Loading...
HomeMy WebLinkAboutRAMERT LT 4Ramert Lot 4 #060-342-10 Municipality of Anchorage Page 1 01 _ 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 InspectionReportS iAJ �p`03 a 6 PID Number. 060'-" 3,TQ — I 0 bon (vans Permit Number: Name: Address: 4J ^ oi g /i Ok 143 O 7 J 4ncho age >4i� g95i �No. 01 Bedrooms: 3 Wastewater System: fir New 0 Upgrade Phone: /' 3S LEGAL DESCRIPTION Cot: t Block: Subdivision: Rafticrt Township: Range: l Section: "3503 ABSORPTION FIELD 0 Deep Trench )4.Shallow Trench 0 Bed 0 Mound 0 011ier Solt Rating: WELL: 0 New 0 Upgrade 1.D GPD/Sq. Ft. Depth 10 pipe bottom from original grade: 3 Ft. Fill added above original grade: 1 Ft. Total Depth from original grade:/ Gravel depth beneath pipe Gravel width: Classification (Private.BC) .: Total Depth: Cased To: rr Wet- 00 Ft. Ft. Oril er: Date Drilled: /� Static Water Level: Installer:...//. •141/. VavJ 14)A l%Lie/15 S-1 -00 -A-7 n. 5 tI) Yield: Pump et at: eight Above Ground: kJGPM I U✓rG✓td.,l1Ft. 1CaSinglI D, Ft. Total absorption area: / FI. Gravel length: Number of lines: iDistance between lines' 1 3 FI. Ft. FI. Pipe material: ©.sso.JFt. ASTfl1 0303��P'810 ;,/_ CeAsirl,t. -,4 Date lnstalled:��) r OQ TANK SEPARATION DISTANCES Ft Septic 0 Holding 0 S.T.E.P. From Well 0 Septic Tank Absorption Field Surface Water Lot Line 62' Foundation Curtain Drain O0'it- Litt Station Holding Public/Private Tank Sewer Lines 51. 1 - ( a$ t nufacturer p � �• ( vreoper Ralf 5.K/Il rcCS Mate lal: al e ) ene Capacity in gallons: 1000 Number of Compartrnents: Size in gallons: i Man "Pump on" level at: P t" leve . 1 ligh water alarm at: onekhown Pump Mak 9.el Electricat Inspections performed by: Remarks: ph,.s/rr ,./ CN4",C- f. D.iR.ln+t:- BENCH MARK C•5 rd Au c.Tl u.v — ) Location and Description: (.7/v4 L-• I r C.4#.4 'Sal L f tkf 7" NAEode.h.i4 7� v /2 r.•G c o -i s T /2 vt,i / e „. -- S rL't ni r7 i¢ t: /j z 1-0G- o/= 7/ /a-/o0 .ro, t -r � 0 om of Se, ing pol>�f' i,A l ' 1 Assumed Elevation: O" I Ft 3 & 3 ENGINEERING 17034 Eagle River Loop Road, No. Inspections performed by: „ ,Alaska 94377, Dates:1st 7- a-040 2nd 7 to- Z Department of Health and Human Services pp oval Reviewed and approved by: 0Date. 3 " 31-0 72-0t3 (Rev. 9/9t) MOA 25 y-1 . v b Alk, I� /W. 11.• 11109 1111. 144 si ROEERT C. COWAN its- fl. Aot 'kV; .. if . \ CE - 8801 .1t.'71 N f ....»•:..»11:14 • •• PERMIT NO £W990326 PAGE 2 OF 4 DEPARTMENT OF ANDhHUNAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 o Anchorage, Alaska 99519-6650 © Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, RAMERT S/D P.1.D. NO. 060-342-10 CUTBANK DBL1 & 08L2 NEW TRENCH NEW 1000 GALLON HDPE SEPTIC TANK LOT 5 SCALE: 1" = 60' ENCS MP OF qt X11 •c. ROBERT GCOWAN it, 4 i"� CE - 8801 r 4'.-m/ 1 r. � j ...... ,� PERMIT NO SW990326 PAGE 3 OF 4 DEPARTMENTOFANDhHUNAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 O Anchorage, Alaska 99519-6650 0 Tele hone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, RAMERT S/D P.L.D. NO. 060-342-10 DBL1 & DBL2 ALT. SITE MT, TH PERMIT NO•SW990326 PAGE 4 OF 4 DEPARTMENT OF Anchorage 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 LEGAL LOT 4, RAMERT S/D P.I.D. NO. 060-342-10 ST1 ST2 /- 98.9' FINAL GRADE 94.5' NEW 1000 GALLON POLYETHYLENE SEPTIC TANK CO1 MT1 , CO2 I MT2 C01 = 98.6' CO2 = 98.1' FINAL GRADE CO1 = 94.2' CO2 = 94.2' MT1 = 91.1' MT2 = 91.0' INSULATION 94.3' A B FCO 4.0' 28.5' ST1 12.5' 29.0' ST2 15.5' 30.0' DBL1 19.0' 31.5' DBL2 20.0' 32.0' C01 29.5' 38.0' MT1 30.0' 40.5' CO2 75.0' 82.0' MT2 68.5' 75.5' N. T. S. =N,,' ... s Z� . , •t... iCn • N.. •t ., •.