HomeMy WebLinkAboutSTANLEY LT 1
/
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SE~RVICES
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: ~'v'/',~7~'~" PID Number: ~> ~'11~-~""/
dame: Wastewater System: [i2~New [] Upgrade
James M. Yassick
~ddre~: 92i0 Vanquard Driye ABSORPTION FIELD
344-5678 ~ Deep Trench ~Shallowrrench ~d ~Mound D Other
LEGAL DESCRIPTION SollRatin,: .7 'GPD/Sq. Ft. Total Depth from original grade:
Lot: / ~ Subdiv~ion: Depth to pi~ ~Eom from odginal grade; Gravel depth beneath pipe
~/~ ~,~ Ft.
Township: Range: ~ Section: Fill added above original grade: Gravel length:
~ ~.~ R. 7~ ~t.
I
WELL: ~ew ~ Upgrade
Gravel width:
' /~ F~. ~ ~ ~t.
Numar of lines:
DiS~ ~n IJn~
Classification (Private, A,B.C): Total Depth: Cased To: Total abso~tion area: Pipe material: ~
.~;~ /~ Ft. 7~ Ft. ~/~ SQ. Ft. ~/~,~~.
SEPARATION DISTANCES ~ septic 'S Holding ~T.E.P.
TO SeptiC Absoft[on L~ Holding =ubll~Pflvate Manufacture~ Capacity in gallons:
~ Mate 'el: Number of Compa~ments:
sumac. >lOC' >loc' >/~' / > /o~' LIFTSTATION
Water
~ StzeingalJons: Manufacturer:
Line Lot ~S ' / ~ ' ~ ~ ' / ~/' F >~ ~ / --
, "Pump on" level at: "Pump o~' level at: High water alarm at:
Cu.ainDrain ~/~ / / / / ~ .,1 o~ IElectricailnspe° pedo~ od by:
BENCH MARK
Remarks: D~s[=~bu[~on pip,hq ho[es
Lo~tion and Description:
3/16" diam~ nn 4' ~- ~¢~ ~/~
~ /
) ~umed Emevation: /~O ~ ~,
ENGINEER'S SEAL
Inspections pedormed by Dates: ls ~ ~
Department of Health and Huma~ Se~ces' approVa I ~,:~;%~ ~.,.~ ~. ~ ~
Revie ed and approved by: Date: ~ .
72-O13 (Rev. 9/91 ) MOA 25
STANLEY
LOT 1
49,507 S.F.
I
SUBDIVISION
Permit No. SW970064'
Page 2 of 3
/
20.0' (~
j"
~: ., CRABTREE
STREET.
165.00'
Per, mit NO. ,,~V~ ~'4:~C~:=~t"
Page .3 of 3
Legal Description:
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
OWNER OFt,AND
ADDR~_~ '
SULLIVAN WATER WELLS'. . ...
L~GAL DESCRIWFiON
DATE - StaKed
PERMIT NUMBER
DRAW DOWN ~. .'
k~[ND OF FORMATION;
From 0~. Ft. to
From. ~
From FL
From., Ft. t~
'
From Ft. to ' Ft._
From Fr~ to Ft,
From~Ft. to.__.Ft
From FL to Ft..
Frm__.Ft to Ft.
From FL t~ ' Ft.~
MISC:L,. INFORMATION:
"75' 6 ' TAT,+'- 6"
From
· From.__
From
Frpm
From~
-
Fmm ,,
From~
Ft. to Ft.
Fl. to Ft. _
.Ft. to Ft.~
, Ft. to Fl,
Ft. to Ft
Ft. to Ft_'__
.Ft. tO__ Ft,_
Ft. to Fl,
Ft. to Ft._
Ft. to Ft.'
Ft. to__Fi ....
· 't. to Ft._
.. FL to__ Ft,
FL to Ft._
Ft. to - Ft._
. Ft. to Ft.
' Fi. to Ft.
