HomeMy WebLinkAboutSKYLINE VIEW BLK 1 LT 17Skyline View
Block
Lot 17
#0§1-192-38
Municipality ot Anchorage Page ~ Df..-~.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · 'relephone: 343-4744
On-Site Waslewaler Disposal Syslem and/or Well Inspection Report
LEGAL DESCRIPTION so,,..,,.~ j.~ ~o,s~
WELL: KHew D Upgrade G,avel width: ~,~FI. '
~l..k. ~ll~p I1-1o-~ 1~7 ~,.I'"'''''''= ,
SEPARATION DISTANCES ~s,,,~ O,o~,, ~ s.~.~.~.
Water I~; {~ ~ LIFT STATION
nema~ks: BENCH MARK
~ ..... ':"'.. ~2~'
J7034 Eagle River Loop Road, No. ~
DeParJmenJ DJ Heallh and "amah ~ervices approval
PERMIT NO. SW000444 PAGE 2 OF' ,~
MuniciDoHtV oF .A.O~h. oFag.e'
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D. Box 196650 ®Anchorage, Al(iska 99519-6650®Tetephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 17, BLOCK 1, SKYLINE VIEW S/D
P.I.O. NO. 051-192-38
/
LOT
3
10' UTILITY EASEMENT
LOT 18
LOT
19
ATH#2
NEW 1000 GALLON
HDPE SEPTIC TANK
BEDROOM
l.IO'.'.~£ · '
16
SEPTI(
ROBERT C COWAN
CE-8801
PERMIT NO. SW000444 PAGE
_., H_u_n i..c ip. g_[i .t y_.o..r .A.n_c h.o r ag.e.
DEPARTH~NI uk HI:ALIH AND HUMAN SERVICES
ENVlRONHENTAL SERVICES DIVISION
P.D. Box 196650 OAnchor~ge, At(zsk~ 99519-66500Te[ephone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 17r BLOCK 1, SKYLINE VIEW S/D
P.I.D. NO. 051--192--58
ST1 ST2 /- 93.5'
FINAL GEADE--/ I 2" INSULATION
no ~'._~ 1000 GALLON I~ ,
~o.~ POLYETHYLENE J ~-89.3
MT1 =83.7'j
MT2=85.7'
C01=93.5'
2c02=90'7'
"INSULATION
l- ~ CO1=88.7:
C02=88.7
·
NO WATER FOUND
77.7' B.O.H,
A 8
FCO 16.0' 55.5'
ST1 49.5' 72.0'
ST2 51.0' 75.0'
DBL1 52.5' 77.5'
DBL2 55.5' 78.5'
C01 56.5' 84.5'
MT1 65.5' 95.0'
C02 87,0' 121,5'
MT2 83.5' 117.0'
Municipality of Anchorage
Development Services Depa~ent
On-Si~ Water and Wast~ter P~m
Softs Log - Percolation Test
5-
6-
7-
8-
9-
11.
12-
13o
14-
16-
17-
18-
19-
20-
COMMENTS
.o, tt
/ Slope Site Plan
WAS GROUND WATER .~
ENCOUNTERED? , _
IF YES. AT WHAT DEPTH?
Re~din~ Date Gross Time Net Ti~e Depth to Water Net Drop
/ f /o/.;2 /7_' .5--"
~./~: r~/;~<../ /c ,, /7~
Y-- , 7" ~. ,'//0" 12",s-"
~,,:~ r, rer.., h~7 ~ t ; .Iz "
·/e" l'z"
/o ,. IR" .T "
PERCOLATION RATE PERC HOLE DIAMETER w ·
TEST AND, ~"'-- FT
/)r,'d,"z~z',,. ,. ~/, oA
PERFORMED B~'.7034 Eagle River Loop Road
CERTIFY THAT THIS TEST, WAS
INEFFECTONTHtSDATE. DATE: II],,~""/,0
· Hey.26 O0 03:33p.* STRPLES 541-?74-~932 p.~
Dep~trtmcnt of Health and Human Services
Permit Number Date O! Issue Tax Ident;ficatiop Number
Date Started ]j_._.~_._~oe Dz~te Completed/_L· ,fo..__~'o ;s well located at approved I~erm I IccatJm~. ~' Yes ~ l'Jo
Legel De,cHillon Block Lot Property Cw~ler Name & Ad:lress:
; I
Bomhole ~: De~ : Methoe Of ~illmg:
Soil Ty~ & Thlc~ess & Ware:' S~a F~
Casing T~pe:~tt Wa~l Thi~ness~_ir. ch~
~' ~P J+ ~ ~ Di~meter~_Jnches, d~h ~.fe~
~ Llner T)~e:._ D;ame[e~Ecnes, dcp~...
