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HomeMy WebLinkAboutSKYLINE VIEW BLK 2 LT 17 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey WATER WELL LOG Revised 08/18/2016 Drilling Started: ____/____/______ Completed: ____/____/_______ Pump Install: ____/____/_______ City/Borough Subdivision Block Lot Property Owner Name & Address Well location: Latitude Longitude Meridian ____________ Township ______ Range _______ Section _______ , _____ 1/4 of _____ 1/4 of _____ 1/4 of _____ 1/4 BOREHOLE DATA: (from ground surface) Suggest T.M. Hanna’s hydrogeologic classification system* https://my.ngwa.org/NC__Product?id=a185000000BYub3AAD Depth From To Drilling method:  Air rotary,  Cable tool,  Other Well use:  Public supply,  Domestic,  Reinjection,  Hydrofracking  Commercial,  Observation/Monitoring,  Test/Exploratory,  Cooling,  Irrigation/Agriculture,  Grounding,  Recharge/Aquifer Storage,  Heating,  Geothermal Exploration,  Other Fluids used: Depth of hole: __________ ft Casing stickup: ___________ft Casing type: __________ Casing thickness: _________ inches Casing diameter: _________ inches Casing depth: __________ ft Liner type: _________ Depth: _____ ft Diameter: _____inches Note: Well intake opening type:  Open end,  Open hole, Other Screen type: _________, Screen mesh size: ____________ Screen start: ________ ft, Screen stop:________ ft, Perforated  Yes  No Perforation description: Perf from: ________ ft, Perf to: _______ft, Perf from: ________ ft, Perf to: ________ ft Gravel packed  Yes  No Gravel start: ______ ft , Gravel stop:______ ft Note: Static water (from top of casing): _______ ft on____/____/_____ Artesian well  Pumping level & yield: ______ feet after _____ hours at _____ gpm Method of testing:__________________________________________ Development method:______________ Duration: ____________ Recovery rate: _________ gpm Grout type: _________________ Volume __________________ Depth: From ___________________ft, To ___________________ft Final pump intake depth: __________ ft Model: _______________ Pump size: _____________ hp Brand name: __________________ Include description or sketch of well location (include road names, buildings, etc.): Was well disinfected upon completion?  Yes  No Method of disinfection: Was water quality tested?  Yes  No Water quality parameters tested: Well driller name: .................................................................................. Company name: ................................................................................... Mailing address: .................................................................................... City: __________________________ State: AK Zip: ___________ Phone number: (________) ________- ______ Driller’s signature: Date: ______/______/_________ Anchorage Municipal Code 15.55.060(I) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City within 30 days of well completion. City Permit Number: _____________________________ Date of Issue: _____/____/_________ Parcel Identification Number: ______-_______-________ *Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: https://dnr.alaska.gov/welts/ OR email electronic well logs to dnr.water.reports@alaska.gov North L17 JAY WILLIAMS DRILLING B2SKYLINE VIEW 5 n 1982 n n CHUCK SASSARA , 001W n S NW 151 NE n 28 015N SE16 3303 Municipality of Anchorage NE (~,~ ~) MUNICIPALITY OF: ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION  825 L Street- Anchorage, Alaska 99501 Telephone 2.64-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS ,~ I LJUPGRADE LOCATION IWell 4-~¢ ;~ ~,~ L IF HOMEMADE: IInside length Liq. c I ci in allons DISTANCE TO: J~ell , , Dwelling No. of hnes Length of Top of til~ f~ish ~ade / Typeofcrib ICHbdJamuter STANCE TO: [Class/) ~P~h ~ Driller 1Width I MatorJal Foundation /~L ~Ot line t~ ,~ Total ~'~§t~pf li6'es~ T~rench--v~th ~' ~ ~ [ ~ inches Material bene~/~tile ~ I/ ~ , Crib depth Building foundation NO. OF BE~D~OOMS ¢ NO. of cornpa/rt~en~_ Licluid depth PERMIT NO. Liquid capacity in gallons Distance b e ,~p,,,~ Total eff~ e'a ~o~t b o pti rea P~RMIT NO. l T ora' ,~'~tiv:,b s:rption ar e: [Nearest lot line -~::~ ~MIT NO. Septic tank Absorption PIPE MATERIALS OTHER SO,LTES RAT,N //0 / [ NSTA L LE.~,/~ .~//~: REMARKS 'THI:::' E:'fEF'"f'H f"F' FI 'TF'~:~:N!j.j:H CIF~: r'!. I '1:'.::: 'TH[= r T':"', ....... ' ' " ~ ............. I ~!,1 ....L". ::: :::"1" .... . .............. II ..f .... ~:. C ~::: "r'~,..ff~: ......... ii .. L..I ,..~..1 II::.:::,. 'TItlE l~[~::~',/ffl bEF.:'7'H 'r': "FHI;E M I: N ]: MU?,] E:,~J?FH Oi::' i~:;~l:::F,/~:'.. .]~](~:"l"~,(E:j:~:~... 'T'H~:' ","7:'::, .... f::lF, t[) 'THE D, frT'T'JF'I OF' THE E:':f/:FI','FFt"]:Ei', ";[N I::'~E~J:'~"::,. . ...................I:::' ~' :::'i:::' [r~:::, '" . .d..I ~'.,! b ~;F'[:J'f:'"'.: :1'-.?:~ Cfi::' nf'-I'.r: I.,.IF:' :z: !::IE:'-.]'FIC:fJ}:['.~'T "1"~': lT!.l;i::~: :,~,l. :::: ....... ......... . ..... IL~I...F 1 L..L.. ]. b,U f" F' l::lhh" '" '-' ':::' ', .............. .............. ~ ................................ ..... :, ! L.t I ~.'.1 :[ 'TH '" . "F F: '[ NFiL.. I '4': F': 7 "" '[ '*' I" f::'f~J[~J:"[' F:'Cff~] I::! F:'l:;]ji~,,,'f::l"'f::' ]-'.~[JJJL.~ IJZff(: :J..~jj'H~jI '1 ?::~:; F'I:::'[: ]='l(~C1!'"f !l~::"::P.1 "I"Hf~J: T' FiE Cfi:' :::'1 IE ~ 1 .... Hf~JL..~ .... ~ ........ N]JF~U!','~ ....' ...... '" . · . ~ ......... ....... . ...... H~EI...L.. ~ ': ,::: ,7 ' ~-' - ~ff.~.: F;~[~X;~L.I]jI:;;2~j[) !:::l~":lljj;, r"l..:~T D,~7~] ?;;~ETT'UF;~:N[~;C, "Ff"l THE I":::'V;'l:;;:""l't=', T THE I.-,t...I.. COF'!I:Z'L.~Tf'J~OM. ~'"" '~"'" ~;' "~'~-I! ~.'~ 'T' ' ...... ................. ~? .... "~' ', ..... ........ R. I .[, r THI:::fT ...... ~ .......... ~:.b.!~. ~.::, FIN[) 'J :::'~ ~ '::' I:::[~ '::: :: T ~"~"~"1 !79 T."ll~ vlLIb,l" C: ~[ F'FIL. ]~ 'T'~-? O~::' ::: ", I~: ,,, (" ~'~::] '~1::: .............. ' ..... ........... ~-" ~..Z.~.