HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 2 LT 4Prospect
Heights
Block
Lot 4
#015-135-12
MUNICIPALITY OF ANCHORAGE
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEINAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ~ P~ONE
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
~ Manufactur~w~. aateria~¢~c No. of ~partments
Liq. :~-~=~allons..n... -- IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO,
O Z ~ Manufacturer
· -- k Material Liquid capacity in gallons
~ DISTANCE TO: 'Wellp~/~ Foundatio~,:.~ o oflines'( ~ NearestlotlineTrench PERM~
Total..ri.th ~th Distance between lines
.o. of lines/ Length 073hZine /~"
-- .: ~ inches ~bsorption
~ ~ ~ Top of tile to finish grade q~ Mate'S[neath tile ~¢ ,riches
~ Total
~ Length Width Depth PERMIT
~ ~ Type of crib Crib diameter Crib depth Total effoctive absorption area
m Well
DISTANCE TO: Building foundation Nearest lot line
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
DATE LEGAL
I)
X %
Permit'
Applicant:
LOcation:
Legal Description:
TYpe of Soil Absorption System Is:
Trench: ~ Drainfield: Seepage Bed: __ Holding Tank:
Maximum Number of Bedrooms:
The Required Size of the Soil Absorption System Is:'
DEPTH 7 LENGTH --/~ GRAVEL DEPTH N-~ WIDTH
MUNICIPALITY OF ANCHORAGE
Departmentf='"f Health and Environmenta/'~rotection
825 ~ Street, Anchorage, AK. ~9501
* * * HANDWRITTEN PERMIT * * *
WELL AND,'~ ON-SITE SEWER PERMIT
, ~JO,4~/ ~'~.'~"~ Mailing Add=ess:
Phone Nu~er:
Lot Size:
The length dimension is the length(in feet) of the t~ench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel, between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /r-~--C~) GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection.and approval by this department
will~ be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 3L 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by'the Municipality of Anchorage.
(2) I will install t~e system in accordance with codes.
(3) I under~~.at the on-site sewer system may rezq~ire enlargement if
the r~sl~nc~is' ~e-~o-q~eled to include more that B ~edrooms
Si~ne~:~ ~~ Issued by:~ ~~
Applican~/ ~/ , ~_"
D a t e: ~//~/~3
/
SNP/024 (1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
OL
1
2
3
~4
6
8
g
10
11 --
12
13
14
15.
16-
17
18
19
20
DATE PERFORMED: 0 c.~, o','~ er
SLOPE SITE PLAN
WA~GROUND WATER
ENCOUNTERED7
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
~!~, ,c,-,$ ~' ' '--/ct -- 'c/o
':'"~ ~'. ,,-f _ , ~q
PERCOLATION RATE Z~, ..~ (minutes/inch}
TE~T RUN.E'~EEN z./ FT AND '/ ~
~FT
CERTIFIED BY:
DATE:
72-008 (6/79)
~-~,-~ [V~-W DRILLING, Inc.
j ' P.O, Box 10-378 * 10300 0Id Seward Highway
. (907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner ~PPS. JOtIN Use of Well Domestic
Location (address of: Township, Range, Section, if known; or distance main road Lot 4 Block 2 Prespect Heights #5
Size of casing. 6"
.Depth of Hole 200' feet Cased to 120.q0' feet
ft. (~imm~)~ (below) land surface. Finish of well (check one) open end ( XXX );
(minute) for 1 hours with ]00% ft.
Static water level 100
Screen ( ); Perforated
Describe screen or perforation
Well pumping test at
of drawdown from static level,
Date of completion Februar?
WELL LOG
Depth in feet from ::: ~ . .
ground surface Gi~ de{aiIs ~f f~rmations penetrated; size of material, color and hardness
0 TO,, 2
2 TO ~7
., ~7 TO 6~
. 6~ TO ~08
108 TO 112
112 .TO. ~4;~)
TO
TO
TO
TO
TO
TO.
TO,
TO
TO
~LiNiC;';'ALITY OF ANCHORAGE
DEPT. OF HEALTH &
E.~viRoNMENTAL pROTECTION
l~g~A Cer~ed Con
~fteste No's. 814.
