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HomeMy WebLinkAboutT12N R3W SEC 33 LT 55 S180' LESS W110'Municipality of Anchorage • .. Development Services Department ._ __- Building Safety Division � � ^ Onsite Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO30385 PID Number. 018-192-13 Name: MARCEL WARMILEE Wastewater System: ■ New ❑ Upgrade Y P9 Address: 3231 EAST 144th AVE. ABSORPTION FIELD Phone: No. or Bedrooms: (907) 440-8501 4 ■ Deep Trench O Shollow Trench O Bed ClUound Gather LEGAL DESCRIPTION Soil Ra": 0.6 Tota Depth Iran a1w grade: GPV/s� In. 10.17 rL Block: Lot: Subdivision: — 55 5180' W110' — Depth to piw baton from W" poet Gravel depth tNhreth pipe. 4.67 MAX r< 5.5 r< Township: 12N Range: 3W Section: 33 rel eadw enan or" geode Gm,* tehptre SEE DWG In. 46/45 n. WELL: ❑ New ❑ Upgrade Gnhel warn: 2.5 hk r w of 6. 2 oieteme W~ Inew 11 n << Cwelicolwr prhole, A.B.t} Taatarts To: Total oeeorptl" area: lea wt~. FL r< 1008 so. rL D 3034/ F-810 Drahr: We Drtsad: static Met. Jewel: k.topw. A+ HOME SERVICES Dat. k.lall.d: 10/8-14/2003 n pwho set A< cwwV pWght Ahww G. : TANK GPN rL R SEPARATION DISTANCES ■Septic 0Holding 0S.T.E.P. Oother io gram Septic Tank Absorption Field lift Station Holding/PrWe Tank sewer Lines Yp1y'IOLI"'a' ANCHORAGE TANK Cap«iry N yamc 1250 Well 100'+ 100'+ — — 25'+ "erw. STEEL a aah.wlhrwrl� 2 Surface water 100'+ 100'+ — - — LIFT STATION Lot Une 5't 10'+ — — — Sin In 9a Foundation 5'+ 10'+ — _ — en lewd el: Ml of High water awrh at: Curtain Drain NONE KNOWN Pr7 tloYa E4cbka k.paationa Worrnad tr Remarks: OLD SEPTIC TANK WAS ABANDONED BENCH MARK Lpa4an oed Dewarip n: PER THE UPC. CONCRETE SLAB ® SE EDGE OF GARAGE Asn.d EMwal.n. 100.00 rt ENGINEER'S SEAL '• 1 AKWWC, INC. oma: 4 �°°o Inspections performed by: Dates: 1st 10/8/2003 2nd 10/14/2003 3rd 10/14/2003 00.� :...e .:......erg:.. Development 0°a . ., c 7953 rvices partment Approval Ftp Reviewed and approved by: Date /7 O4 ��°dearth eeelo"off �O (R.- 12/e1) �0440000�6 I NUMBER: AS—BUILT DRAWING Pro NUMBER: SW0 - 018 SW030385 018-192-13 . \ I 100' WELL RADIUS I \ A B \ 37.80 49.70 45.37 87.88 1 STI m DBL1 47.69 59.77 DBL2 47.90 60.66 C01 43.36 67.04 MTI 44.07 67.80 CO2 81.12 95.68 MT2 79.29 93.64 CO3 31.47 53.52 MT3 31.14 53.12 MT4 72.18 83.52 C04 71.55 82.68 FS 55.51 72.90 I %A� I yC—_—_______— I,___ I` I \ I I 1 / ©►�m CO2 144th AVE. �DQN O INP7 I � E�� I 1 75 W 1 \ I DATE: c p6�0 r" � 10/29/2003 0(��F _ .._ a� L' • 77" DRAWN BY: �... . ..... �40 ALASKA NATER & INAST>CNVATER N.C.H. �p� . T X000 CONSULTANTS, INC. SCALE: ¢ 1 — 40 .......... .. ............. 701 E TUDOR BOLD. Sl11TE 101 • encNOBeGF. AK 90307 • PeONF (00))33)-OA9 •FAR f0071338-3746 — D IEPARED FOR: PHONE NUMBER: PAGE NUMBER: WARMILEE MARCEL (907) 440-8501 2 OF 3 Q P ..j tr y arnesS: 0 '.CAL DESCRIPTION: Q — 9 ,Q T12N• R3W SECTION 33; LOT 55, S 180' LESS 110' 004 o`o� PE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE �44000��00.�. PERMfTNUMBER` AS—BUILT D RAW I N G PARCEL NUMBER: SWO SW030385018-11 92-13 THj1 TOP OF TANK AT INLET ^ 94.82 INVERT OF BUNG / AT INLET ^ 94.30- RELATIVE ELEVATION - OF BOTTOM OF TEST HOLE ^81.57 EAST TRENCH MT Co rFINAL GRADE 99.2 S F NEW 1250 GALLON SEPTIC TANK L GRADE 97.66+ c FILTER FABRIC INVERT OF PIPE ^ 93.57 BOTTOM OF :NCH ^ 88.07 10' TOP OF TANK AT OUTLET ^ 94.84 ` INVERT OF BUNG AT OUTLET ^ 94.07 WEST TRENCH 10/29/20 DRAWN BY: ALASKA WATER & IVASTERTATER SCALE: N.C.H. CONSULTANTS, INC. 1 ^ = 40' 3701E TUDOR ROAD, SUITE 101 • ANCWO AGE. AK 00507 • PNONF (007)337.6170 • FA% (007)338.37&6 PREPARED FOR: PHONE NUMBER: PACE NUMBER: MARCEL WARMILEE (907) 440-8501 2 OF 3 LEGAL DESCRIPTION: T12N, R3W, SECTION 33; LOT 55, S 180' LESS 110' TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE TH12 FINAL GRADE 97.90+ ---,CFlLTER