HomeMy WebLinkAboutNORTH SLOPE #1 BLK 3 LT 3No th
lope
Block 3
Lot 3
#050 511-16
Municipality of Anchorage '":~
Development Services Depadment
Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6~50 Page I of
vnvw.ci.anchorage.ak.u$ (907) ~4~-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SX,~,J O0~i~ PID Number. 05
""~: 7~)~'$O~"s"\~ ~tDn's~r'~"--~'16"f~'~ .G WastewaterSystem: [~lNew D']Upgrade
"~"' ~)..~3 ,(~o"), "f~O7..10 ;?.A~\t,~.~ !~:~(, ABSORPTION FIELD
LEGAL DESCRIPTION 0, (.~ ,~,,~,,,f ./.o - i .~'~,,
Well: 'J~ New [] Upgrade
SEPARATION DISTANCES ~ Septic [-I Holding [] S.T.E.P. [] Other.
Tank Field Station Tank SewerUne ~R~.J"~.,--/ P~-~t S 5~L.kl~C-%'5.% ..:L~oc) ca.
,..~w.,., j~O't' J0g't ~ / ~ LIFT STATION
~'"~': ~.~ ~v3~,~:~R ~' t~,,~,--. BENCHMARK
~ ~ i i Eflgiflee~tamp
5 & S ENGINEERING ~.'
EagTo River, Alaska 99577 1~ ~' ~-
Inspections pe~o~ed ~y: Dates:
Development Se~ices Depa~ent Approval
Reviewed and approved by: ~~/~- ~ate: I' I
PERMIT NO. SW000167
p~r 2 or 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
LOT 3, BLOCK 3, NORTH SLOPE {~1 S/D P.Lu. No. 050-51{.-16
CO~
N[W 1000 GALLON
- POLYETHYI.[NE
SEPTIC TANK
DOUBL~ CLEANOUT$
¢0~.~ ,t
SPUT~E~ E F ~ )
ROBERT C. COWAN
CE-8801
p£RMIT NO. ~W000167
PAGE 3 or 3
Municipality of Anchorage
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
L£C. AI. LOT 3. BLOCK 3. NORTH SLOPE {~1 S/D P.'.O. NO. 050--511--16
90.4'-- . -FINAL GRADE
INSULATION · -
. / } ~o~ ~.~ } ~7.4,
87.6 ~
C02 = ~'q- ~. '
CO1 = ~'q,o~ ~
COl = ~i'~'~
C02 = $~.~:'
,a 8
rCO 2 t .0' 6.5'
ST1 27.5' 22.5'
ST2 29.5' 24.5'
DBL1 52.5' 29.0'
DBL2 55.5' 55.0'
~'S 74.5' 65.5'
~01 56.0' 16.0'
~T1 37.0' 16.5'
~02 ,lt6.5' t12.0'
MT2 ~ttT.5' {15.0'
CO~ 50.5' 28.0'
kiT~ 52.0' 50.0'
C04 81.5' 69.0'
~T4 83.0' 71.0'
·
WATER FOUND
6~' B.O.H.
SCALE = N.T.S.
January 18, 2001
ROBERT C. COWAN, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
PO Box 196650
Anchorage, AK 99519-6650
Attention: JeffPoet
Reference: Lot 3, Block 3, Northslope Subdivision #1
Dear Mr. Poet,
On the above referenced property, the soils throughout the length of the 100 foot
trench are consistent and appeared to have a percolation rate of around 20 minutes
per inch. The trench was lengthened to allow for a shorter 2nd trench that would
not encroach a 25%+ slope.
Ifyou require any further information, please contact us at 694-2979.
Sincerely,
Robert C. Cowan, P.E.