~. PAGE ,1 OF 1
DEPARTMENT OF HEALTH J~D HU}Odq SERVICES
P.O. BOX 1966S0r 825 "L" STREETt ROOM S02
g~!'CHO RAGE ~ ALASI~ 99S19-66S0
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970064
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NANE:YASSICK JANES M
OWNER ADDRESS:9210 VANGUARD DRIVE
ANCHORAGE, ALASKA 99507
DATE ISSUED: 4/18/97
EXPIRATION DATE: 4/18/98
PARCEL 1D:05115457
LEGAL DESCRIPTION:
STANLEY LT 1
LOT SIZE: 49507 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED. ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
q7
MEMORANDUM
RECEIVED
DATE:
TO:
FROM:
April 25, 1997
Dan Roth
Mike Anderson, P.E.~''~
APR 199
D M~io~Pali~y ot Ancfl
ept, Health & Human ~o~ag.~e~_
rVtc~
SUBJECT:
Lot 1, Stanley Subdivision
Septic System Permit
Permit No. SW970064
The owner of Lot 1, Stanley Subdivision has decided to move the location of his house and
is requesting the location of the septic system be changed. The attached site plan illustrates
the new location north of the proposed house. The soils in this area are identical to those
found in Testholes No. 1 and 2 and were found to be a very clean poorly graded gravel
with a percolation rate less than 1 minute per inch. The 2' sand liner will still be required.
The water level in Testhole No. 3 was found at 6.5' below the surface which is the same as
Testhole No. 2. The bottom of the absorption bed will be placed at 1' below the surface
allowing a currant separation distance from groundwater of 5.5'. The pressure distribution
system will still be used for the system.
Please review the attached information and revise the permit to allow the new location of
the septic system. The Contractor is planning to install the system this week end and we
would appreciate your prompt review.
./
NO0°1,
a~o.Te (77-~a)
1.]5.55
I I
I
135.84.
~7 'BLM
SITE
SCALE 1" = 50'
L75 77-115) _ -'.I~,~, S_C
661.51 (77-11.3
PERFORMED FOR:
LEGAL DESCRIPTION
1
2
5
6
7
8
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
. Muntd~ty of Ant, borage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Ancl~orage, Alaska g95[]2-.0650
SOILS LOG ~ PERCOLATION TEST
, DATE PERFORMED: r
;nShip, Rm ge, S;
SITE Pi. AN
WAS GROUND WAT ~,q I'~
ENCOUNTERED?
,F YES, ^'r,,,^'r /~.~"/
!
Gro~ Net D~pth to Net
Reading D~te Time ~ Wet~ Drop
FERCO~..ATIONRATE * ~-0 (mmut~sml,"h) PENCHOLED~J~,IETER ~'~"
r,EF~ORM=n BY: ' ~-,'~/?.c. / ~"'/
March 19, 1997
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 1, Stanley Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
We hereby apply for a permit to construct a well and onsite septic system
on Lot 1, Stanley Subdivision. The attached site plan and backup
documentation identify the size and location of the new system as well as
the proposed location of the well to serve the house to be constructed on
the lot. Groundwater was located at a depth of 7.5' below the surface so a
pressure system has been designed to assure a separation distance of 4'
from groundwater.
A percolation test completed on the soils in the area of the new
absorption trenches indicated a rate of less than one minute per inch. A 2'
filter layer will therefore be required to slow the rate of percolation into
the underlying soil. We propose to place a 15' wide absorption bed with a
total length of 72'_ Total depth of the system will be 2' below the
surface. A 2,000 gallon S.T.E.P. tank and pressure distribution system will
be installed. The drainage patterns on the lot will not be affected by the
construction of the new system. The ground surface slows at a gradual 1%
slope from the northwest to the southeast.
If the system is constructed as designed the following statements can be
made:
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.
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.
Lot 1, Stanley Subdivision
March 19, 1997
Page Two
The system, if constructed as designed, will have no adverse
impact on reserved space, either surface or subsurface, on any lots
located in the area.
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
MEMORANDUM
DATE: April 17, 1997
TO: Dan Roth
FROM: Mike Anderson, P.E.
SUBJECT: Lot 1, Stanley Subdivision
Septic System Permit
I have revised the shallow bed system proposed for Lot 1, Stanley Subdivision in
accordance with our conversation of April 17. The groundwater level in Testhole No. 2
has recently risen to within 6.5' of the surface as opposed to 7.5' below the surface as
determined on our last measurement of March 13. The system is now designed for a
maximum water level of 5' below the existing ground surface.
All other aspects of the design package remain the same. The total dynamic head will
increase by 1' as a result of raising the elevation of the distribution piping. The specified
pump, however, will be able to deliver the effluent through the distribution piping at nearly
5' of head even with the additional elevation. No adjustment is required.
Please review the attached system profile and advise if additional information is required
before a permit can be issued for the construction of the septic system for Lot 1, Stanley
Subdivision.
dAYH AWK DR.
CHES~K
THIS PROJECT
KAREN LN.
TARIKA AVE.
LOCATION MAP
NO SCALE
NO0°1.