FABRIC INVERT OF PIPE 92.62 BOTTOM OF :NCM ^ 87.13 RELATIVE ELEVATION OF BOTTOM OF TEST HOLE -80.80 4fr N53 s: Ldp 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 Upgrade Date Issued: Sep 17, 2003 Expiration Date: Sep 16, 2004 Permit Number: SW030385 Parcel ID: 018-192-13 Legal Description: N -24 R301 SEC 33 LT -55 S1W LESS W 110!' Design Engineer: 0041 AK Water & Wastewater Consultarn Site Address: 003231 144TH AVE E Owner Name: Marcel Warmiiee Lot Size: 39600 SQ. FT. Owner Address: 3231 East 144th Avenue Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516-3925 This permit is for the construction of: ❑✓ Disposal Field ❑,/ Septic Tank ❑ 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 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: -I 1,9 -0 Date: % 02 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 ON-SITE SEWER/WELL PERMIT APPLICATION ^ c' FOR A SINGLE FAMILY DWELLING Parcel I.D. lJ D 7-- 1 '71) Permit Numbers1,-030383_ Property owner(s) MARCEL WARMILEE Day phone 440-8501 Mailing address (2) Zip Code 99501 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) SECTION 33, T12N. R3W. LOT 55. S180'. LESSw110' Lot Size Q�i Acre Sq.Ft. Number of Bedrooms 3 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 ❑ I 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. ALASKA WATER & WASTEWATER CONSULTANTS, INC. Permit Fees: 4 C) C) Date of Payment: Receipt Number. L! �q ' Waiver Fees* Date of Payment: Receipt Number: ALASKA WATER & WASTEWATER CONSULTANTS, INC. August 29, 2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 55, T12N, R3w, Section 23, S180', less 110' To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The existing septic system is in a state of failure and needs to be upgraded. A test hole was dug on the property. The drainfield will be designed around the 30 foot radius of this test hole. We are proposing that a new 1250 gallon septic tank and also deep trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 0.6 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 30 minutes/inch b. Proposed Application Rate: 0.6 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1000 ft2 f. Total Depth: 10 feet (max.) g. Effective Depth: 6 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 84 feet long k. Effective absorption area =1008 ft 3. SURFACE RATERS: There is a stream along the west end of the property. The septic system is to be installed 100+ feet from the stream. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: akwwc.com 4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography in the area of the proposed drainfield is fairly flat. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. NOTE. Attached is a site plan drawing, a design drawing, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: akwwc.com I I 1 i T12N, R3W, SEC 3a T12N, R3W, SEC 33 T12N, R3W. SEC 33 LOT 42 ♦\ LOT 41 LOT 431) �/],/ 1 I \ \ RADIUS WELL 1 1 1 _ I 1 j � ♦♦ I IXISTINC W Gas Es, 2k 823 ► 737 7 —__� / V / n 4 BEDROOM HOUSE ____12s.00____ E_====—=—==3-- �_ �\ �� T12N, RJW, SEC 33 /LOT 12Q' WELL RADIUS SB T12N, R SEC 33 / LOT S4 ^, I QUONSET \IXHUT / PROPOSED SEPTIC UPGRADE (SEE DESIGN PACE 2 OF 2) SEPTIC SYSTEM� �i� TH/1 144th AVE. \ \ --- % I \♦\ WELL 1 �,A. I T12N, R3W, SEC 33 1 \ \�W1V / i LOT 73A \\ 1 - I 1 \♦ \� _�--� i j ♦♦` jRADjU5 1 WELL I \ ��. 1 \\ \\ ♦ % 712N, R3W, SEC 33 1 ♦� LOT 74 \ ♦ I T12N, R3W, SEC 33 `� ---- (:SEPnC ARS ♦♦ 1 LOT 738 l �i T12N, R3W, SEC 33 1 LOT 73 I 9/2/2003 \!� DRAWN BY: C.J.G. ' � ' S1'L'WA'I'RR WATER & RA �j �V.••• f>'' ••. �`ti'�. ALASKA CONSULTANTS. INC. S� Ew 1 100' • ..... ........... .w[ Tl 9n. 9nAn c" n7c �N • A4^-n9Acc nM 99X.7 • Ourv.Ic (9nln})-A'79 • FAX l9yn.n.1TAM1 y. iw PREPARED FOR PAGE NUMBER: MARC LL WARMILLE (907 348-6660 1 OF 2 Corn L, ss: 53 �� 53 •• �� LEGAL DESCRIPTION: T12N, RM SECTION 33: LOT 55, S 180' LESS 110' ��.