•....1n�.' : NO WATER FOUND - 85.0' B.O.H. f+ ?t„ 9;s ROBERT C. COWAN r ��. 4'?-f.,y CE -8801 :. . PERFORMED FOR: Municipality of Anchorage . . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST D0N � y4S • V 14► p DATE PERFORMEDs:6:`?.f.J: LEGAL DESCRIPTION: " 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (FEET) S s.+ ° AL 4,4 C S Township, Range, Section: SLOPE s Ii -7y C -4.A V' G� LAR4�i PJce i3u o t_ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 0 Depth to Water Alter _ Monitoring? Date: S L 0 P E SITE PLAN N )-r' c i) Ns /34 r—r +E/'o /t- 1 Reading Date Gross Time Net Time Depth to Water Net Drop Rh.S OAK -] J '7400 _ 3 I't-A,c wo a?/,,^ ,0 /0 ,,,, b f '/...3'1z n ,, -D.,/1,. a / 3 5-4 I. a. 3/'y 30 (p '/1t" '3 S`/e " ,I a ail ry ,,r o " 6?/� , a. I, O. a '/y.. s a " sl . 6 0 V� 'i ` 3 r/.1 PERCOLATION RATE '' a (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN G /?- FT AND 7 FT COMMENTS 5 & 5 ENGINEERINGL�t/ 24" PERFORMED BY e'�e qqqg rT�'�-- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITANIE STX Is�,Rt 5RL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. 4/85) 7 //6/00 16:15 SSS ENGINEERING .m.a-A4. s..4- c 4- C 4 Jf 694 1211 P.02 5 LTt1iT1tn l (mart 4.07 by emu daft -away w'rr'�i ,1F a f rem EL i .O. BOX bT0272, CHUGLAK, ALASKA 99867 • TELEPHONE {sg s7:.V. OWNER OF L &Nn j j/,___14.__S-k i BORE HOLE DATA ADDRESS S-4 t) 1YtP1lt!.t. n.... y � DEPS . " LEGAL DESCRIPTION Aj r def PERMIT NUMBER, -171014, Data of (ssue�; i-_7? TAX NNDENTIFf c•ATION }*,,�r,�I/:} �a ER A, _ 42 CN 9wreEd a• /iT/I4U _ T ►n.+•hlj rr !8 well located at approved permit IM.sL'o:;? u es 0 No Method of .G ill-og: � �l--ot ary Q cable toot 1 7e2 Depth of well:, / 0 O if rl .rSic7 t.a. r.{ .F _ -,tel 1 J t e',r.►�r b GKc- r,{�:yyrJ 4J•V Casing Type _ ieg Wall Thickness r —�-511 1 ---- �- a c Q inr}loc I 1 �. .. Diameter 4 q inches. dei.t.i -, iii feet _ a-11 • —a 24sciC Add Liner T ._ -: ,,Ai n� X51 r _ I s - iliG hi�'a 1_d; ....�.., ri,�• - �.�' l�+' _ i'�c�Fo•�tti•'fi'!� ..l £ (1RoC,�C . 1'_ Casing Stickup Above Ground: .�., G L�4 feat •t,- < i^ �_ Crwf i� lAl6.�. Love s. �� .� Q � teeiY r Lovee {fiord gtund levet): -r- , feet _ io0 .1 Pumping level: level:�._ _feet after hrs. pumping _,_____eprn Recover Rate: ,.}a rjcn► it J _Pl-chtde) thod of Testing: fir Weil Intake Opening Type: D Screened; Start Q Perforations Start Groat Type• lt.•-. s t. Depth: from_ i Fran End O Open Ho;e C' = seat Stopped feet . -�- feetStonned f.,_. (� 1 feet, 't0 Pump Intake Depth: Pumpr:.... few i Fest I I hp Brand Name Well Disinfected Upon Completion? irsares No Mettio of r :. r =14 vrs.m?rZ .iAni Yc• Commen(lts: 'Cr/1 c“."'" . Y^ f 1 ., Driiif re Naitte J i �� 1-.•�' ATTENTION: It it «., , ''-•�° y of the � . the yr ra;vinl property owner to subm t a copyof of Anchorage: pPr,artn,n{.► i.i I-1....,.�, Ls, ... the well log to thP. ntOna� 2�.u....:w. t o rte. ♦- rertm •••. V. .with Human Servicesr- r .v...]. a Borj Ul Department of 1_nvironmantal C^n,.e ....... and/or Department of Environments! Conservation. iu_..c�� �.. ;M • owi{t. ..t V Mme. {. to/TA �Cirf.r • TOTAL P.G2 0 m 1 v r 2 Q m 0 IA LI 23100 0 U m mr we • w 0 N 9 P 0 00 o aw G M 00 o v Y v• 2a % o 92 • Y BE Q o ▪ 0. E§ Y o O w 0 o Qi O 0 (31 4. 4.45. , 10: •qC �• i P a P '. • iyt► r v m • ID 10 w CC. 8 /0, / tz,:z5v W / cl- I �d� 24.r 33.3 /,�0 s' $ /4�d �. ?9.z ecoJ 37.4 1= / "t, w 0 /^ O �o o r p 0 o 0 m 1 aD /44C:31. /022 N A W . r c0HC• T O CD co T tat U (0 0 Ln 50 I i 1 15' TELE. 8 ELEC. EASEMENT — dPwn. LO N 00° 10' 12*W 280.00' TR 8-A 50 1 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 t! nopect►o-1-1 7b400Q/; & 9 7 //e2/oo @i{ S4fr ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW990326 Legal Description: RAMERT LT 4 Design Engineer. 