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Home My WebLink AboutBLUE SKIES ESTATES #1 LT 3Blue Skies states #1 Lot 3 #021-011-27 Municipality of Anchorage Page _ ~ of ~'~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Sile Waslewaler Disposal System and/or Well Inspeclion Report Permit Number: -~(-'"'J C~(::)00~ PID Number: .~m.: p~ ~V~ Waslewater System: ~New ~Upgrade Address: '~10~ ~l~ ~r. ~n~o~e.~ ?~J7 ABSORPTION FIELD iND. Gl Bedrooms: Phone: ~ -- ~.~ O ~ Deep Trench ~ShallowTrench ~ Bed ~ Mound O OU,er LEGAL DESCRIPTION S°ilRating: /.~ GP~/Sq. Ft. IT°taIDeplhfr°m°riginalgrade:~ Township: J Range: J Section: Fill added above original grade: Gravel length: WELL: ~ New ~ Upgrade Gravelwidth: ~ Numberoflines: ~Dista.cebelweealines: Classification (Private~A,B,C): ~ Total Depth: Cased To: Total absorption area: - Pipe maleriah brg er: . ~ ~ Date Drilled: Static Water Level: installer: ~ Date instaUed: ' : Casing Height Above G,ound: TAN K SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. To Septic Absorplio~ Lifl Holding Public/Prlva ManuJaolurer: Capacily Jn g8Jlons: From Ta,k Field Station Tank Sewer Lines ~''~'"~ ~'~ Well- ' l~t* I~''~ ~ ~ ~5'¢ Material: ~+;~1 NumberofCompartments:.~ Sudace Water I00'+ J~"+ ~ LIFT STATION Lot Fou,dat,o. ~0' I~' J "P"mP °n" level a ': ~'e~water alarm at: Remarks: ~,'~ _5'~'&~ ;-~/.9~Y BENCH MARK E ' [ Location and Description: S & S ENGINEERING 17034 Eagle River Loop Road~ NO, ~ f 2ndT-~7'-q~ Department of Health and Human ~ervmces approval PERMIT NO. S~W990043~ PAGE 2 OF 3 Plunicipatit oF AnchoraGe DEPARTMENT OF HEAl_TH AND HUIVTAN SERVICES ENVIRONMENTAl SERVICES DIVISION P.~. Box 196650 ~Anchopage, Alaska 995]9-6650~Te[ephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, BLUE SKIES ESTATES /fi P.I.D. NO. 021 -011 -27 LOT 2 \ \ \ \ LOT lA rBM ST1 CO1 1250 GALLON~' SEPTIC TANK ALT. DBL1 & DBL2 FD (FLOW DIVIDER) SCALE: 1" = 60' ROBERT C. COWAN CE-8801 ROBERT C. COWAN, P.E. SEWER&WATER INSPECTION WELLINSPECTION & FLOWTEST SOIL TEST PERCOLATION TEST ONSITE WASTEWATER C~SPOSALSYSTEM DESIGN January 14, 2000 Municipality of Anchorage Department of Health & Human Services~.:.~¢~:::- PO Box 196650 Anchorage, AK 99519 Attn: JeffPoet .. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Reference: Lot 3, Blue Skies Estates #1 Dear Mr. Poet, This letter will certify that the test hole locations relative to the trenches shown on the On-Site Wastewater Disposal System Inspection Report are correct. The discrepancy between the test hole locations on the as built and the original design document is the result of the locations on the design documents being in error. During construction the trenches were placed near the test holes as they existed in the field. If you require additional information, please contact us at 694-2979. Sincerely, RCC/skh :' :'~ :~ 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 PERMIT NO. SW990043 PAGE 2 OF 3 Municip. c[il oF AnchorcQe DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 OAmchon(lge, A[(lsk(i 99519-66500 Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, BLUE SKIES ESTATES #1 P.I.D. NO. 021 -011 -27 \ \ \ ACTUAL POSITION OF HOUSE .~/ & SEPTIC PIPES ARE // APPROXIMATE - WAITING ON // SURVEYOR'S AS-BUILT. ...