HomeMy WebLinkAboutHULTQUIST HEIGHTS LT 3Hultquist
'D
Heights
Lot 3
#020-044-05
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Municipality of Anchorage amp
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141223
PID Number: 020-044-05
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple
(SF and/or D) Project: 0 New ❑ Upgrade
Name:
HULTQUIST HOMES
ABSORPTION FIELD
Address
❑ Deep Trench ® Shallow Trench 0 Bed ❑ Mound
12580 OLD SEWARD HWY ANCHORAGE AK 99515
El Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1,2 GPDISF
7.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot
3.0 Ft 4.0 Ft
HULTQUIST HEIGHTS 3
Fill added above original grade Gravel length
Township Range Section
0-1.0 Ft 60 FL
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES
5 Ft. Ft.
Toj Septic Absorption Holding
Sewer
Total absorption area
Number of trenches
_
Dist. between trenches
From Tank Field Lift Station Tank
I
Line
soo Ft=
1
NA Ft.
well >100' >100' >100' NA
>25'
TANK ❑septic ®S.T.E.P. ❑Holding ❑ Other
I
Manufacturer
ANCHORAGE TANK
Capacity
1500 Gai.
Surface Water >100' ' >100' I >100' NA
Material Number of compartments
Lot Line >5' >10' >5' NA
STEEL 2
NA
Foundation >5' >10' >5' NA
LIFT STATION
Manufacturer
Capacity
_
Curtain Drain j >50' 1 >50' >50' NA
ANCHORAGETANK
1500 Gal,
Remarks
Pump on level at
Pump off level at
High water alarm at
25 in.
44 in.
22-5 n.
J
Pump make and model
Electrical Inspections performed by
ORENCO
MOA
PIPEMATERIAL Housetotank3034 TanktoSCH40
drainfield
Installer
A+ HOME SERVICES
Drainfield SCH40 CCIMT3034
inspector LARS SPURKLAND/ANSON MOXNESS
BENCHMARK (Assumed elevation)100 ft
Inspection V 8/22/14 $/26)%14
Location and description
2""
3° 8126114 4"1–—
TOP FOUNDATION SW CORNER
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineers Stamp
Conditional Approval:
Date
a Ve, A4,4
pH
URIK' NO
A roved Gl/
pp
Date
rJ
Inspection Repor(_g-,'K1ZAocl/
LOT 2'. I
i
LOT 3 I W
(, INSTALLED 4 -BEDROOM SEPTIC SYSTEM
INSTALLED 1500 GALLON STEP TANK
FRENCH LENGTH 60 FEET �o
TRENCH WIDTH 5 FEET
MAX EXCAVATION DEPTH 7 FEET
- ROCK DEPTH 4 FEET
PROPOSED
a H5-9 I1
Pr +?5fq
_ SWING TIES A 8 C diSiY'
S. T. C. 0. D 11.0' 31.0'
LIFT STATION OFE20.0' 36.0' `..