0003 S & S Engineering Owner Name: Don Evans Owner Address: PO Box 143503 Anchorage , AK 99514-3503 Date Issued: Sep 09, 1999 Expiration Date: Sep 08, 2000 Parcel ID: 060-342-10 Site Address: Lot Size: 84190 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑� Disposal Field Q✓ Septic Tank Q Holding Tank El Privy 0 Private Well 0 Water Storage All construction must be in accordance with: 1. The attached approved design. 2. ATI 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. 0'5.. The following special provisions. CA SOILS TEST SHALL BE PERFORMED BY THE ENGINEER AT THE TIME OF CONSTRUCTION IN THE AREA tOF THE PROPOSED ABSORBTION FIELDS.' 7- 27-00 ivELL-PR/cc tie la-aa-7To MOv€ THE W ELL To sootrq 5u„,a To 6-6r fr C6o$ELt TO 7744E koro;E. nit Essr App Received By yZ�-- Date• 9 - 1- 91 Issued By: )9—ac P)Cj2 72-1r Date: 9-9- / ? A• V li V "Engtneening soy HEALTHAUMDRTV APPROVALS SEWER & WATER MAN EXTENSIONS SEWERS WATER INSPECTION ENGNEERN°STUDIES AND REPORTS WEU INSPECTION 8 FLOW TEST SITE FLANS ROAO DESIGN SOI. TEST PERCOLATION TEST STRUCTURAL& MECHMACAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM COIGN ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907) 694.2979 •FAX (907)694-1211 August 20, 1999 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 4, Ramert S/D Request you issue a permit to install a well and 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, 10-20-94, no water was found. After seven days of ground water monitoring, no water was found. 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/bjj Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577 1 � / �. 0 cn ) 0 o 0 in -1 is ?` .,, � 1; 41 a � ® 1. I !i 0 M\ / , < c4 E-1 INICS,03 31a13313 1 14003131 41 555CO §w� Nrd-11S co A S v 1100Sv3 31a13313 1 N033131 .S1 NOISJQ Q O a ee = a tngtnnrring 1703A EAGLE RIVER LOOP ROAD CAGLE RIVER. ALASKA 99577 PHONE/ (907)694-2979 PAI/ (907)694-1211 LOT 4, RAMERT S/D NLCKLR BY: B.J.J. R.C.C. 8-20-99 E1: 2 OF 2 z a -J a W 1- () z ET) Lai 0 DESIGN CRITERIA: 3 BDRM = 450 GPD SOILS = 1.2 GPD/SQ.FT. 450/1.2 = 375 SQ.FT. REQ'D. RAINFIELD CRITERIA: 6. /' DEEP 4.0' .FFECTIVE 5. CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. UTBANK Miieseararaimnini HILAN OAD 0F4 RADIUS 0 N 1 0 25%+ FILL SLOPE ATH#8 ATH#7 DRIVEWAY FLAT± INSTALL ECU 1000 GALLON SEPTIC TANK II 35' MIN. CAL T. SITE -L MT MT CO '-0- ALL PORTIONS or WITH IEYs THAN 3.6 COVER REQUIRE INSULA C o�Z DOUBLE CLEANOUT UJ I.f 0.0.11.1 W Evn D ('lO'S : cw.E¢a r r .easwn. ro 4(0 ca.alos Municipality of Anchorage DEPARTMENT OF HEALTH E HUMAN SERVI:ES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: l i eo P—J¢A462-7 Baposso LT 4, Tete. LEGAL DESCRIPTION: Rs4.Ap6ALi NovrLs-AA O 1 P T,H v 6- 7- 8 9- 10- 11- 12 13- 14- 15- 16- 17- 18- 19- 20 - a Ofd MC- BAH Z 4- DATE PER FORID�f(k)/%Y�sZ�P r f .`G k Township, Range, Section: SAIrdray GonQIK seri C m.# Soot) L2.nia 4/ a �w L4xat dnur.oEAS erp to sett. COMMENTS TN. ECAU47F-O gr. -7 . N, PERFORMED Br ACCORDANCE WIT ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. 4/85) 0 ON Zo SLOPE WAS GROUND WATER /'1_ ENCOUNTERED? / �V IF VES, AT WHAT DEPTH? Depth to Wain Aker Monitoring? Dale Ia')hal S L O P E SITE PLAN TNr/? Reading Date Groet Time Ne Time Depth to Water Net Drop 0/0147/ f, R.S 3t)ap.^ r air" — '2S (me- 3'!x" 1IY" 130 S ,. 44 rr 'r b Ij[ ,,/..-;" it. 1%n S ., 4 (ft - J—.—_________--- Otto/iJ Iy? -- a'h 157- C.a.. 3s4" t% Sa- b Nr+ 4 44t 0 PERCOLATION RATE I (mmutevmch) PERC HOLE DIAMETER TEST RUN BETWEEN __.3___. FT AND Y FT ?.56 Acrta. 