~' \ \ \ \ 1250 GALLON SEPTIC TANK OBL1 & T2 FO (FLOW DIVIDEN)- SCALE: l" = 60' ]~NGINEER STAMP PERMIT NO. SW990043 PAGE 3 OF 3 unlclp, aUi oF Anchoraqe DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 eAnchor'o, ge, A~o. sko, 99519-6650 e Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, BLUE SKIES ESTATES #1 P.I.D. NO. 021-011-27 95.3' _/FINAL NEW 1250 GAL SEPTIC TANK GRADE ~INSULATION -90.3' C02 C03 C02 = 82 2' N R C03 82:2'L MT1 I ~ GRADE 2" INSULATI, "~H._dco2 = 79.2' 03 79.2' MT1 = 7%0' MT2 = 74.0' C04 C05 · NO WATER FOUND 68.0' B.O.H. A B FCO 37.5' 18.5' ST1 131.0' 126.5' ST2 139.0' 135.0' DBL1 149.0' 145.0' DBL2 150.0' 146.0' FD 213.0' 201.0' MT1 243.0' 235.0' MT2 250.0' 239.0' C01 102.0' 97.5! C02 213.0' 200.0' C03 245.0' 235.5' C04 225.0' 209.0' C05 250.0' 239.5' MT2 C04 = 80.0' = 79.4' C04 = 76.2' = 76.1' Oct 03 99 03:31p Peter Cuova Municipality ofAnchor. Department of Health and Human Services 825 "L" Stceet P.O. Box 196650 Anchorage, A~aska 99519-6550 Pick Mystrorn http://wv~v,ci.anchorage.ak,us Mayor Permit Number: #SW 990043 Date of Issue: 3-26-99 Date Started: 7-1~6-99 Date Completed: 7-16-99 Legal Deseriptiota: .B!ue SkiesE. states #f Lot 3 Property Owner Name & Address: Pete~eva 2104 Belair Drive Anchorage, Ak 99517 Borehole Data: Depth (ft) Soli Type, Thickness &'Water Strata From To Stick up 0 2 Weathered rock 2 9 9 245 Bedrock H20 200+ =Parcel Identification Number: 021-011-27 Is well located at approved permit location? [] Yes [] No [] cable tool Method of Drilling [] air rotary Casing type: steel Wall Thickness: .025 inches Diameter: _6 inches Depth: 2__0 feet Liner Type: Diameter:__ inches Depth: Casing stickup above ground: _2 feet Static water level (from ground level): 37 feet Pumping level: 245 feet niter. _2 hours pumping 4 gpm Recovery Rate: _4 gpm Method of.Testing: air lift feet Stopped feet Stopped __ feet Well Intake Opening Type: [] Open End [] Open Hole [] Screened Start__ feet [] Perforations Start__ feet Grout Type: bentonite Depth: Start_O feet Stopped__ Volume: 1 bag Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? [] Yes [] No Method of Disinfection: Alpine Drilling & Enterprises P.O. Box 110496 Anchorage, AK 99511 - . Comments: Well Driller: Attention: The well~gtet~o.~e4tan~ll log to the property owner~within 30 days ofcompletlon and the property 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 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date issued: Mar26, 1999 Expiration Date: Mar 25, 2000 Permit Number: SW990043 Legal Description: BLUE SKIES ESTATES #1 LT 3 Design Engineer: 0003 S & S Engineering Owner Name: Peter Cueva Owner Address: 2104 Belair Drive Anchorage, AK 99517- Pamel ID: 021-011-27 Site Address: Lot Size: 210830 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] 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. R[C IVEI ~i~l~.~rALH ¥ (JI~ AN~H~II~:~I~ ROBFRT C. COWAN, p.E. [[i",IVIRON~I~I'qT^k ,~R¥1¢1~$ DI¥1~I~N CIVIL ENGINEERS (907) 694~2079 FAX (907) 694-1211 March 16, 1999 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 3, Blue Skies Estates #1 Subdivison Request you issue a permit to install a septic system to serve the four bedroom dwelling on the referenced property, ENGINEERiNGST ANDREPORTS Two test holes were excavated and percolation tests performed. location of the test holes are located on the attached site plan. The approximate WELL INSPECTION &FLOW?EST At the time of excavation 9/3/98 water was not found. water monitoring the monitoring tube was dry., After seven days of ground We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any futm'e development on any of the adjacent prop erties. If you require additional information, please contact us. SOILTEST PERCO/AT[ON TEST Sincerely, Robert C. Cowan, P.E. RCC/rdp Enclosure STRUCTURAl.