HomeMy WebLinkAboutSLEEPY HOLLOW #1 BLK 2 LT 7$1
py Hollow
Block 2
Lot 7
#051 - 501 - 10
Municipality of Anchorage
Development Services Department .-- - :_
Building Safety Division
On-Site Water & Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 ~ ~'
www.ci.anchorage.ak.us (907) 343-7904
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Numben SW000298 PID Number:. 051--501--10
Name:
MIKE WILLIAMS Wastewater System: · New r'l Upgrade
AddrllS:
18611 GIBENS CIRCLE * EAGLE RIVER, AK 99577 ABSORPTION FIELD
Pho~e: No. of ~edroOrnl:
(907) 688-6006 .3 r'lDeep Trench · Shallow Trench I"tBed r'tMound ' DOther
LEGAL DESCRIPTION ~ ""~
1.O ~,o/s~ .. 7.0 - 7.5
2 7 SLEEPY HOLLOW #I 2.7.3 - 5.25 .. 4.27
- - - SEE DWG. r~ 45+
WELL: [] New [] Upgrade 5 rL 1 -
r~ 450 =~.n D .30`34/ F-810
_.,- ,,,.$ & A ENTERPRISES ~/,31/2000
~ ~ ~ TANK
SEPARATION DISTANCES .s,.~o n ~ld~ng n S.T.F..p.
From Tank ri. Id Station Tank s.-,, u~ ANCHORAGE TANK * 1250
"/rO~'+ 'mO'+ - - 25'+ ~ STEEL 2
s.,~oo, wot., ~oo'+ ~oo'+ - - - LIFT STATION
LotUne 5'+ ,o.+ - - -
FoundaUon
5'+
10'+
Remarks: *INSTALLED LARGER SEPTIC TANK THAN BENCH MARK
NECESSARY PER OWNERS REQUEST. TOP OF CONCRETE WALL O POINT "B'
j"""~
2nd 8/31/2000
3rd 2/5/2002 ~ '..l
~o~_ ~.:_ t ~7,'~' ..-'..~
· Development Services Department Approval ~h.~/
R~wewed and approved by:.~;~__~.=~~ Dote:-3- -/~)-o.2. ~°"' :'''~ ....... "
.-. ,~,) r-///-T/ - ,~
~,~0.~, AS BUILT DRAWING
SWOOO2gB - 051-501-10
:.o
5T1 42,31 55.68 / X
5T2' 50.02 63.05 / ~
9BL1 ~8.07 70.9~ /
~ / 7M~"///
~ I /.,' !~ ~ ~ ..
;... I.:.'~
. ....
.i;.' ~ "-;.'-~ :':
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..................... O~ ~:
J.~.
~S~WATER & WASTE~TER ~ ~:.. ~)::~ , ~ .~
COUSULT~TS. ~nC ........... ~..~,~ .. ~ .....~ ......
NUM~:
[""~ % ~" ..... ;r ......
M~CHAEL AnD C0nn~E W~kHA~S (907) ~88-6006 2 Or 3
~ ~.,~:
SLEEPY HO~OW SUBDIVISION ~1= LOT 7, BLOCK 2
~g OF WOR~ '~rofesslo~
AS-BUILT OF SEPTIC SYSTEM
~: AS BUILT DRAWING
SW000298 - 051-501-10
/-FINAL GRADE ,-
- /99.95-100.44 =
TOP OF TANK AT-.-% - ,/-"TOP OF' TANK AT
m~.~t oF BONe SEPTIC TANK ~NV~T or BONO AT
AT INL[T ~ g3.47
ORICINAL GRAD£'-~ ~F /96.71-98.64
~ 92,99 (AVG.)
- ~.72 Om.)
ALASKA WATER & WASTEWATER ~
CONSULT^N'm. ~NC. H.T.S. I ........ ;" ~ ...........
MICHAEL AND CONNIE WILLIAMS (907) 688-6006 5 OF ~
~r?.~....~ ..... .**~
SLEEPY HOLLOW SUBDIVISION ~11 LOT 7, BLOCK 2
PROFILE AS-BUILT OF SEPTIC SYSTEM
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
/,5-0 0Z,
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Aug 15, 2000
Expiration Date: Aug 15, 2001
Permit Number: SW000298 Parcel ID: 051-501-10
Legal Description: Sleepy Hollow #1, Lot 7, Block 2
Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 18611 Gibens Cir.