G~I. 5~.~, m~;~. ~]~ 0 ~ ~e Casing St{cku, AbcveG,ou,d:.~~feet____
Stoic ~ater Level {f~m ~und lev~l~:~feet
~[e~ Pumping Level; f~t
R~w~Rae: /~ ~m
Wail Intake Openln~ Ty~e: ~ Open End -~ O~q Ho~e
D Pedorat~ns S~ff feet Stopp~ feet
GmutT~e:.~o ~ ;~L~'olume
~ Pump I~e ~pth: fe~
~ ~ WelIDIslnf~ed UponCompletlon? g Yes ~ No
~ I Comment,:
.,, Company~~
,CI~ ~ State, ~- 71p ~//
Attention: Th9 well c~riller shali p,'owde a well log to the property owner w;thin 30 days of ccml:l~tion.
~,',-~' ~9~;~$¢ ,~.o.c-~ ,,~9~$~1 O-S. $ # OGI31
FK)BERT C. COWAN, P.E.
i"K:)B EFIT A. SHAFER, RE.
Date,'
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-121 !
Municipality of Anchorage
DEPARTMENT OF ItEALTH AND IIUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE:' LOT 17 ~Aoc.= I fl<)~~.i_ v,~ J/m
The septic ins.sec~ions for the referenced property were
performed on/Of30/a~ and /O/3o/Do . Prior to submitting
the On-site Wastewater Disposal System and/or Well I.nspection
Report we are waiting for the /~o J~.x)~ 7!~ ,~ ~% to be
completed. 'erJ D',~,~T ~ ;'
If we may be of further service please contact us.
Sincerely,
, P.E.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 ', EAGLE R1VE R. ALASKA 9957'7
MUNICIPALITY OF ANCHORAGE
Department of Health end Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 3434744
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Oct 19, 2000
Expiration Date: Oct 19, 2001
Permit Number: SW000444
Legal Description: SKYLINE VIEW BLK 1 LT 17
Design Engineer: 0003 S & S Engineering
Owner Name: Chris Benediktsson
Owner Address: PO Box 774534
Eagle River, AK 99577-
Parcel ID: 051-192-38
Site Address:
Lot Size: 19080 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. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day,
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date:
September 25, 2000
ROBERT C. COWAN, P.E.
CML ENGINEERS
(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 17, Block 1, Skyline View 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.
A test hole was excavated and a percolation test performed. The approximate location of
the test hole is located on the attached site plan. At the time of excavation, 7/12/95, water
was not found. After ground water monitoring, the 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~'/j
Enclosure
17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE PdVE R. N,.A~ KA 99577
""~ LOT 17, BLOCK I .}SKYLINE VIEW S/D
B.J.J. R.C.C. 9-25-00 1 OF 2
rrin~ DESIGN ~RITERIA: ~,o~,~ ~,~,~,~,~~' '"
SOILS=5.2 GPO/SO.FT. /~ i /I wo~,. l ~k ,&,, c cow~ t~
~so/,.~: ~s sO.rT. R~O'D./ ~ ~~LOT 2
,..,,.,,,,,_,,,, ,.,..,.,,, LOT 3
¢iXl (i07)694-t 211
~D~T~T~T~T ~ ~l/.10' ~TiUTY [A$[~[N~ % . 10' UTIklTY [ASE~ENT L L
~,~,~ ,-~~ - -~ ~,$~ - ~ - ~ -' y~~ -~ ~ 7
7.5' DEEP ~ /i ', ~¢~ / ~ / /
~/ LOT 9~ . ~ ~~ k
LOT S~ /.,, ~ i -,~,~, ~~ ~
"~ LOT 17, BLOCK 1, SKYLINE VIEW S/D
~ ~"' CONTRACT ~ I$
~ rring DESIGN CRITERIA:
3 BDRM = 450 GPD / / woad. . ~ .L
SOILS = 1.2 GPD/SQ.FT. /
PHO.E~FAX~ (907}694-1211(007)694-2970 ~PROXIMATE) - -
DRAINF~ELD CRITERIA:
~:~, ~CT,vEIO' UTILIT~ EASEMENT/~ - 1p_ ~TILITZ EASEMENT
l UT ~ ...
