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HomeMy WebLinkAboutSMITH TERRACE LT 19Smith Terrace Lot 19 #051-101-21 rNO Municipality of Anchorage Page __L of Z DEPARTMENT OF HEALTH AND HUMAN SERVICES ' ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: C)"5 1 1 D I Z Name ; Wastewater System: ❑ New ❑ Upgrade Ad -2-G ABSORPTION FIELD eAPhone: FO No. of Be rooms.eep Tre Sall rench ❑ Bed ❑ Mou ❑ Other LEGAL DESCRIPTION Soil Rating Total Depth lro riginal grade: GPD/S Ft Lot: Block: Subdivision Depth to p1pe bottom from original grade: Gravel pIn beneath pipe Ft Ft Township: Range: Section: Fill added above original grade: 6favel length: Ft WELL: ❑ New ❑ Upgrade Gravel width: Numberollines: Distance behreed lines: Ft Ft Ctaswftp n fPfwate, A.B.CY ��t//// Total Depth: Cased To: Total absorption area: Pipe material: Ft FI. SO Ft Driller: Date Drilled. Static Wale, Level: Installer: Date installed: Ft. Yield : Pump Set at: Casing Height Above Ground. TANK GPM Ft Ft. SEPARATION DISTANCES septic ❑Holding ❑S.T.E.P. To Sepuc Absorption Ut Holding '.bhc/Pnvate anufacturer:Tye Capacity In gallons - From Tana Field Station Tana Sewer Lines I r�% I ozo PL, W I I •� ..._ Maleria�.il:3. �.�_1� �, NumberQf Compartments: Surfac Waere 1�+ — �– ^ LIFT STATION Lot �• Size in gallons: Manufacturer: Line Foundation /_ ,/ 'Pump on" level at:"Pu level at: High water alarm at: CurtainO 1 t� Pump MaLeBM Electrical Inspections performed by: Drain Remark4—�/E p� �L�, BENCH MARK •� Location and Description: 1 N o� i t. r 'P-•EPo� o� '�F}� G •PT T•P n11L Ont l.r Assumed Elevation: I OZ Ft ENGINEER'S SEAL OF A 1 Gide 'y% �+ RINd t � Inspections performed b : 1Loss e.o►. River �P Ro.a�N 204 I�t P P Y �It�Z Q91m ....«... « -��—i3ates:ls Eapl� River, jFm_R J. 1AFER : W o�Q'N,A Department of Health and Human Services approval a No. 82 5 •2�� Reviewed and approved by:9ate:._'17 - 73-0t3 JR.. W911 MOA 25 Permit No: �lJPageof —� Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description:4*'117rm 4+ R2 i-�, � I9 PID No.: 42`5 1101 Z1 72-017 A (Rm. 9/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920272 DATE ISSUED: 9/08/92 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 9/08/93 OWNER NAME:HAYES DAVID A & OWNER ADDRESS:20508 CHAPEL DR CHUGIAK, AK 99567 PARCEL ID:05110121 LEGAL DESCRIPTION: SMITH TERRACE LT 19 LOT SIZE: 8720 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: r DATE• •� .F unici]pality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 10, 1992 Roger Shafer, P. E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lots 16 & 19 Smith Terrace S/D a Waiver Request #WR920047, PID #051-101-21, SW920i2-oZ A1- Dear Mr. Shafer: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are: a private well and the new septic tank of 80 feet on Lot 19; a private well and the existing seepage.pit of 92 feet of Lot 19; and, a private well on Lot 19 and the septic tank on Lot 17 of 75 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, / / ''���C� �4/ Robert W. Robinson Civil Engineer On-site Services ljm:#6 Concur: rJ m' h, P.E. m Manager On-site Services A - MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review worksheet WR# WR920047 PIN 051-101-21 HA# Permit Date Received: August 26, 1992 Legal Description: Lots 16/19 Smith Terrace Subdivision Engineer: Roger Shafer, P. E,. S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Applicant: David & Beverly Haves Waiver Requested: private well and the new septic tank and seepage pit at 80 ft and 92 ft. also between the wel serving the referenced property and the septic tank on Lot 17 `)>i Criteria: 1. Geology: Points A. Water Table B. Soil Sorption C. Permeability A D. Water Table Gradient 2 9 E. Horizontal Separation '41 TOTAL:��'� 2. Special Conditions: 3. Other: Waiver is Granted: List Conditions or Reasons for Waiver As NOT Granted: Rec #: 23987 Amount: $ 590.00 Date Paid: August 26, 1992 A 11tC\ a� j• s 0 August 25, 1992 ROBERT SHAFER. P ROGER SHAFER. P.E. CIVIL ENGINEERS (90716942979 FAX 6941211 HEALTH AUTHORITY APPROVALS Muni.ci.pa.tity o6 Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stteet P.O. Boz 196650 SEWER&WATER Anchotage, A£a6ka 99519-6650 MAIN EXTENSIONS REFERENCE: Lots 16 8 19; Smith Terrace Subdivision; Request you issue a pertmit to reptace a septic tank and grant waivexs SEWER&WATER bon the horizontaC zepatation distance between a pxivate weU and the INSPECTION new septic tank and existing seepage pit at 80 it., and 92 6t.I betoeen the Ywpective.ly., Aho requeated is a waivex boa the distance weU serving the re6erenced pnopexty and the septic tank on the adjacent Lot 17 at h5 6t: ENGINEERING