Owner Name: Mike Williams Lot Size: 112511 SQ. FT.
Owner AddreSs: 18-611 G[bens Cir. - Total Bedrooms: 3 Permit Bedrooms: 3
Eagle River, AK 99577-
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: /(~f~TL,t~
Date:
ALASICa WATER & WASTEWATER
CONSULTANTS, INC.
August 4, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reft Proposed Septic System Design for Lot 7, Block 2; Sleepy Hollow S/D #1
To whom it may concern:
The proposed 3 bedroom house will be served by a community well and septic system. Two test
holes was excavated on the property where the proposed septic system will be located. The
proposed septic system will be designed around the 30 foot radii of these test hole. We are
proposing that a 1000 gallon septic tank and a 5-wide trench type drainfield be installed.
Comments regarding the proposed design are summarized as follows:
1. SOILS: Attached are two soil logs which shows the soil profile, and the percolation test
results. In both test holes, the soils below the organics and ML/organic layer is a GW/SW
material to 14.0 feet {bottom of test holes). A percolation test was performed in TH#I between
the depth of 5.0 feet and 5.5 feet and found the rote to be <1 minute/inch. TH#2 was visually
rated to be the same as TH#1. Ground water was not encountered during the excavation of the
test hole. It is our opinion that the insitu sandy soils will act as a sand filter and that a 1.0
application rate should apply.
2. TRENCtl DESIGN:
a. Percolation Rate: <1 minute/inch
b. Allowable Application Rate: 1.0 gallordday/fl2
e. Number ofBedrooms: 3
d. De. sign Flow: 450 gallons per day
e. Minimum Absorption Area: 450 fl2
f. Maximum depth: 7.5 fl.
g. Effective Depth: 4.0 fl.
h. Width: 5.0 ft.
i. Length: 45 fl.
k. Effective absorption ama = 450 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
6901 Debarr Road, Suite 2B - Anchorage, AK 99504 ~ Ph: (907)337-6179 ~ Fax: (907)338-3246
4. TOPOGRAPtlY: As can be seen on the attached design, the a proposed trench is to be
installed on a slope that runs from approximately east/southeast to west/northwest at a 3 to 5
percent grade; in short, there are no slope concerns. The trench is to be installed parallel to slope
contours. There is a slope that is greater than 50 percent to the north/northeast of the proposed
drainfields; but the drainfields will be installed 50+ feet from this slope.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 33%6179. Thank you for your
assistance.
~.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, two soils logs, and a 7 page
construction specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 ~ Ph: (907)337-6179 ~ Fax: (907)338-3246
~C~H~
C~C~S
CONSULTANTS, INC.
'~rZ~/~... ~1
SITE P~N FOR PROPOSED SEPTIC SYSTEM
NOTES:
1. IHIS PROPERrf WI~.L~. BE SER~/I~O BY A CLASS 'C' WELL
rHAT IS LOCATED 200 4. AWAY. 'II-IE COuUUNI~f WATER /
5YS'rEM IS AN APPROVED SOURCE BY ADEC. (PWSID ~215522~ /
2. THE CONTRACTOR SHALL HA'V~ THE WEST/NORTHWEST /
PROPERTY LINE F'LAOC~D BY A REGP~II:.~ED LAND SURER /
/ ~ / / MAXIIdUld BY 5 FEET WlDE MINIMUM
/ ~ / / BY 4,5 FEET LONO. ADD 4 FEET OF
>,,,
/ ........ /x.Z/ s c,AN
~ '/~ / / /// /
/ ',,,/ / /// / r--~...~
· / ¥i /// ~ ~' I - P~O~
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/ ~'"V// \
/ z.~, ~-INETALLDOUBI Ir I I
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~-..
CONSULTANTS, INC,
:'R[PARED FOR: PHONE NUMOER: PAGE NUMBER:
MICHAEL AND CONNIE WILLIAMS (go7) 696-6800 2 OF' 2
.~. O~CR,~O.: ~L~':' ~-'~.'"';g
SLEEPY HOLLOW SUBDIVISION t~1; LOT 7, BLOCK 2 '.
DESIGN O? PROPOSED SEPTIC SYSTEM ~.%~:~,~..~..~.'~.