~ ....... Jt , . ,:::, PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 ~4 5 7 8 10 11 12 14 15 16 17, 18- 19 20 COMMENTS [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION TEST 825 L, Street, Anchorage, A~aska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLO/I/E SITE PLAN Robed A, No, PERFORMED BY: 72-o08 (6/79) WAS G.O ND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Time Time Water TEST RUN BETWEEN AND , FT Net Drop APPLI(, FILLS OUT UPPER HA[ ONLY Property Owner Chuck Saaaara MaIHngAddress P.O.Box 596 Girdwood Ak. 99587 Buyer Gor~on & Laura Hamilton Address '~'%~.Box 1268 Eagle River Ak 99577 Phone Z~pCods 995~ 783--2917 Zip Code 99577 Lending l.slltution First Alaska Mort. & Escrow Phone Address Eagle ~iver Loop Rd. Eagle River Ak. f Zip Code 99577 694-9433 Really Co.&Agenl Red Carpet Great Land Realty Phone Kathy Geraci ~ 694-93.25 Address D.N_Rn_~ 63~ ~gl~ ~Ver a~_ / Legal DescriptDn Lot 17 A Blk. 2 Skyline ~/~. Street Locat[~ Wildwood & Skyllne Type of Resi~nce Zip Code 99577 ~ Single Family [] Multiple Family [] Other Water Supply ~] Individual [] Community [] Public Utility Sewer Disposal NO. of Bedrooms_ 3 ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available). ~) individual [] Public Ulility [] Holding Tank Year Individual Installed: 1982 When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCEs~SING CAN BE INITIATED. Time Time Time Time '-,~ ~ ,,,~ ~--/ Date Insp~tor .. Insp~tor Insp~tor ( ~ROVED BEDROOMS ~ ~ *CONDITIONS OF APPROVAL ( ) DISAP~OVED ( ) CONDITIONAL APPROVAL' Soils Rating Da~e ~wer installed �T tiT 0 Vl CD MV `' / r- I- CD CD 0') CY) N m L L c 0 U O W W (1) C,6 co ^L^`` Qtf O Q) v) DO 1 l J LO N O N d7 d' N cz n C O cu 0- x X W ti co LO Q r J � N U J >m � O W W Q Z J `Jy co/ W Y N co C) c m 0 �- Q O U U) U ca J U) O O 0 N W 0 �L 0 cc 0 N c m E 0 A N O N m LO SE Co] 0 N O 0 0 O t^o, W ^�^ C 'U / ca ♦_�/ •y 0O / N 0 O E a) ON O ~ ai Q. U) O U ~ O 0 O 0 O N O L r N O U y aa) s b 0 - O > 0 Ol a) L Q m Q � 'a 'N N 'E 0 L O Q. � Q. E c a) gggo N L L 0 v W O L O c 1 O O 4-1 v N C as N E ^ 0 ^, W > 0 'a O C O Q 0 L C cn rte• _ E o c 0 U O W W (1) C,6 co ^L^`` Qtf O Q) v) DO 1 l J LO N O N d7 d' N cz n C O cu 0- x X W ti co LO Q r J � N U J >m � O W W Q Z J `Jy co/ W Y N co C) c m 0 �- Q O U U) U ca J U) O O 0 N W 0 �L 0 cc 0 N c m E 0 A N O N m LO SE Co] 0 N O 0 O t^o, W ^�^ C 'U / ca ♦_�/ •y 0O / N N O E a) ON O ~ ai Q. U) O U ~ O 0 O 0 O N O L r N O U y aa) s +� 0 N O > 0 a) C fa a) L Q m Q � 'a 'N N 'E 0 L O Q. � Q. E CL m N L E VJ 0 v M O L O c 1 O O 4-1 v N C as N E ^ 0 ^, W > 0 'a O C O Q 0 L C cn U E o N o N s F- >1 C C C S Z Q X L 0 Ln O N ,U > U LL Q m U o a) Q V! L z (n 0 Y W O -0 m - = U Q t— O U Q H I— Q ,It I- 0 m O7 CA M M C7 Ch rIL rl� 00 (1) X run Oil V � �Q O V Z LL itS O ` ©moi J E (D �1U) V o L CL Co Z � m U_ co N 06 �Cc 3: CL o' (DU) (� M c 69. a) a) LL Q U) 0 r.1 �k :3 a O = U)N O C �= cm L ❑ C 0- O N N Q to Q -a El CLN Uj CO Q Y E v a > E ® �. O a- U co c Q = J V N Y U c i aai m ❑ ai 0 _ .L � CO � i .Q ; COSA Checklist.docx COSA Checklist Legal Description: SKYLINE VIEW BLOCK 2, LOT 17 Parcel ID: 051-192-10 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 5/28/1982 Total depth 151 ft Cased to UNKNOWN ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4/19/2024 Static water level at beginning