MArS STVDIES AND REPORT$ The septic system waving the xe6exenced property also enetoachea upon a Cta64 'C' ura tocated on Lot 18.. These wai.vexa have been obtained Jrom the State Depatftent o6 EnviAonmentat Con6envation (DEC). Ptease re6et to out .fetter dated August 4, 1992 with attached zupptementat WELL INSPECTION ,i,n6o4mati.on and the DEC aesponse tetter dated August 21, 1992.. & FLOW TEST 16 you have any questions of %equine additional in6otmatoin Jot your review,pfease contact us.. SITE PLANS Sincetefy, ROAD DESIGN ROGER J.._ SHAF R, P.E. RJS ggm ATTACHMENTS SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 WALTER J. H/CKEL, GOVERNOR RECEIVED DEPT. OF ENVIRONMENTAL CONSERT#ATION ! AUG 2 41992 ANCHORAGE DISTRICT OFFICE J 800 E. DIMOND BLVD., SUITE 3-470 Dept-1 ealth& Human Seryof ices ANCHORAGE, ALASKA 99515 August 21, 1992 Mr. Roger J. Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Eagle River, AK 99577 Subject: Lots 16 & 19, Smith Terrace Subdivision, Chugiak, Alaska; ADEC Project Number 9321 -WV -005, Review Dear Mr. Shafer: This is in response to your submittal, received in this office on August 4, 1992, in which you requested four horizontal separation distance waivers. The first two requests cover the separation distances between the existing Class C Public Water System Source Well on Lot 18 and the proposed septic tank and existing soil absorption system from 150 feet to 115 feet and 132 feet, respectively. The second two requests cover the separation distances between the existing private well on Lot 19 and the proposed septic tank and existing soil absorption system. I have completed my review of the submitted information and this office's file on this subdivision. Based on this review, I have the following comments. Since separation distance waivers between the Class C Public Water System Source Well on Lot 18 and the existing septic tank and soil absorption system on Lots 16 & 19 were granted by this Department on November 20, 1986. The separation distance waivers granted in 1986 between the Class C Public Water System Source Well on Lot 18 and the components of the wastewater disposal system on Lots 16 & 19 are still valid, as long as the following requirements are followed during the installation of the proposed septic tank on Lots 16&19: Water tight couplings/joints are used during the installation of the septic tank. 2. The proposed septic tank will need to be cathodic protected and properly installed. 3. Verification that the above items have been addressed will need to be submitted to this office under the stamp of a Professional Engineer (P.E.). Roger J. Shafer 2 August 21, 1992 The other two horizontal separation distance waiver requests concern the separation distance between a private water system source well and the on -lot wastewater disposal system serving a single family home. At this time, the Municipality of Anchorage, Department of Health and Human Services, On -Lot Services handles all waiver requests regarding single family private water systems. I recommend that you contact them to discuss your separation distance waiver request. Thank you for your coordination with this Department. If you have any questions, please do not hesitate to contact me. Sincerely, �6e eL, Keven K. Kleweno District Engineer KKK/Cf cc: John Smith MOA, DHHS August 4, 1912 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVILENGINEERS (907) 694 FAX 694.1211 HEALTH AUTHORITY APPROVALS state o6 Atadka DEPARTMENT OF ENVIRONMENTAL CONSERVATION 800 East Dimond Blvd., Suite 3-470 Anchorage, Ataaka 99515 SEWER A WATER MAIN EXTENSIONS REFERENCE: Lots 16 1 19; Smith Terrace Subdivision Request you issue waivers boa the horizontal aeparation distances between a propoaed septic tank and a Ctaaa 'C' welt and a private welt at 115 6t. and 80 6t. respectively. We also request you .Lague waiveU SEWER {WATER INSPECTION bon the hotizontat aepaaatcon distance between an existing seepage pit and a Ctasa 'C' welt and a private welt at 132 6t. and 92 6t. neapectivety. ENGINEERING STUDIES The septic system aerving the ne6erenced property (the 3 bedroom house 116. Both AND REPORTS is Located on Lot 19 whereas the septic system is on Lots 19 tots are owned by the same people) was inatatted in August 1976. The in4taltation was inspected and approved by the Greater Anchorage Anea Borough, Department o6 Envikonmentat Quality. The private welt was WELLINSPECTION then drilled in Juty 1977. Although no date is Bated on the Ctaaa 'C' FLOW TEST welt tog, .it was apparently drilled around 1976. An adequacy test wza pe46ormed on the seepage pit and the results were aati46actory. In