ALASKA WATER & WASTEWATER CONSULTANTS, INC._~._ ~ ~,,~'~-~'~
PHONE (907) 357-6179 * FAX (907) ;~38-3246
ISOIL LOG - PERCOLATION T£STI i.,.~.::f~t~ ~ ~....~.,j
PERFORMED FOR: MIKE ~D CONNIE WI~S .........
o. ,cs mTesT HOLE ~lJ
::
2~o~~ I t A
~ ~ GP ~ ML
~ SW ~ ~H
'~*, I SP~ CH
~ sc
7~ 3ROUNDWATER DATE
~ GW/SW ~ 4/3/~ooo ~--_ ~) m' =moo'
~.~, TIME (MIN~ES) READING (INCHES)
/
17
is I
19 PERCO~TION ~TE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
20 TEST R~ BETWEEN 5.0 FT. ~D 5.5 FT.
COMMENTS: ~E INS~ ~DY SOI~ SHOU~ A~ ~ A ~D RL~R.
PERFORMED BY A~ WATER ~ W~ATER. I. JEFFR~ ~ G~NESS. CERTI~ ~T THIS
W~ PERF~R~ED IN ACCORDANCE WEH ~ ~ATE ~D MUNIClP~ CUIDEUNES IN EF~CT ON
DATE: ~ ~/~
DEPTH TO
3ROUNDWATER DATE
DRY 4/3/2000
DRY 4/12/2000
,~z~s~ w^~a & w^s~w^~a cossu~'r,~rrs, n~c.
~o, ~ ~. ~ ~. ~o~. ~. ~, ~...~;~. ~.~:~ :~' ~.~
ISOIL LOG - PERCO~TION TESTI
LEGAL DESCRIPTION: S~E~ HO~OW SUBD~SION ~1; LOT 7, BLOCK 2 ~ ...........................
PERFORMED FOR: ~IKE ~D CONNIE WI~S ~ .~ .,~:....~
DATE PERFORMED: 4/3/2000
~U~ ITEST HOLE ~2j
. SO~L C~SS~nCAT~O~S
~ GP ~ NL
~ sw HH
GROUNDWATER
~;~ ~w/sw ~ ~--_ z~ ,'= ,oo,
~ NET TIME NET DROP
TIME (MIN~ES) RE'lNG (INCHES)
16
17
18
19 PERC~TION ~TE - (NIN,/INCH) PERC, HO~ DIA. 6 ,(INCHES)
20 TEST R~ BETWEEN - FT, ~D - FT,
COHHENTS: ~E INS~ ~DY SOI~ SHOU~ A~ ~ A ~ND fiLTER.
PERFORMED B~ A~ WATER & W~ATER. I, JEFFR~ A. GARNESS, CERT[~ ~T THIS
W~ PERF~B IN ACCORD~CE WEH ~ ~ATE ~D MUNICIP~ GUIDEUNES IN EF~ ON
DEPTH TO
GROUNDWATER DATE
O~ 41312000
DRY 4/12/2000
RECITALS:
W'H~. pu~'u~nt to the terms of the A~eemenl to Purch~e si~ed by ~e ~'ffii~ on
~e ~'il~ wi~ be ~e c~ of~e pmp~ ~bed ~ follows'
. .
Lot 7, Block 2. SL~gPY HO~OW 5L~DI~IONNO. I, a~o~
' ::'"- :: ~:; ~ ~ ~ ~'~'~ t~ ~ ~ ~'l~Y ":"" ' ":'"
HOLLOW S~D~ION NO. ~ a we~ ~d ~ w~ ~d~ ~t~ t~ .............
~ via m~d pip~
'
the irarties hereto desire to make provisiom for the use of the well for domestic
NOW 'i'HI~OP,~ it is agreed by and between the parties hemo as follows:
i. The Williams, th~ hcL-,s, successors, and ~ssigm, shall have the fight and privilege of
oht~nb~8 wa~' for their dome~t/c puzposes from the well on Lot FL~een (lS), Block One (I),
HOLLOW SUBDFv~SlON NO. 2. These righ~ will te'n~i~Ie whm a publ~c ~dty cr c~,~.,,u~ty
system .wh/ch provides ~ter is ~v~ih~le to the ~hove-&sCnbed lot or when su~ lmbEc ~lhy cr
~umW w'~r .~'~em rephces the at,ye-described ~ sysco.
