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HomeMy WebLinkAboutCHEROKEE RIDGE LT 4Cherokee Ridge Lot 4 #015-272-97 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT DEC 0 2 2015 Permit Number: OSP151267 PID Number: 015-272-97 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project. IN New ❑ Upgrade Name: White Raven Development, Inc. ABSORPTION FIELD M Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 12580 Old Seward Hwy. Anchorage, AK 99515 0 Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 .8 GPD/SF 10.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.8 Ft. Gravel depth beneath pipe 8 Ft. Subdivision Block Lot Cherokee Ridge 4 Fill added above original grade FL 1.5-2.5 Gravel length 60 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines Distance between lines Ft, SEPARATION DISTANCES TO Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 960 FP One Ft. well >100' >100' >100' >75' >25' TANK III Septic ❑ S.T.E.P. ❑ Holding 0Other Manufacturer Anchorage Tank Capacity 1,500 Gal. Surface water >100' >100' NA NA Material Number of compartments Lot Line >5' >10' NA NA Steel Two NA Foundation >5' >10' NA NA LIFT STATION Manufacturer Capacity Curtain Drain None I Noted cal. Remarks Pump on level at in. Pump off level at in. High water alar at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank D3034 drainfieldn d D 3034 White Raven Development, Inc. Drainfield F810 Conwr Inspector W. Roberts BENCH MARK (Assumed elevation) 100.0 ft Inspection in $�24/15'� $/24/15 U"'� dates: Location and description 2 s'" a Garage Slab COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp Conditional Approval: Date.•'•• OF Ik' •�! ......... a �••'z��/ .. ..... i MICHAEL E.4ANDER SON� `•QST, No. E- 381 Approved Gl/ Date�� a•+ ::+'••�• p U Q T z �$ o - .n N0o o LU q LUJ /00 ^ � N J o c m N oQ m 00 mfw.- (n ;.n 00� o` 00 00 Sw Q'� W� U Q T (D }— O 5LJ .TLLJ C .n N0o o LU W �4» a W O Wy3 J o O w a� ry W m c 00 G \/ �O c r RF ,00'09L 3„ X,0 L.00J m � o \ L 0 \ v \ \ m d \\ v a L` U 445 Q a � N co N IO7 o N n a' a (3) r RF ,00'09L 3„ X,0 L.00J m � o \ L 0 \ v \ \ m d \\ v a L` U 445 Q a � N J L Ic w E w N 0 w Iw to J;� M«SS,04.QON y it z W , a O � J J I I � C C N 7 O v MF- q) Z ?oLo°o ca X02 c Q Lw o c. 3 w L. Ln F W c.� ILLI W �oFYO QM F z Q J co `n IO7 e'd lb (3) 0 O J J L Ic w E w N 0 w Iw to J;� M«SS,04.QON y it z W , a O � J J I I � C C N 7 O v MF- q) Z ?oLo°o ca X02 c Q Lw o c. 3 w L. Ln F W c.� ILLI W �oFYO QM F z Q J e'd w m (3) z Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSPI61267 `f s .5 98.5 0)rMnUV 1,500 Tank v 2 Page 3 of 3 PID No. 015-272-97 � LO n 4-21-14 60' (Trench Length) 49th f ffA I. MICHAEL E. ANDERSON PROFILE AS -BUILT 3; Na. CE 4381 No Scale ���'''�:',�.'_; 93.1 M MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: PERFORMED FOR: DATE: . 8/24/15 PARCEL ID#: DEPTFT (feet) 1 OB/OG 2 3 4 5 6 7 8 9 10 11 12 13 16 17 18 19 20 PROJECT No.: TECHNICIAN: W. Roberts TEST HOLE 4A Silty GTavel with Sand GM/SM SITE PLAN See Site Plan t DATE No WAS GROTND WATER ENCOONITRF.D? C DEPTH TO LVATER (INCHES) IF YES r WITATD=11? 