nepai.ri.ng the septic tank cteanout jot Heatth SITE PLANS Authority Approvat purpoaea, it was bound the existing bibergtaaa septic tank is o6 pooh integrity and in need o6 neptacement. During a waters and newer review .in 1986 jot Lots 17 1 18 (the Ctaaa 'C' welt being located on Lot 18) the tesaer aeparation distances were noted and ROADDESIGN approved by your o66ice in a tetter dated December 23, 1986 by Steve Eng. At this time we wish to only .install a new tank (thus, new waiver requeata) in the same location as the old tank. TheAe6ore, we ane only .improving the conditions which allowed the issuance o6 pr¢vioua wzivena. The juati6icationa jot the new waivets are the dame as jot SOIL TEST the existing waiveta. These include: 1. The wetta are relatively deep at 191 6t. and 220 6t. Welts at these depths ane rarely in6tuenced 6rom on-site septic systems. PERCOLATION TEST 2. The we.tL logs show several tayera o6 so4.t. Some o6 these tayera include hardpan. This atrati6ication o6 soita would help to alleviate the migration o6 septic e66tuent tocacnd and into the aqui6er• STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lots 16 t 19, Smith Terrace Subdivision; August 4, 1992 3. The topography o6 the area .is such that all aut6ace flow, and pteaumably sub4ur6ace blow, would be ditected west. This is away jtom the wells which ate at a hdghet elevation. 4. The ao.ila .fog jot the .inatallat.ion o6 the te6etenced septic system shows a GM-S-itty Sandy Gtavel layer between 10jt. and 14 it. This denaet type of ao.i.f has a "put.i6y,i.ng" e6 ject on e66tuent as ejjluent pasaes through it. This would jutthet alleviate the poaaibit ty of contamination o6 the aqu.ijer. 5. In viewing the well logs, and as pointed out by Eagle Rivet Engineering Setvicea during the Claaa 'C' well wzivet review, the static watet levels in the wells ate above the depth at which the aqui6et was encountered. This is indicative o6 a conjined aqui6et. The con6ining layer would also nerve to alleviate the migration o6 e66luent toward the aqui6er. 6. Bactetialog.ical and nitrate aampting tesulta 6tom both wells show no bacteria and 4ati46actotily low leveU o6 nittates of 1.9 mg/t and 2.9 mg/l. With the issuance of the tequeated waivers we will apply to the Municipality o6 Anchorage, Depattment of Health I Human Services jot a peRmct to teplace the septic tank to serve the 4e6e4enced aingte family home. Ij you have any questions or requite additional in6otmation jot your review, please contact us. S.incetely, �\ ROGER J. SHAPER, P.E. RJS/gm ATTACHMENTS 6KO23IOPG218 .' DECLARATION OF EASEMENT FOR SEPTIC SYSTEM WHEREAS, DAVID AND BEVERLY HAYES A(HEREINAFTER HAYES) ARE THE OWNERS IN FEE OF LOTS SIXTEEN (16) AND NINETEEN (19), SMITH TERRACE SUBDIVISION, ACCORDING TO THE OFFICIAL PLAT THEREOF, FILED UNDER PLAT NUMBER 63-69, RECORDS OF THE ANCHORAGE RECORDING DIS RICT, THIRD JUDICIAL DISTRICT, STATE OF ALASKA --- COMMONLY KNOWN AS0508 CHAPEL DRIVE, CHUGIAK, ALASKA 99567; AND WHEREAS, THERE EXISTS PARTIALLY ON LOT 16 A SEPTIC SYSTEM AND RELATED APPARATUS OWNED BY HAYES, WHICH PRESENTLY SERVES LOT 19; AND WHEREAS, HAYES DESIRES TO ASSURE THE CONTINUITY OF SEPTIC SERVICE TO LOT 19. NOW, THEREFORE, HAYES DECLARES AND COVENANTS AS FOLLOWS: 1. THERE IS HEREBY ESTABLISHED AND RESERVED, FOR THE BENEFIT OF LOT 19, SMITH TERRACE SUBDIVISION, ACCORDING TO PLAT 63-69, RECORDS OF THE ANCHORAGE RECORDING DISTRICT, STATE OF ALASKA, AN EASEMENT FOR THE USE AND MAINTENANCE OF THE PRESENTLY EXISTING SEPTIC SYSTEM WHICH IS LOCATED PARTIALLY ON LOT 16 AND WHICH SERVICES THE PROPERTY ON LOT 19. 2. SAID LOT 19 SEPTIC SYSTEM IS LOCATED AS DEPICTED ON THE SITE PLAN DATED 7-28-92, WHICH IS ATTACHED HERETO AS EXHIBIT A. THE WITHIN ESTABLISHED EASEMENT IS INTENDED TO PROVIDE REASONABLE ACCESS IN, T0, AND AROUND THE PRESENTLY EXISTING SYSTEM, AS WELL AS ANY FURTHER CONFIGURATION OF A NECESSARY REPLACEMENT SEPTIC SYSTEM, OR ANY PORTION THEREOF, WHICH IS LOCATED ON LOT 16 AND IS SERVING LOT 19. THE PURPOSE OF SAID EASEMENT IS FOR THE USE AND MAINTENANCE OF ANY SAID SEPTIC SYSTEM. 