HomeMy WebLinkAboutGLENN VIEW ESTATES WEST PH 1 BLK 1 LT 3Glenn View
Estates West
#1
Block 1
Lot 3
#051-793-03
'r Municipality Anchorage ..°1,
,Y.4,.
of •
.1- Development Services Department
Building Safety Division s ..
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW010440 PID Number: 051.793.03
r .
of
Name:
Arctic Devco, Inc.
Wastewater System:
LNew ❑ Upgrade
Address:
PO Box 3489 Palmer. AK 99645
ABSORPTION FIELD
Phone: Number of Bedrooms:
D Deep Trench ® Shallow Trench 0 Bed 0 Mound 0 Other.
LEGAL DESCRIPTION
Soil Rating:
0.6 GPO/FP
Total Depth from original grade:
4.0 Ft.
Block: Lot Subdivision:
1 3 Glenn Vw. Estates West Phase 1
Depth to pipe bottom from original grade:
1.7 Ft.
Gravel depth beneath pipe:
2.2 Ft.
Township: Range: Section:
Fill added above original grade:
1.3.2.8' +/- FL
Gravel Length:
148 Ft.
Well: •
New •
Upgrade
Gravel width:
5 Ft.
Number of lines:
2
Distance between lines:
10 FL
Classification (Private. A, B, C):
Public
Total Depth:
FL
Cased to:
Ft.
Total absorption area:
1060 Ftp
Pipe Material:
D3034 & F810
Dnller.
Date Drilled:
Static Water Level:
FL
Installer.
Turner Const.
Date Installed:
10/30/2001
Yield:
GPM
Pump Set at Casing Height Above Ground:
Ft., FL
TANK
SEPARATION DISTANCES
C4 Septic • Holding • S.T.E.P. • Other:
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
Public/Private
Sewer Line
Manufacturer.
Greer
Capacity
1250 Gal.
Well
200'+
200'+
NA
NA
25'+
Material:
Steel
Number of Compartments:
2
Surface Water
100'+
100'+
NA
NA
LIFT STATION
Lot Line
5'+
10'+
NA
NA
Size:
Gat.
Manufacturer.
Foundation
5'+
10'+
NA
NA
Pump on level at
In.
'Pump oft" level at
in.
High water alarm at:
In.
Curtain Drain
NA
*50'+
NA
NA
Pump Make 8 Model
Electrical Inspections performed by:
Remarks:
*none known
BENCH MARK
Insulation over tank & field
Location and Description:
Garage Slab
i
Assumed Elevation:
100 FL
Engineer's Stamp
4"bE OF A 4. 1%.
ar II
0'k;• 9TH
p•... *.... @•e•. ... ill
osi-
.. • ....•, •,•,.
+1 Kenneth M. Du : ��
J':• CE 7116 • ��/
'�4p_e ••. ..••• �vs
t;ep RO•*....0
``42.044' -".
Inspections performed by: KND Engineering, Inc. Dates: 1st 10/3012001
2nd 10/31/01
Development Services Department A proval3 t'Gl2s o
1
Reviewed and approved by: `/J/� 4/. Date: .7—//— 0 2—
(Rev. 12/00)
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW010440
GLENN VIEW WEST ESTATES S/D, LOT 3, BLOCK 1 PID#051-793-03
SEPTIC
Lot -4'
fC°
K
Lot 3
ZABEL SPLITTER
VACANT
EXISTING 1250 GAL
SEPTIC TANK
FC0
A -C= 33.0'
B -C= 16.5'
A -D= 30.5'
B -D= 24.2'
A-E= 64.4'
B-E= 55.2'
A -F= 68.9'
B -F= 67.1'
A -G= 28.2'
B -G= 63.6'
A -H= 15.7'
B-H= 52.3'
CLCAIQJT
INS
CLEANOUT
Ana
•:III:1 I_1:1
—.1250 GAL
Tag
SEPTIC:(=
TANK
SCALE: NTS
II�Jr�ii•�w
SCALE: 1' 50'
rONITOR TUBE
FINAL GRADE
fn.TCR fAYUC\ �INSULATI l
MONITOR TUB
0100.3
95.7
93.4
SEWER ROCK
TRENCH 1
.MONITOR TUBE
CLENQJT_ 98.7
74'
FINAL GRADE
CANOUT
Ara":s'°FAL��
KENN FF
D �'IibFESSIO14p=
CE -7116
fILTCR fARRIC \ /INSULATI[M
•
t"-9s.7?�
SEWER ROCK
TRENCH 2
74'
MONITOR TUBE CLCANDUT
99.06
.. h - VARIES
9s.7 1� '3�3'•
t2•
I
84.40
PREPARED FOR:
REX TURNER
ARCTIC DEVCO, INC.
