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HomeMy WebLinkAboutHUNDRED HILLS 1ST ADDITION BLK 4 LT 7a At time of COSA, Engineer to verify cover over septic tanl Hundred Hill Block 4 Lot 7 #078-191 - 10  Municipality of Anchorage Development Services Department :~"'=-=- Building Safety Division ~'~ ~-; On-Site Water & Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW080200 PID Number: 078-- 191 -- 10 Name: JOHN THOMPSON Wastewater System: · New [] Upgrade Address: 17343 SANTA MARIA * EAGLE RIVER, AK ABSORPTION FIELD Phone: No. of Bedrooms: (907) 240-2020 5 [] Deep Trench · Shallow Trench [] Bed []Mound []Other LEGAL DESCRIPTION so,, Rating: 1.2 GPD/Sq. Ft. Total Depth, ..... 7 MAX'g'nc' grade: Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Grovel depth beneath pipe: 4 7 HUNDRED HILLS #1 2.99 MAX Ft. 4.01 Ft. Township: Range: Section: Fill added above original grade: Gravel length: - - - SEE DWG. Pt. 45 Grsvel width: Number of lines: Distonce between lines: WELL: · New [] Upgrade 5 Ft. 1 -- Ft. Clcssiflcation (Private, A,B,C): Totol Depth: Ccsed To:(BEDROCK) Total absorption area: Pipe material: PRIVATE 280 Ft. 101 Ft. 450 SQ. Ft. D 5034/ F-810 Driller: Date Drilled: Stotic Water Level: Instoller: Dote installed: SULLIVAN WATER WELLS 9/23/08 47 Ft. SOUTH FORK 9/24-25/08 Yield: Pump Set At: Cosing Height Above Ground: 6 GP. 261 rt. 2 rt. TAN K SEPARATION DISTANCES · Septic [] Holding [] S.T.E.P. [] Other* T~.~-'~....~To Septic Absorption Lift Holding 3ubllc/Privote Manufacturer: Capacity in gallons: Tank Reid Station Tank S .... Lines ANCHORAGE TANK 1000 Material: Number of compartments: Well 100'+ 100'+ -- -- 25'+ STEEL 2 Surface Water 100'+ 100'+ -- -- -- LIFT STATION Size in gallons: Manufacturer: / Lot Line 5'+ 10'+ -- -- - Foundation 5'+ 10'-~ _ _ _ "Pump on" level at: "Purer alarm at: Curtain Drain - NONE KNOWN . Pump Medical Inspections performed by: I I Remarks: ADDITIONAL SOIL COVER WILL BE PLACED BENCH MARK Location and Description: OVER THE SEPTIC TANK IN THE SPRING OF 2009 BOTTOM OF SIDING @ FCO A ..... d Elevation: 1 10. 91 ENGINEER'S SEAL Inspections performed by: OEO, Ltd. Dates: 1st 9/24/08 2nd 9/25/08 ~'--' 3rd - ." Development Services Department Approval ~_TU '..?. Conditional approval: ~'~, Date:'~-'._.2_-0 ti v,¢~'-"'";' ..................... Reviewed and approved by: Date: %~,oCes~',o~ (Rev. 4/06) -'~%%%~ AS BUILT DRAWING $W080200 - 078-191 - 10 A B ST1 47.42 50.52 / ST2 47.79 ~ 56.49 / ~, D~L1 48.68 58.52 / XXX ~LTERNAIE SITE DBL2 49.13 59.53 -- / ~,~ ~ XXX~-- ~ ~ C01 55.68 70.71 . / ;;~%1* X¢ ~ ' MT, 54.74 71.51 ~ 5~X / C02 , 77.50 ,109.03 / Xx Xx MT2 76.49 106.41 / '. / SCALE: ~ - I 1" = 50' ~ ~7 .:..- ; .... ,' 7-'~.....~~ OARNESS ENGINEERING GROUP, Ltd. ~'4~~ ,,°, ~. -~, ,o~. su~ ,o, . aC.OaOZ. ~ ,,,o, · ,.o,, (,Om,,-,,,,· m (,On=a-,Z~ · w~m~ PREPARED JOHN FOR:THOMPSON PHONE NUMBER: ] PAGE ..... NUMBER:' ...... Crt.da, .... ('~'~ '".deft"" ~: ;~;~ ................. 