3. THE SAID EASEMENT SHALL RUN WITH THE LAND AND SHALL BE BINDING UPON THE OWNERS OF LOT 16, FOR SO LONG AS THE LOT 16 SEPTIC GREATER ANCHORAGE AREA BORuJGH • ��� Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 SPECTION REPORT ON-SITE SEWAGE DISPOSAL SY NAMZEyo Zd MAILING ADDRESS S LOCz / �: L DESCRIPTION SEPTIC TANK: =2-13 ,.I DISTANCE �/_ NUMBER OF Z_ FROM WELL{//////,,,,,,������������pppppp��yy��....,,,,,,����� MANUFACTURER 4 MATERIAL COMPARTMENTS V V / INSIDE LENGTH___ __ INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY_e"Lo GALLONS. SEEPAGE PIT: / PlAf / NUMBER OF PITS / DIAMETEg OR WIDTH �� LENGTA DEPTH �Z LINING MATERIA �' t&-0-0 ^^`� B SIZE: 71 11 DIAMETER—DEPTH— DISTANCE FROM: WELL i TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA1 °117SQ. FT. ADDITIONAL ABSORPTION WELL: � p TYPE — CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL , OTHER SOURCES NEAREST SEWER LINE APPROVED DISAPPROVED REMAR DISTANCES: INSTALLED BY: rM' PIPE MATERIAL: LOT SLOPE: REMARKS: Fo•m No. EO -031 DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK , SYSTEM_ DIAGRAM OF SYSTEM Feli � �'71f i sr it DATE 010 It(' APPROVED 0A,, V " 1 T\P G.A.A.B. V r-1 U r+i I 1::�L I -r O F F -i -4 C, F<: FI G E 3 DEPARTMENT- H HEALTH AND ENVIRONMENTAL� 'POTECTION 76 2515 E: TUDOR RD. , ANCHORAGE, Ak:. 507 c^ 276 WELL F1r-jr C�tJ—� I TE .•EWER: PERM I T PERMIT 140. C 76455 )na-_n-_ `— �. �� A J 77i�: /1 n APPLICANT DAVID HA'�F4 LOCATION MILE 21.5 GLENN HWY LEGAL L19 5112TH TERRACE SUB SR BX 7110 CH.IGIAK 99567 LOT SIZE 8795 TYPE OF SOIL ABSORBTIOH SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 132 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF•-J-H= ::LID L_Et-41C3-r 1= =3: CiF-:F-0.'EL ©EF='TH= 5=• 7 THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN 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 CIN FEET). F<:E� •l J I F EC• S~EF'T I C TFJt-,JFC 0I== 1 4=ICICy 13RLLC-jr-4S BACKFILLING OF ANY SYSTEM 14ITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT I -JILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSUP.E PROPER INSTALLATION. F'EF -'M I T '+'FiL I C• F'CJFZ O"E 'r'EFiF? Ff20M I'c11 1E I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I l•IILL INSTALL THE SYSTEM IN ACCORDANCE 141TH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY. REQUIRE ENLARGEMENT IF THE . RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED : -6HA<YES------PNT DAUB 9 /l I SSUED BY-- '�/t ------ DATE -'.T=L --1 _ ---If 7 ,' (). L►1! II rte•!'.{ .I � 1',!-!. �.. r �� 4 ,.. - � �,I ` • ,r. :!'! '..'i . �! •1'' 'J'a'i -. ��r _. i .,. .i r. ..� ..,, :I .•. r.,l �.r 11.1 '.. �. { I r , •�"j Irk li'L�' �. ... n.,. ,I ' 4 :: 1, a - . t.l :._-.11.Ji '•i 'rl i i —_, _ .' _ � —, i'.. _':! .� >;, � —, i .. is .. i i• I I f , n '"•; ,;f�fi�� OJ �I V I:rLir i -rip j/::. I_.. •r .. � i 0 Et E GEO', CHNI CAL Et DEVEL,, PMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 6942774 or 66&2280 Russell Oyster Earl Gis 694-2774 SOIL LOG 668-2290 Soils Er Foundations Land Development Performed for: Name:�� :' . �oy �n tN S!� ss Tel. No. Mailing Address: X11(1 0 Legal Description:- L_.rt N`'\ o43� Depth (feet) Soil Characteristics �---��- — I Mme' S��.._t Y07S6•� W/2eo'cs 5Oa'6A�,�s 2 GLJ- SAor->y Ground Water Encountered: Yes No �If yes* what epth Proposed Installation: Seepage Pit Drain Field Comments: %'N uD A�rac�xa.c�,��z• y �r x Z� Performed by: Date: 7.S'.,,y Vh'76 3 / 4 6 7 tL) 8 1 b 9 G ►1S 10 GQ " Sc;:,9y G Aufi �VCo�sg►:� �O G.'� 1,2ra°fE�2 12 13 14 r / 15 16 Ground Water Encountered: Yes No �If yes* what epth Proposed Installation: Seepage Pit Drain Field Comments: %'N uD A�rac�xa.c�,��z• y �r x Z� Performed by: Date: 7.S'.,,y Vh'76 r ("SA -W DRILLING, INC. n DRILLING LOG Well Owner David Hayes Use of Well Dom. Location (address of: Township, Range, Section, if known; or di tance main road Lot 19 Smith Terrace, ftyrXS ULZR' Size wf .abing 61 , .il of Hole 220 !set Casod :o_ 21 A 5 feet Static water levet 1 b U ft. (ice) (below) land surface. Finish of well (check one) open end ( Xx); Screen ( 1: Perforated ( ). Describe screen or perforation N/A Well pumping test at 8 gallons per (Pti34+F) (minute) for l hours with.—I-0-0L. rx of drawdown from static level. Date of completion7/27/77 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 2 2 Tp 55 SS To 58 58 TO 174 174 To 190 190 TO 206 206 To 216 216 To 220 —TO- -TO- -TO- -TO- -TO- -TO- OTOTOTOTOTO NO— .TO Casing Casing stickup Silty gravel cobble Boulder Gravelly hardRaan. eo� Wet sand and grauel h enuing Heaving sand Gravelly hard pan Water sand and gravel . .. ll't Cr.l•• 1 . !•....if ' rl n I — CUSTOMER r CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561.5301 INALISIS RESULTS for INVOICE t 55728 Chenlab Raf.t 92.3391 Sample t 1 Natri:: NATER Client Sample ID : L19 SMITH TERRACE Client Nava :S 6 S LN,^.INEERINO Client lect :SNSENOP PWSID : OA spot Pot :NONE RECEIVED Collected : JUL 9 92 4 14:00 hrs. Re9t ' Received : JUL 10 92 4 14:15 his. Ordered Iy :I. SNIPER Pia aved with ; AS RIQCIRED Analysis Completed : JUL 13 92 Send Reports to: Laboratory Supervlsox ' STEPHEN C. RDE 1)S G S ENGINEERING Released By :�7 2) ......................................................