8/24 TEST HOLE PRESOAKED PRIOR TO TESTING: DEPTH OF WATER AFTER MONITORING: None DATE OF MONITORING: 9/15/15 DATE REAPING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO LVATER (INCHES) NET DROP (INCHES) 8/24 TEST HOLE PRESOAKED PRIOR TO TESTING: 110:13 0.75^ 2 10:43 30 3.00^ 2.25" 3 10:44 1.00° 4 1.0:45. 30 3.25° 2.251 5 10:46 0.75^ 6 11:16 30 3.00" 2.25" PERCOLATION RATE:13.3 (MLN/INCH) PERE. HOLE DTA. 6 (INCHES) TEST RIJN BHTWEEN: 4 FT. and_5_�FT. COMMENTS: TESTHOLE PRE SOAKED PRIOR TO TEST. TEST HOLE PLACED TO VERIFY SOILS FROM SUBDIVISION DEVELOPMENT. SOILS ENCOUNTERED ARE SIMILAR TO THOSE ANTICIPATED. SOIL LENSE (GM/SM) VVAS UNIFORM FULL DEPTH. TEST PERFORMED BY ANDERSON ENGINEERING. i, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 12/4/15 Alpine Drilling & Enterprises r { Well Log Permit Number. #SW 151267 Date of Issue: 8-6-15 Parcel Identification Number: 01527297000 Date Started: 9-09-15 Date Completed: 9-10-15' Is well located at approved permit location? x Yes ❑ No Legal Description: Cherokee Ridge Lot 4 Property Owner Name & Address: Hultquist Homes Inc 12580 Old Seward Highway Anchorace, Alaska 99515-3506 Borehole Data: Depth (ft) Method of Drilling x air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing type: steel Stick-up 0 2 Wall Thickness: .250 inches Organics & sill 2 3 Diameter: 6 inches Depth: 241 feet Liner Type: silt 3 4 Diameter: inches Depth: _ feet gravelly silt 4 18 Casing stickup above ground: 2 feet Static water level (from ground level): 152 feet cobbly gravel 18 34 silty cobbly gravel 34 60 Pumping level. --L35 feet after gravelly silt 60 96 2 hours pumping 20+ gpm Recovery Rate: 20+ gpm silty gravel 96 151 Method of Testing: airli Sill 151 159 Well Intake Opening Type: water sand & gravel 2 gpm 159 163 x Open End ❑ Open Hole sill ` 163 168El Screened Start_ feet Stopped _ feet ❑ Perforations Start — feet Stopped ? feet gravelly silt 168 180 Grout Tyne: bentonite granules Volume: sandy sill wet 180 235 tart 0 feet Stopped feet Pump: Intake Depth _ feet silty water sand & gravel 235 241 Pump size _ hp Brand Name Well Disinfected Upon Completion? x Yes ❑ No Method of Disinfection: chlorine tablets WATER QUALITY TESTING Comments: GDIi(orm bec C011100mL NIh ISS 1-6R MA Well Driller: Alpine Drilling&Enterprises Arsenio ND Ug/L PO Box 110496 Anchorage AK 99511 RECEIVED SEP 14 20th 07/30/2015 04:59 907-345-0202 ALPINE DRILLING Development Servlces Department Building Safety Division • On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Merkg69kh Anchorage, AK 99507 Mayor W WzMUrl.an/onsite (907}349-7904 Pump Installation Log Well Drilling Permit Number: SW +61287 Date of Issue: 8.6-16 Parcel identification Nombert616272970o PAGE 01/01 baD Legal Description Property Owner Name & Address: Chemkee Rklge Lot 4 HuRquiat HMM Inc 1269017ld SeWard HID" Anammae, Alaska 99615.3906 Pump Intal 2000 Date: iiM16 Pump Intake Depth Below Top of Well Casing. 297 feet Pump Manufacturer's Name: Gams Pomp Model: 108H10 Pomp Size + hp P itless Adapter Burial Depth: WA feet 19tless Adapter Manufacturer's Name: MA Pitless Adapter Installer. WA Well Dlstafeeted Upon Completion? V1 Yes No Method of Disinfection: Comments: Pump Installer Name: Aermv pomp a well serwce, LLc P.D.S 119496 Anchomge, AK 99611-0496 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. F dtiilSX+!