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HomeMy WebLinkAboutFOREST RIDGE BLK 2 LT 6Forest Ridge Lot 6 Block 2 #017-112-93 Municipality of Anchorage .�. Development Services Department Building Safety Division S A „ On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-112-93 HAA# 030513 1. GENERAL INFORMATION Expiration Date: i — ;2 — o 1l Complete legal description FOREST RIDGE SUBDIVISION: LOT 6, BLOCK 2 Location (site address or directions) 15031 SOUTH WINDSOR CIRCLE * ANCHORAGE, AK * 99502 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DENNIS EFTA Day phone 522-8209 15031 SOUTH WINDSOR CIRCLE * ANCHORAGE, AK * 99502 Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone • 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water. System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority' Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. 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 this application, shows that the on-site water supply and/or wastewater disposal system is(are) 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSO Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE V Approved for bedrooms. Disapproved. Phone 337-6179 Date 1'01.4, Conditional approval for bedrooms, with the fllowing stipulations: <<vtinfrfwr�rr/. ON-SITE ; G� WASTEWATER nnrlr_RAM Attachments: ���'•.•••.•.••S HAA Checklist Manitenance Agreements JJJ�J Septic System Advisory. _ _Supplemental Engineer's Reort Well Flow Advisory Other By: �U'�1 Original Certificate Date: (Rev. 12/01) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: FOREST RIDGE SUBDIVISION; LOT 6, BLOCK 2 Parcel ID: 017-112-93 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSIDt# N/A Date completed 9/6/1996 Sanitary seal (Y/N) YES Total depth 101 ft. Cased to 101 ft. FROM WELL LOG Date of test 9/6/1996 Static water level 8 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires properly protected (YIN) YES Casing height (above ground) 18 in. AT INSPECTION 9/1/2003 33/34 ft. 6.67 — 9 -p.m - Coliform 0 colonies/100 ml. Nitrate 0.100 mg./L. Other bacteria 0 colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 9/1/2003 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/STEEL Date installed 7/1/1996 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 8/23/2003 Pumper CHUGACH PUMPING C. ABSORPTION FIELD DATA ELOW EX IS11 GRADE TRENCH $1 (SOUTH) TRENCH 2 (NORTH) Date installed 7/1/1996 Soil rating 0zD>r ftlbdrm) 0.6 System type WIDE DRAINFIELD Length 120 ft. Width 5.0 ft. Gravel below pipe 4.0 ft. Total depth 6'+ ft. Eff. absorption area 1200 ft' Monitoring tube YES Depression over field NO Date of adequacy test 9/1/2003_ Results (Pass/Fail) PASS For 4 bedrooms 20.5/ 296/ 25.75/ Fluid depth in absorption field before test 6.5 in. Water added 404 gal. New depth 14 In. 161/ ,25�— Elapsed Time: 235 min. Final fluid depth i 3 in. Absorption rate >= 600+ —9-p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date TRENCH #1/TRENCH D. LIFT STATION Date installed 9/1/1996 Size in gallons 1500 Manhole/Access (Y/N) YES "Pump on" level at 46 in. "Pump off' level at 43 in. High water alarm level at 55 in. Datum BOTTOM OF TANK Cycles tested 1 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES 5`'tsT`�"'' � s 1r4 UUS 4-9 Fu e-T7Q-fd b- NoRMsrtl Fes- SEPARATION DISTANCES FROM WELL ON LOT TO: `rte Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main N/A Sewer /septic service line 25'+ 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 LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F " F. COMMENTS G. ENGINEER'S CERTIFICATION �`�� �F• • •I ' S�� 1 certify that 1 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. .J A. a ess:' Engineer's Printed Name JEFFREY A. GARNESS oO��mfe 7953 10ApG� �@ ....