P.O. BOX 3489
PALMER, ALASKA 99645
SCALE: NTS
111
FIELD BOOKS
COMPUTED:
90UNOARY: LANG
DRAWN: VBG
STAKING: LANG
CHECKED:
ASDUILT: LANG
DAn' 6/26/02
OHC. FILE:
GRID:
ACRD FILE: 01100.DWG
NW1459
Jos Na: 01100
END ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
Lot 4
15' TELECOM. 8
ELECT. EASEMENT
c;
NORTH WOODS SUBD. UNIT III 1
N 89°59'0311E 144.40'
15' TELECOM. 8
ELECT. EASEMENT
10' BUFFER —
LANDSCAPING
EASEMENT •
Lot 3
41,953 s.f.
SEPTIC CLEAN -OUTS
)foomPttinor-1
PLOT PLAN ASBUILT k SCALE IN ' 5°' GRID
Lang acAssociates, Associates, inc. 11500 Daryl Avenue, Anchorage,
Registered Land Surveyors (907)• 522-4625 Fax
1 hereby certify that 1 have surveyed the following described property:
Lot 3, Block 1. GLENN VIEW ESTATES WEST, Phase No. 1
Anchorage Recording District, Alaska, and that the improvements situated
thereon are within the property lines and do not encroach onto the property
adjacent thereto, that no improvements on the property lying adjacent thereto
encroach on the surveyed premises and that there are no roadways, transmission
Tines or other visible easements on said property except as indicated hereon.
Dated this the 2-s Day of APR.LL.
Lot 2
NW
1459
. ?.002 at Anchorage. Alaska
It is the responsibility of the owner to determine the existence of any
easements, covenants, or restrictions which do not appear on the recorded
subdivision plat.
Lot 1
,19'911 3.91,£1,00 S
30.00'
Project No. 01-165.
Alaska 99515
"7
O ,gO°o4
O?: 4918 .
1k•
e`c, :KENNETH b. L
�'•. •GyJ�:
•
4J!LS-52024jVPA••••••r....•
p�ssioN '�7
O000
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
/6/ 50/6 / lb:$b,o-ii
t /: �p
/6/v( !/ A'w.
Date Issued: Oct 18, 2001
Expiration Date: Oct 18, 2002
Permit Number: SW010440 Parcel ID: 051-793-03
Legal Description: GLENN VIEW ESTATES WEST PH 1 BLK 1 LT 3
Design Engineer: 0070 KND Engineering
Owner Name: Turner Construction
Owner Address: PO Box 3487
Palmer , AK 99645 -
Site Address:
Lot Size: 41953 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
Disposal Field Q✓ Septic Tank rj Holding Tank 0 Privy ❑ Private Well 0 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (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.
Received By
Issued By:
Date: /d/ —a 41
Date:/0 -la-al
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I D D 5 1 - 7C(3 — d3 Permit Number SW 0%1440
Property owner(s) Turner Construction Day phone 242-4555
Mailing address (1) PO Box 3487, Palmer,AK 99645
Mailing address (2)
Zip Code
Legal description (Lot, Block & Sub'd_) Glenn View Estates West Ph1, Block 1, Lot 3
Legal description (Section, Township & Range)
Lot Size 4.Q.,000+ Acres/Sq.Ft. Number of Bedrooms 4
yi
THIS APPLICATION IS FOR:
Sewer Only ® Well Only
Sewer and Well ❑ Water Storage
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi
Swimming Pool ❑ Water Softening Unit
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
]KNENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
October 11, 2001
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer permit — Glenn View Estates West Phase 1, Block 1, Lot 3
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit on the subject
lot. On April 20, 1999 and October 1, 2001 testholes were excavated for the proposed
septic system. The results of these tests are attached. The general slope of this lot is flat
or of moderate slopes from east to west at a grade of approximately 0 - 3%. We have
designed our system utilizing the testholes we excavated for the 4 -bedroom house,
which is proposed for this lot. The lot will be served by public water. We propose to
install a 5' wide shallow trench. Water was not encountered during the excavation or
monitoring.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
MID Engineering
Kenneth M. Duffus, P.