° cq♦ '" TYPE OF WORK:44V�ad��`h65910 SITE PLAN FOR SEPTIC SYSTEM UPGRADE ;,,,I— -- NOTE: THE CONTRACTOR SHALL HAVE ALL OF THE 100 FOOT WELL RADII AND THE SOUTH AND EAST 33 FOOT SECTION EASEMENTS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. EXISTING WELL Vn PROPOSED 1250 GALLON 'TANK FCO SEPTIC EXISTING QUONSET HUT TO BE REMOVED -INSTALL DOUBLE III CLEANOUTS PROPOSED DRAJNFIELD. EXCAVATE A TRENCH! THAT IS 10 FEET DEEP MAXIMUM BY 2.5 FEET WIDE BY 84 FEET LONG. ADD 0 FEET OF CLEAN, WASHED SEWER DRAINROCK. I IATHJ I IT ISTING SEPTIC SYSTEM TO BE APPROXIMATE LOCATION OF COMPLETELY ABANDONED EXISTING SEPTIC TANK. TO BE COMPLETELY ABANDONED 33' SECTION EASEMENT E. 144TH AVENUE DATE: O`*A 9/2/2003 DRAWN BY., 10' 04;* C.J.G. ou ALASKA IVATE R & NVASTEWATIE R CONSULTANTS, INC 3701 F TUDOR ROAD &JITF 101 6 ANCHMAGF. AK 09507 - N ONF (007)337.6170 - FAX (007)33R-SM6 1" = 40' .... . 0. . .... ........ PREPARED FOR: PHONE NUMBER: PAGE NUMBER: WARMILLE 348-6660 2 OF 2 ... . . . ..... ... MARCELL f A. Q a —7953 s: e; LEGAL DESCRIPTION: T12N, RM SECTION 33; LOT 55, S 180' LESS 110' 'rofesslor,o TYPE Of WORK: DESIGN OF SEPTIC SYSTEM UPGRADE ALASKA WATER & WASTEWATER CONSULTANTS. INC. 7701 C T WR RWD. SUDS 101 • ANCIIORACE, AX. 99507 • 9HMC' (9071777-9179 •FAX: (90»335-M46 • WCn : Wi.eea SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: T12N. R3W, SECTION 33, LOT 55; S180' LESS 110' PERFORMED FOR: MARCEL WARMILEE DATE: 8/15/2003 IEP TEST HOLE 1 1 -== ORGANICS 2 3 4 5 6 7 8 9 10 11 12 GM/SM SM 13;.: DATE DRY 8/15/2003 IIIIIIIII 8/22/2003 \ i ms`s.•: 2:42 i 6' %/A 15 »• • 30 5- 1' I 3 114111'1 - B • 4 4.0.11. 17 5• 1• 18 5 3:42 19 6' - wellwol -. • . DATE DRY 8/15/2003 IIIIIIIII 8/22/2003 \ i i111J1 2:42 i 6' %/A \ 1 HHN Iilllllll • 30 5- 1' I 3 114111'1 - B • 4 3:42 APPROXIMATE_ DEPTH TO GROUNDWATER DATE DRY 8/15/2003 DRY 8/22/2003 \ i 1 2:42 � DATE READING CLOCK TIME 1 1�0' WELL RADIUS I WATER LEVEL READING NET DROP (INCHES) \ i 1 2:42 � 6' - \ 1 2 3:12 30 5- 1' I 3 3:12 - 6• - 4 3:42 APPROXIMATE_ 5• 1• LOCATION OF 5 3:42 TRENCH 6' - 6 4:12 30 5• 1• E. 144th AVE CO SITE PLAN 1'100' , DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 8/19/2003 1 2:42 - 6' - 2 3:12 30 5- 1' 3 3:12 - 6• - 4 3:42 30 5• 1• 5 3:42 - 6' - 6 4:12 30 5• 1• PERCOLATION RATE 30 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6.0 FT. AND 6.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: JOE MARCHETTI COMMENTS: PERFORMED BY AKWWC, INC. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS W ERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: WALoi To Whom It May Concern: 21 August 2000 This is concerning the leach field at 3231 E. 144'" Ave. Anchorage, Alaska. To the best of my recollection my father installed it in the early 70s soon after we moved from 3401 E. 144h. The question that this letter is to address is the manufacture date stamp on a visible pipe that is part of the leach field. If it has a newer pipe it would only have been placed to fix an existing pipe. II �L . #C'e'r�a Jerry S. McEwen 1408 W. 10"' Ave. Anchorage, Alaska 99501 HM 276-2359 WK 564-1986 Subscribed and sworn to before this 21 ' day of August 2000. Victor D. Carlson Notary Public for and in the State of Alaska. My commission expires g S -c') a 1 r • To Whom It May Concern, I, Marcel Warmilee, purchased 3231 E 144' , S 180 Lot 55, Section 33, T12N, R3 W, S.M. except W. 110 on October of 1997. The summer of 1999, I was excavating the roadside on the south side of the property where I noticed a large boulder. I was planning to move the boulder in my yard for decoration. Under the boulder, I noticed a pipe. I started digging around the pipe and found it was the end of the leech field. Yours Truly, Marcel Warmilee If you have any questions, please c STATE OF ALASKA On this vqlk day of in the year, before me, the undersigned notary public, personally appeared: ftf—(e'\ WOVCM known to me to be the person whose name is subscribed to the within insturment and acknowledged that he executed the same for the purposes therein contained. No ary Pu lic My commission` 2xpt'res �=-'NOTARY EE PUBLIC.