of test 141 ft. Well production at time of test 2.1+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 3.43 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 4/22/2024 Comments NEW SANITARY SEAL & CONDUIT. CONSERVATIVE FLOW WHICH MAY HAVE BEEN REDUCED BY PLUMBING / RESTRICTED AT SPIGOT. B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 4/19/2024 Required maintenance completed, if AWWTS Comments: Deck is less than 30” high, is not over tank & no supports over septic tank. C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/11/2015 ALL standpipes present per record drawing Total measured depth from grade 10.3 ft (max) Measured depth to pipe invert from grade 5.3 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 4/19/2024 Results Pass Fluid depth prior to test 0 in Water added 470 gal New fluid depth 0 in Elapsed time <1 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 48 in (MOA 4’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 48 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 4/29/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 4/29/24 1" = 30' WELL 0 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: SKYLINE VIEW SUBDIVISION LOT 17 BLOCK 2 PLAT P-508 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouli any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants., or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE; E -MAIL - APRIL 26, 2024 1 =30schullerokOgmall.com 24-028 DRAWN BY. ICHECXED BY: GRID NUMBER: I BWF/-PAGE: JLS NW1 159 240134 * = FND-'-),1'8" REBAR z 0 (D I 30' 30 AMMW Is up V AANWW AGOWW OT A �V 4 AW W_ 0�11 low lop 49TH =� �_ �..........,............7 � .. ....... / ?A JOHN L. SCHULLER.-* 0 ewLS-10408 _14 1831 Talkeetna Street ,P. Anchorage, Alaska 99508 \'O�' MW k ofession& (907) 227-1455 office l�', (907) 274-4992 fax 0 Tw < Fri I 30' 30 AMMW Is up V AANWW AGOWW OT A �V 4 AW W_ 0�11 low lop 49TH =� �_ �..........,............7 � .. ....... / ?A JOHN L. SCHULLER.-* 0 ewLS-10408 _14 1831 Talkeetna Street ,P. Anchorage, Alaska 99508 \'O�' MW k ofession& (907) 227-1455 office l�', (907) 274-4992 fax Q-1 LO t co 9 (0 co (D a) a) 0 a) C° 0 ry m CL CL W CL a < 0 2CD x Hw C/) 0 CD >- F4 m CO C14 4* -�; r-� cB CO ui C: t-- CO Ga U 0 LL 19LU C: 00 Cd 0(ul < cn m Cd 0 oll a M LLz c — rn 0 .2 ry C) En LLI U) a) -0 0 (n 0a) LL m 'C' a) L- a) <cP 0) (D 0- Ln 0 m a) C;) a) IL ()o co w Q a) W E w 0 0 Ofa) L.: a) CD a a) a) I Qo as cu r) 0 a. U) 0 F -I El El co I-- 'F a) LL a 0)= C E C/) 0 0 E =0 w 0 CL X (D o co —1 F -I El E ca N o 0) oU) ()i a0a) 0 (L ) to 0 .0 E Z >, w cn — U) (D -1LL E w cn U) W cu U- w (D cu cu c C/) L- (D x LL (D 0 LL cu = c = ca s0 0 LU' -0 "R E W MC CL E 0 :3 >- ED,❑ 0 C: o 0- z C-li mt L.: a) CD a a) a) I Qo as cu r) w W W Z 0 Z W m Z _O P U W CL U) Z U- 0 Z w LLLU r CA cC � C L O O (0 .0 N 616)o ns -a Eao a) Q.fn _. . > M -0 .c � 6 y O O _ c: M L c °p�cC a)=C, a) a) >-0,� —�cu�a) 3U! .cA O " L M U m pcvB > c.Q L L O p c Q.N Q) »_• a3 3 O Q E (6 in a) .