OF. M.T. lK F 56.0' 53.0'
OF. M. I. )f' G 44,0' 775' A
F
I 0
I E TH7
zd
I T11N R3W SEC 2 SE4SW4NW4NW4 /
I 3 Septicn
(- Area
1 Y
RESRfY£*: AWWFS MAXIMUM APPLICATION RATE 60PDIM
USE SHALLOW TRENCH W/ 4 FT EFFECTIVE. MINIMUM
TRENCH LENGTH=4*f/5*0.5=10 FT
NOTE: SLOPES EXCEEDING 25% WERE NOT OBSERVED
WITHIN 50 FEET DOWN GRADIENT OF THE PROPOSED
ABSORPTION RaD LOCATIONm,
NOTE.: THIS IS NOT A SURVEYED PLAT. WELL R SEPTIC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT 00CUM£NTATLON. ALL LOCATIONS SHOWN ARE
APPROXIMATEE,
25 0 25 50 75 100 125 150
SCALE 1' = 50 FL
4' CONTOUR LINES
N
V 1SAND ENGINEERING SEP NST HEIGHTS LOT 3 SEP
20303 W TIC SYSTEM ASSUILT
T1L AVENUE
ANCH. AK 99501 HULTQUIST HUMES DATE AUG 28 2014
(907) 279-3916 15872 ELIZABETH ST ANCHURAGE AK 99516 SHEET 2/3 6RID SV3238
I PERMIT # OSP141223 PID # 020-044-05 HULTOUISTHEIGHTSLjSC50-ASB.BV6
WIDE Trench:
5' vio'e
60' Long
T Max. Depth
4' Serer Rock
3116' hate 30' on Center
1 114' SCH 40 PIPING
TII
Er atv
loaf
eas' armr
aew
� Na
sir
•i r 6 Ur JC[J wL fCVLK
1500 GAL STEP TANK
BENCH MARK TOP FOUNDATION SW COMB
ASSUMED ELEVATION 100 FEST
SPURXLAND ENGINEERING HULTQUIEST IIEIGM LOT 3 SEPTIC SYSTEM ASBUILT
203 W AVENUE
ANCH. AK.
RUL TOUIST HDMES DATE, AUG 26 2013
9 9 95(11
(907) 279-3916 11 15872 ELIZABETH DR, ANCHlIRAGE AK 99516 SHEET 313 GRUA SV3238
PERMIT # IISP141223 PID # 020-044-05 HULTBUISTHEI6HTSL.3D3-ASB.DW6
09/19/2014 10:43 907-34202 ALPINE Di2ILLI PAGE 0"
Alpine Drilling & Enterprises
Well Log
Permit Number: #SW141223 Date of Issue: 7-10-14 Parcel Identifleation Number: 02004405000
,Date Started: 10-25-14 Date Completed: 10-30-14 Is well located at approved permit location? x Yes ❑ No
Legal Description: Hultquist Heights Lot 3
Property Owner Name & Address: Hultquist Homes Inc
12580 Old Seward Highway
Anchorage. Alaska 99515
Borehole Data:
Depth (ft)
Method of Drilling x air rotary ❑ cable tool
Soil Type, Thickness & water Strata
From To
Casing type: steel
Stick-up
silty gravelfill
Organics silt
0 2
2 g
8 9
Wall Thiclmess:• 2U inches
Diameter: 6 inches Depth: 486 feet
Liner Type: pvc
Diameter: 4 5 inches ,Depth: 16-470 £rd.
gravelly snit
9 29
Casing stickup above ground: 2 feet
Static water level (from ground level): 37 feet
bedrock :. • ' 29 486
Pumping level: 486 feet after
24 hours pumping 7 gpm
Recovery Rate: 7 gpm
Method of Testing: _,,,
Well Intake Opening Type:
❑ Open End x Open Hole
❑ Screened Start _ feat Stopped ,_ feet
❑ Perforations Start _ feet Stopped ^ feet
Grout Type: bentonite granules Volume:L-bv
De the $ 0 feet Stopped ? feet
Pump: Intake Depth feet
Pump size — hp Brand Name ___,^
Well Disinfected Upon Completion? x Yes El No
Method of Disinfection: chlorine tablets
Comments: Well was hydrofraced with results of 7 gpm
at 40 feet of drawdown for a 24 hour period
Well Driller: Alpine Drilling & Enterprises
POBox 110496
Anchorage AK 99511
development Services Departmep
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Mark&egich Anchorage, AK 99507
Mayor www.muni,orglonsite
(907)343-7904
Pump Installation Lag
Well Drilling Permit Number: SW 141223
Parcel Identification Number: 02004405000
Date of ISSUe: 71102014
Legal Description Property Owner Name & Address:
Hultqutst Heights Lot 3 Haitquist Homes Inc.