- ............................................. Parameter Results Units method Allowable Limits NITRITE -N 1.9 107/1 EPA 353.2 SO Sample ROUTINE SINPLt COLLECTED IT: III. Remarks: ............................................................................................ 1 Tate Performed Sea Special Instructions lbon UA -Unavailable NO. Nona Detected " See Sample Ramaxks Above NA. Not Analyzed LT -Las Than. GI-Gxsetet Than rONSGS Member of the SGS Group (Socidtd Gdndrale de Surveillance) I l CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING 3 ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FAX: (907) 561.5301 1NALTSIS RESULIS for I170ICE 1 55728 Chanlab Ref.1 92.3391 Sample 1 3 Matrix: WATER Chant Sample ID : LO13 17 AND 18 SMITH TERRACE Client Kane :S 6 S ENGINEERING PWSID : O1 Client lcct :SNSENGP Collected JUL 9 92 / 14:20 his. DPOt a POt :NO1tt RECEIVED Received JUL 10 92 1 14:IS hrs. Re91 : Preserved with : 13 REQUIRED Ordered 1y :R. SHIIER lnalysls Completed : JUL 13 92 Sand Reports to: Laboratory Supervisor : STEPHEN C. EDE 1)S 6 S ENGINEERING Released 1y "-'.............."--............"......----...............................................-"-....................---............ Parameter Results Unite Method plowable Limits NI2A1IE-N 2.9 sq/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED DT: 112. Remarks: ............................................................................................ . 1 Toots Performed See Special Instructions lbove UA -Unavailable NO- None Detected See Sample Remarks Above N1- Not lnalyzed L2 -Len Than, CI -Greater Than %BGS Member of the SGS Group (Socidt9 Gdndrale de Surveillance) ROBERT A. SHAFER CIVILENOINEER 6912979 DATEOFTEST: '7'14'12 - LOCATION OF WELL (Legal Description): _U m 12 S M 1 T#A 'I"F_Re.art E '-k WELLDEPTH: ZZo' FT. CASINO: 2-1 U-5 FT. SCREEN: DATE DRILLING COMPLETED: STATIC WATER LEVEL (Top of Casing): 1 ti l,1 FT DRILLER: M' W DATE: '7 -IA -97— CLOCK 92 CLOCK TIME ELAPSED TIME SINCE PUMPINGR STOPPEDPPEID,,MIN.N. DEPTHTO DRAWDOWN/ WATER,FT. RECOVERY PUMPING RATE,OPM REMARKS !i 0 1L.1.� (SWI) 0 0 Start R -t- 1 ..i FJLI,— t 10 15 20 25 30 35 40 45 Z'v5 50 0' 22 ' S. q 55 60 (1 hour) 90 120 (2 hours) 015' 2z ' S. 4 150 180 (3 hours) 210 ;) 240(shours) job, Z2' s, RECOVERY t 0 p 6 10 is 20 25 30 35 Comments: \ fst.t. pp'oo oe,fs h Kr -1 of 7,9 GI/M Flow Is not Guaranteed Subsequent Variations Can Ociur. AUCHORAGENESTERN DISTRICT OFFICE 437 'E' STREET, SUITE 303 ANCHORAGE. ALASKA 99501 November 20. 1986 Eagle River Engineering Services P.O. Box 773294 Eagle River, Alaska 99577 274-2533 SUBJECT: Waiver Horizontal Separation between Well and Septic Systems. Lots 17 E 18, Smith Terrace Subdivision, Chugiak, Alaska (8721 -WA -033) Dear Sir: The Department has re -reviewed the subject waiver request and hereby conditionally waives the horizontal separation between well and septic systems to the following: 1. On -lot septic tank: 95 feet. 2. On -lot drain field: 125 feet. 3. Off -lot septic tank: 115 feet (Lot 19) 4. Off -lot drain field: 132 feet (Lot 19) Conditional approval is given upon required engineered verification of septtankateV4ty and submittal of a current coliform acteriological water test. The waiver will be only valid for a 6 bedroom multi -family ` i � residence. Upon receivins the required information, we may then issue a 'Certificate of Operation for the water system. If you have any questions, please contact me at our Anchorage/Western District Office. Sincerely, c IP. Lewis Environmental Engineer MPL:caa 007922 ANCHORAGE/WESTERN DISTRICT OFFICE 437 ' E' STREET. SUITE 303 ANCHORAGE. ALASKA 99501 December 23P 1986 Mr, Lou Butera. PE Eagle River Engineering Services. Inc. PO Box 773294 Eagle Rivers Alaska 99577 SUBJECT: Lots 17 Q 18. SMITH TERRACED Chugiak 8721—UA-033 & 8721—DA-091 Dear Mr. Butera: 274-2533 The Department has reviewed the Engineer As—built plans for the subject project. Final approval is hereby given for the sewer and water systems. The waiver distances from our November 20. 1986 letter are enclosed. Any future expansion of the subject project will require additional approval from this office. Sincerely. 1�f St van W. EnOPE District Engineer SWEtpkk ENCLOSURE .. 007915 MUNICIPALITY OF ANCHORAGE e1 MIAUgPAtIlY OF UCPARTMENT OF ENVIRONMENTAL OUALII It ANCHORtG DEPT. OF HEALTH 2 3330 "C" Street, Anchorage, Alaska 99503 — 274-4561 i1JVl RONMENTAL N&OTECTp OrJ AUG 2 6 1977 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES R C [C CC It D . 