/ ~ _SEPTIC~ I ~[.~ ~ ~ ~
Vov..~,.~ ,~..,o.. / / ~, ~ /~ I I
Municipality ol Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~----.~ ~'~
LEGAL DESCRIPTION;
1
2
4-
5-
6-
*7-
8-
0-
10
11
12
13
14-
15.
16-
17-
18-
19-
20-
Township,~ Range, Section:
SLOPE
SITE
WAS GROUND WATER
ENCOUNTERED?
DEPTH?IP YEs. ATwHAt
Oe~th to Waer After
IdoflitariAg?
Gross Net Depth to Net
Reading Date Time Time Water Drop
'/.. I ,,'. ,
COMMENTS
PERCOLATION RATE ~ (m,nutes~mch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~ FT
$ & $ ENGINEERING
PERFORMED BY: i lU,~ =~gle RI'~=r LC,,,p ~-,~'~ Nc,. ~ 17'"~1-~"~ ,.3 1~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH/~r.~'J~t[4M"H~(~UIDELINES IN EFFECT ON THIS DATE. DATE;
72-008 (Rev. 4/85)
ROBERT C, COWAN, P.E;.
CML ENGINEF_.}'~
(907) 694-2979
FAX (907) 694-12t I
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 17, Block 1, Skyline View Subdivision
September 25, 2000
GENERAL:
The scope of this project includes the installation of a 1000 gallon septic tank
and a new trench to 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 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 sealing.
Contractors installing wastewater .disposal systems must be certified by the
Municipal tlealth Department for system installations. Owners installing their
own systems must also receive prior approval from the Municipal tlealth
Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be conslructed by a certified septic tank manufacturer.
Construction shall include two 4" clcanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent sealing or shifting of
the tank.
17034 NORTH EAGLE RNER LOOP · SUffE 204 · EAGLE RNER, ALASKA 99577
Page 2
Lot 17, Block t, Skylln® View $/D
S®pt®mb~r 25, 2000
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCIUDRAINFIELD 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 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
Lot 17, Block 1, Skyline View
aeptember 25, 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:
Type of Pipe Perforated ,Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 0-1DPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use ora 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 tlI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
A permeable nontoxic silt barrier CF)par 3401, Mirafi 140N, or equal) must be installed
between the final ieachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform to
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 17, Block 1, Skyline View
September 25~ 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 & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St,
P.O. Box'196650 Anchorage, AK 99519-6650
www.ci,anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
de~:dption__:. Lot 17;
Complete
legal
Expiration Date:
Block 1; Skyline View Subdivision
AK 99577
'" Location (site addres~ or directions) NHN Iris Street, Eagle River,
Current Property owner(s)
Dayphone 415-706-77t'~
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent
Mailing Address 16600 Centerfield Dr.
Un/ess othervv~e requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
Debbie Lewis / Re)tax ER Dayphone 694-4200
Eagle River, AK 99577
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 (HA, A) 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) 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 cf issue for properties se.wed by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (CertiQcates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year far properties served by C~ass 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
Municipal[b/ 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.
Phone G~-~-~ '~¢/
Name of Firm s & $ ENGINEERING
17034 Eagle River
Address ~,, I~;ve~. Alaska
Engineer's Printed Name "-~"O_/~ /'~(~
DSD SIGNATURE
~ Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date:
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
wv~v.ct.anchorage.ak.us
(907) 343-7904
Legal Dascrlpflon:
A. WEII DATA
HEALTH AUTHORITY APPROVAL CHECKLIST
Well type'~ ~A./'~ If A, B, or C provide PWSID #
Datecompteted~l!.o_to0 Sanltmyseal (Y/N) ~/'
Tota~ depm ~..ft. Cased to ~O4- ft.