240-2020 2 OF 3 "~": LEGAL DESCRIPTION: DRAWN BY: ;;' HUNDRED HILLS ,1, BLOCK 4, LOT 7 KDM AS-BUILT DRAWING 2/3/2009 A B ST1 47.42 50.52 ST2 47.79 56.49 DBL1 48.68 58.52 DBL2 49.13 59.53 C01 55.68 70.71 MT1 54.74 71.51 C02 77.50 .109.03 MT2 76.49 106.41 PERMIT NUMBER: AS BUIL DRAWING PARCELID NUMBER: SW080200 - 078-191 - 10 f FINAL GRADE = 101.21-101.59 ST1 / /'-2" INS~2TION ooo INVERT OF BUNG J I I SEPTIC TANK I I ~INVERT OF BUNG ADDITIONAL SOIL COVER WILL BE PLACED OVER THE SEPTIC TANK IN THE SPRING OF 2009 /"-FINAL GRADE - 100.94-101,20 RELATIVE ELEVATION 0 OF TESTHOLE =89.10(DRY) i~.~ELATIVE ELEVATION OF BO]rOM F TESTHOLE =86.10(DRY) ENGINEERING Gl CONSULTANTS & GENERAL CONTRACTORS ONE (907)557-6179 * FAX (~ PHONE NUMBER: I PAGE NUMBER: I 240-2020 I ,3 OF ,3 I GARNESS ENGINEERING GROUP, Ltd. 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 * PHONE (907)557-6179 * FAX {907)558-5246 * WEBSITE: www.gamelsenglneering.com PREPARED FOR: JOHN THOMPSON LEGAL DESCRIPTION: HUNDRED HILLS #1, LOT 7, 'TYPe OF WOrk: PROFILE DRAWING t z~ u~ 1 Z?~l p ~ulllvan Water Wells by DOC CO, dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 *TELEPHONE 688-2759 OWNER OF LAND: ..C.? ¢ '* .... '~ .... ¢ ADDRESS: ~B~RE HOLE DATA DEPTH DATE: ~¢-/'~ ~,//S, ? PERMIT NUMBER: F~ ~ ....... Date of I~ue T~ IDENTIFICATION NUMBER: ~=/~,~- - Is well I~ated at approv~ pe~it location? ,~Y~'¢'~ No Method of Drilling: 4~r rota~ Q cable tool Depth of well: Casing Type ~ f' ¢; ~ ~-..Wall Thickness ,, ~ ~ inches .¢ Diameter '.~ inches, depth ,.." ¢ feet Liner Type: Casing Stickup Above Ground: Static Water Level: ¥4 ?' Recover Rate: ~"-,' gpm Method of Testing: ~'i Well Intake Opening Type: Q open end .~.o'~n hole feet feet feet Stopped '. feet feet, S.,topped feet Volume feet, to ,:,% .C3' feet 3 No Q Screened; Start Q Perforations Start Grout Type: ~;F~-,:*~ Depth: ~rom Well Disinfected Upon Completion? Method of Disinfection: Comments: From To Driller's Name A1-FENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. ARCTIC PUMP & WELL INC. Jhn Sullivan, CPI PO Box 770197 Eagle River, AK 99577 (907) 688-2510 (907) 258-2510 (907) 745-2510 apw~gci.net Pump Installation Log Well Drilling Permit Number: SW080200 Date of Issue:9-18-08 Parcel Identification Number: 07 8-191 - 10 Legal Description:Hundred Hills#1 Lot 7: Block:4 Property Owner Name & Address: John Thompson 17343 Santa Maria 1~c~1~ D~,7,~- Al( OO~'7'7 Pump Installation Date: 10-16-08 Pump Intake Depth Below Top of Well Casing:261 Feet Pump Manufacturer's Name: Pump Model:MBF2-100-S2 Pump Size: 1 Dempster hp Pitless Adapter Burial Depth: 10 Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: feet Martinson Southfork Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page 1 of 1 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 I WATER SUPPLY PERMIT Initial Date Issued: Sep 18, 2008 Expiration Date: Sep 18. 2009 Permit Number: SW080200 Legal Description: HUNDRED HILLS #1 BLOCK 4 LOT 7 Design Engineer: 0855 GARNESS ENGINEERING GROUI~ Owner Name: JOHN THOMPSON Owner Address: 17343 SANTA MARIA EAGLE RIVER, AK 99577- ParcellD: 078-191-10 Site Address: NHN WOLF DRIVE Lot Size: 104934 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail 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: ~ RUSH! Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.a nchorage.a k.us (907) 343-7904 -{)N-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Property owner(s) JOHN THOU~;0N Mailing address 17343 SANTA MARIA * Site address ~k,~ ~ L~ ~.