�. O ccn(on a)Ec oa. -c c6 c .4) cn-a E20•O �� a)oEcc > _ 0—;E5U O U Fu O c N a) v 3 c c0 ,� c _r_O a) Q) to v- O L a) N O N � _ 0— 30 Q) � E L cn-- _ 'a O M Q) NU� O� — O O co O O >, m a (0 a) c 0-0 5 In ` 'a Z) ccuZ 0._ O Q) L In ._ xca)Nia=0U) �+_ E.a L c c a) iia in a) o o m 3 L � O O E @ a) �- O .c, c -0 M <) cn a) a) A U �O cnca -CL�Oa Q.O /n�O O.N O �7 t J cc Q- cl O O a) E E 0 0 r� -O o ) a)OL a) E O Z z o E L O a. U- a U) L O' U O m 2 c Z -0 c Q W O 0 Q) O CL N > � O m O O >, ,mss, A �j/JTj))4) 11 D)1)�011 L U cl LIWJ ca C: O IS T O a U)cu a� c c') Y 0 > O o w CL to Q a) N w a�Ei c T N .Y c4 2 3 U N y C9rn `m � o . c = O (D .� _ Or _ a) U) cu m _ 0 . > N C 'U N U o N o fl. N `—� o c p a N U c O � o O N E N a O 0 � o U `O a) LO .0 .c o a=i m ,o m`n o m a a o rnm = >_ en 0 �' .� cm 0. O 12 L �o CO T N Q m .0 O _a Q _ U 2 w c 'M CL O O 'E O cq �-• 'a Q O n tn F— Z uj = Y U , O -� U Q E N >, co >— Q o Q p U N co N 4 If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system I'M r. L14-411 11MMETT ME Legal Description: /it/jE (/(,���) 132 4.1-7 Parcel I D:OSI A. WELL DATA Well type 119 q If A, B, or C provide PWSID # Well Log (Y/N) A— Date completed / 8Z Sanitary seal (Y/N) Wires properly protected (Y/N) V d Total depth//A/4 ft. Cased to ft. t- Casing height (above ground)/min. FROM WELL LOG AT INSPECTION Date of test '— C/a 5/1 Static water level ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 2. 87mg/L Arsenic N _� ug/L Date of sample: S B. E3OLDING TANK DATA Tank Type/Material Iii AI fC �S7,<� Tank size 100 gal. Number of Compartments Z Collected by: 21 Date installed Cleanouts (Y/N) �f Foundation cleanout (Y/N) -y— Depression over tank (Y/N) /V High water alarm (Y/N) Date of pumping Al F K2 Pumper C. ABSORPTION FIELD DATA Date installed, Soil rating (g.p.d./ft2 or ft2/bdrm) 1. System type 2:;g ' c'f4 Length 3 l ft. Width S ft. Gravel below pipe 4-1 ft. Total depth 7 5 ft. Eff. absorption area 3 ft2 Monitoring tube --)� Depression over field Date of adequacy test E Irl) Results (Pass/Fail) 1AJA For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION /04 Date installed "Pump on" level at Datum Size in gallons in. "Pump off" level at _ Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot ma /lot - Absorption field on lot / d a *'-t Public sewer main /1r (�e- Sewer /septic service line Z S /t Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots 1A D "Y' r Public sewer manhole/cleanout Holding tank /00 t Animal containment areas -5-a � Manure/animal excrete storage areas l O Q -1,t- SEPTIC/HOLDING ,tSEPTIC/HOLDING TANK ON LOT TO: Building foundation ZJ �Property line /�� f Absorption field Water main Z Q 7` Water service line �/ Q f- Surface water �OG 74 - Wells Wells on adjacent lots -"i` ABSORPTION FIELD ON LOT TO: Property line fi Building foundation"F Water main / 4 Water Service line ZO t Surface water /(M (� Driveway, parking/vehicle storage ..,e- Curtain -tCurtain drain �: o , Wells on adjacent lots la a f F. COMMENTS G. ENGINEER'S CERTIFICATION certify that / 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¢ Printedame Date v �� /IS - COSA yellow sheet_2-6-15.doc