& MECHANICAL INSPECTIONS ONSITE WA.q TEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 ° EAGLE RIVER, ALASKA 99577 , SCALE DESIGN DETAIL oO~oo ?¼ o ~ L~j \ \ SITE PLAN DESIGN '1" = 100' SCALE / ,/ z ~ ,~o o~ ,/ Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST g 10 11 12 ~3- 14- 15 16 17. 18- 1 2 3 4- 5 6 7 Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop 1,'~ ~. 4- $ ,~ q. ~ ,~ fir. L-,~ s f TH/I./.., ~ ,~ / ,v / PERCOLATION RATE ~ ~ {minules/inch} PERC HOLE DIAMETER __ TEST RUN BETWEEN ~ '/2._ . FT AND . ~ '/z~ FT COMMENTS 51 ,~.V'~ J~ ~'Z. y J/.j/' p~ S & S ENGINEERING RFORMEDBY: .......... : ' ~''~ ~''~ CERTIFY THAT T~S TEST WAS PERFORMED ~/u~ ~ag~e ~Jver ~p Noad No 2~ ' - - / - ACCORDANCE W T A ~l 0 ~ / ~N~, ~ GU~U.ES ~N E~FECT ON ZH~S OAZ~. DA~: ' '// / 72-008 (Rev, 4/85) iN 3-15-99 2:19 PM ;ALASKA TESTLAB 9075633953;# 2/ 2 O0['ON O~ # 0~# 0~'o~ 0~# Of ~ PERFORMED FOR: LEGAL DESCRIPTION: ,~7'~ 2 3- 4 6 ? 8- 9 10 11 Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, ARchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 13- 14 15 16- 17- 18 lg 20 SLOPE WAS GROUND WATER ENCOUNTERED? ./~ IF YES, AT WHAT -- O DEPTH? p E IYlonilering? . StTE PLAN Reading Cate Gross Net Depth to Net Time Time Water Drop ~n ~A~,~ .,~ PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN '~ FT AND . ~ ET oop Ro~d No. 204 ' ' ~ ACCORDANCE WiTH~.~j~j~:~r~i~[~i~N!~.,~,~.GUiDELiNES IN EPPECT ON THIS DATE· 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: ' ~-~ // 0 /0'~ ~/ ENGINEERINGSTUOJES ANC REPORTS WELL INSPECTION & FLOWTEST SITE PLANS SOILTEST STRUCTURAL& MECHANICAL INSPECTIONS ROBERT C. COWAN, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979, FAX (907) 694-1211 REFERENCE: Lot 3, Blue Skies Estates #1 Subdivision March 16, 1999 GENERAL: The scope of this project includes installing a 1250 gallon septic tank and leachfield to serve the four bedroom residence. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page 2 Lot 3, Blue Skies Estates #1 S/D March 16, 1999 A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Two flow dividers shall be installed sending 3/4 flow to longer trench and remaining 1/4 flow to shorter trench. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be with/n 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt battier must be installed between the fmal gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The f'mish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 3, Blue Skies Estates #1 S/D March 16, 1999 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. '3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Miraft 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. Page 4 Lot 3, Blue Skies Estates #1 S/D March 16, 1999 The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519~6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 021-011- 7 1. GENERAL INFORMATION Completelegaldescription Lot 3, Blue Skies Estates Ill Location (site address or directions) NHN Glen Alps Property owner Mailing address Lending agency Mailin. g address Agent Address Peter Cueva Dayphone 4031 Lunar Dr., # Bs AnchoragesAK 99504 Residential Mort./LeAnn Willi~ayphone 222-8835 1400 W. Benson, 2~ Floors Anchorages AK 99503 Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 4 NOTE: Individual well XX× Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XXX Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl MOA o 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 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Phone Name of Firm ;7~,% 7'-~1;~ R;v~r Loop E~ad i'~o. 204 Eagle R|ver, Alaska 99S77 Address . ~r.. ~.7~ Engineer's signature ,~,',~'i-~/-- '"---"-- Date .