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LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANC Well on D. ABSORPTION FIELD DATA LIFT STATION TO: On adjacent lots Manufacturer Manhole/Access "Pump off" Level at Cycles tested Surface water ► 91 1 `� e, ► Soil rating ��� S stem e G�iB G Date installed � ng (GPD/Ftz) /ov y type r � � Length I' -S- /?3' Width -2 • Gravel thickness u� ,sTotal depth //P Total absorption area 920 i-ul lc2 Cleanout present(D/N) __Depression over field (Y/� Date of adequacy test & -,2 / e/ s Results (pass/fail) 1 ,9 5 for - F Bedrooms Water level in absorption field before test D H After test l Peroxide treatment (past 12 months) (Yqg If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot lb o On adjacent lots 97 Property line /b ' !� To building foundation 3-o ' To existing or abandoned system on lot On adjacent lots 30 ( 4-- Cutbank r•I 1 Water main/service line !c 4 - Surface water l 0 ° (4-- Driveway, parking/vehicle storage area Curtain drain IJ/4 Sf--J— (-r� V- /tri E. 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