J7 'BLk4 550.75 '(77-115)
SITE PLAN
SCALE 1" = 50'
001..51
SYSTEM PLAN
NO SCALE
1" PVC DISTRIBUTION LINE ~,,~..~
1.5" PVC TRANSPORT LINE
MONITOR TUBE
2,000 GALLON
S.T.E.P. TANK
PROPOSED 5 BEDROOM HOME
LOT 1, STANLEY SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Five Bedroom Home
Perc. Rate: L.T. 1MinJInch
Application Rate: .7 GPD/SF
Groundwater Level : 5'
Shallow Bed System
New 2,000 Gallon S.T.E.P.
Pressure Distribution System
2' Filter Layer Required
5 Bedrooms X 150 GPD -- 750 Gallons Per Day
750 GPD/.7 GPD/SF = 1,072 SF ! 15 LF (Width)= 72 LF Total Length
Therefore: Construct a Shallow Bed System With Two Beds a Total Length
of 72' and 15' Wide. Distribution Piping to. Be Placed 6" Below Existing
Ground Surface.
NOTE:
TYPICAL SHALLOW BED SECTION
-(NO SCALE)
Minimum 4' Separation from Ground Water.
Grade Area Over Bed to Drain Away.
Minimum 3' Cover Over Bed or Direct Bury Insu
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRI.TIO.= Z- /, ~-~y ~.
11
12
13
14
15
16
~8
Township, Range, Section:
SITE PLAN
*---- I-ri
SLOPE
WAS GROUND WATER
ENCOUNTERED? Y
IF YES. ATWHAT
DEPTH?
Gross Net Depth to , Net
Re~ding Date Time Time Water ~ Drop
/~ :~ : ~ ~ 7, ~ ~
PERCOLATION RATE · '~ b (mlnute~';nch) PERC HOLE DIAMETER
TEST RUN SE'i'WEEN ~ FT AND ~' FT
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0550
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
1
6-
7
8
9-
10-
11
13-
14-
15-
16-
17-
18-
19~
20-
WAS GROUND WATER
ENCOUNTERED?
Township, Section:
DEPTH?
SLOP;
SITE PLAN
Gr~ss Net Depth to Net
Reading Date Time 'lime Wate~ Drop
PERCOLATION RATE ' ~ (mm~tes/m~l) PENC HOLE DIAMETER
TERT RUN BE'rWEEN -% FT AND ~J~ FT
COMMENTS
^cco~D^.CE w,*. ^L~ S~^~E ^.~"U.'C'P^' GU,D~.,.ES,N E~FECT ON T.,S D^T~ RA*;' ' ~//? Iq*
72-~O8 (Rev. 41851
FILTER SAND SPECIFICATION
ACCEPTABLE SOURCES:
Road sand from Central Paving Products (Palmer).
ASTM D 33 concrete sand from Quality Sand (Wasilla).
Pit run sand from Beaver Lake Sand & Gravel (Wasilla).
Any sand from a source other than the above must have a sieve
analysis performed which indicates that the product is a sand and
has less than 4% passing the #100 seive and less than 2% passing
the #200 seive.
I
= 30,33
£N !S (t0/78)
1/2Hptol 1/2Hp
.+..~...~..~.. 4-.: ..L..L .~.4 ~
~ ~.--. 4.t.~ ........ +--t 4 ........ +' "~"~"~'"i .......................
~.~ ~ ~ ~ . .......... ~S/g2
,- 4..F.~ ......... ~.~'~-'~- ..:...~...s-~-~"~" ++"":":-t .... i'-~"~"*' ~ t~'"
..~..~... [' ~' ~ L.i...i.. ..~..;..~.+- ..~.~- ..,......,- -~-~.~ .... ~.~ ~
..~ ..... ~..~.. ~-. ~. -i--i-~.4-. ..~. ~_~ .......... : , , , ~"~ -i~
t'f"f" ~'T' "~"+' '+"~"~"~"'~ ..................... ": ' ~"~"+'+' '~"~" "~'"~'" "~"
'-rT'
'- ..... r'r'~" , , ,, ~ ' ,, ~...~.~ ,~.
~ "T'T'T''~"~ ....... ~ ....
-,..~'"'"r' ....... ' ~..~-! -~F.~ ~ '--~::~ i .... ~,~ ...... ~ ....... ,:~"+' "*"
"T"f..,.., .... ...,..,..~. - d .~..[. : , , ..~-~-i... ~..*-~'
~ ~ "FT'~ T' ; ~ ,..
~ ..~..,..~.. 44... ~ ~ ...~...~...~.. ~i ....