3 -- CONTRACTOR
DE:i::%iI:~:Ti'"hr::-::NT Or.. HE'C_~'H F:lf-,ll.7:, E.N'v'ii-:~:ON.F'iE:N'T'FIt.. ~ ,.~OTECTION .
;.-':.2 ~":; 4 -4 '7 ~.:.:: ~3
CEdq TFIt]::T
LEi.,.! ! E; ,tOH?',!
LOT: ,:.1.
F~tFI.I'.,!,GE: 1':'[:!.,.!
E~L.C if<: '2
I . E:Ei-'~!TI {.'-"'-F THi'::I'T:
:1....T l::!i'] F:'A~,' T. ........ IFIR 14"7i'1-! THE"' ,r';~'E:;'.:.'.~_ ZF'E.-..~,]E:F.T'5 FEiF.: E¢',i-':;ZTE:. ...... :::,,.::.b.l~R.-:,":'L': F' ..,,_ F:IIqE:, t.,.tE'.L.L.~; FI.E"; ~;ET
FOF<TH ":; THE I"'IU",tI:iFI:iLIT"¢ [3F' F:h~',!E:F'ICI[.~:FtC. iE <i"'t0i::1) FIN[> THE :'.'5, TFI]"E: r:F' la!...F:l!';l<Fl.
;..]!:. ]: 1.4:i]LL. iN:i..-,'i"F:l[ ...... 'T'H.E :E;.,h.':.2;TE~]Pi iF,! Fff':~']_"¢'[',F. hlj:F:.j .t,.ilTH Fd._ I','l".:R CL-~E:,L-T.:E'; FIND
I::I~'.,i[> .~-.,t I::Ol'"iF'i...']FgI'"E i.,.iZTH .... L~::'
· I,,~. F.:,F:":'-';TGN E:F.:I'TE:.r.;~:ZF~ OF' THif..; F'E:F. ff,'IIT.
~' I I..t.t.~..b FiDI"iEf--::E 'FO ,4. ..... HOF:I fr-ff.,i[', :i.:,TI:tTL~ O.~' I::II...I:::P'~I';'FI I:,]EL.ZUZF~:Ei',~iEN'I"'E F'OF4: THE:
C'-T.::--';TFii",iCE'.::; F'i:;::C!i"I F:Ii'.4'.~'.E;:.:;I~:;T:ri'.4G .14ELL ...... iI::'IL:.:'TE:.[4F!'t'EF.' [>I'.::;F'Et~';FIL. '.'..:.7¢::..7TE1','1 r'.:t~' F'U[3LtC:
..... E., ......... I~,...~:..:, =,T[:.!'I ON 'T!--it':'j; i;)~;: t::}["4"r' R[>.J'F:iC:Eh!T C;F:: i"4EH'F..[:,~' L. CIT.
[:,F1TE:
. MUNICIPALITY OF ANCHORAGE
Department.:~ Health and Environmenta]~rotection
,- 825 ~ Street, Anchorage, AK. 3501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit ~
~ ,.f',-,, /~ ~ .... ~-~
WELL ,~__. ,[, ....... PERMIT
Appiic t: Jot} Mailing Address:~R/~ ~ ~_~~,
Location: Phone Number: ~
Type of Soil Absorption System Is:
Trench: -----"-Drainfield: ~ Seepage Bed': ~.- Holding Tank:
Maximum Number of Bedrooms: Soil Rating (sq. ft/br)
The Required Size of the Soil Absorption System Is:'
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in'feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /[///9- GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements-may apply. Specifications and construction diagrams are
available to insure proper installation.
'-' * * * PERMIT EXPIRES DECEMBER 31, 1 9 * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I u~~~at the on-site sewer system require enlargement if
th~_ ~si~/~' ~odeled to may
include more~~bedrooms.