12580 Old Seward Hwy -
Anchorage, AK 99515
Pump Installation Date: 12/1112014
Pump Intake Depth Below Top of Well Casing: 452 feet
Pump Manufacturer's Name: Goulds
Pump Model: 5GS15412CL
Pump Size 1.5 hp
Pitless Adapter Burial Depth: 12 feet
Pitless Adaptcr Manufacturer's Mame: Maass
Pitless Adapter Installer: David Harper
Well Disinfected Upon Completion? Z Yes ❑ No
Method of Disinfection:
Comments:
Pump Installer Name: Aarow Pump & Well Service, LLC
P.O. BOX 110496
Anchorage, AK 99511-0496
Attention: The pump installer shall provide a pump installation log to the DSD within 3)0 days of pump installation.
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a
Attention: The pump installer shall provide a pump installation log to the DSD within 3)0 days of pump installation.
On -Site Water & Wastewater System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141223
Tax Code Number: 02004405000
Work Type: WellSeptic Initial
Permit Effective Dates: July 10, 2014 to July 10, 2015
Design Engineer: SPURKLAND ENGINEERING
Subdivision: HULTQUIST HEIGHTS
Site Legal Address: HULTQUIST HEIGHTS LT 3 G:3238
Owner/Address: HULTQUIST HOMES INC
12580 OLD SEWARD HIGHWAY ANCHORAGE AK 995153506
Site Mailing Address: 15872 ELIZABETH ST, Anchorage Lot Size in Sq Ft:
Total Bedrooms:
This permit is for the construction of:
0 - 2 2 -/Lf
55464
4
Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
C01 1/"evz1es 4/e v`eserdf dl"'}" Af Id.
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcell.D. 020-044-05
Property owner(s) HULTQUIST HOMES Day phone
Mailing address 12580 OLD SEWARD HIGHWAY ANCHORAGE AK 99515
Site address 15872 ELIZABETH DRIVE
Legal description (Sub'd., Block & Lot) HULTQUIST HEIGHTS LOT 3
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field El Initial Single Family (SF)
Q
(w/wo ADU)
Septic Tank ElUpgrade F]Duplex
(D)
F1Holding
Tank ElRenewal E]Multiple
Dwellings
❑
Privy ❑ (SF and/or D)
Private Well 0
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
property owner or authorized agent)
Permit/RushFees: (A-;?l5'=IN^
Date of Payment: 2y /
Receipt Number: 011vi G
Permit No. OSJ?i1�i �Z
Permit App_9-1-12.doc
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
&Ak
Spurktand Engineering
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
HULTQUIST HEIGHTS LOT 3
Municipality of Anchorage June 16, 2014
Development Services Department
On Site Water and Wastewater Program
4700 Elmore Road
Anchorage, Alaska 99519
Subject: Well & Septic System Installation Permit
15872 Elizabeth St
Ladies and Gentlemen:
I am writing to request a well & septic system installation permit for the above referenced
property. The proposed system will serve a new 4 -bedroom single-family residence. Soil logs,
design calculations, a site plan, design drawings and construction specifications are enclosed for
your review.
Design Calcs: Groundwater observed at 13' BGS in 10/2013. No groundwater to 15' on 6/16/14
Soil Rating. From Mike N. Anderson, P.E. test hole 6/15/13
3.33 min/in =1.2 gal per sq.ft./day
No. of Bedrooms 4
Required Area per Bedroom: 150/ 1.2 =125 sq.ft.
Total area required: 125 x 4 = 500 sq.ft.
System: The existing We are proposing a 1500 gallon STEP tank followed by a wide trench
absorption field. The absorption field will be 60 feet long and 5 feet wide and contain 4.0 feet
(600 sq.ft. effective) of sewer rock.
Soils: A test hole was excavated on July 15th, 2013 by Anderson Engineering. See the attached
soil logs. Ground water monitoring will continue through construction of the septic system. Per
Mike Anderson, PE there was ground water at 13' below the ground surface in October 2013. No
groundwater was found on June 16, 2014.
Surface Water: There are no surface waters within one hundred feet of the proposed septic
system upgrade.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
S urk nd En ineerin
p g g
Environmental Consulting and Design
Topography: The ground level generally slopes down towards the west at around 20% slope.