..~..,... ii~-ji .....~I ~..~... ...~...~... ..~.. ..~..i..+..~- ~..~..~.i.. ~... '",:, :~,..' ,'''., '',, '.
~ ~ ! ~ ..~..~ ..... ~.4..~..~.. ,.~-f..4-*-.~ 4-~.~ --}.-~..~.. - ~-+' "~"f' "i"'
~ ~ i i 40OSI0~HH 2stage
:q"Y' '"b - 'qt'~' w / 1/4" flow controller "~"n~-~ ";'~ :"
0.~ 5.~ 1B.~ 13.~ ~.~ ~.~ 3 .~ 35.~ ~.~ 45.~
NET DI~HAgGE GPM
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: Lot 1, Stanley Subdivision
GENERAL:
The scope of this project includes the procurement and
installation of a 2,000 gallon S.T.E.P. Tank with a lift
station and the construction of a total of 72 Linear Feet of
15' Wide absorption bed with a 2' gravel filtaration layer
beneath the distribution piping.
Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
The Contractor shall be
underground utility locates
system.
responsible for obtaining all
and for the layout of the septic
Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. The property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
LIFT STATION INSTALLATION
1. The lift station is to be constructed by a certified tank
manufacturer. Construction shall include an 18" manhole
for access to th'e lift station.
Lot 1, Stanley Subdivision
March 18,' 1997
Page Two
2. The lift station shall be sufficiently
settling or shifting of the tank.
bedded to arevent
All standpipes on the lift station shall extend a mimmum of
12 inches above final grade.
4. Lift stations installed without 4' of cover shall have a
minimum of 2" of direct burial insulation.
A foundation cleanout shall be installed one to four feet
from the building foundation. No cleanouts are required
between the lift station and the drainfield in a pressure
distribution system.
6. Final grading over the lift station shall be such that a
positive slope exists away from the septic tank.
ABSORPTION BED CONSTRUCTION:
The absorption bed shall be constructed to the dimensions
shown on the design. The bottom of the bed shall be within
2" of level.
Distribution piping must be placed level with perforations
down atop a Ira/el bed of drainfield rock. Rock should then
be placed over the pipe to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion in the drainfield
rock must be Perforated.
Direct bury insulation must be placed over the distribution
system when less than 3' of backfill depth is available.
Lot 1, Stanley Subdivision
March 18,' 1997
Page Three
Finish grade over the bed must be mounded to prevent
settlement or depressions.
MATERIAL SPECIFICATIONS:
1. The lift station must be constructed
approved septic tank manufacturer. An
HHF - 5 is recommended.
by a Municipally
Orenco 20 OSI 05
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated, but
not solid) and ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical 0o. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted
watertight couplings (Caulder, Fernco, or equal).
with
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska.' The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
Lot 1, Stanley Subdivision
March 18,' 1997
Page Four
of any gravel. A septic tank may be set in' place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of the second inspection.
The contractor is responsible during the layout of the system
to assure that all separation distances from adjacent wells in
the area are met.
MUNICIPALITY OF ANCHORAGE /'~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6G~NICIPAI-ITY OF ANCHORAGE
343-4744 ENVIRONMENTAL SERVICES DIVISION
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL. FOR A SINGLE FAMILY DWELLING
05115457
1. GENERAL INFORMATION
Complete legal description
Lot 1, Stanley Subdivision
Location (site address or directions) Crabtree Street
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
921~ V~ng,~r~ Driv~
Day phone 344-5678
Annhnr~g~; AR 99507
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 5
TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72q)95 (Rev. 1/91) Front MOA#21
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 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 structu re 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.
Name of Firm Anderson Engineering
Phone__ 563-7155
Address P,O, Box 240773 Anchoraqe, AK 99524
DHHS SIGNATURE ;:.
/
~'. Approved for '-~ bedrooms. "?';::- .
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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 DH HS 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.
Municipality of Anchorage
DEPARTMENT Of HEALTH & HUMAN SERVl~lp^tl~' o~^NOAOP~O
Environmental Services Division ENVIRONMENTAL SERVICES DIVI$11~
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
jut. 2 4 1997
Legal Description:
A. WELL DATA
Well
Log present fi/N)
Total depth
Sanitary seal
Hea!th Authority Approval Checklist
~?L~tt4//~5/ ~<et/--'~e~. Parcel I.D.:
/
R[(EIVED
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed ~/~7
Cased to 7~ ~ t Casing height (above ground)
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date oftest ~/~"7 ~7/~'7
!