••'•' Ecco Date to f 13 y3 ��Q�'Or fesatoQa� `'�Oppoo HAA Fee $ 375.00 Waiver Fee $ Date of Payment 10/9/2003 Date of Payment i Receipt Number 42957SJ Receipt Number I. (Rev. 12/01) p.2 0tc 3�.00.fl;.cp 73 N �9 z 1 o LIO (V m Y ^ n r. V)Ir r, � Ls.! Mn! & 07 r� y to O to w ; w N outs: •�• n L 1 ♦� �,t� �sf/♦i ♦ �� �'� ♦'� OLL- .o '� Mj nt) _�' ♦ o cow �C .• J � •�� ''��` a •'. � .r I *; •fib.• Q �• � :r rd c e - = Y o r at ` ' �p 1 • s • : O � � k 6 • • e . o - t O = u 1 P 7 - c •' • C .. w M W ' •� o - •: Y w o a 130.19' RoS�' 1 W O - - - W S 04'12'41"E . o La = to : - - • - e r SOUTH WINDSORCIRCLE10 I \ r •; n E J dr G: e V f S N 3 m V • � �' re 9- 9-03; 8:09AM; ;907 5615301 it 2/ 3 SGS Ref.# 1035581001 All Dates/Times are Alaska Standard Time Client Name AK Water & Wastewater Consultants Inc. Printed Date/Time 09/05/2003 16:35 Project Name/# 15031 S Windsor Collected Date/Time 09/01/2003 12:32 Client Sample ID Lot 6 Blk 2 Forest Ridge Received Date/Time 09/02/2003 7:45 Matrix Drinking Water Technical Director Stem . Ede Released Sample Remarks: Parameter Qualifiers prep Analysisers Results PQL Units Method Container ID Limits Date Date lrllt Waters Department Nitrate -N 0.100 U 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (<-10) 09/02/03 JJB col/100mL SMI 8 9222B A (<=1) 09/02/03 JS Municipality of Anchorage -• Development Services Department r' h, , Building Safety Division On -Site Water and Wastewater Program I. , IV 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FORT7 A SINGLE FAMILY DWELLING ((��lfI Parcell.D.Dr�4 %�r( — SIJ COSA#d�7(/pp�� 1d / Expiration Date: --7 —.2:z— 0c) 1. GENERAL INFORMATION Complete legal description Lot 6; Block 2; Forest Ridge Subdivision Location (site address) 15031 South Windsor Cir. Anchorage, AK Current Property owner(s) FEDERAL. NATIONAL MORTGAGE ASSOCIATION Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 400 COUNTRYWIDE WAY SV -35 . SIMI VALLEY CA 930656298 Unless otherwise requested, COSA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Weli❑ Individual Water Storage ❑ Community Class Weil ❑ Public Water System ❑ Day phone Day phone 261.7678 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska.. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems 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. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. 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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm s a s Engineering Phone 694-2979 Address 158618 Birchwood Loop Rd. Chuglak, AK 99567 Engineer's Printed Name Roberta. Shafer 5. DSD SIGNATURE _jZ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: ^T 'cam 7— O q (Rn 11M) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYST M Legal Description:/ S APPROVAL CHECKLIST Len -6; Btoc.��' �DeEgT 126& 51b i A. WELL DATA Well typeVl� If A, B, or C provide PWSID # = Well Lo (gl 1) Date completed �6/i� Sanitary seal(ON) LICE Wires properly protecte y! I) '/t-5_ Total depth Cased to /OI ft. Casing height (above ground) 0 'f ln. FROM WELL LOG Date of test y 6 9to r Static water level ft. Well production /a g•p•m• WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate ,00mg/L Arsenic: ug/L date of sample: AT INSPECO ION N Ib Flo ft. Other bacteria,,- colonies/100 mL Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Matedal S'7- 6, P� S7trX_ Date installed '"1 Tank size / 6co gal. Number of Compartments Cleanouts&Nj n> Foundation cleanout ) _ i > Depression over tank (Y®_,Q0 High water alarm AS Date of pumping Pumper f 1 n AP . AJC V t C6:4_ C. ABSORPTION FIELD DATA _ Date installed Soil rating (g.p.d./ft= or fe1bdrm) 0.0 System type 'SilhU01 J � r , Length ft. Width 5 ft. Gravel below pipe 4,0 ft. r Total depth ft. Eff. absorption area �ftz Monitoring tube ( Depression over field -LIP Date