1. Type of Inspection: CMRO VA FHA CONV X 2. Property Owner: David A. Hayes and Beverly E. Hayes, husband and wife Mailing Address: SR Box 7110, Chugiak, AK 99567 Day Phone 688-2197 3. Name of Buyer: Same (Refinance) Mailing Address: Day Phone 4. Name of Lending Institution: 1st National Bank of Anchorage Mailing Address: P.O. Box 720 Anchorage, AK 99510 Phone 276-6300 Ext. 561 5. Name of Realtor or Agent: N/A Mailing Address: -Phone 6. Legal Description: Lot 19 Smith Terrace S/D Location: KHN Chapel Drive, Chugiak, Alaska 99567 7. Type of Facility to be inspected: Single Family Residence No. Bdrms. 2 8. Water Supply Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation Eaa37 anal I Paye Two n Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities, Legal Description: Lot 19 Smith Terrace Subdivision Comments: Affadavit Attached: ( ) .7`., 'Approved: Disapproved: Department Worksheet: Letter Attached: ( ) Date: 9— �c3 — % Date: MUNICIPALITY OF AN ANCHORAGE DEPARThi� ���� �• s OF HEALTH AND ENVIRONMEI")L PROTECTION 825 L Street, Anchorage, Alasfia 99501 J n (� a` 279-2511, ext. 224 or 225 f� V Date Received: August 29.x1977 #1: Time #2: #2: Time #3: Time Date Q_Q--)-1 Ok"nS. Date Date Insp Insp Insp — REQUEST FOR APPROVAL OF INDIVIDUAL.SEWER AND WATER FACILITIES 1 Lending Institution Request: First National BAnk of Anchorage Mailing Address: Post Office Box 720 99510 Phone: 276-6300/561 2. Property Owner: David A./Beverly E. Hayes Phone: 688-2197 Nailing Address: Star Route Box 7110 99567 3. Legal Description: Lota 19 Smith Terrace Subdivision 4: Single Femily Residence: (x) Number of Bedrooms: Two Piultiple Family Residence: ( ) Number of Bedrooms: 5. 4le11 System: Individual Well (x) Community/Public System ( ) Permit # Construction Depth of Well 0 Well Log on File ( ) Bacterial Analysis 6. Sewage Disposal System: On-site System ( ) ????Public Utility ( ) Permit # Installed —5 - Installer Septic Tank Size lee"n Manufacturer Absorption Area efioils Rate Material I 7. Distances: Well to Septic Tank to Absorption Area _ to Sewer Line to Nearest Lot Line Nearest Lot line Absorption Area Municipality of Anchorage ,,� .�,• !� Development Services Department Building Safety Division On -Site Water and Wastewater Program 5 • ... 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ei.anchorage.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. XZ- io- iai HAA# nSGt�f�- Expiration Date: 8 !47 S 1. GENERAL INFORMATION' Complete legal description Ifue-- --- Location (site address or directions) Current Property owner(s) a a Tz:er� Mailing address ;w Lending agency Day phone &Fq- f707 Day phone Mailing address i:•:///�.,�"..� a;,il�ra�tc) Day phone sG.z Real Estate Agent Mailing Address ___,1�v/%r {�nz 3�Oi n kr 00Lr 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 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 al are ran equventfpr rofessional the transfer civit engineer registered in the State of Alaska. Certificates of Health Authority App title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water ao supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval 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.) served by Class A or B wells or a public water system. The Certificates are valid for one year for properties Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: Individual On-site ,Er ❑ 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 al are ran equventfpr rofessional the transfer civit engineer registered in the State of Alaska. Certificates of Health Authority App title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water ao supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval 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.) served by Class A or B wells or a public water system. The Certificates are valid for one year for properties 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, 1 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 Eagle River Engineering Sefvioes Phone logy — 5*/9S 10421 VFW , Sdta 201 Address _Eagle River AKQg= Engineer's Printed Name ,2. 1,wep 5. DSD SIGNATURE _V**' Approved for .3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other BY: l 11 `��L Original Certificate Date: (Rw. 01,02) 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 HEALTH AUTHORITY APPROVAL CHECKLIST '//J Tnn,r—�!� � [ilfiBrr /�/ Parcel ID: Legal Description: cr A. WELL DATA Well type JJ711a If A. B, or C provide PWSID # _ Well Log (9N) Date completed 2,1.2-7/7 7 Sanitary seal O/N) fJ(- Wires properly protected 01N) Total depth eft. Cased to 1/6.6 ft. 00 Casing height (above ground) min. FROM WELL LOG Date of test 7 7 Z r Static water level Well production 8 9 P.M. WATER SAMPLE RESULTS: Coliform _j2' coloniWl DO ml. Arsenic: R Q mg./I. Nitrate -J.