RCC/skh
17034 NORTH EAGLE RN~R LOOP · SUITE 204 ', EAGLE RIVER. ALASKA 99577
FROM : DI$OTEU_ CONSTRUCTION
NO. : I 987 6960215
Sap. 0B 2000 04:$6PM P4
by
P.O. ~OX B70Z?2, CHUG[AK. ALASKA 9956? & TELEPHONE B~8-2759
OWNER OF LAND
BORE HOLE DATA
DEPTH
ADDRESS
LEGAL DESCRIPTION
PERMIT NUMBER D b ,%/~-, ':~'- [
T*X,.OE m 'CAT'ON /4_
Is well located at apl~roved permit location? ~ C~ No
Method of D tilling: ~'J~r rotary O cable tool
Depth of well: _ !~
Casing Type ..,.~..~_.~;T.F__4,_Wall Thickness j~,.~ ~ _inches
Diameter (p // inches.* depth /~ I feet
Liner Type: _ a ).,.,~
Casing Stickup Above Ground: r'~ feet
Static Water Level (from ground level): /,, ~..' , fe;t'
Pumping level: feet after hrs. pumping gpm
Recover Rate; ~/~ gpm
Method of Testing:
Well Intake Opening Type: [~pen End O Open Hole
~ Screened; Start ..feet Stopped feet
C~.Perforations Start. ~e~ Siopped' ' feet
· Depth: from ~ feet, to feet
Pump Intake Depth: feet
Pump Size hp Brand Name
Well Disinfected Upon Completion? I~S C~ No
Method of Disinfection: ~/.~.4 ;,
Comments:
Ddllefs Name
ATTENTION: It is the responsibility of the property owner to submit a. cbpy of the ~vell log to the proper authority, Municipality
of Anchorage: Department of Health & H~man Services and/or Department'of Envfronmentat Conservation. MatSu Borough:
Department of Environmental Conservatioh; * <!
~- .,;~ .: :
Id~llflclpallly OI Aimhotage
bEPArtTMENt OF IIEALIII & ItUMAN SERVICES
825 "L" Stleel, Altchofage. Alaska g9502-0650
soILS LOG -- PERcoLATIoN TEST
DATE PERFORMED:~~,''J ~'~
2
3
'
8
Reading Date Gr osf, ~let Del)ih lo Net
Time Time Water D,op
'1 '/ ~0~,~ q" ~ "
t4.
g,ot
I1-
/
I~EtlFOIlldED BY: R J[~ I~ldC. lldt;l~l~ll~j~ I CERtifY IlIAI 1Ills 1ES~ WAS PEIII:ORMED I1~1
t2 oeo IRe,. 4,esl Eagle River, Alaska 99577
ROBERTC. COW,aN, RE.
ROBERTA. SHAFER, RE.
Date
CIVIL ENGINEERS
(907) 694-2979
FAX (~07) 694-1211
SOtL TEST
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
~nchorage, Alaska 99519-6650
REFERENCE:
The septic olnstcCions for the referenced property were
performed on__~7 I-~O and '~-~/°~O . Prior to submitting
the On-site Wastewater Disposal System and/or Wfi~l Igppection
Report we are waiting for the ~~to be
completed. 3~V~
If we may be of further service please contact us.
Sincerely,
Robert C. Cowan, P.E.
17034 NORTH EAGLE RNI[R LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
MUNICIPALITY OF ANCHORA GE
Department of Health and Human Sen'ices
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 I WATER SUPPLY PERMIT
Initial
Date Issued: Jun 14, 2000
Expiration Date: Jun 14, 2001
Permit Number: SW000167
Legal Description: NORTH SLOPE #1 BLK 3 LT 3
Design Engineer: 0003 S & S Engineering
Owner Name: Carl Disotell
Owner Address: PO Box 770210
Eagle River, AK 99577-
Parcel ID: 050-511-16
Site Address:
Lot Size: 43260 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
'This permit is for the construction of:
[] Disposal Field [] Septic Tank [] 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: ~ ~
Date: - 14- o
RODER r C. COWANo P.E.
April 21, 2000
CML ENGINEEI'~
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 3, Block 3, North Slope S/D
It is requested that you issue a permit to Install a well and a septic system to serve the
proposed three bedroom dwelling on the referenced property.
Two test holes were excavated, and percolation tests performed. The approximate
location of the test holes is located on the attached site plan. At the time of excavation
4-13-00 water was found at 8 feet. After seven days of ground water monitoring, water
was found at 5.5 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 ofthe adjacent
properties.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC oj3
Enclosure
17034 NORT[! EAGLE RIVER LOOP * SUITE 204 * EAGLE RIVER, AL/~KA 9~577
"'~ LOT 3. BLOCK 3. NORTH SLOPE S/I)
-
~Q~ / ~ILS = 0.6 G~Q.F~ /
4507 - 750 SQ.