of adequacy test /6 �� Results Pass Fail) t R� for bedrooms �� r� Fluid depth in absorption field before test in. Water added gal. i New depth 8 in. Elapsed Time: Mmin. Final fluid depth in. ` Absorption rate >_ f g.p.d. Any rejuvenation treatment (past 12 mo.) (Y lg& type) If yes, give date '— /�Pt)?F'17UC) Fl El lfJ—?RV.;C4h1X& 1 WIp— TO 7TI-3TIA.)lo r 2czo G/+iCCMJ ; D. LIFT STATION Date installed V, ke u `Pump on' level at L in. Datum37t-M c FT o< E. SEPARATION DISTANCES Size in gallons /-Iino Manhole/AccessON) C -S n ,r "Pump off" level at 22� in. High water alarm levet at 55 in. Cycles tested J Meets alarm ti circuit requirements? r'S SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank lift station on lot /00 IF Absorption field on lot /4_)'f Public sewer main dJ-f% Sewer /septic service line oZJ Animal containment areas .L) // I On adjacent lots /60 4 / On adjacent lots /� f Public sewer manhole/cleanout L)<i Holding tank A)//i Manure/animal excrete storage areas . 2/i SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r r I Building foundation S 4- Property line 5+ Absorption field 5a I r Water main f# Water service line /D + Surface water /CO 4 r Welts on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r I Property line /O + Building foundation /O / Water main iU A Water Service line 104 Surface water /Gid * Driveway, parking/vehicle storage /O F Curtain drain MOU Y -M010 Wells on adjacent lots 100 -L F. COMMENTS G. v CERTIFICATION CAIU /certify that 1 have determined f ugh field inspections and review of Municipal records that a above s ms in conformance with MOA COSA ui lines n He o this ate. Engineer's Printed Name ' 10_ Date elhZt I A COSA Fee $ Date of Payment o� Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number FGOta) P ,t9[ A �r A� f ' aen•a.'sSot.. qQ 1, ,137Q SGS ReEN Client Name Project \amt/N Client Sample ID \lams Sample Remarks: 1091432001 S R S Engineering L 6;B 2; Forest Ridge L 6;B 2; Forest Ridge Drinking water Printed Date/time Collected Dateltime Rectired Daleftime Technical Director 04/202009 9:57 04/13/2009 13:05 04/132009 14:00 Stephen C. Fade Allowable Prep Analysis Parameter Results PQL Units Mcdwd Container ID Limits Date Date but Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.9 C (<10) 04/14'09 04/16/09 NRB Waters Department Total NitratcMitritc-N ND Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 2 of4 0.100 mg/L SN1204500NO3-F B (<10) col/IOOml- SM209222B col/IOOmL SM209222B col/IOOmL SM209222B A (<200) A (<I) A (<I) 04/17/09 1DT. 04/13/09 DLC 04/13/09 DLC 04/13/09 DIX Municipality of Anchorage -� Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "r Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 017-112-93 HAA# 6/bbb Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 6, Block 2, Forest Ridge S/D Location (site address or directions) 15031 South Windsor Circle Current Propertyowner(s) Vicki Vickery Dayphone 522-5314 Mailing address 15031 South Windsor Circle, Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address / Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well p Individual On-site Q Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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. 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. 72-025 (Rev. 0 VOW 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 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 `1- 7 °I 7 Address Eagle River, Alaska 99577 Engineer's Printed Name )CO 13IF R — C , C o wq ni Date 6. DHHS SIGNATURE _L--� Approved for _ bedrooms. Disapproved. Conditional approval for Additional Comments 6 91„� RCCERr C. COWAN f bedrooms, with the following stipulations. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: i �/%�%�`���-+ i Original Certificate Date: 1 /-"k9- o b Expiration Date: - d 0 Reissue Date: 72.025 (Rev. 01/00)' Municipality of Anchorage Department of Health and Human ServiRsE C E I V E Division of Environmental Services On Site Services Section 625 V Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 NOV 16 2000 www.ci.amhorage.ak.us (907) 343-4744 11 UNICIPAUTY OF ANCHORAGE ENVIRONMWAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L -O T (0 13t-oc `c a FoR4 r: R a GE Parcel I.D.: _ 0 1 7-1 I a "% 3 A. WELL DATA Well type MV 4; It A, B, or C provide PWSID # Date completed 2&/_44 Sanitary seal Y4. J Total depth )D I It Cased to o/ It FROM WELL LOG Date of test 7/6 I9 G Static water level 9 It Well production 10 g.p.m WATER SAMPLE RESULTS: Well Log y4 J Wires properly protected Y't s Casing height (above ground) la+ in. AT INSPECTION /1//0/oo 3) It 7 g.p.m Coliform O colonies/100 mi Nitrate O . S mg/I Other bacteria D colonies/100 ml Date of sample: 010 10 0 O Collected by: 5 i S ENGINEERING B. SEPTIC/HOLDING TANK DATA 17014 Eagle River Loop Road No. 204 aayb River, Alaska 99577 Tank Type/Material SK l r, c - l S T* 4 Date installed 7 /1 Tank size s0 gal Number of Compartments D- Cleanouts Y4, J Foundation cleanout 'Y I Depression over tank nv o High water alarm Y4 J Date of pumping Jo3/00 Pumper NORrN-A-A C. ABSORPTION FIELD DATA SNAµ o w Date installed 7/1144 Soil rating g.p.d r ft2/bdrm) 0-4 System type Y as cNt J Length I d% 0 If Width S" ft Gravel below pipe ,Y_ft Total depth 6 It Effective absorption area 1 ao0 ft2 Monitoring tube YtJ Depression over field Date of adequacy test 1► �I0/0° Resutts Pas ail) PA $5 For bedrooms " P Fluid depth in absorption field before test 1 3 in Water added �0 Y gal. New depth) gS in. Elapsed Time: :13 min Final fluid depth > In Absorption rate >= 6 0 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N10,4 t lcNu wN If yes, give date 72026 (iw. 01/00)' D. LIFT STATION Date installed 711 q L Size in gallons / Y_0 O "Pump on" level at M rr Nin "Pump off' level at S 0 3 " in Datum -7j," o1c MpN„y,f Cycles tested 3 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /0 D f On adjacent lots Absorption field on lot /00 On adjacent lots Public sewer main N /,4 Sewer /septic service line a S =r Manhole/Access Y& f High water alarm level at 1i in Meets alarm & circuit requirements YE -S Public sewer manhole/cleanout )'IA Holding tank N /A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /o 0, Properly line rs / Absorption field S �t Water main N 14 Water service line 10 /+ Surface water /00 '+ Drainage r' 14 Wells on adjacent lots / O 0 �_x SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I a" Building foundation y Water main N 1A Water Service line ) O 14- Surface water / O 0 �� Driveway, parking/vehicle storage So + Curtain drain Ne fit K fO,f Wells on adjacent lots ) 0 0 '-t F. COMMENTS 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. Engineer's Printed Name R08i/t7— C. CowNN ,% ROBE1T C COWAN CE - 8801 �r t Date �f, •., etch. G.,'„�.0 HAA Fee $ 3 ® © D . Date of Payment 11-16-010 Receipt Number &42C/15Zl 72.026 (Rev. 01100)' Waiver Fee $ Date of Payment Receipt Number I1-15-00 10:16 FRO"TE ENVIRONMENTAL 5615301 T-626 P.02/03 F-016 G CUE Environmental Services Inc. ata• CT&E Ret.# 1007141001 Client Name S & S Engineering Project NamctN Lot 6 Blk 2 Forest RidRe Client Sample ID Lot 6 Blk 2 Forest Ridge Matrix Drinking Water Ordered By PWSID 0 Sample Remnrin: Client PON Printed Date/time Collected Date/time Received Date/time Technics l D or tephm Released 11/15/2000 8:51 11/10/2000 13:45 11/10/2000 14:20 Allowable Prep Analysis Panmeta Rnalts PQL Units Method I.immts Date Date Init Waters Department Nitrate -N 0.500 U 0.500 mg/L EPA 300.0 Microbiology Laboratory Total Coliform 0 col/100ml. SM 18 9222D 10max 11/ia= SCL 11/10/00 JDT