** *E 6189707, � -1, ,0 ?p • � Municipality of Anchorage On-Site Water and Wastewater Program i.6. nt.l i (907) 343-7904 ,FST r' ,' Certificate of On-Site Systems Approval °� Parcel I.D. 018-192-13 Expiration Date: (9 - 6 - 1 ? 1. GENERAL INFORMATION Complete legal description T12N R3W Sec 33 Lot 55 S180' Less W110' Location (site address) 3231 E. 144th Ave. Current Property owner(s) Scott & Terri Gagne Living Trust Day phone Mailing address 3231 E. 144th Ave. Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: l Received b,:;.t►'ei�► �1 ��i�t. ■/1'� i.ji! Date: T) _ :�.i��..— COSA to be released to the engineer,unless • erwise reque- by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 12-S I 11 Date of Payment Receipt Number 022_t{L Receipt Number COSA# OSC W ! 112_ Waiver# 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, based on procedures outlined in the Certificate of On-Site 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 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. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 3/21/2018 OF AL,q‘kk kk 6. DSD SIGNATURE > . ,! �4/ System #1 Approved for • 1 bedrooms .Steven R. anno e System #2 Approved for bedrooms 4 ��, CE-8149 �� WW Disapproved (!\ � OFESS4���' "` Conditional approval for bedrooms, with the following stipulations: •QP�\-c\, OF Hryeyo == ON-SITE G5 tf WATER AND WASTEWATER o 4PROGRAM \a, tAIr gc9 \1\ By: �^-- IC/ Original Certificate Date: 3- 3 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil 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 r. COSA blue sheet f '• , c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: T12N R3W Sec 33 Lot 55 S180' Less W110' Parcel ID:018-192-13 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N Date completed N/A Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 76+ ft. Cased to 40+ ft. Casing height(above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test UNK 3/16/2018 Static water level UNK ft 66.4 ft. Well production UNK gpm 4.2 g p m WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 3/16/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/14/2003 Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(YIN) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A Date of pumping 3/15/2018 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 10/14/2003 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type Deep Trench Length 46/45 ft. Width 2.5 ft. Gravel below pipe 5.5 ft. Total depth *10'8+ ft. Eff. absorption area 1008 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3/16/2018 Results (Pass/Fail) PASS - F r 4 bedrooms Fluid depth in absorption field before test 11/13 in. Water adde• 4a.Ie( •al. ew 11/14 t in. dam / Elapsed Time: 150 min. Final fluid depth 11/13 in. Absorp i = �"'� (9(9d g. .d. N Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS *Below final grade. Survey on file. G. ENGINEER'S CERTIFICATION .r�„��"` ' Cq ilia ' OF A• c4 I certify that I have determined through field inspections and :74:‘•000"03.- review p . • 4.—•••1:771#k review of Municipal records that the above systems are in 0*; /\ -.*T9 conformance with MOA COSA guidelines in effect on this date. %....14.N. •• g Engineer's Printed Name Steven Pannone / •onnone Date 3/21/2018 r6}1y.. CE-8149 •„ape k' , ` . COSA canary sheet_2-6-15.doc