-D mg./l. Date of sample: B. SEPTICS TANK DATA Tank Type/Material / w� Tank size 4_ga gal. Number of Compartments ,2 AT INSPECTION 05' //0 7 ft. /!.7 g.p.m. Other bacteria colonies/100 ml. Collected by: ✓Dlf.✓ lmzngR/ Date installed Cleanouts 61N) VZ d (�,� High water alarm (Yu Foundation cleanout bi/N)'ii'— Depression over tank (Y(I�j �' 9 Date of pumping AL'f�� Pumper C. ABSORPTION FIELD DATA Date installed 2ZIEZ-1(o Soil rating opp3jne or ft2/bdrm)_2- System type Length .26 ft. Width /a ft. Gravel below pipe IF ft. Total depth 1Q_ ft. Eft. absorption area i_ft2 Monftoring tube Depression over field �%- Date of adequacy test �214i(&5— Results 143%Fail)p�-v For �_ bedrooms Fluid depth in absorption field before test a in. Water added,$ gal. New depths in. Elapsed Time: [j96' min. Final fluid depth 00 in. Absorption rate >= S93 g p d• Any rejuvenation treatment (past 12 mo.) (Y(9 & type) Y%B If yes, give date T— D. LIFT STATION Date installed 'Pump on" level at _ in. E. SEPARATION DISTANCES Size in gallons 'Pump ofP�l yELaf—� Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanker on lot .FO r Absorption field on lot 9,2 Public sewer main Sewer /septic service line Z S SEPARATION DISTANCES FROM SEPTIC r Building foundation Q Property line _g High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 7E r On adjacent lots le)674 Public sewer manhole/cleanout / 00 { Holding tank 10,04 ON LOT TO: Absorption field (8 / Water main _ 1,00-o' Water service line t Surface water r 0U r Wells on adjacent lots //7 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation /0 r Water main 1/4 - Water Service fine /O f Surface water /00 t Driveway, parking/vehicle storage /04 Curtain drain S0'0Wells on adjacent lots /I I , n on a known F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that l 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. Engineer's Printed Name C 1 r7DPf/6e ,F LV01 h Date 3.403./ .4-6- HAA 5 HAA Fee 5 `f -*)' 111) Waiver Fee $ _ Date of Payment J// /&G T Date of Payment Receipt Number /c q Sqd Receipt Number (Rev. 12/01) " 4at 0 io fir/LTY fS/�y1• �YB� s9 k/ ego. U FEZ"F�r7�/fiP7�'if�. f��GZ••f ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALEi/�slo I �%,� FOLLOWING DESCRIBED PROPERTY= OF At +% sirirrirE,r r9�E fug Cor /9 DATE= i P(� , ..... , �S b AND THAT NO FNCROACHMEISTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDi or eI / EASEMENTS, COVENANTS, OR RESTRICTIONS • Hy//,� r9 ���.v�' WHICH DO NOT APPEAR ON THE RECORDED SUBDI-. Duen, Merk Sw,rA VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB` B�ZB f` . 15-5916 •• `�•� ANY DATA HEREON BE USED FOR CONSTRUCTION iqr ' • . AWN] OF FENCE LINES, OR FOR ESTABLISHING BOUND- DR ARY LINES. 2-08: 5:OOPM: :607 5815301 • 2/ e SCS ReLM 1050856001 Client Name Eagle River Engineering Project Name/# Smith Terrace Lot 19 Client Sample ID Smith Terrace Lot 19 Matrix Drinking Water Sample Remarks. All Dateslrlmes are Alaska Standard Time Printed Daterrime 03/0212005 14:44 Collected Datdrime 02/21/2005 15:15 Received Date/time 02/228 15:08 Technical Director / SteJpenA.Ede Results L Units Mcthod Container ID Allowable Prep Analysis Init Paramettr PR Limits Date Date Waters Department Nitrate -N 3.59 0.100 Microbiology Laboratory me/L EPA300.0 B (<-10) 0222105 XM Total Coliform 0 eoVI00mL SW09222B A (<-1) 02/22/05 DKC e Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcell.D. naHAA#l-to-113 Expiration Date: GENERAL INFORMATION Complete legal description Lot 19 Smith Terrace Subdivision Location (site address or directions) 20503 Chapel Drive Current Property owner(s) Mailing address Lending agency Mailing address David Hayes Day phone 20508 Chapel Drive, Chugiak, AK 9956 Day phone 688-2197 Real Estate Agent Remax/Carolyn Greiner Day phone 604-4200 Mailing Address 16600 centertipio` e o " Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well © Individual On-site Individual Water Storage ❑ Individual Holding Tank C Community Class Well [ Community On-site Public Water System C Public Sewer G The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an indepencent professional civil engineer registered in the State of Alaska. Certificates cf Health A.uthcrity Approval are required for the transfer of title (except between sccusesl on properties served by a single family cn-site wastewater disposal and.br water supply system. DHHS also issues HAAs uccn recuest to home owners. Certificates of Health Authority Approval are valid for 90 days from the gate cf issue for properties served by a private or Class C well and may be reissued with new water samcle results