1"nA11ac S it S ENGINEERING age ' 'tar Loop Read No, 204 IEayI. DIi.a . AINlet9y — CERTIFY THAT / IST ST WAS PERFORMED IN ►%riigy 1 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502.-05 80 SOILS LOG — PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 oRC• Ol.. GU, V [or//// ,i n Pit? 16,14 szck 1! COMMENTS tic-, EXCA..MeT PERFORMED BY' ACCORDANCE WI 72-008 (Rev. 4185) nil .•. .. .�S :t 04 ******* OLIV440.1 ROFERT C. COWAN i V � tt e;',...`(�N• DATE PERFORMIZ1. r 4 • „` • Township. Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? epth to wrier Alter Montt/ring/ No oats II/b/9Y S L 0 P E SITE PLAN 7714, 718 Reading Date Gross Time Ne Time Depth o Water Net Drop h/rtC/i'1FCAKE.O. V, 0Pv's — yip" — :/5 S,,AW 6" 1'L." :AO c ?vs-" 11/1 :15 c . • 6*'• s" :18 — el%t% — :13 Sar. Ole' 1" 88 .Cm... e %E r• 1" e k3 Sm,,. Vbd• Iri PERCOLATION RATE 4 F (minutevmch) PERC HOLE DIAMETER TEST RUNBETWEEN FT ANDFT Or° .2.C6 ik/1.F P/,cccc. h7 • S & S ENGINEERING 17034 Eagle River Loop Road No •3q4 atilv1 CERII 1NAT THIS Thy WAS PERFORMED IN H ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE' /I/ CON/ ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 4, Ramert Subdivision August 20, 1999 GENERAL: 1. The scope of this project includes the installation of a 1000 gallon septic tank and Ieachfield trench to serve the proposed three bedroom residence located on the referenced property. A 44 r,...4 Thr ,144-t 4- 1.'..) nCQ<oAnrD A-7 Tind. O< co,.$7.1v .riv/1. rt r- To a 2. 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. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. 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: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page 2 Lot 4, Ramert Subdivision August 20, 1999 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. 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. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. 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. 2. 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. 3. 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. 4. 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. 5. 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 4, Ramert Subdivision August 20, 1999 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type ofPipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (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. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. 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. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. 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 4, Ramat Subdivision August 20, 1999 1. 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. 2. 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 On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 060-342-10 Expiration Date: a/a-W/9 1. GENERAL INFORMATION Complete legal description Ramert, Lot 4 Location (site address) 7540 Hiland Rd. Current Property owner(s) Lawrence Adkisson & Joy Lynn Day phone Mailing address PO Box 6882 Gulfport, MS 39506 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well (] Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 11 Public Sewer ❑ WaiverNariance request for: Received by: i Distance: COSA to be released to the erbtneer, unless otherwise requested by the engineer. Date: f I / 10.61 3 COSA Fee $ Date of Payment Receipt Number COSA# �rla1/i3 Ogatit Oscisicaq Waiver Fee $ Date of Payment Receipt Number Waiver # 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 