~'~ ~_~ Legal description (Sub'd, Block & Lot ) HUNDRED HILLS ~/1. LOT 7. B/0(~: Legal description (Township, Section & Range) Lot Size I~)~ I ~ ~-~ Sq. Ft. Number of Bedrooms Day phone 240-2020 Zip Code 99577 THIS APPLICATION IS FOR ( [] all that apply): Absorption Field [] Septic Tank [] Holding Tank E] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade ~E] Renewal 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. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush Fees: Date of Payment: ~/.// 7/ Receipt Number: ~ L~q~'~ (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: GA-R NESS'-ENGiN-E R'ii 5'-- ROUP --L 'd i ............... ~':' '- CONSULTANTS & GENERAL CONTRACTORS ~,--.,.: ....... -~ ;~.=-~. ~. September 16, 2008 Municipality of Anchomge Development Service Department On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Reft Proposed Septic System for llundred llills #1; Lot 7, Block 4, To whom it may concern: The proposed 3 bedroom house is to be served by a private well and septic system. We are proposing to install a 1000 gallon septic tank and a 5-wide trench type drainfield. Two test holes were excavated on the property. The drainfield will be designed around the 30 foot radii of these test holes. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3, SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPilY: As can be seen on the attached design drawing the average topography below the drainfield is a 15-20 percent slope running approximately northeast to southwest. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. Ifyou have any questions, please contact us at 337-6179. Thank you for your assistance. ~ mes.~.E., M.S. y(~f ~tTEf ~t!!sht~a~ ~te;apc~a~.d~.aG~..~t~. 5~rd~s7igp~g~drac*~ ~;tg~-u;ttti;sn~:~p~c~c:th~ hn ~,ttreear J) part of the design package for 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com / .~'' ~',,. HUNDRED HILLS. /' --\ BLOCK ~, LOT 4 ~ "~'~ ~ ~ X ~ ~,-- ,~. ' ',, ,'/ ....... ~ / X"'/ / I~u x --~ ...... ~ ~ ?,~( ~ I ,o~s~ _~. ~ -- ~ ~ ..... / '~ /' //-- xx III ~mc ~ // iI I N I ~ ~ .... . i iI ,U~D~[D~i~.~ ~ ~ ~ ~. ~ ~ I I [~/ ~[~.LOT~ ~ ~ $) ~ ~ ~ ~ ~ ~ HUNDRED HI~ t1. ~ ' ~ I I m ~.~c ~ ~ ~_ ~ . . ,~) . . .............. :....~ ~ ~ ~sc.r..o.: ~w..~: ~'O~j ~.~c[~..." .~/ HUNDRED HILLS ~l, LOT 7, BLOCK 4 K.D.M. SITE P~N 9/5/2008 DESIGN CRITERI~T 'PROPOSED DRAJNFIELD fLLLANOTE: THE CONTRACTOR HALL HAVE THE WEST LOT INE AND ALL WELL RADII (;CED BY A RE(;ISTEREDI ND SURVEYOR PRIOR TO CONSTRUCTION. NUMBER OF BEDROOMS: ,3 GALLONS P£R DAY (GPO}: 450 PERCOLATION RATE/S: 1.66 & 2.5 MIN./INC~ PROPOSED APPUCATION RAT~:: 1.2 MINIMUM DRAJNRELD SQ.FT.: ,375 MAXIMUM DEPTH: 7 FEET ~R THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD PROPERTY OWNER AGREE I~AT THEY INS"FALL PROPOSEI BEDROOM HOt~E JOHN THOMPSON I 240-2020 I 20F'~~rnes.s..:, ~E OY WORK mOAT[; ,...o [:OPOS ED SEPTIC SYSTE~ D ES ION I 5/16/2008 ,,QARNESS ENGINEERING GROUP, Ltd ~i:"' , · ~. ~ ,o, ~ ,~ ,,,~, · ~ ~,~,.~,..,,,o. ,,~ ~,~,~,,_,:,~. ~ ~.. JSOIL LOG - PERCOLATION TESTI LEGAL DESCRPTION: HUNDRED HILLS B4. L? PERFORMED FOR: JOHN THOMPSON W/CT CONSTRUCTION DATe.. 0/8/08 ~?