ for Tot ~l Cohfo~ Bacteria A.~,o,..*. A~ Tel: {~) ~ ~D BY WA~RSUppLI ' A~s sh~ws lhls W~ S~MPL~ t be u.tali~lc ~o1 ~ o~o~ old at ~ s~mplc via sp~ial ~liv~ ~ail, ~ : A~lytical Melh~: cm~c Pil~ ~d ~ ~ Nomb~ flfcolO~i~lOD mi. SAMPLg TYPE; with lab ref. hQ. :.) Di~: Tim:: Client nmifled a¢ uns~isfatfory SpecTal Put.se Time Coll~ed SAMP~ LOC~TION Coll~ed ~Y ~ ~CT~} ~LOGICAL WA~ R ANALYSIS ~CO~ MMO-MUG ~ult: Tel I Coliform ~ Col; M~ue Fllte~ D[~ Count , ~ __ Coloni~tOO mt Ve~flcatlen; LTB ~ 8GB ,, COLIPIRM. ~nil Mcmb~.~ ~ ~ ' CQBfoFmlIOO mi ..... ~ ~ Member ~t~o ~ ~ Grou~ig~l& Genar~ ~ Su~ellla.an) ....... ENVIRONME~L FACIU~ES IN ~S~. ~UFORN~. F~RID~ {L~N }[S, ~RY~ND, MleH~N. MIgGOURI, N~ JERg~. OHIO. wEST Vf~UIN[~ TOTAL P.