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HomeMy WebLinkAboutPROSPECT HEIGHTS BLK 2 LT 8 .. Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,~JffS'ol;~z. 'PID Number: Name: ~'o H'~ 6bo~'4 ~ ,~o Wastewater System: ~ New D Upgrade Address: ~ ~. ~ A~. ~,~os A~,.;A~.~o~ ABSORPTION FIELD Phone: ~ ~ ~C C No. of B~rooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION Soil Rating: / - Z GPD/Sq. Ft. Total Depth from j°riginaIo ' grade: Lot; Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: Number of lines: Distance be~een lines: WELL: ~ New ~ Upgrade Graveiwidth: ~' ~ Ft. I ~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: ~C~GE Date installed: Yield: Pump Set at: Casing Height Above Ground: SEPARATION DISTANCES ~ se,t,c ~ Ho~,n~ ~ S.T.~.P. To Septic Absorption Lift Holding =ublic/Private Manufacturer: Cap~cityin gallons: From Tank Field Station Tank Sewer Lines ~ ~ ~ ~ Material: Number of Compa~ments: su..c~ , LIFT STATION Water Joe + Joe ~ ~ ~ Lot ~ ~O/ Size in gall°ns: I Manufacturer: ~ "~ : Line ~ ~ "Pump on" eve at~ff" level at: High water alarm at: Foundation ~ ~ ~ ~ ~+ ....~ i " Cu~ain Pump Ma~l Electrical Inspections pedormed by: Drain ~ h d~E ~ ~ Remarks: ~T~47E ~K~c~ ~~0. BENCH MARK Location and Description: ,J ~sumed Elevation: ., Inspections performed by: s & s ENGINEERING Eagle River, AlasEa ~5~ 2nd. ~ - zs- ~ Department of Health and Human Se~ices approval Reviewed and approved by: ~~ ~ Date: 7-fl/-~ Pea'mit No, SW950132 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LegalDescription: LOT 8, BLOCK 2, PROSPECT HEIGHTS S/D PIDNo.: 015-135-17 FCO 3-.5' 11.5' ST1 3, ' 15' ST2 2; .5' 23.5 DBL1 2' .5' 25' ._,3~¢ ~/[ SPRINGS DBL2 2' .5' 26' /// /I MAIl rAINED MINIMUM DV $,~' 51.5' '~' 'l SETB,~CK TO SURFACE C01 $,~' 51.5' CO3 6 .5' 42.5' (;04 ~: bo- . MT1 4 .5' 63' C05 4'" 74.5' , MT2 4'" 75' ~ ~50' SETBA C06 1 ,5' 55' / ' ~ / SLOPE '5 Inous INSUreD U DER BEWE 1 NSTALLEO (INST~EB 6-25-9 D FLOW D R R ~99.5' II o 8E US RE I LNEW 12 ~0 GAL ~ X~WSSO GAL __~ ~ , ~PTIC TANK 9 ' ~95 LT. , A 85.6' 100' WATER. 72-O13 A (Rev. 9/91) MOA 25 K FROM JUN-20-19gG 12:27 FROM THE BLOMFIELD CO TO 6g41211 P.02 ~ ~ - ~'~ ~,. ~ATE OF A~8~ " DEPA~M~T OF NATU~L R~OURC~ D~ION OF ~J~fNO · WAT~ MGM~ ~O~TION O~ ~ WATER W~L R~ORD LOCATIONISK~CH: ~L O~: ~.~ . .,'.> ............ '" .......... Depth of Martial ~pe a~d Co~r From To ~ - / M~HOD OF DRILLING: ~-air W~ INTAKE O~ING TY~ ....... ~ perforated ,~ open Depth; 0f 0~o~ngs: $CRE~ ~PE: DEem: GROUT TYPE: Voice: ~ f ' Municipality o~ Ar ;~orage D~ELOPM~T M~U~Dt ~,4 , PUMPING L~ AND YIE~ ~MP I~AKE D~Ht ~ . CONTRACTOR INFORMATIOht: REMARK;: PLEASE MAlL WHITE COPY OF LO0 TO: DNmDIVlSlON OF MININO& WATER MGMT PO BOX 10700E ANGHORAGE AK TOTRL P. 02 Rick Mystrom. Mayor Municipality of Anchorage Department of Health and Human Services 625 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 June 27, 1996 Sandra Ilene Blomfield 7610 Wildwood Circle Anchorage, Alaska 99516 1015 Subject: Lot 8 Block 2 Prospect Heights Subdivision Permit #SW950132, PID ~015-133-17 The subject permit, issued June 27, 1995 by this office for a single family well and/or on-site wastewater system, has expired as of June 27, 1996. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion° When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. /~.7~rely' Program Manager On-site Services enc: Copy of Permit cc: S & S Engineering PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NLrMBER:SW950132 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BLOMFIELD SANDRA ILENE OWNER ADDRESS:10200 PROSPECT DR ANCHORAGE, AK 99516 DATE ISSUED: 6/27/95 EXPIRATION DATE: 6/27/96 PARCEL ID:01513317 LEGAL DESCRIPTION: PROSPECT HEIGHTS BLK 2 LT 8 LOT SIZE: 82500 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. June 2, 1995 CIVIL ENGINEERS HEALTH AUTHORflY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of H~alth and Human Services P.O. Box 196650 Anchora9e, AK 99519 REFERENCE: Lot 8; Block 2; Prospect. H~ights /~ec~cre~t 9'0- issu-e ape. rm,~ ta ~ a tue,~ a. nd Z. n6~ a se~ptie, sb'stem to ~se~ue the p~po,sed ~oruc bed,'mora kou~e on ~ ne~e~eneed pc. opera. A test hole was excavated and a percolation test performed. The approximate location of the t~st hole is located on the attached site plan. At the time of excavation, water was encountered at 15 fe~t and after seven day ground water monitoring ~ter was found at 15 fe~t. This property has cnough ar~a for a future septic upgrade which can be seen on the attached site plan. We do not anti,pate any adverse effects on n~ighboring properties by the i~tallation of the proposed septic system. There are no point~ of co~[mi~on within the proposed w~llradius which can be seen on the attached site plan. The proposed 1250 gallon septic tank is to be placed outside the w~ll protective radius. Attached is a site plan which depicts the location of the proposed tank. If you requ~e additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 * EAGLE RIVER. ALASKA 99577 Z ZO m~.~ ~2o a__O too_ ,,, < ~°~ N91S3CI [' NYqd 3.LIS ,0~ = ,,~ .'1" = 50' 8GALE 0 O0 lc/) Fq (il EDZ DESIGN ISITE PLAN --i00 --I 0 >z tOC.) .TiT -< 1 I~" (DO--I-- I--'t ou) O I' z..-4 ~ 02 m~.m< >~ 0 / Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL D E S C R I PT I O N .'~O~c.i-~ 1 2 /~L 3 8 9 10 11 12 13 14 5 16 17 18 19 2O COMMENTS '-~/~'~ c F,)('~.~, ~/,cl-"~/~.:.~P DATE / ~ownship, Range, Section: WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN S IF YES, AT WHAT (~ C',lr~' ~ DEPTH? ~/"T p Depth to Water After ~ Monitoring? l.~ Date: ~!-~L[q~ Gross Net Depth to Net Reading ' Date Time Time Water Drop P.: ~o ~ ~%" - :~% ~,~ ~ ~ /,/~" ~ s~ ~ ~ V~" _ · ~o ~,~ ~ s/~" I'/~" : ~ ~ ~ 5~/~'' l Yy" PERCOLATION RATE TEST RUN BET~/EEN (minutes/inch) PERC HOLE DIAMETER FT AND ~ FT $ & $ ENGINEERING PERFORMED BY: '~ ~'~'~ ~'u~- R;v~r i.~p Rea~i No. 'JO~, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE W~TH AF~I~it~e~I~41(~9~[L;'Z~U~DEU NES ~N EFFECT ON THiS DATE. . 72-008 (Rev. 4/85) ROBERT C. COWAN, P.E. ROBERTA. SHAFER, RE. CIVIL ENGINEERS ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE pLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 8, Block 2, Prospect Heights S/D June 2, 1995 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tank and a leachfield trench to serve the proposed four bedroom residence for the referenced property. 