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE 1 i System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 11/18/13 s -QF 1/46.1k4kk , �l* :Uer k'fsunrio e ri 1:.. CE -5149 rr bedrooms, with the following stipulations: tif((((((((f/ r ON-SITE '6 = ITIW)A)TER}L AND ° WASTEWATPR oz; l' PRO;;;;# Oma` ����O�l9 : By/ p A41' Original Certificate Date: Thenicipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet f Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Ramert, Lot 4 A. WELL DATA Well type Private Date completed 9/9 Total depth 100 ft Date of test Static water level Well production If A, B, or C provide PWSID # gI I , LSanitary seal (Y/N) Y Cased to 20.3 ft. FROM WELL LOG ggi2g Si 111606 r 27 20 WATER SAMPLE RESULTS: Coliform ec colonies/100 mL ft. g.p.m. Nitrate 3. l g mg/L Arsenic /V n ug/L Date of sample: (/ 7/ 5 /t Parcel ID: 060-342-10 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) $1 / 2 in. AT INSPECTION 11/15/13 26 4.0+ ft. g.p.m. Collected by: PI5 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Polyethylene Date installed 7/12/00 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) �N High water alarm (Y/N) N Date of pumping // �17 I t 3 Pumper J %L S ( (cn 'nil r C. ABSORPTION FIELD DATA Date installed 7/12/00 Soil rating (g.p.d../ft2 or ft2/bdrm) 1.2 GPD/BR Length 47 ft. Width %" 5 System type Shallow Trench ft. Gravel below pipe 3 ft. Total depth 7.9 ft. Eff. absorption area 405 Monitoring tube Y Date of adequacy test 11/15/13 Results (Pass/Fail) Pass Fluid depth in absorption field before test 35 in. Water added 452 Depression over field N For 3 bedrooms gal. New depth 37 in. Elapsed Time: 840 min. Final fluid depth35 in. Absorption rate >= 450+ Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date g.p.d. D. LIFT STATION Date installed "Pump on" level at Datum in. E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump off" level at in. High water alarm level at Cycles tested Meets alarm & circuit requirements? WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Water main 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ in. Holding tank 100+ Manure/animal excrete storage areas 100+ Property line 5+ Absorption field 5+ Water service line 10+ Surface water 100+ Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS System is 97% used there is no guarantee on how much longer it will last 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 COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 11/18/13 COSA brown sheet 10-10-12.doc A rt.~'(.Or. ACgyl Aw S1;Ga li.'Poririane: 'CE -8149 %,r,/ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Septic System Advisory Certificate of On -Site Systems Approval # OSC131614 During a recent adequacy test on the septic system for Lot 4 of Ramert subdivision, 35 inches of standing water was observed in the absorption field. This indicates that approximately 97% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval 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 r2 5 t sSOF Parcel I.D. B6Ma—lo HAA# _py0)4+ Expiration Date: I - 6 d 1. GENERAL INFORMATION Complete legal description Lot '4; Ramert Subdivision Location (site address or directions) 7540 inland Road, Eagle River, AK Current Property owner(s) Don' ::Evans Mailing address C/0: Eva Loken, Vista RagleRiver, AK Lending agency Day phone Mailing address Real Estate Agent Eva Loken Day phont 689-6476 Mailing Address 16635 Centerfield Drive, Eagle River, AK Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone 689-6476 Real Estate 16635 Centerfield Dr. 