Static water level (~ e /e> /
Well production 3; ~ ~,, c> g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: 7/P/~'/
B. SEPTIC.~ TANKDATA
Foundation oleanout (Y/N) ~" Depression (Y/N)
Date ofPumping ~ff~ Pumpar /V'~-'
Collected by:
Number of Compartments ~ Cleanouts (Y/N) ~"
High water alarm (Y/lq) 7
Date installed //~ '7~_9//~T Soilrating (g.p.d./ft:orft2/bdrm) °'7 Systemtype
Length 7~' / Width /~' Gravel thickness below pipe ~ Totaldepth.
Effective absorption area ~/~' ~Monitoring Tube present(Y/N) ~c' Depression over field (Y/N)
Date of adequacy test ^t fi, C---- Results (Pass/Fall)./ For . ~ bedrooms
Fluid depth in absorption field before test (in.)L.~ Immediately af~'"'~al, water added (in.):
nuld dep.~""'~ 0.s.~ M~nutes later: .~-"----~'A~sorption rate --
Peroxide treatment (past 12 months) (Y/N) ~"'~ If yes, give date
D. LIFT STATION
Manhole/Access (Y/N) )e- "Pump on" level at*
High water alarm level at* ~ff~ # *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WEI~L ON LOT, TO:
Septie/~tank on lot /~Z~ / ; On adjacent lots
Absorption field on lot //o / ; On adjacent lots
Public sewer main /a4/~..s, Public sewer mmfllole/cleanout
Sewer/septic service line /o~v / Lift station
SEPARATION DISTANCES FROM SEPTIC~ TANK ON LOT TO:
Building foundation / ~, ~2 r Property line ' ~ ! Absorption field /-~ /
Water main/service line >~..~-t' Surface water/drainage ~ /~-'~'vr Wells on adjacent lots ~ /~-~ *
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Buildil~g foundation
Surface water
Curtain drain
Property Line /..~ / Water main/service line >' ~..~--r
Driveway, parking~vehiele storage area
Wells on adjacent lots > /Z-~ /
F. ENGINEER'S CERTIFICATION
I cer#fy that I have determined thru field inspections and review
in conformance with MOA HAA guidelines in effect on this date.
Signature ~<~e~ ~..~ ~-~
Engineer's Name Michael E. Anderson
Date 7/22/97
HAAFee $ ~ ~ t~
Date of Payment. ~/~/f ~7~ .
ReceiptNmnber ~:~[/~ ~ff./~,~
Rev, 8/95 eSS: haa,wk,doc
Waiver Fee $
Date of Payment
Receipt Number
2~0 W. Po~er Drive
Tel: (go?) 562-2343
2~AD INSTR O'C~ION$ ON _~I/ffJ~f£ StZlf BE~Olil~ CO-r~t-t~gT'l~vG fA MPZ~' 'Fa~: (907) 561.5301
-el $~nd ~e~ul~ El Stnd lnvoh:~
l~Ionth .' Da>' y~ar
SAMPL~mfP_E: ti Treated '~ atcr
~'Routine
· Repeat Samgle (for routine sumple ~ Untre~,-.~t Water. ~ ..
~I with lab ref. no, __ )
C~ Special Purpose Time Collected
ysis shows tis Water SAI~LE lo ~..
Satisfae~. .
a gn~O~
a' ' ~ple o~ 30 houa o1~ ~1~ may
n~ ~ ~ 4~ ~OU~ usu -- ~--
!
~O-MUG R~uI~ To~I Cnlifa~ -- ·
Membr*ne ~ilter: Di~ Count __
BGB
Fe~t Coliform Confirm~on __ ~ ~ Cotifo~lO0 mi
~po~ed BY~~ ' , Time
I0/I0'd 10£fI9~&06
~'~..~ ~ Member of;he SG$ Gr.'up ($°ci~'t~ GAnArals de Sun's'llanos)
39U~JOHDNW I53 3~lO ,'.I :TT
2,661-EE-gFI-/'
JUl~-l?-l~g? 18:19 CT~E ESI ANCF~DR~
~K .- CT&E Envlmnment~l Ssrvivas Inc.
CT&E Re/.// 973701001
Client Name Anderson ~-~
l'miect Name/#
Cliott Sample I]) Lot I Stanley Sulxl,
Matrix Drinking
Ord~ed By
Nitrnte-N
Resutts
tJni t~
0.500 mg/L
Clleat PO//
Printed D~e/T'mze 07117197 16:47
ColL.,~od Date/Time 07109197 16:20
#ethed Limita once Date ln~t
SH18 &5OO-NO,.1F 10
o7/lO/97 ~BL
TOTAL P. 02