pHON[~ (907)694-2979 100 WELL RADIUS
~.o~-~.5' 9E[P (~[~ O~OA.~CS) ~X -~C(/~ ~ ~
0.5, EFFECTIVE (R = 1.0) r / ~ - Z~ ~ r>_ ~
5.0 W~DE / /
LOT 4
PERFORMED FOR:
Municipality o! Anch0rl~ge.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
3
4
5
6
7
8
9-
10-
12
13
15
.t5.
t9-
20-
·
DATE PEnFORMEt
Township, Range, Section:
SLOPE SITE PLAN
I
I
I
/
I
/
. I
'1
WAS ~IOI]NO WATER
Idonl~lng?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLJkTION RATE
(minule~'inch) PERC HOLE DIAMETER
TEST RUN BETWEEN -- FT AND FT
PEn~Oflt~EO BY: - $ & S ENGINEERING I /,r~.f,.,(,~.7 ,f~ CERTIFY THAT T/HIS T~T WAS PERFORMED IN
E~le River, Alltkl
12-~ (R~. 4/85)
(ENGINEER'S SEAL)
Municlpalily of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L Strut, Anchorage. Al~sk~ g9502~50
SOILS LOG -- PERCO~TION TEST ~~"~
.................
LEGAL DESCRIPTION: ~ ~ / ~ ~[ ~. ~ Township. Range. Section: '"'.
SLOPE SITE PLAN
?
g
DEPTH? pO
13 /' I~lil~il'l~ ? "" '"~
L
14- j~/...~-
15-
16,
17-
18-
'19-
Heading Date Gross Net Depth to Net
Time Time Water Drop
20 - ~. PERCOLATION RATE__~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~/"~ FT AND '~', 0 FT
COMMEN
PERFORMED BY: ~,7~..~. E-';~e olve~. ~? Road NO, 20,41 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCO.OAN EW,T t ¥ 'O ,DEL,NES,.E.ECTO. T.,SDAT D^T 0/
72-008 (Rev, 4/85)
RODER I' C. COWAN. P.E.
ClV/L ENGINEEn~
(907) 694-2979
FAX (907) 694-121 !
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 3, Block 3, North Slope
April 21, 2000
GENERAL:
The scope of this project includes the installation of a 1000 gallon septic tank
and a. new trenctuto serve the proposed three bedroom residence 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 Wastcwater 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.
17034 NOml ! EAGLE RIVER LOOP · SUITE 204 · EAGLE RivEn. ALASKA 9q577
Page 2
Lot 3, Block 3t North Slope 8/D
April 21, 2000
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
Septic tanks installed with less than 4 IL 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 leachfleld there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These eleanouts 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 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 (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 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 ofthe 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
Lot 3, Block 3, North Slope
April 21, 2000
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.vpe of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM FSI0 (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 polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caul&r, 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 leachfleld gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the/1200 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
Lot 3, Block 3, North Blop~ S/Ii)
April 21, 2000
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 8, 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 Engineefing'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
Development Services Department
Building Safety Div!sion .
On-Site Water and Wastewater Program·
4700 South Bragaw St. / ,
P.O. Box 196650 Anchorage, AK g9519-6650,
www~ci.anchorage.ak.{Js, '..
(907) 343-'~9,04 .
CERTIFICATE OF HEALTH AU,,T..H,.O,,R,!~....~.pP~ ROVAL
FOR A SINGLE FAMIL~Y.'DWELLING ..
Parcel I.D. 050-511-16
1. ~GENER~L INFORMATION
.; :. COmpletelegald~sfi~iption ~.ot 3,
" ?cation (site address' or directions)
"} ' :Current- Property .°w~er(s)~
Mailing address'
I'~in'g agency'
Mailing address
Expiration Date:
Block 3, Northslo~)e #1
NHN Kuparuk Avenue
Disotell Construction Dayphone 694.5797
PO Box 770210~ Eagle. River~ AK.99577 '-2
Day phone-
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2, NUMBER OF BEDROOMS: 3
Day phone
3. 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 Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based onty upon the representations given in paragraph 5 by an independent professional civil
engineer registered In the State of A~aska. Certificetes 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 [rom the date of issue for properties served by a private or Class C well and may be reissued with
new w~ter sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samlJles.) Certificates are valid for one year for properties served by Class A er 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 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 tiles and from my investigation and Inspection, the on-site water suppty 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.
$ & $ ENGINEERING
Address Eagle RiY~', Alaska 99577
Engineer's Printed Name ~.~bert C. Coven. P.F,. Date.