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site E Individual Holding tank Community On-site E 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 fromthe 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 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 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&S Engineering Address17034 N. Eagle River Loop, Eagle River. AR 99577 Engineer's Printed Name Robert C. Cowan Phone .694-2979 Date 10-01-04 os0 q sJ� fPIN' �i .19 IP v. ro o d...,., ... wt/ 5. DSD SIGNATURE `j 13 k ROBERT C. COWAN I�q,� Fc\ CE - 8801 r/41,' ✓ Approved for 3 bedrooms. tt . ...r'<�� J Disapproved. ttaaiia`4�i `�+ Conditional approval for bedrooms, with the following stipulations: By: Additional Comments ON-SITE ,t WATER AND : rn WASTEWA'EK ; PROGRAM . oAs. ii-9NT)SE ;.\‘ Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other (Rev. 01/02) Original Certificate Date: 1 0- r!p - o uniclpa Ay of r nc (rage Development Servi,ces,Department Building Safety Division On -Site Water & Wastewater Program South Braga* St' :. i oz' 966`50' fa age AK 99519-6650„ ccan:Cann f chorage.ak us 9" r)'7904 EALTH AUTHORITY APPROV A . CHECKLIST w>, egal D°escrrp ion: A-vAter . teltxtr ...,;f. !VtTT� Jel type If A B, or C provide PWSID ate c plete .j 00 Sanitary seal ON) \/ otatepth ft.Cased to ft • too ft. ate of test tatic tawater level Jell production' RE'3LTS colonies/100 ml", c. y�UeIICo9 y),,7,n Wires properly protectedl) Casing height (above ground) in: C"ibM_ itrate f a' - mg /I 2.f ple: /2Z 'feof_sam411, atd eA: ,,,e` rryi:l.;. M2nriss,f,,,n4 ,. ank si e' •CO gal. Number of Compartments 2Z. oun.a on ceanou (CON e3 epression overtank (Y1 t ,pimping Zgj/Oy; Pum er date of pumping p Other bacteria . colonies/100 ml. Collected by: i 0S f !10 Ifratit Date installed • /2_100 Cleanout (1r/b) `16.51 h0 High water alarm (Y/N) i(314 UW4Ptt31,3627 Z Systemtype H* LOw f a e ins a ed i �'% Soil rating g p.d./f�r ft2/bdrm) I a essxfur rx r f ength z t ft Width 5 ft Gravel below pipe 3 ft. -,„, ,,.....:,r;A:o-rs.,,:.-u4w,4,.,,. 4;,,,gw,%4 Iota- w^ anis.;, ,am; .,:.;a y, otal :e ft.Eft absorption area yob ft2 Monitoring tube /6g Depression over field /� p a#e of a egIncli test 123/03 Results 4 ail) t`r s For 3 bedrooms so .,. uia oep in absorp ion ti fef be pse d lapses nerd.� min. aliatVeST ny rejuvenation treatment (past ore es 4.5 in. Water added537 gal. New depth Lb in. b5"'�kx�.}'�',��i""-�C3�6k,=pkyku••u �3vW�:�n✓ty, ra .rc'.r xc.;, . s1 �4 .,�: .rw <„,s u. - Final fluid depth in Absorption rate >_ i g p•d o:) r &type et; Tfyes, `give date "N/ LfF sirkrION r4:. Date installed ivrt Pump on" level at MA - Datum Pit Size in gallons it-74- in. p}in. 'Pump off" level at /01 in. Cycles tested .; r E SEPAitatioN`biST/ NOES SEPARATION`DISTANCt OM ON LOT TO: Septic tank/lift station on lot l �r t Absorption field on lot lb() -t— Public sewer main Nle' Sfivreflseptic service line o`Z5j +' Manhole/Access (Y/N) /J rt High water alarm level at ion in Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank cE'S"sFROM SEP I / OtbING TA ON LO TO. Building foundation g Property line b 2 6 '-t- Water main Mart' :. Water service line ld `t-' Surface water ( 00 'T' Wells on adjacent lots to SEPARATION DISTAN-CE"FR'`OIVtTh O-PTIO ELI O 0 Property line 5 LI Building foundation 2.S u Srface water Water Service line Ib�I-- < 1 b© 4— Driveway, parking/vehicle storage 1 0 "k' Curtain Wells on adjacent l�1cu%e lG�.00c.a�: lots 106 -(E. ccikiriNeare— — Absorption field Water main K314. G. ENGINEER'S CERTI'FTTc`/tTT5N I 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. Engineers