Date: ~-- /~-- ~ .
s /024
Mmlicipaliiy of Anchorage
Development Services Department
. Building Safely Division
On-Site Water and Wastewaler Program
`{700 Soulh Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.ak.Us
(907) 3,{3-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O I S - 1 3 ,,5-- I ?- '
1. GENERAL INFORMATION
Complele legal description
· Location (site address or directions)
HAA# H,"R
Expiration Dale: '~ - / '~ '~:~
Current Property owner(s)
Mailing address
Lending agency
Day phone
Day phone
Maili~rg address
Real Estate Agent
Day phone
Mailing Address
Un/ess otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Waler Slorage
Commtmily Class __
Public Wa[er System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
[] Individual Holding tank
Community On-site ~
Public Sewer []
The Munlclpa~ity of Anchorage Development Services Department (OSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
e,gineer regi.~tered In the Slate of Alaska. Certificates of Heallh Authority Approval are required for the transfer of
title (except between spouses) for propedies served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Cedilicales of Health Authority Approval are
valid for 90 dnys from the date of issue for propedies served by a private or Class C well and may be reissued with
n~.w waler sample results less lhan 30 days old. (Cedi[icates may be reissued for a period of up to one year wilh
vnlid water snmples.) Certificates are valid i'or one year for propedies served by Class A or B wells or a public
water system. The Municipality of Anchorage Is not responsible for errors or omissions tn the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
o
As certified by my seal affixed herelo and as of thb validation dale shown below, I verify Ihat my Invest~ga{ioh,
based on procedures ouUined in the Heatlh Au{horily Approval Guldelines for this applicaUon, shows Ihat Ihe
on-site wa~er supply and/or wastewater disposal sy{terd Is(are) safe, functional and adequate for the number of
bedrooms and type of structure Indicated herein. I [urfller verify thai based on the Information oblalned from the
Municipality of Anchorage files and from my Invesfigallon and Inspection, Ihe on-site water supply and/or
wastewaler disposal system Is(are) In compliance Wilh all applicable Municipal and State codes, ordinances.
and regulations In effect at the time o[ Installation.
~ & $' t-NGiN£~.RING
Name of Firm !TnqZ~ I=~,?le Riv~ Lo~3 Road No. 2
Address Eagle River, Alaska 99577
Engineer's Prinled Name ~/~4..e;" C_ Co~4,,./
DSD SIGNATURE
~ Approved [or ~
Disapproved.
Conditional approval for
Phone
Date
~....=..~:~...~ .~....,~
bedrooms.
,~,, .' .......
bedrooms, with Ihe following stipulations:
~ t WASTEWATER :
Additional Comments
Attachments:
HAA Checklist
Septic Sysiem Advisory
Well Flow Advisory
X
Maintenance Agreements
SUpplemental Engineer's Report
Other
Original Cedificate Date:
Municipality of Anchorage
Development Services Department
Budding Safety Division
On-SIta Water & Wastewatar Program
4700 South Bmgaw St.
P.O. Box 196650 Ancherage, AK 99519-6650
www.cLancherage.ak.us
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Descripflon: /--o 7' ~ 8coc,c 3. P/~;,e4~-7' ~T$ =~5",ParcellD: 015--13,.T'--I'~.
A. WELL DATA
Well type
Data completed
Total depth ~'o 0 fl.
Data of test
Static watar level
Well production
If A, B, er C provide PWSID #
FROM ~L L~
/o0
~ - ~ g.p.m.
We,
Wires properly protected ~N)
Casing height (above ground)
AT INSPECTION
IlO n,
/ o ~' g.p.m.
~ 3-4' in.
WATER SAMPLE RESULTS:
Coliform . O colonies/lo0 mi.
Date of sample: '~/~3'/o 3.
Nitrate 0. ~$~ mo J1.
Callectod by:
B. SEPTIC/HOLDING TANK DATA
TankType/Material $~.~r~ c. // .s
Tank size ~ ~- S"O gaJ. Number of Compartments '~'
Foundation cieanout {~) ~r~,~,~, Dep _r~__~on over tank (Y~ ~,O
Data of pumping ~/13/O*Tt... Pumper
Other bacteria O colonies/100 mi.