~ ORG ITEST HOLE #lJ GW ~ ORG GP ~ ML GM CL GC OL SW MH ,SP CH SM OH SEE SITE PLAN GM SC DEPTH TO GROUNDWATER DATE DRY 9/8/08 DRY O/i 5/08 SCALE: 11 DATE READING CLOCK NET Tilde WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 12 9/9/08 1 .3:50 - 6- _ 2 .3:40 lO 2" 4' 15 .3 .3:40 - 6- 4 .3:50 10 2' 4" 14 5 3:50 - 6- _ 1,5 6 4:00 10 2' 4" 7 4:00 - 6- _ 16 8 4:10 10 2' 4' 17 18 19 PERCOLATION RATE . 2.5 (MIN./INCH) PERC. HOLE DIA, 6 (INCHES) TEST RUN BETWEEN 5 FT. AND 6 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: [] YES [--J NO SOILS LOGGED BY, JODY MAUS PERCOLATION TEST PERFORMED BY: KYLE MAUS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WASI PEI~FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: .ARNESS ENGINEERING GROUP, Ltd ISOIL LOG - PERCOLATION TESTI LEGAL DESCRIPTION: HUNDRED HILLS B4LOT 7 ~ ~ PERFORMED FOR: JOHN THOMPSON W//CT CONSTRUCTION DATE: 9/8//08 ORG ITEST HOLE #21 GM ~,×~ I GW ~ ORG ;-',"~ GP ~ ML  GM CL GC OL · ~ SW NH · SP CH SM OH SC DEPTH TO GROUNDWATER DATE DRY 9/8/08 DRY 9/15/08 DATE SEE SITE PLAN SITE PLAN 1'=100' READING CLOCK NET TIME WATER NET DROP TIME (MINUTES) READING (INCHES) 1 3:31 - 6' - 2 3:41 10 O' 6' 3 .3:41 - 6" - 4 .3:51 10 O" 6' 5 3:51 - 6" - 6 4:01 10 O' 6' 7 4:01 - 6' - 8 4:11 10 O" 6' SOILS LOGGED BY: COMMENTS: PERCOLATION RATE 1.66 (MIN./INCH) PERC. HOLE DIA.. 6 TEST RUN BETWEEN 5 FT. AND 6 FT. A FOUR HOUR PRESOAK WAS PERFORMED: I YES F-]NO JODY MAUS PERCOLATION TEST PERFORMED BY: KYLE MAUS (INCHES) PERFORMED BY GEG, Ltd. I. JEFFREY A. GARNESS. CERTIFY THAT THIS WAS REREORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:, C~/It~/otl Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 j Anchorage, AK 99519-6650 ..,~, ~,'t w~vw.muni.org/onsite (907) 343-7904 / CERTIFICATE OF ON-SITE SYSTEIvlS ,b, PPROVAL FOR ,b, SINGLE FAF'lILY DWELLING Parcel I.D. 07~' - IC~ ~ "1 1. GENERAL INFORMATION COSA# ©q, Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HUNDRED HILLS ~1, BLOCK 4, LOT 7 7~-o ..NHN"WOLF DRIVE ' EAGLE RIVER, AK 99577 JOHN THOMSON Day phone 17333433 SANTA MARIA * EAGLE RIVER~ AK 99577 Day phone 24O-2O2O Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: .3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ~ Individual On-site Individual Water Storage Individual Holding tank Community Class Well [] Community On-site Public Water System [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska.. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 samples. (Certificates may be reissued for a pedod 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER AS certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 vedfy that based on the information obtained from the Municipality of Anchorege 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. NameofFirm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineers PHnted Name JEFFREY A. GARNESS, P.E. Date ~/2~/~ Engineer's Comments: In conducting this evaluation, GEG, LtD. ettempted to provide e thorough, conscientious engineering analysis of the system in accordance with ADEC and ~gOA DSD Guidelines & Regulations. The reported results described the podormance 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 welts and septic systems depend on the local soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future