DSD SIGNATURE
~ Approved for ~
Disapproved.
Conditional approval for
~;~ ~', ..; ............
bedrooms. '~ ~,'.~
· j,~-2 ...............
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: J - J ~ - 0 !
(Rev, IZ~0)
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.anchomge.ak.us
~O?) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~ Parcel ID: ~,O*'~11 - I~'
A. WELL DATA
Well type ~
Date completed ~-.1_. ',.
Total depth /0 / ft.
If A, B, or C provide PWSID # iu/~,
Sanitary seal ~/N) ~/
Casedto ft.
Date of test
Static water level
Well production
FROM WELL LOG
Wires properly protected~)N)
Casing height (above ground)
AT INSPECTION
in.
ft. J ft.
g.p.m. J g.p.m.
WATER SAMPLE RESULTS:
Coliform ~) colonies/100 mi.
Date of sample: /" I O - o /
NitrateD, 5'?/ mg./I. Other bacteria O
colonies/100 mi.
SEPTIC/HOLDING TANK DATA
Tank Type/Material /~/e/.~f ~Z./Poc.,V
Tanksize /0~0 gal.. Number of Compartments ~'
Foundation deanl3ut~lN) y Depression over tank (Y~ P
Date of pumping P/4'- ~J~) Pumper A J/4-
Date installed /'/-//-
,/
High water alarm (Y/H)
Length
Total depth .~-'~,~" ft.
Data of adequacy test
ABSORPTION FIELD DATA
Date installed '~'//"~ Soil rating (g.p.dJft= e~lE:~,m) ~,/"
ft. Width ~' ft.
Eft. absorption area '7~'e ft2 Monitoring tube ..
i~/,a - ~ ~4~ Results (Pass/Fail) ----'
Fluid depth in absorption field before test "'"-- in. Water added'-'-- gal.
Elapsed Time: "-'"'-m~. Final fluid depth ~ irt. Absorption rate >=
Any rejuvenation treatment (past 12 mo,) (Y/H & type)
System type .~'~q,~l
Gravel below pipe ~ 5' ft.
~/~5 Depression overfleld
For "~edrooms
New dean.
g.p.d.
If yes. give date
D. UFT STATION
Date installed.
"Pump on" level at
Datum...--~-
Size in gallons Manhots/Access (Y/N) /
in.
Water alarm level at.
Cycles tested Meets alam~ & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanldlifi station on lot ////
Absorption field on lot / I b. ~"
Public sewer main /~/~'
Sewer/septic service line ,~'~ / ~
On adjacent lots
On adjacent lots
Public sewer manhole/deanout
Holding tank ~ ~'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /'], ~' /
Water main /'/~'
Wells on adjacent lots /o0 r~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /.~'
Water Service line
Curtain drain
Property/line /0/~
Water se~ce line
Building foundation. / ~'~''
Surface water [ o ~) / ~
Wells on adjacent lots /b~ H'
Absorption field. ~'/'~
Surface water / O0 ~ ~'
Water main ~//~
Driveway, parking/vehicle storage
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal recoils that the above systems are in
conformance wt~ MOA HAA guidelines in effect on this date.
C,
Engineer's Printed Name f~JaO4E'~7'
Date /1//t, /d /
Date of Payment \ / \~l ~ 0 ~
Waiver Fee $
Date of Payment
Receipt Number
01-16-01 10:50 FROM-CTE £NVIRONII~NTAL
,~t~__ C T&E Environ m entnl Services Inc.
5615301
T-I?4 P.02/03 F-172
CT&E Ref. O
Client Name
l~rojKt Name/~
Client Sample
M~trlx
Ordered By
PWSID
Sample Remado:
1010259001
S & S ~gineering
North Slope #I L3B3
North Slope #1 1.3 B3
Dx/nk/ng Water
0
/'QL
Units Mc~bod
Client PO~
printed DateYTlme 01/16/2001 8:47
C011ected Dnte/Tlme 01/10/2001 13:44
Received Date/Time 01/11/2001 10:55
Tt~hnlcal Director Stephen C. Ede
Allowable Prep Analys~s
LimiD Ds~e Date Init
Nitm~e-N
0.571
0.500 mg/L EPA 300.0
OI/ll/Ol GCP
Mt.c~:ob:t olog'/ r.~bor a~.or~'
Total Coliform 0
col/lOOmL SMI8 9222B
01/11/01 SKW