less than 30 days cld. Certificates are valid fcr one year fcr prcperies served by Class A or E wells c. a puciic Nater sv<_;em..:e blanic:pality of Anchorage is nct resccnsible fcr errors or omissions in the ,rciessicral encireer'S'Ncrk. "' -i ^. Cps• 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 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 in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S $ S ENGINEERING Name of Firm 17034 Eagle River Loep Road No. 204 Phone C 117 cl Address =510asxa , Engineer's Printed Name Robert C. Cowan Date 6. DHHS SIGNATURE RC3L.2T r =NA,y i Approved for bedrooms. Disapproved. Illi Conditional approval for bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Maintenance Agreements I Septic System Adviscry Supplemental Engineer's Report Well Flow Advisory Other Ey' '� �� ��'-`"�� Original Cenificate Date: Expiration Date _ .:e •P�� 11 c_ • I eissue Date: Municipality of Anchorage IcECEIVED • Department of Health and Human Services NOV 13 2000 Division of Environmental Services On -Site Services Section 825 `L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519.665WMCpAU y OF ANCHORAGE www.ci.anchorage.ak.us MMONA WALSERyMDrvism (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: GOTI y .5m / rH 1 -LAAGZ— 49 Parcel l.D.: OS/" /O/ —Z 1 A. WELL DATA Well type PaIV .TE-- Date completed 077 Total depth 2201 It "A, B, or C provid PWSID # = Sanitary seal /5 Cased to 40 +- It FROM WELL LOG Date of test —0'1— Static water level z82tt Well production 8.0 9 -p -m WATER SAMPLE RESULTS: Well Log S Wires properly protected Casing height (above ground) /- in. AT INSPECTION /b9 It 9 -p.m Coliform colonies/100 ml Nitrate a O - gb mg/I Other bacteria—0 colonies/100 ml Date of sample: /1&th Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material[ 'G"71c, Date installed ',� Tank size G2� gal Number of Compartments Cleanouts Foundation cleanout -4L— Depression over tank A.1c)_ High water alarm Date of pumping I l Pumper cTep 5 C. ABSORPTION FIELD DATA Date installed /9 Soil rating (g.p.d./ft2 0�) /3L System type6 Length �ft Width Z:=_ft Gravel below pipe ft Total depth _L�_;ft Effective absorption areajkLf12 Monitoring tube Depression over field AL Date of adequacy test / I44M-1 Results ail) eaA SS For 3 bedrooms � na Fluid depth in absorption field before test in Water added SZ4 gal. New depth� in. i Elapsed Time: min Final fluid depth 3 in Absorption rate >=46b 9-p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Ak,^ E /6/cW^/ If yes, give date -- 72 026 72026 (aw. 01,'00)' D. LIFT STATION Date installed p. Size in gallons Manhole/Access "Pump on" level at in "Pump ofP level at in High water alarm level at _ in varum Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot_ PO On adjacent lots -4- S Absorption field on lot q 2 1 On adjacent lots 147) /t - Public sewer main _I" ��_ Public sewer manhole%leanout Sewer /septic service line *05- F Holding tank _ /V 1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Buifdlhg foundation ''f' Property line 0 Absorption field S Water main ni A Water service line /D Surface water /oa '-r- Drainage -rDrainage S"y /r Wells on adjacent lots 1 _.ILS C'c.as� G o0\1 coT /8 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -4ey- Building foundation /0 1 4 Water main iV 1A Water Service line IO 1 f. Surface water /0U0 /a- Driveway, Parking/vehicle storage / o f Curtain drain AS 4VPWAI Wells on adjacent lotsl3Z I Ct_A ss C 6,-i LOT 1 & F. COMMENTS s>? G. ENGINEER'S CERTIFICATION Aq5 7- Lar I certify that I have determined through field inspections and review of Municipal ~` ' " •s¢r 4( NGI E records that the above systems are in conformance with MOA HAA guidelines in effect on this date. " Engineer's Printed Name IQ J 13 i R : C� wA� p` ` R08E1rI. L. CCN f� Date_ 1�1 13%oJ ++�,F;y CE-a�W :. t HAA Fee $ _ Waiver Fee $ i Date of Payment _ ' '�� I� �.. ' Date of Payment Receipt Number �.�9y'39 Receipt Number 72-048 (Rev. 01100)' .11-13-00 15:03 FROM -CTE ENVIRONMENTAL 5615301 T-580 P.02/03 F-944 cr&E Rtr# Client Name Project Name/H Client Sample ID Matrix Ordered By PWSID Sample Remarks: CT&E Environmental Services Inc. 1007112001 S & S Engineering L-19 Smith Terrace L-19 Smith Terrace Drinking Water N Client POM Printed Date/time 11/132000 14:32 Collected Daterrime 11/082000 16:50 Rcceived Date/time 11/092000 10:55 Technical Director St phcn C�E7/'� Released BY RR7 Allowable Prep Analysis Init Aesutts PCL Units Method Limits Date Date Parameter v tern Deoe� .hent 2.86 0.500 mP� CPA 300.0 10 max 1l/09/OU SCL llivate-N �chioloovoov Labora+'ory 0 coUl00mL SM1892228 ll/09/OU IDT Total Coliform