Attachments: On -Site Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
KND
GLENN
VIEW WEST ESTATES S/D, LOT 3, BLOCK 1
SE ot) 5
Lot 6
VACANT
Lot 3
i�oo ww orm+
VACANT
Dt 8
Lot 2
Lot 7
NO PUBLIC WELLS WITHIN 200. OF
PROPOSED SYSTEM.
NO PRIVATE YELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200. Or
PROPOSED WELL EXCEPT AS NOTED.
SEPTIC
Lot
. AksN
* '4 • H " 7*�
KENNETH ' DU
CE -7116
""oFESS100'
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/.6 GPD PER SO. FT. (8.89 MIN/IN.)= 1000 SO. FT
(1000/5'(W)) X .70(RF) (2.0' GRAVEL) = 140 FT. TRENCH
USE 2 TRENCHES - 70 (L) X 5' (W) X 2.0'(D)
Total depth of system is 4.0' from original grade.
Total depth of' gravel below distribution pipe is 2.0'
NOTES:
1. USE 1250 GAL SEPTIC TANK AND INSULATE IF < 4' OF COVER.
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM.
3. CONTRACTOR WILL ENSURE MINIMUM 2X SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
MIN. 3' COVER IF REQUIRED.
5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS, LOT LINES, FOUNDATIONS & ALL OTHER SETBACKS.
PREPARED FOR:
REX TURNER
ARCTIC DEVCO, INC.
P.O. BOX 3489
PALMER, ALASKA 99645
Scate: 1'= 100'
PAGE 1 OF 2
FIELD BOOKS
CouPUTEo:
e0UNDARY: LANG
0RA1YN: VBG
STAKING LANG
cxEcx(o: KMD
ASBUILT: LANG
°ATE: 10/9/01
Dw6. FILE:
CRIo:
NW1459
ACRD FILE: 01100.DWG
d'e No.: 01100
ItN RD ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
KND
WASTEWATER DISPDSAL SYSTEM DETAILS
GLENN VIEW WEST ESTATES S/D, LOT 3, BLOCK 1
FLA
TH#01-0
co
MT
FLAT
Lot
Z200 FLOW DIVIDER
PROPOSED 1250 GAL
SEPTIC TANK
FCO
CO
CO 10
CO
FLAT�
PROPOSED 4
BDRM HOUSE
PREPARED FOR:
REX TURNER
ARCTIC DEVCO, INC.
P.O. BOX 3489
PALMER, ALASKA 99645
Scale: 1'= 20'
PAGE 2 OF 2
FIELD BOOKS
COUPUTED:
BOUNDARY: LANG
DRAWN: VBG
STAKING: LANG
CHECKED: KM D
ASBUILT' LANG
DWG FILE:
DATE:
GRID:
10/9/01
NW1459
ACAD FILE' 01100.DWG
doe No.: 01100
END ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
•
KNLJ ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
Performed for:
Project:
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
SOILS PERCOLATION TEST
Arctic Devco
Lot 3, Block 1, Glenn View West
i.••• ,� ...
; Kenne,n i.1. Dui 44 44of
r C• CE 7116
4 q•o••�(�c'.s.
O O •••e....• ,
4 �1 ROFESSIO\ '
Date Performed: 4/20/99
TEST HOLE # 99-1/3
Depth
(Feet)
Org/SM — rootmat red/brown
SM/GM —loose red/brown
SM/GM —brown/gray, loose
w/cobbles to 8, sand in high
quantity w/ some silt,
increasing density w/ depth
B.O.H.
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? No
Depth to water after monitoring? NO
What depth? NA
Date? 05/15/99
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
4/20/99
12:00
-
8"
-
2
12:30
30 min
4 7/16"
3 9/16"
3
12:30
-
4 7/16"
-
4
1:00
30 min
11/16"
3 6/16"
5
*
1:01
-
8"
-
6
2:31
30 min
410/16"
36/16"
*
Water
Added
Percolation Rate 8.89 (min/in) Perc Hole Diameter 6"
Test Run Between 3 feet and 4 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
KND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
Performed for:
Project:
Depth
Feet)
2-
3-
4-
5-
6-
8-
9-
10-
11-
12-
13-
14-
15 -
SOILS PERCOLATION TEST
Arctic Devco
:E 9F'A.gs-a1
i10�• TH '"�A`,, *+ISI
...•. ....- .••. .. • r
F .
4014: 44,4 Itt
Kenneui iv ... u�
j� J, •.• CE 7116
8 �'`ROFESS\O' '
Date Performed: 414070131;..6;-.'\1\\*.