Waivers: None
Well: Due to neighboring septic systems, the well will be placed in the back yard such that the
100' protective radius does not impact neighboring properties.
The installation of this well and septic system will not prevent wells and septic systems from
being installed on the adjacent lots. The proposed septic system will not change the general
slope of the area. Ponding and/or concentration of surface runoff will not result from this
installation.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
G�'�
Lars Spurkland, P.E.
Civil Engineer
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
Tr Cii
I I
swwwwom
VIM RSW SEC Y SE4SWO MMW I I W"
I I
NOTE: THIS IS NOT A SURVEYED PLAT. WELL i SEPTIC
LOCATIONS TAKEN FROM ON—SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
50 0 50 100 150 200 250 300
SCALE; 1' = 100 FT,
SPURKLAND ENGINEERING
HUMII.�UISY' HHIGHI S' LOY' 3
SEPTIC
SYSTEM DESIGN
203 W 15TH. AVENUE
ANCH. AK. 99501
HUL TQUIST HOMES
11
DA TE,
JUNE 16 2014
(907) 279-3916
15872 ELIZABETH STREET, ANCHORAGE AK 99516
SHEET,
1/3 GRID, EV3238
PERMIT # OSP1110XX
PID # 020-044-05
HULTQUISTHE16HTSL 3.SC100.DWG
W
LOT
PROPOSED
TI IN R3W SEC 2 SE4SW4NW4NW4
RESREVE4• AWWTS MAXIMUM AAPUCATTON RATE 66PD/FT2
USE SHALLOW TRENCH W/ 4 FT EFFECTIVE. MINIMUM
TRENCH LENGTH=4'f/5'0.5=I0 FT
NOT£.• SLOPES EXCEEONG 251 W£RE NOT OBSERVED
WITHIN 50 FEET DOWN GRADIENT OF TH£ PROPOSED
ABSORPRON FIELD LOCATION.
N01£.• 1TB5 IS NOT A SURVEYED PLAT. WEU k S£POC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
INSTALL 1500 GALLON STEP TANK
TRENCH LENGTH 60 FEET
TRENCH WIDTH 5 FEET
MAX EXCAVATION DEPTH 8 FEET
ROCK DEPTH 4 FEET
COVER 3-4 FEET
PROPOSED
4 BDRM SFR
25 0 25 50 75 100 125 150
SCALE., 1' = 50 FT.
4' CONTOUR LINES
W
LZ
W
ISPURKLAND ENGINEERING I I HULTQUIST HEIGHTS LOT 3 (I SEPTIC SYSTEM DESIGN
203 V 15TH. AVENUE HUL TOWS HOMES BATE. JUNE 16 2016
ANCH, AK. 99501
(907) 279-3916 15872 ELIZABETH ST ANCHORAGE AK 99516 SHEET, 2/3 GRID: SV3238
PERMIT # OSP141XXX PID # 020-044-05 HULTOUISTHEIGHTSL3SC50,DV6
WIDE Trench,
5' Wide
60' Long
8' MQX. Depth
4' Sewer Rock
3-4' Cover.
3/16' hole 30' on Center
1 1/4' SCH 40 PIPING
Trench Elevation (TyP)
Monitors
Slit Barrier
Install Foundation Cleanout
4 Pt of Septic Rock
1500 6AL STEP TANK
ISPURKLAND ENGINEERINGI I HULTQUIEST HEIGHTS LOT 3 I I SEPTIC SYSTEM DESIGN
203 W K 99501 15TH AVENUE
ANCH. AK. HULTOWS T HUMES DATE, JUNE 16 2013
(907) 279-3916 15872 ELIZABETH DR, ANCHORAGE AK 99516 SHEET, 3/3 GRID: SW3238
PERMIT # OSP141XXX PID # 020-044-05 HULTQUISTHEI6HTSL3.D3.DWG
06/13/2014 08:55
9073437997
ONSITE
Municipality of Anchorage
Development Services Department
Building Safety Division
On -SM Water and Wastewater Program
470D Elmore Road
P.O. Box 196659 Anchorage, AK 99507
wwrv.ci anchorage ak.us
(907)343-7904
PAGE 03
*'49TH
•yYjaY�gY�e+YSYSY•.