ENGINEERING
~ River, ~ls~ ~
cl~),
H~Gh ~t~ al~
Co
ABSORPTION FIELD DATA
Data installed h/~t/~ Solirating (g.p.d~lt~er~ II 7
Length ~ O fl. W~dlh "'% fl.
Total depth '7 ft. Eft. absmption area .Z/4~' ftz Monitoring tube
Data of adequacy tast N/,'J/o'J... ResuIts'J?~F ail)
Fluid depth in absorption field before test C/ in. Watar added~ ODe gal.
Elapsed Time: GO min. Final fluid depth ~ in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type 'T',~ e,,~
Gravel below pipe ~ ft.
Depression over field
For -,~ bedrooms
New depthS' ~'9 'in.
~ ~"0 g.p.d.
If yes, give date
D. UFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
on" level at in. "Pump off" lev~
Datum __ ~..----'"'-'-"~ycies tested Meets alarm & cimult requirements?
In.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot! O 0 -/'-
Absorption field on lot I O O -V---
Public sewer main
Sewer/septic service line
On adjacent lots / O 0 -/'--
On adjacent lots / ~ O ~ -~-
Public sewer manhele/deanout
Holding tank .
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /OD ~'- Property line ~'0 "+- Absorption field
Water main /'//4 Water seneca line /~) ¥' Surface water
Wells on adjacent lots / ~ O 'W-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
lO -~ Buildtngfoundation Ioo '/'- Watermain
Water Service line / o ~ Surface water /O O -~-
Cu~taindran.>,0~,l. ~,,,~v,~/ Wellaonadjacentlots. /04 ~
leo -/--
D~. pa~ing/vehide storage .-~
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inepect~ons 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 R bZ~- ~'. ~'O ~4~,,/
Date /'~/, 5-'/0 Z-
HAAFee $ ..~ '7~-.
Date of Payment
Receipt Number
(Rev. 12/00)
APR-O2-02 05:16PM FROM-CTIE ENVIRON~NTAL SRV
~ql~r~ CTIE Environmental Services Inc.
9075615301 T-376 P.02/03 F-l]?
CT&E Ref. N 1021~22001 Alt Dnt~'TImes are Alnska St~ ndml"d Time
Client ~Tlmc S & S Engin~'z~g Prlntc'l Date/Time 04/02J~002 ]6:*[1
Project l~lm~/N Prospect Ht~ #~ Colk~.'ted Dlte~J'lme 0:3~5~002 14:30
~fent ~ample lO LOt ~ Block ~. RecclvM Date/rime 03/2qA007 14:57
Matrix l~ing Water Technical Director Stephen C, ICde
Ordervd By Itel~sed By
PWSID 0
NitraTc-N 0.2S4 0,200 mB/L EPA 300.0 (<101
03/2S/02 JDT
Total Coliform 0
col/lOOmL SMI8 ~F222B (<11
03A~/O~ YAP
ONE¥
c/o
i
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# {;! ~- I'~ ~- ~.%
1. GENERAL INFORMATION
Complete legal description
Lot 4;
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Jane~ Mamiku;-~¢~
8101 Oney Circle
8101 Oney Circle
Anchoraqe, AK
Anchorage,
Day phone
AK 99516
Day phone
346-i121
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
XXX
If community well system, provide written confirmation from State ADE~ ~ttest-
lng to the legality and status of system. ~
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
XXX
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verifythat based on the information obtained from
the' Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and' State codes,
ordinances, and regulations in effect on the:date of this inspection.
$ &.5 ENGINEERING . Phone .~ q y .-- ;_~?.,7 ~
Name of Firm' ilo~4 F. agie River Loop ~pa~l No. 204.
Eagle River, Alaska 99577
Address -,
Engineer's signature ~-~/~'. ' ...... Date , /[9 /9 4-
DHHS SIGNATURE
Approved for -'~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date 2 -/ - ~'~
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
Legal Description: )~o T q
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERV[~g~.