peffon'nanoe of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or pady is not authorized, nor will it confer any legal dghl whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for --'~ bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory - . V Arsenic Advisory Maintenance Agreements Supplemental Engineer*s Report Other Original Certificate Date:, Municipality of Anchorsge Development Services Department Building Safety Division On-Sile Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HUNDRED HILLS #1, BLOCK 4, LOT 7 Parcel ID: ~ 7~' A. WELL DATA Well type PR~vA'rE If A, B. or C provide PWSID# N/A Date completed 9/23/2008 Sanitary seal (Y/N) YES Totaldepth 280 ft. Casedto 101 ft. (BEDROCK) FROM WELL LOG , 9/25/2008 Date of test Static water level 47 ft.. Well production 6 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: ~'~7.. ug./L. , B. SEPTIC/HOLDING TANK DATA g.p.m. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION YES YES 2 in. Nitrate O ,rog.IL. Other bacteria C) coloniesll00 mL Daie of s'ample:~ Collected by: GE(; Ltd. Tank Type/Material Tank size 1000 gal. Foundation cleanout (Y/N) YES Date of pumping NEw ABSORPTION FIELD DATA SEPTIC/STEEL Number of Compartments 2 Depress,ion over tank (y/N) NO Pumper' Date installed 9/24-25/2008 cleanouts (Y/N) YES High water alarm (Y/N) N/A Date installed 9/24-25/o8 I Soil rating Or ft='/bd,rm) 1.2 Length 45 ft. Width 5 ft. Totaldepth '8.1 ft. Eft. absorption area 450 ft~ Monitoring tube YES Date of adequacy test NEW = Results (Pass/Fail) PASS Fluid depthin absorption field before test - in. ' Wateradded - gal. Elapsed Time: - min. Final fluid depth - in.' New depth Absorption rate >= .450+ NONE KNOWN If yes. give date Any rejuvenation treatment (past 12 mo.) (YiN & type) System type TRENCH Gravel below pipe 4.01 ft. Depression over field NO For ,,3 bedrooms - in. g.p.d. D. LIFT STATION Date installed Size in gallons ~ ~ "Pump on" level at in. 'Pump oft" leve_.[~. High water alarm level a ~n. ~ ...-.-- Cycles tested. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100% Public sewer main N/A Sewer/septic service line 25% Animal containment areas 50'+ 100% On adjacent lots. 100% On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N,/A Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation. 5'+ Proper~ line 5'+ Absorption field Water main N/A Water service line 10% Surface water 100'+ 5'+ 1100% We/Is on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10% Building foundation. 10% Water service line 10% Surface water 100% Curtain drain NONE KNOWN Wells on adjacentlots. 100% Water main N,/A Driveway, parking/vehicle s[orage F. COMMENTS 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ (~ ~. o o Date oi Payment Receipt Number ' (Rev. 11/~5) Receipt Number. FRO~ To393 P.OOZ/O0~ F-148 ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTYz AND THAT NO ENCROACHMENTS [:'XIST EXCEPT AS INDICATED. IT IS THE RESPONSI~31LITY OF THE OWNER TO DETERMINE TH-'. EXISTENCE OF ANY £ASEMENTS, COVENANTS~ OR RESTRICTIONS WHICH DO NOT APPEAR ON THE REC, OR'DE::) SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES S~ ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINESz OR FOR ESTABLISHING BCXJND- ARY LINES.