· Z Thc W~lli~=.s. the~-be~-s, successors, and ~ssi~s. sJ~ll be re~por~sible for my v~
~ eq~e~ req~ed for ne ~.s~h~on md mz~en~c~ of ~mde~ ~.d pipes c~me~
&~.bed property with the existing wa:er ~'m. The Owner is in no way tespomible for the installat/on
cr .mamm"~nce of th/s comect/on nor is he li,ble for any costs incun'ed incident to install~on and
maintenance of said connection.
o ~ eu ~=e= ~nm ~x uwn~r, shall ~y ~ a ~g a~ ~ ~'d ............
~ll ~. ~e cl~ to cp~ th= ~ s~t~ ~ n~ ~ ~d ~. ~e
~ ~ ~ g~ ~dition and ~. ~e ~ shah n~ be held ~able f~ ~ well ~
4. The Ovmer. his heir, succ.~som,
o~se ~vi&d ~ ~s ~t ~ ~ m ~t ~ ~t~ ~ ~ all ~ h~to. w~
mo~fi~ ~ ~e~:n~ ~s ~c~plat~ no profit ~ ~ ~ be ~hed ~ ~ ~ a
~t of~e well's o~m~ ~t~ of av~labili~ to
p~ph ~e (3) ~l
5. Ibc lrartic:s herc'.o cont~'mplat~ fl~I one or more other pa~es may tnatct into a well ag:r~tment
with the Owner and ack~,owtcdge that the Ow~e: retains sole fighu to make further Well Ag'orments with
other p~zes wt~mg to obmLu the use of the ~ sys%.-m for domestic puzToses, ll~ese pm'tz~ will be
r~sp. on~ible for ~nd equally Ii~bI¢ for tb.~ costs of well test~, maintenance, reVaj~ ~nd,'or r~pI:~ement or,ny
cqmpment of the wat~ syslem ~md payment of elcc~city to ope~'-~ th~ we2er system.
~. This Agre .em. ent ~.all ~c binding upon all thc patties h~'eto, t~e[r h:ir. s~cce~sots and ~sigm.
·nd fl~ll nm wi,.~ the land.
)ss.
~.lt f OF ~.'<¢HORAGE )
'fhJs is to c~ ~t ~f~ me a~~, to m= ~o~ to ~ ~ ~di~
~ hc~in ~d who ~e~cd ~ fo~ ~ ~d ac~owl~ed ~e ~e to ~ his si~c.
S~bed md sworn ~ me ~ ..~ &y of~ 2~.
N'ot,~. Pub ie.t~r,te
My commission .-xpires ..~-_~ -_~,~_
Municipality o.f Anchorage (~~
Development Sen/ices Department ~! ~
Building Safely Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
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
Parcel I.D. 051-501-10
1. GENERAL INFORMATION
Expiration Date:.
Completelegaldescription ~ SLEEPY HOLLOW SUBDMSION ~1; LOT 7, BLOCK 2,'
Location (site address or directions)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SLEEPY CIRCLE * CHUGIAK, AK 99567
MICHAEL AND CONNIE WILLIAMS Day phone. 688-6006
18611 GIBENS CIRCLE "' EAGLE RIVER, AK 99577
Day phone
Day phone
Unless othetwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well E]~
Individual Water Storage
Community Class '(:;" Well []
Public Water System
TYPE OF WASTEtNATER 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 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.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ ~ l~-.~'-at, or prfor
to closing for the engineering services provided.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my
investigation, based on procedures outlined in the Health Authorfty Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(am) safe, functional and adequate
forthe number of bedrooms and type of structure indicated hemin. I further ve6fy 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 wfth all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER & WASTE'WATER CONSULTANTS, INC. Phone
Address 6901 DFBARE ROAD, SUITE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. CARNESS, P.E.
Date
337-6179
Engineer's (~omments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC end MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
· distancesmeasuredtoreadilyidentifiablefeatures. Theoperationallifeofallwellsand
septic systems depend on the local soils condition, groundwater levels that may
fluctuate dudng the year, and the water usage of the family being sen/ed by the system.
These conditions are outside the control of the evalualor of the system. Satisfactory test
results do not guarantee futura performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AW1/VC, Inc. can therefore not provfde
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 poraon or party is not autho~fzed, nor will it confer any legal tfght whatsoever.
5. DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
bedrooms, with the ~owing stipulations:
.~.k ~.~t ~,, ,--_
SiTE '.
~ ~ WASTEWATER : :
'... .....s
....