�e� Permit Number: Tax Code Number: On -Site Water & Wastewater System Permit OSP151267 01527297000 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Work Type: WellSeptic Initial Permit Effective Dates: August 06, 2015 to August 05, 2016 Design Engineer: ANDERSON ENGINEERING Subdivision: CHEROKEE RIDGE Site Legal Address: CHEROKEE RIDGE LT 4 G:2635 Owner/Address: HULTQUIST HOMES INC 12580 OLD SEWARD HIGHWAY ANCHORAGE AK 995153506 Site Mailing Address: 11490 ELMORE RD, Anchorage Lot Size in Sq Ft: 57203 Total Bedrooms: 5 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: PRIOR TO CONSTRUCTION: A new test hole (USC visual classification, 7 -Day Groundwater elevation, Percolation test results) shall be completed to verify the design. Percolation testing shall be for all soil stratum used for absorption in the design. If required, an approved change order shall be issued prior to construction. The test hole results shall be submitted with the inspection report. Received B Issued By: S_ 1, MUNICIPALITY OF . Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE yam, Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-272-97 Property owner(s) Hultquist Homes, Inc. Day phone Mailing address 12580 Old Seward Highway Anchorage, AK 99515 Site address 11490 Elmore Road Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Cherokee Ridge, Lot 4 Legal description (Township, Range & Section) Lot Size 57,203 Sq. Ft. Number of Bedrooms Five (5) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial 0 Single Family (SF) Q (w/wo ADU) Septic Tank El Upgrade ❑ Duplex ❑ (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well n Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. WQ,j E (Signature of property owner or authorized agent) Permit/Rush Fees: 9A 12454- 4-16u Waiver Fees: Date of Payment: 81(PII'S Com+- Date of Payment: Receipt Number: (%3Ln Receipt Number: Permit No. O5P) 5I2*1 Waiver No. Permit App_9-1-12.doe August 5, 2015 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4, Cherokee Ridge Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer The owner of Lot 4, Cherokee Ridge Subdivision intends to construct a new five - bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new well and septic system to accommodate the home. The attached Site Plan and backup documentation identify the location and configuration of the proposed well and septic system along with the alternate site. Also identified on the plans are the existing wells in the area and septic systems on surrounding lots. No conflicts exist between the proposed septic system and well or septic systems and wells on adjacent lots. Drainage contours are shown on the site plan showing the grade and direction of flow on the lot. The drainage pattern will not be changed as a result of this project. The test hole placed on the lot in the area of the absorption trench and alternate site indicate silty gravel with sand (GM). The percolation rate of the soil was determined to be 11.9 minutes per inch. No groundwater was found during the placement of the test holes and. none was noted during the monitoring period. An application rate of .8 gallons per day per square foot was used in