Sbils Log - Percolation Test 1
Performed For: C LA
II l Date Performed:
Legal Description: i,/Q Township, Range, Section:
ope
SI
11
1
COMMENTS
"4) .
h r -n
WAS GROUND WATER
ENCOUNTERED?
y Y
IF YES. AT WHAT DEPTH?
s
L
Wath to WOWAnor
MOnRCHn/g7
O
f E
L Date:
Rohl
I's r '04 20'
MICHAEL Iv, ANIORSON
CE -9469
aiMw a. G� YY
®®®�®
P
PERCOLATION RATE lg j? IminuMslmmJ PERC HOLE DIAMETER
TEST RUN BETWEEN^3 FT AND FT
PERFORMED BY: m6 A• I CERTIFY THAT THIS TEST
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
06/13/2014 10:04 No.: B708 P. M3/004
UP TA
Municipality of AnJora'2 8 2,.,,_5
On -Site Water and Wastewater Programer _,
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 020-044-05 Expiration Date: 2 /D
1. GENERAL INFORMATION
Complete legal description Hultquist Heights, Lot 3
Location (site address) 15872 Elizabeth St.
S, Hultquist Homes INC.
Current Property owner(s) Day phone
Mailing address 12580 Old Seward Highway Anchorahe, AK 99515
Real Estate Agent Day phone
2. TYPE OF DWELLING:
FxFl Single Family (w/wo ADU)
[I Duplex
F-1 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
f -.1
Individual Water Storage
F-1
Holding Tank
F-1
Community Class Well
F-1
Community
F -I
Public Water System
F-1
Public Sewer
❑
WaiverNariance request
Received by: � 4�212f Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 41-90 Waiver Fee $
Date of Payment 111111K — Date of Payment
Receipt Number lltv&+ mm Receipt Number
COSA # 09cLS 10 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
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Phone (907)272-8218
Date 1/21/2015
��waoegN
OF AI
�:'49,ZH it
• Steve i�dnno
CE -8149;
Conditional approval for bedrooms, with the following stipulations:
By: � Original Certificate Date:
Theunlcipa /e nchorage 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
COSA blue sheet E ..
If more than 1 septic system is on the tot:
COSA Checklist # I of
Structure served by this system r
Certificate of On -Site Systems Approval Checklist
Legal Description: HUltquist Heights, Lot 3
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 10/30/2014 Sanitary seal (YIN) Y
Total depth 486 ft. Cased to 486 ft.
FROM WELL LOG
Date of test 10/30/2014
Static water level 37
Well production
7
ft.
HIM
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate L)0 3 ,mg/!_
Arsenic n L� ug/L Date of sample: 1/20/2015
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P./Steel
Tank size 1,500 gal. Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (YIN) N
Date of pumping New
Pumper
Parcel ID: 020-044-05
Well Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) 18+ in.
AT INSPECTION
New
New ft.
New
Collected by: PES
tela//!
Date installed 8/26/2014
Cleanouts (YIN) Y
High water alarm (YIN) x
C. ABSORPTION FIELD DATA
Date installed $126/2014 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Shallow Trench
Length 60 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 8 ft. Eff. absorption area 600 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test New in. Water added New gal. New depth New in.
Elapsed Time: New min. Final fluid depth New in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date
D. LIFT STATION
Date installed 8/26/2014
"Pump on" level at 25 in.
Datum Top of Tank
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons 250
"Pump off"level at 44
Cycles tested New
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 50+
in.
Manhole/Access (Y/N) Y
High water alarm level at 22.5
Meets alarm & circuit requirements? Yes
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
l 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 Steven R. Pannone
Date 1/21/2015
COSA brown sheet 10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 110+
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s
a
_
a