ManitenanceAgreements 7~/.., ~- ..,
Supplemental Engineers Reo~
O~er
(Rev. 12/01)
Original Certificate Date:
Municipality of Anchorage
Development Services Department
6ul~ng Safety Dlvblon
On-SM Water & Wssfewater Program
4700 Sau~ Bragaw St.
P.O. Box 196650 Anchorage, AK g9519.6650
wvnv.cLanchorage.ak.us
(S07) 343.?~04
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal De~: SLEEPY HOU.OW S/,D ~1; LOT 7~ BLOCK 2~ Parcel ID: 051-501-10
A. WELL DATA
Well type . %" If A. B, or C provide I:qNSID~ =,~3s~ Well Log (Y/N '
Date completed Sanitary seal Ires properly protected (Y/N)
~ Cased to ~.ft. Casing height (above groun,~) in.
Date of test
StetJc water level
FROM WELL LOG
ATINSPEC~ON
Well production
.-- f
WATER SAMPLE RESULTS:
Coliform ~ colonies/1 O0 nd.
Arsenic: N/,A mgJL.
SEPTIC/HOLDING TANK DATA
Nitrate 7-./.8 mgJl.. Other bacteria .
Date of sample: 2/11/'02 Collected by:
elNS'rAllrr~ L/~RO~]~ $1;~11C TANK
NECESSARY PER OWNERS REQbI~i.
Tank Type/Material
Tank size °1250 gal.
Foundation deanout (Y/N) YES
Date of pumping NEW
C. ABSORPTION FIELD DATA
Date installed"
Length ' 45+ ft.
Number of Compa~mmnts 2
Depression over tank (Y/N) NO
Pumper
Soil rating ~ fl~qxlrm) 1.0
Width 5 ft.
~t' colonlesJlO0 mi.
AWWc~ INC.
Date installed 8/31/2000
Cleanouts (Y/N) YES
High water alarm (Y/N) N/,A
System type TRENCH
Gravel below pipe 4.27
Depression over field
ft*
NO
Foi 3 bedrooms
Now deplh - in.
- g.p.d.
If yes, give date -
Toteldepth *&o-to.oft. Eff. absorption ama 450 ft= Monltmlngtube YES
Date of adequacy test NEW Results (Pass/Fall) -
Ruid depth in absorption field before test - in. Water added - gal.
Elapsed Time: - min. Final fluid depth - in. Absorption rate >=
Any mjovanatJon treatment (past 12 mo.) (Y/N & type) , -
D. LIFT STATION
~ Cycles tasted , Meets alarm & cimult requirements?.
Septic tank/lift station on lot
Abson~tion field on lot
Public sewer main
E. SEPARATION DISTANCES
CLASS "C" WATER
SEPARATION DISTANCES FROM WELL ON LOT TO:
On adjacent lots
Public sewer manhole/deanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation. 5'+ Property line 5'+ Absorption field
Water main 10'+ Water sewlce line 10'+ Surface water.
Wellsonadjacentlots 100'+ IS~ ~ 01~,~$~'C '!
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
SYSTEM
Property line 10'+
'~100'+
Water service line 10'+
Curtain drain NONE KNOWN
Building foundation I0'+
Surface water 100'+
Wells on adjacent lots 100'+
Water main 10'+
Driveway, parking/vehlde storage
10'+
F. COMMEN*r8
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections end
review of Munlclpel records that the above systems ere in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name J~rrKEl' A. OARNESS
Data -~ /
HAA Fee S
Date of Payment
Receipt Number
(Rev. 12/01)
Waker Fee $
Data of Payment
Receipt Number
FEB-IZ-OZ O?:O§PM FROI,~CT,tE ENVIRO~IJENT,~L $R¥
,~E CT&E Environmental Services Inc.
9075515301 T-304 P.02/O] F-zTg
CT&K Ret.# 1020793001 Olcnt
Client Name AK WIIter& Wastewater Consultant~ Inc. Printed Date/Time 02/12/2002 18:33
Project Name/# LT, B2, Sleepy Hollow S/D #1 Collected Date/Time 02/I 1/2002 8:15
Clieflt Sample ID LT, B2, Sleepy Hollow S/D # ] Received Date/Time 02/11/2002 13:00
Matrix. Drinking Water Technical Director Stephen C, F..de
-~amplc Remarks:
Nitr~te-N 2.68
Allowable I~r~p Anslyl~
PQL Units Melhod Limits Date Date lnh
0.200 mg/L EPA 300.0 (<10) 02/I 1/02 IDT
Total Coliform 0
col/lOOmL SMI8 922213 (<1)
02/I 1/02 KAP
o