the design of the absorption system. We are proposing to place a new 1,500 -gallon Septic Tank and a 60' long by 3' wide by 8' effective depth absorption trench to treat and dispose of the effluent generated in the house. The elevation of the distribution line in the absorption trench will be 3' below the surface and the total depth will be 11'. A minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the absorption trench and 4' over the septic tank. The ground surface on the lot in the area of the septic system slopes to the northwest at a shallow grade with some cross sloping from the east. The new trench will be constructed parallel with the contours of the slope as much as possible in conformance Lot 4, Cherokee Ridge Subdivision August 5, 2015 Page Two with Municipal requirements. The new septic system will be constructed a minimum of 100' from all wells and any surface water and 10' the proposed and existing water services in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments 49th •�. MICHAEL E ANDERSON N O J ' 0 I\ I \c\ I I " IW I O w II I J J I m N N O F 1 11 1 1 m Q m W N oo< � W W W Y O Q W U 0 J N O J I GI Ln p J O J 4� 4� 0 O J p J N � li arrvuxaa •awn�r � — — a I a OVOb 3bOVM 3 aooa o,ewn\ _ \ mom, �.a.m o J II J J I INPI 1 0 I I J li I,r LJ I Is N O J ' 0 I\ I \c\ I I " IW I O w II I J J I m N N O F 1 11 1 1 m Q m W N oo< � W W W Y O Q W U 0 J N O J 0 lJ HAMli iii JO 00 09 L `3,�0u 1,005 O U y a v � D d w >O 73 O N U F tL WLjj r l o ® J O / ,•� l iii Q 3 �i 0 C -cc). ,,...'r ° v I m w . 1 \ N >wn 0 CDi II C^ x N I__L V/ v , C o Q o -\\ \ LLI N� I —� o 00 �� \I\ m 34 \ U 00co W N/ O OQ V (n V) O O O o z rn v^ O a �� J to J ` 3v «r t� w �a3rim- 3-� 3 9) t I m W n W ° o CN N N 3 _y IW `RC1 \ Z U m � W p ��♦ ��� �c ca , M,,99,9 1.00N • J O ' Z �• �- LOT 4, CHEROKEE RIDGE SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Five Bedroom Home Deep Trench System Pere. Rate: 11.9 Min./Inch 1,500 Gallon Septic Tank Application Rate: .8 GPD/SF 8' Drainfield Rock 5 Bedrooms X 150 GPD/.8 GPD/SF (Application Rate) = 937.5 SF Absorption Area 937.5 SF/16 SF/LF = 58.6 LF Trench Length THEREFORE: Construct 60' Long x 3' Wide x 8' Effective Depth Absorption Trench at the Location Shown. Flow Line Elevation in Trenches to be 3' Below Original Ground Surface. Total Depth to be 11' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Maintain 100' Separation from Wells in the Area. Natural Backfill 2'6" Geotextile Fabric 6„ O 4" Perforated PVC (Holes Down) LKII 3' -11 Drainfield Rock TYPICAL DEEP TRENCH SECTION -- OF (NO SCALE) p�p-............ q( •� NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock.�..; 49th :.. Minimum 4' Separation From Groundwater. �................. .....:. Minimum 100' Separation From Wells in the Area. MICHAEL E. ANnn�oeasoN Minimum 100' Separation From Surface Water or Streams. #U-11\ No. CE -0 81 ,.: 7 8 9 t0 ON SILTY SANDS 11 sM AND GRAVELS 12 TEST HOLE 4 NONE' 1 OR ORGANICS 2 jolq-11y 140.4 13 3 12.25 TIGHT SILTY 7.61 3.09 GRAVEL 4 GM 4.65 6 4 18 S 7.33 GRADUAL SOIL 8 12:59 INTERFACE 7 8 9 t0 ON SILTY SANDS 11 sM AND GRAVELS 12 MONITORING? NONE' 13 4/21/2014 S,is /IY 14 jolq-11y 140.4 13 2 12.25 16 7.61 3.09 W 12:26 4.65 BOH 4 