FROM WELL LOG
Date of tast It 11'0 J O0
Static water level ' I 1(9 ~ ft.
Well production / ~ g.p.m.
Well Log (Y/N)
c~ing he~t (abeve ground)
AT INSPECTION
ft.
g.p.m.
WATER SAMPLE RESULTS:
Date of sample: ~'/~f/OI
Nitrate *~mg./L Other bacteria ~ colonlas/100 mi.
Collected by: ~'¢'~
B. SEPTIC/HOLDING TANK DATA
Tank size ~~gal. Number of Compartments
Foundation cleanout (Y/N) Y Depression over tank (Y/N)
"Dateofp,,mpin0 A/(:'"r./ -- .amper
C. ABSORPTION FIELD DATA
Date Instailed/.~/'~/__00 Sail rating (g.p.d./ft2 or ft2/bdrm)
Elapsed Time: min. Final fluid depth in.
Any rejuvenation tmab,ent (past 12 mo.) (Y/N & type)
Date instetted
High water alarm (Y/N) ~///,~
Gravel below pipe ~ ft.
Depression over field ~
For .~ bedrooms
New depth in.
Absorption ~ ~
If yes, give date
D. LIFT STATION
Data installed
"Pump on" level at .
,/?/~'~ Size in gallons
in. 'Pump off' level et
Datum / Cycles tested.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/li~L, el~IOn on lot / O¢~
Absorption field on lot / 0 ~ ~-
Public sewer main /~///~'
Manhole/Access (Y/N)
High water alarm level at
Meets elam & cimuit requirements?
On adjacent Io~s
On adjacent lots ;/~ 0 / .~-
Public sewer manhole/cleanout /V,/vec
Holding tank . /~/'//~- '
Absorption field ~'/4.-
Surface watar /~C) /-r-
Driveway. pmking/vehicle storage
SEPARATION DISTANCES FROM SEPTI~TANK ON LOTTO:
Building foundation ~ /~' Property line
Water main /~J//~ Water service
line
Wells on adjacent Io~//0 ~:)
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / c~ / 're'' Building foundation. / O ~ Water main
Water Service line /~) ~
· ,~' Su~ce watsr /~)~ /''~''
Curtain drain/1/~/E'/~'~//'/~)~Well, on adjacent lots //
/o/.,-
F. COMMENTS
G. ENGINEER'S CERTIFICATION ~.?<,~:~,.'"
/
· I certify that I have detenwined through field ir~pec~lons and ~,~ ./ ~
review of MunicJpal records that the above systeme are in
conformance w~th MOA HAA gulde/ines in effect on this data. ~ ,""7~/~FS~S ~
. ...... ......
Engineer s Printed Name ~:)0~[' ~- . ~.(~uv/fH [~",~' CE 880!
.
Date ~ ~.'/3'<~10 I tt ~<'~.;' ................
~ tt ,., ,.': ..... .,:,'.
HAA Fee $
Data of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
DEC-2?-OI 04:I~PM FRO~CT~E ENVIRON~NTAL SRV
~T~. CT& E Env,ronmenta, Service, ,nc.
9075615~01
T-290 P.0I/0Z F-365
CT&E Ref.#
Client Name
Project Nqme/~
Orde~ ~y
PWSID
Snmple Rcmn.rks:
1018595001
S & S Engbleezing
S~line View L17, Bl
Skyline View LIT. BI
Drinking Water
Client
Printed Dlte~X'|me 12/27/2001 ! ]:43
Collected Date/Time 12/21/2001 11:00
Rp:elved Date/Time 12/21/2001 13:40
Te~hnica[ Director Stephen C. Ede
Nit~tte-N
~Lerob'tnto_a¥ La1,,o ~-a t:o~.~_p
Total Coliform
4.2?
PQ~
U~la ]v~d
0.200 mg/L EPA 300.0
col/100mL SMI8 9222B
AUow~lc p~p A~alysis
Limits D~rc D~ue Init
(<10) 12/21/01
(<1) 12/21/01 KAP