~/~2 ~,,,~ O o DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~d~g ~ ~ [0] ~,.' r -- The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Hearth 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 responsibte for errors or omissions in the professional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERV~u, Environmenta~ Services Division '-. 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) Health Authority Approval Checklist Legal Description: ~O~'- 3 15Z.,j ~. $~J~.~ ~- S'?, Cf/Parceli. D.: 0 ~1 - O II -- ~,'7 A. WELL DATA Well type ~1 ~,,~'T~ Log present ~N). Tota~ depth Sanitary seal CN) IfA, B, or C, attach ADEC letter. ADEC water system number 8. ~. Casing height (above ground) Wires properly protected Date completed Cased to ~.-0 / 7- ~ Date of test Static water level "~ '~ Well production · t,.,/ FROM WELL LOG AT INSPECTION g.p.m. /Y g.p.m. WATER SAMPLE RESULTS: Co, orm %O .: Date of sample: ,....~ ¢~,¢¢.. - Nitrate SE.T C/.OLD .e TA. .AT^ Date installed '7/~"7/~ ~J Tank size Foundation cleanout ~N) Date of pumping Collected by: Depression (Yt~ Pumper Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road Eagle River, Alaska 99577 Number of Compartments ~- Cleanouts (~N). ,~¢ o High water alarm (Y/¢. /¢ O C. ABSORPTION FIELD DATA Date installed "7/~ -/ /dj Length~ ~ 3q ~ '-' 7~ / Width Effective absorption area Date of adequacy test ~//~ - ~f~' Results (Pass/Fail) For Fluid depth in absorption field before test (in.); immediately after gal._..~pa(kted (in.): Fluid depth (ins) Minutes later:~~ g.p.d. Pero~ if yes, give date Soil rating ~or fF/bdrm) )- ~ System type Gravel thickness below pipe ~ Total depth · ¢~" Monitoring Tube present ~N) 'Ycf Depression over field (Y~ bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump ~ High water alarm level at* J ~ *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main N /,~ Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~,~) / Property line ~ ~ I Absorption field "7 f Water main/service line ! b ¢' Surfacewater/drainage /o ~) ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line } o~ ~ Building foundation Water main/service line Surface wate~ ) O 0 'f'- Driveway, parking/vehicle storage area /OO -~ Curtain drain /~ o~ ~ /~,~ 0 ~ ~) Wells on adjacent lots ? D ~) '-/- F. ENGINEER'S CERTIFICATION I certify that lhave determined thru fie/d inspections and review of Municipal in conformance with MOA ~A~idelincs in effect on this date. Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number · O~-ZS'O0 15:~4 FRO~-CT£ ENVIRONEENTAL ZtK CT&E Environmental Services In~. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWS]~ Sampl~ Remark: tOOt 167001 S & S Engineering Lot 3 Blue Skies EsL #1 Lot 3 Blue Ski~s Es~. #1 DriVing Wa~er 0 Client PO~ Pria~ed Date/Time 03/24'2000 15:51 Collected Date/T/me 03/22/2000 10:00 Received Date~ime 03/22/2000 12:05 T~chnical Director Stephen C. Ede Rgleased ~,~~ ~ ~TERS DEPT 0.597 0.500 m~,/L E~A 300.0 (~10) 03/22/00 SCL NICRO LAB Total cotfform I 09, ~o Coti cot/10Omg $H18 9222B 0~/21/00 gAP