Printed Name Rots SAT' C , Game.) Date )0 // /0'i Date of Payment -S13 a /o , Receipt Number '-t ' ri '1 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number 9-30-04; 4:31PM; SGSICT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS OR REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER o PUBLIC WATER SYSTEM IDC In -PRIVATE WATER SYSTEM ❑ Bend Reauta Bend brook* Nana Wats Mlee� _t ,65r- G�g RJGY' ca dell n Mana'r Fa NISNaw 11•116004*M' CN Sista &caM SAMPLE COLLECTION: FW vela sax patnal ani roIntl men* Ganda ❑ Bend RstoM ;907 5615301 * 3/ 3 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-552-2343 Fax: 907-561-5301 Lab Ref No. 1046239 iR �. []Sena linden Wer apsm Irmeramasy Nemo ConlY1 Noma PIS Mena Fos *now MeenaAd*eas • oe Scodo SAMPLE TYPE: Ela uurN 0 Treated Water Repeat Sample D Untreated Water (refer to lab no. . Special Purpose ' Transported to Lab By: •Deemtras collector Other. PMad Nemo apnmw. TO BE COMPLETED BY LABORATORY Sample Receivinn: Date: Time: Terme Delivery Method: Received By: Carnment: gji2(D¢ 6446- NMed�sr f �l� P Nemo ❑ Sample over 30Imes old: 0 RUSH SAMPLE Results may be unrdlebI ❑ 48 Hour Waiver or it F44 641 Phone ft: Fast Bacteriological Water (Analysts Record: �}� Analysis Began: wIetz /w �`(O r1V Analyst JL/{ f •4 MMO-MUG IPIAI RESULTS: Toll CelIorm: E. Cat Analytical Method: MEMBRANE FILTER RESULTS: Direct Count Veri&eatnn: TMP cram Reported By: ® Membrane Filter ❑ MMO-MUG (PIA) ,o.00. slembte Colonied100mL • Benito ADEC: ANC FBN JUN Date/Time� Sent to Client Phoned ❑ • faxed 0 Dale/Timm Spoke With: LTB: rl BGB: ER) Sa istactory nmotrem { EC• ❑ Unsatisfactory Date/Time: r(2-14 (Irt /Zito TNT. Teo Nimwan a Capt 01 .oanr anted' C...a nM MCa •nl•71M1 9-30-04; 4:31PM; SG9 SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1046239001 S & S Engineering Lot 4; Ramert S/D Lot 4; Ramat S/D Drinking Water Sample Remarks: ;907 5615301 # 2/ 3 All Dates/Times are Alaska Standard Time Printed Date/Time 09/30/2004 13:11 Collected Date/Time 09/22/2004 13:45 Received Date/Time 09/22/2004 14:15 Technical Director Step C. Ede ��� Released $�� 1 Parameter Results PQL Allowable Prep Analysis Units Method Container ID Limits Date Date Init Waters Department Nitrate -N Microbiology Laboratory 1.96 Total Coliform 0 0.100 mg/L EPA 300.0 B (<=10) 09/23/04 JIB coV100mL SM20 92228 A (<=1) 09/22/04 DKC ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENt20ACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER N0 CIRCUM$TANGES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTI ON O� FENCE LINES, OR FOR ESTABLISHING BOUND Wd �( LINES. SCALE: DATE: GRID: FB� / of eeel DRAWNs r+ corst II , " •. S et Duane Merk Seward •% .$ r r' 1S-6919 g p nnlgr'�'s-ssora•` .� AR.a Ts! 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 HAA #� D f o Expiration Date: � - 3 /- 0 L f Parcel I.D. 060-34 2-10 1. GENERAL INFORMATION Complete legal description Lot 4: Ramert Subdivision Location (site address or directions) NHN Hi land Rd. Current Property owner(s) Don Mailing address Lending agency . Mailing address Real Estate Agent Mailing Address Evans Day.phone 696-3581 PO Box 143503 Anchorage, AK 99503 Day.phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. 'TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site PublicSewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Heaith 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 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 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 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. -- - Namc of Firm. S & S Engineering Address 17034 N. Eagle River Loop .Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date 3 3 0 / 0 r7' a Si T X ROBERT C. COWAN i 5. DSD SIGNATURE �la`o,%J;:ti CE -8801 /$"of Approved for bedrooms. t,iy1� •-al'►`~• Disapproved. Conditional approval for bedrooms, with the following stipulations: Pnone .694-2979 Additional Comments tii1u// . Qpm .- -•,cr J2• ON-SilE WATER AND In WASTEWATER •. PROGRAM o .• ,.• �JJol�nr�s�`�g\� Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other (Rev. O1'02) Original Certificate Date: 3 -3 l -0 "T Municipality of Anchorage Development Services Departmen Building Safety Division On -Site Water & .Wastewater Program 4700 South Bragaw St. P.O. Box 1.96650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us ;(907) 343-7904 I -I M Tu A I ITLJt r i -r:. APPROVAL r,r,. , ,... ,,'. _ it CI:77, Legal [ i A. WELL DATA Well type • Date completed 8///oo Total depth' /co ft. Date of test al!. Static water level II Well production • • • If A, B, or C provide PWSID # "� 'l ! Well Log (Y/N) 1..� Sanitary seal (Y/1N) 7 Wires properly 'potected (Y/N) 'd Lf Casing height (above ground) /8 in. AT INSPECTION • la 7.61 SA CYY Cased to FROM WELL LOG ell (Ob WATER SAMPLE RESULTS: Coliform Y colonies/100 mi.:. Arsenic B. SEPTIC/H91,431ka TANK DATA 1II g.p.m. Nitrate '0.�.1 g,/I, •Date of sample:3/r I2 00 Tank Type/Material . 9ePTi c. / Ft 0 p, - Tank size '( gal. Number of Compartments ° Z Foundation cleanout (Y/N) - 7" Depression over tank (Y/N) IH f pumping I 5 J7.A /(2 3Date Pumper C. • �1 ABSORPTION FIELD DATA Date installed 12/v0„ Soil rating (g.p.d /ft2 or ft2/bdrm) I.1'1'1 ' ,,/ 2 Length I 4-° ft 'Width Sri' ki.' L! Total depth 4& ft. Eff. absorption area4D. ft2 Monitoring tube'._ Date of adequacy test - Z 03 1 Results (Pass/Fail) IA-sS 1 14 I' a Other bacteria colonies/100 ml. - Collected iby: $ S &J6 (NJ f 1 AJ -- I ,, 4 ' !I Date installed Cleanouts (Y/N) High water alarm (Y/N) ft. Fluid depth in absorption field before test :71'n i ! Elapsed Time fro min. Final fluid depth :7 i Any rejuvenation treatment (past 12 mo) (YIN & type)• IZIoo System type` 5 H. l 2,.,G l../ ;.Gravel below pipe 3 1 ft. of ,I Depression over field ! ;I .For 3 bedrooms Water added .537 gal I New depth/0 in. Absorption rate >_ g.p.d. • f yes, give date i• .. . D. LIFT STATION Date installed Al zik- Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at , in. Datum Cycles tested ' Meets alarm & circuit requirements? ' E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tenliliftption on ICA / 00 11-- , Absorption field on lot / 00 Public sewer main f•• 7 A 'WC- /septic service line '7 5 14- Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r 1 r- Li Building foundation 5 1.4- Property line 4- Absorption' field r /0 -I-- Surface water 160 11-:, On adjacent lots On adjacent lots 100 1(00 ! Public sewer manhOle/cleanout • )1///'( - Water main IVA Water service line Wells on adjacent lots 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 L Building foundation 119 -I Water:Bervice line - /0 1-F— Surface water 1,00 I +- Curtaind:rain i\lboi-'1<;.1.0-r9x) Wells On adjacent Iots / 00 1.4 F. COMMENTS ,,.. • G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field injections 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 t tetr C . Cs0 Pdifv.1 : . Date 3 / • Water main Driveway, parking/Vehicle storage -1(-1 c) 4.0 fty • v.. :v. RI I or, rj ri #Of 4 ' 1, 4t,x ' Ex, . . HAA Fee $ Date of Payment 33 0— 6 1-7t 14 3 0 Receipt NUmber (Rev. 12/01) 1-71c7 qlif KUS/1- INalver Fee $ Date of Payment Receipt Number 1,7 7 3 0, t(-- 9 8 3 I . I .•