18 30 MIN 7.33 DATE PERFORMED: 4114114 49TH .MICHAEL E. AND )sf , CE 4381 #'ceF" :,(-I) SOILS LOG - PERCOLATION TEST SLOPE x TH vvro unuuZ VVA I en ENCOUNTERED? N IFYES, AT WHAT DEPTH? NONE' DEPTH TO WATER AFTER MONITORING? NONE' DATE: 4/21/2014 S,is /IY A�l1{ool jolq-11y 140.4 SLOPE TH x READING DATE CLOCK NETTIME WATERTIME LEVEL READING NETOROP 1 4114/14 11:65 -- 4.52 -- 2 12.25 30 MIN 7.61 3.09 3 12:26 4.65 4 12:56 30 MIN 7.33 2.78 8 12:59 5.92 e 1:29 30 MIN 7.41 2.61 PEROLATION RATE 11.9 (minBnch) PERC HOLE DIAMETER 6lnche8 TEST RUN BETWEEN 5.6 FT AND 6.5 FT n. Prec hole Was presoaked. Perc test ran fnr at least 1.5 hours. Last three readings reported Bottom of Pere hole In GM/SM Test performed in representative soil. PERFORMED BY: Steven R. Pannone RE. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPPA�L�GTTUIDL77II�NEES THE DATE OF THIS TEST. NOTES: 7I�NT�E�FvFEf(C+TTTIlON PANNONE ENG UVC LLC PA. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 �'� p �tl r '�F' •" �:4S11t �*4Py*�,� v�•, $ 4a�n'node� 'f)dyf•,r/ ,�1 ��91oT590 J Dote 5�27�2014 FOR MOA REVIEW ONLY scaNTs PID 212 222 PERMli N0. x T12N R3W, SEC 21 N2SE4SE4NE4 BRIAN T. HARTEN$'teveCE ELMORE ANCHORAGE, AK 99516 SOILS LOG SheetOF 5 t 5, ,STATEMENT OF INSPECTION BY ENGINEER As certified by my eal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of. On-$fte 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 tiedrooms 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. Anderson En. ineerin Phone 522-7773 Name of Firm g g Address P.O. Box 240773 Anchorage, AK 99524 Michael E. Anderson, P.E. 11/30/2015 Engineer's Printed Name._ Date wo��E OF P S �e + y 49th 6. DSD SIGNATURE - r T�'t , - 0#.';T%.. 'MICHAELE ANDERSON System #'!.Approved for bedrooms +00. ^' System #2 Approved for bedrooms \f 410, t410, FESS% Disapproved Conditional approval for bedrooms, with the following stipulations: Or ��iiI�STT'� Gi =� WATER AND .WASTEWATER z , PROU iv, By: Original Certificate Date: - The Municipality of Anchor a Development Services DivWon­ (oSD) issues 'Certificates-of Onsite Systems Approval (COSA),.based _only upon the representations+.given in paragraph 5 by an. independent professional dvil 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 X Nitrate Advisory Septic System Advisory "' Arsenic.Advisory , Well Flow;Advisory. Other COSAMiesheet_f '. •� c:. _ N more than 1 septic system is on the lot COSA Checklist # of _ Structure served by this system Certificate of On. -bite Systems Approval Checklis# Legal Description: Cherokee Ridge, Lot 4 Parcel ID. 015-272-97 , A. WELL DATA Well type Private lf,A, B, or C provide PWSID # Well Log (Y/N) Y Date oompieted 9/•10/15 San• y tatted (Y!N) YY — 241 241 �N) Wiresroperly pro �1$ Total depth _ft Cased to ft Casingheight (above ground) in. FROM -WELL LOG AT INSPECTION ._Date of te:;f F1Of15 ' -Staff water level ft it WATER SAM�C 20 g.p.m:: g -P• E RESULTS. Coliform - 0 .. coionies1100 mL Nitrate mg/- � Arsenic ND uglL Date of sample: 11/19/15 Collected by: And.Engineering B SEPTIC/HOLDING TANk DATA Tank _ Type/Material Sep#C/Steel. Data installed $'/24f15.urrd' Tank size 1,500 gat. Number of cocrharanents.2 %^ -c7e06uts (YrN) Foundation cleanout (Y/N) Y Date of pumping New Const. C. ABSORPTION FIELD DATA Depression over tank (Y/Nj N High Water alarm (Y!N) N Pumper Date installed 8/24115 SoN rafin9 (g•P•d./itz or ft e/bdrrn) •8 GPDISF -systeDeep Trench m.type Length 60 ft. Width 3 ft travel below Pipe $, •� R. Total depth... 