2e Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. e Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Se Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3e Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 8, Block 2, Prospect Heights S/D June 2, 1995 Se Se Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. e Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. So Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Lot 8, Block 2, Prospect Heights S/D MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.0oA. or D.E.C. requirements° Page Four Lot 8, Block 2, Prospect Heights S/D June 2, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. e The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/OWNER qp 0-0 • rye ;`i'i>'lw: A - • C„•r:� • Municipality of Anchorage I °1V1&y L `a1018 3 On-Site Water and Wastewater Program (907) 343-7904 s a F ET ti w •fe . C'31\otss �9 Certificate of On-Site Systems Approval Parcel I.D. 015-133-17 Expiration Date: a- 1. GENERAL INFORMATION Complete legal description Prospect Heights Block 2 Lot 8 Location (site address) 10200 Prospect Drive Current Property owner(s) Charles & Sandra Blomfield Day phone Mailing address 10200 Prospect Drive Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 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 Q Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received bc: ) X f7l� Date: KtJi , COSA to be released to the engineer,unless otherwise request�d by the ngineer. COSA Fee $ 6-161 Waiver Fee $ Date of Payment 6f 9 /C$ Date of Payment Receipt Number O d 0716 Receipt Number COSA# O X 1'S 133 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 5/23/2018 *: ' • II i •*% 6. DSD SIGNATURE � ��'P � X System #1 Approved for 4( bedrooms O Sieven i. F56nnone: f t♦ ,•. CE-8149. System #2 Approved for bedrooms s•. r Disapproved ll '40FESSIONA�`4 Conditional approval for bedrooms, with the following stipulations: ,S-.kt C-i- LS 42 cac -Q 0-Qei A v o I. _0 U� c, Ste(. .Q- --� -c v K t� 2_0 yv, 01...,,b �= c, , ,c__o i`t_e) otxX �-4.r t reS 6-u2,49,v4, -elm e. o •N p,S GRP�� • pRO c c Ii p By: / Original Certificate Date: �� F���` 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 COSA blue sheet • ,. 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: Prospect Heights Block 2 Lot 8 Parcel ID:015-133-17 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 7/25/1995 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 225 ft. Cased to 40+ ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 7/25/1995 5/9/2018 Static water level 37 ft. 42.5 ft. Well production 3 g.p.m. 2.4 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2.26 mg/L Arsenic ND ug/L Date of sample: 5/9/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/25/1996 Tank size 1250gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 11/5/2017Pumper Isaac's Pumping Service C. ABSORPTION FIELD DATA Date installed 7/25/1996 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Deep Trench Length 50/50 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth 10 ft. Eff. absorption area 500/500 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/9/2018 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 5 in. Water added 600 gal. New depth 8 in. Elapsed Time: 225 min. Final fluid depth 5 in. Absorption rate >= 600+ g.p.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 0+ 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 G. ENGINEER'S CERTIFICATION �� 4 i � OFA�q`ts,, I certify that I have determined through field inspections and rie0)..Airy Aseoct1 ...t..";$#1, review of Municipal records that the above systems are in 0*: - TH /\ -.*7 conformance with MOA COSA guidelines in effect on this date. %•• �1047# r•••• 0 Steven Pannone •• Engineer's Printed Name -1,1:-.. • Sleveri 'annone Date 5/23/2018 1,19f,. CE-8149 �; r COSA canary sheet_2-6-15.doc