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-4744
Health Authority Approval Checklist
BLoC~ ~ PRa~P~t'r ltCts ~ParcelI.D.: 01~
A. WELL DATA
Well type
Log present
Total depth
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed & [/(, / q' q
Cased to J ~ I ~
Casing height (above ground)
Sanitary seal (~)N) 7 £ 3'
Wires properly protected ~N) ¥£ 5
Date of test
FROM WELL LOG
~,/~ ~/~v
AT INSPECTION
Static water level
/
)1~
O.q5
Well production ~, ,5'- g.p.m.
WATER SAMPLE RESULTS:
Coliform O Nitrate
Date of sample: / / / ~ / ff C,
B.~I_~dHOLDING TANK DATA
Date installed ~!/~ /~ 3 Tank size
Other bacteria O
Collected by:
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
Number of Compartments & Cleanouts ~/N) Yg 5'
Foundation cleanout (Y/~}
Date installed It/'t /g'~ 3 Soil rating (g.p.d./fl2 o~/bdrm~
Length 8'0 Width '."5 Gravel thiclo~ess below pipe
Depression (Y~) /a 0 High water alarm (Y/I~) /v c~
System type
/
Total depth
Effective absorption area q 6 (o Monitoring Tube present~/N) ¥~ 3- Depression over field (Yff~ w 0
Date ofadequacy test / /lb' / c~ 6 Results~ail) /gd-.-f5 For ~ bedrooms
Fluid depth in absorption field before test (in.): ,fi- Immediately ,after 3)~,. gal. water added (in.): I ~
Fhfid depth Il '/~ .(ins.) Minutes later: / ~ ro Absorption rate = ht 5"0 "/- g.p.d.
Peroxide treatment (past 12 znonths) (Y/N) r,'c',,.,L ~,vc:w~ If yes. give date --
D. LIlT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cy~
Size in gallons ~
"Pump on" leve *.gl.a!..*-~--~ "Pump off' level at*
*Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
~lolding tank'~'''~
on lot / O 0 "~ : On adjacent lots
Absorption field on lot / 0 0 -'/- : On adjacent lots
Public sewer main ~ /,4 Public sewer manhole/cleanout
Server/septic service line /O ' -4- Lift station
SEPARATION DISTANCES FROM~OLDING TANK ON LOT TO:
Building foundation / o o 4- Property line / 1.9o -+- Absorption field 7, g-
;
Water main/service line /oo 4- Surfacewater/drainage /0o -/-- Wells on adjacent lots /0o /%-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
/ /
Building foundation J O o -+- Water main/service line /o 0 -/--
Surface water / o O + Driveway. parking/vehicle storage area / O o
Curtain drain Ne ,v,i, ~,~ o t,~,~V Wells on adjacent lots ] O 0 /q"- Property line
F. ENGINEER'S CERTIFICATION
I ceftin, that I have determined thrufield inspections and review 9fMunicipal records tha&~~ ~ are
in confomnance with ~OA H~ guidelin~ in effect on this date. .~}~Z:i..~2. .~.
/// ~ /
HAA Fee $ ~' ~ Waiver Fee $ '
Receipt Number / ~ ~~D Recei pt Number
Rev. 8/95 OSS: haa.wk.doc
01×16/96 09:48 COMMERCIAL TESTING
CT&E Environmental Services Inc,
CT&E R~f,#
Matrix
Cli~n~ 8ampl~ ID
~4 B~Kg PRO~p~CT~ZGH~ #5
Client Name $ & S ENGINEERING
Ordsrsd By R. COW~
Project Nam~
Project#
PWSID UA
~au~ple Remarks: HAMp~ COLLeCTeD BY: BOB C.
WORK Order 20650
Received Date 01/12/~6 ~ 1O;$0 hr~.
Technical Director 8TBPHEN C. EDE
Released By .~//~~
QC Allowable ~xt. ~lal
Parameter Results Qual Unica Method Limits Da~s Da~e Init
Nitrate-N 0.10 U mu/L EPA 353.2 10. 01/15/96 Sb~!.~
~ Sss Special Instructio~ Above UA g~avalla~J,e
'.' U - U~detec~ed, Reported val~e i, the practical quantlfloatloll limit. LT = L~ Than
: g - SeooDdary dilution. GT = Oreabo~ Than