0/01 /� ..6
Glenn View West B1, L3
TEST HOLE # 01-01
Org — w/ red -brown overburden
GM/GP - brown dry loose gravel
SM/GM — gray/brown silty
sand and gravel
, w/cobbles to9", dry
firm density
ity increasing w/ depth
B.O.H.
16-
17-
18-
19 -
HOLE PRESOAKED
20- PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? NO
Depth to water after monitoring? DRY
What depth? NA
Date? 10/09/01
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
10/4/01
1:00
-
8"
-
2
1:30
30 min
512/16"
2 6/16"
3
*
1:31
-
8"
-
4
2:01
30 min
511/16"
2 4/16"
5
*
2:02
-
8"
-
6
2:32
30 min
511/16"
2 5/16"
*
Water
Added
Percolation Rate 13.33 (min/in) Perc Hole Diameter 6"
Test Run Between 4 feet and 5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-793-03
HAA # i- 09-D Oca
Expiration Date: % — % /" O 3
1. GENERAL INFORMATION
Complete legal description Glenn View Estates West Phase 1, Lot 3, Block 1
Location (site address or. directions) NSA Linda Jo Circle, Chugiak, AK 99567
Current Property owner(s) Arctic Devco, Inc. Day phone (907) 745-8334
Mailing address PO Box 3489 Palmer, AK 99645
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
❑ Individual On-site
❑ 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 an independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health
Authority Approval are 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.) Certificates are valid for one year for properties served by Class A or B wells or
a public water system. The 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, I 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 KND ENGINEERING, INC.
Address 20441 Ptarmigan Blvd., Eagle River, AK 99577
Phone (907) 696-6111
Engineer's Printed Name Kenneth M. Duffus Date7,(
11
.0•OF.s
A( 4ltl
s * j4 I•t
o
•
Kenneth M. D f7 j
5. DSD SIGNATURE 4 c�t.•••. CE 7116 • ; ®�
V- Approved,t`kk0b0RopEsS0'...+—
for /� bedrooms. >ta�`"_`�`�
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
\tOt -cy Tr4 %.
= ON-SITE •^ '.�0'
m
•
WASTEWATER :
PROGRAM
fit!'
i ' TIENT SEA \\
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev. 0i102)
Original Certificate Date: %-1/— 02_
, ,
Legal Description: Glenn View Estates West Phase 1, Lot 3, Block 1
'iI:
A. WELL DATA t -
Well type" -PUBLIC If A, B, or C. provide PWSID # We I Log (Y/N)
il
Date completed Sanitary seal -(Y/N) ' Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
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 ' t
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel ID: 051.793.03
Date of test
Static water level
I •i
• Well .production g.p.m
WATER SAMPLE RESULTS:
ft.
ft.
g.p.m.
Coliform colonies/100 ml. Nitrate mg./1 Other bacteria colonies/100 ml.
Arsenic:mg./l. Date of sample: Collected by:'
!
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material septic/steel Date installed 1013012001
Tank size '1' 1250 gal. Number of Compartments 2 Cleanouts (YIN)' Y •
I'I
Foundation cleanout (Y/N) "Y Depression over tank (Y/N)N_High water alarm (YIN) N
Date of pumping NA - New tank Pumper
C. ABSORPTION FIELD DATA
Date installed 101301011' Soil rating (g.p.d./f12 ft2/bdrm) 0.6
Length l! 148 , ft. Width 5 ft. Gravel below pipe 2.2 ft.
Total depth 6_6 ft.: Eff. absorption area 1060 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NA- New System Results (Pass/Fail) Pass Fora4 bedrooms
in. Water added - ga
Absorption
System type Shallow Trench
Fluid depth in absorption field before test
Elapsed Time: min. Final fluid depth in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
New depth in.
ate >= g.p.d.
If yes', give date
D. LIFT STATION
Date installed NA Size in gallons
"Pump on" level at _ in.
Manhole/Access (Y/N)
"Pump off' level at in.High water alarm level at in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+
Water main 10'+
Wells on adjacent lots 200'+
Property line 5'+
Water service line 10'+
Absorption field 5'+
Surface water 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water Service line 104 Surface water 100'+
Curtain drain 50'+
F. COMMENTS
Wells on adjacent lots 200'+
Water main 10'+
Driveway, parking/vehicle storage 2'+!.
G. ENGINEER'S CERTIFICATION
I certify that I 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 Kenneth M. Duffus
Date 07103102
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HAA Fee $375.00
Date of Payment 07/03/02
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
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