13,- ft. - Eff. absorption area 960 .��+ianrtcring tube Y.'" WprBssish over`fleld"N Date of adequacy test New Const. Results (PasslFarj) For _bedrooms, Fluid ddPth in absorption field before test in. Water added - gad. New depth Elapsed Time: min.' Final fluid depth in. Absorption rate x g.p.d. Any rejuvenation treatment (past 12 mo.) (Y!N &type) N If yes, give date D. LIFT STATION Data installed "Pump on" level at in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons Manhole/Access (Y/N) "Pump ofP level at in. High water alarm level at Cycles tested Septic tanknift station on lot >100' Absorption field on lot >100' Pubgo-sewer main >75' Sewer /septic service line >25' Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO Meets alarm & circuit requirements? in. On adjacent Tots >100' On adjacent lots >100' Public sewer manhole/cleanout >100, Holding tank >i Manura/animal excrete storage areas >100' Building foundation ` >5 property fine >5 Absorption field >5 Water main >10' Water service One >10' Surface water >1 d.0'` Wells on adjacent lots ABSORPTION FIELD ON LOTTO: � Property line >10, Building foundation >10' Water main N VAI. >I -Of Water Service fine>10' ;. Surface water >109 Drumaway: paddngly Ide storep Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Cosnbm" 10.10-12.doo G. ENGINEER'S CERTIFICATION I car* that 'l have determined through field inspections and review; of Municipal records that th@ above. systems are in iyi a.•�E confaran a with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anddis6n,'P.i=. Date 11 /30/2015 MICHAEL E. ANDERSON ..., •:{;,. O0, f�9 NO. CE -4381 Cosnbm" 10.10-12.doo o0V n w o 0 w n w ma om o� CD r a m _ �o � W �. c I 0 09 r 0 N00'15'55"W 165.11''^ m o a — — _..... .....` 4 A aZO DI Vm tl1 a V O X Ap�pW A� ml O O OA *�Cq I C m xmn ..w0 r 3 ' �partogsLA I Q N If "<a, m � nW,< fh I @a '` .4 VOR°a• CD 6 CAI O n» r co 4P a � m 000v� 'na 77 dp o orermm w ti .s. O v a t ^. a •p. +yam . •P. d F�mxm w R I s g t V) -M vol I 1 s Wmom PO V' Ul + o. I y C'F. Ry o0V n w o 0 w n w ma om o� CD r a m _ �o � W �. c I 0 o0V o� F 00 -L m ro �ovpx° ii SOQ'10'30"E 150..00' 0 r- 0 6 ,6'61• In CD 0 fD ..: N �P a 0 r 0 fv 15.08' N00'10'30"W 0 0 ioLM. m SGS Ref.# 1156810001 Client Name Anderson Engineering Project Name/# 11490 Elmore Road Client Sample 1D 11490 Elmore Road Matrix Drinking Water Sample Remarks: Parameter Results LOQ Metals by ICP/MS 11/24/15 11/24/15 EAB Arsenic ND 5.00 Waters Department 11/20/15 NEG Total Nitrate/Nitrite-N 1.69 0.100 Microbiology Laboratory E. Coli Negative 1 Total Coliform Negative 1 Printed Date/Time Collected Date/Time Received Date/Time Technical Director 11/25/2015 13:55 11/19/2015 13:50 11/19/2015 16:50 Stephen C. Ede Allowable Prep Analysis Units Method Container ID Limits Date Date [nit ug/L EP200.8 C (<10) 11/24/15 11/24/15 EAB mg/L SM21450ONO3-F B (<10) 11/20/15 NEG 100mL SM219223B A 100mL SM219223B A 11/19/15 MEV 11/19/15 WV