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Home My WebLink AboutROCKHILL BLK 2 LT 15 Permit Number:OSP261136 Tax Code Number:01536227000 Work Type:SepticTank Upgrade Effective Date: Design Engineer: Site Legal Address:ROCKHILL BLK 2 LT 15 G:2438 Owner:DESJARLAIS EUGENE & MAY Site Mailing Address:6550 LIMESTONE CIR, Anchorage Lot Size in Sq Ft:50263 Total Bedrooms:5 This permit is for the construction of: Disposal Field Septic Tank Holding Tank Privy Non-Public Water Well Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Coodinate with On-Site staff regarding preferred method. 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 6/3/2026 6/3/2027 HUBER ENTERPRISE Expiration Date: ¨þ ¨¨¨¨ Issued To: Issued By: Date: Date: 6/3/2026 6/3/2026 HUBER ENTERPRISE Curtis Townsend MUNICIPALITY OF ANCHORAGE On-Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On-Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 01536227000 Property owner(s) Desjarlais, Eugene & May Day phone Mailing address 6550 Limestone Circle, Anchorage AK, 99507 Site address SAME Legal description Rockhill BLK2 LT15 Number of Bedrooms 5 Engineering Firm Huber Enterprise AK Building Permit Number Not Applicable 0 APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Disposal Field ❑ Initial ❑ Septic Tank 0 Upgrade 0 Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: No Waivers Requested Permit/Rush Fees: �� V,' Date of Payment: ,/ 2 Permit No. Waiver Fees: Date of Payment: Waiver No. Distance: May 2025 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261136, Curtis Townsend, 06/03/26 Rockhill BLK2 LT15 SepƟc Tank Design NarraƟve Project NarraƟve/DescripƟon: The Project Site is an exisƟng 5-bedroom residenƟal property. Based on available as-built informaƟon, the residence has an exisƟng sepƟc system that was installed in 1996 and consists of a single 1500-gallon sepƟc tank connected to a Deep Trench AbsorpƟon Field. The exisƟng absorpƟon field has been inspected and is in operable condiƟon, however, the tank is failing and is in need of replacement. Design CalculaƟons Flow Rate: 5 Bedroom Main Residence at 150GPD/Bedroom - Design Flow = 5 bedroom X 150 GPD/bedroom = 750 GPD SepƟc Tank Size: Minimum Tank Size shall be 1000 gallons plus 250 gallons for each bedroom over 3 per - 1000 + (2x250) = 1500 gallons AbsorpƟon Field: - Based on available asbuilt informaƟon, the exisƟng deep trench absorpƟon field is 94 feet long with an effecƟve depth of 5 or 6 feet. The inspecƟon report and the asbuilt cross- secƟon indicate 6 feet of gravel. The asbuilt plan view sheet indicates 5 feet of gravel. However, the inspecƟon report calculates the total absorpƟon area by using 5 feet of effecƟve depth. Assuming 5 feet is correct, this provides 940 SF of absorpƟon area. Soil condiƟons at the Ɵme indicated an applicaƟon rate of 0.8 GPD/bedroom. This meets current standards for required absorpƟon area. I am unaware of any adverse impacts this installaƟon would have on any wells or sepƟc systems constructed in the adjacent area. Should you have any quesƟons or require any addiƟonal informaƟon, please do not hesitate to contact me. Sincerely, Logan M. Huber P.E. (772) 528-6287 Lhuber87@gmail.com Feet 0 20 40 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261136, Curtis Townsend, 06/03/26 25' 25, i ANCHORAGE R] AS -BUILT OF: ROCKHILL Sl LOT 15 BLOCK 2 YLA'1' 81-143 I SURVEY CERTIFICATE: I, 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 shoulc 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: MAY 27, 2026 1 "=40' schuiier0ok.net 2 6 — 0 49 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: JLS SW2438 260206 SUR W �..,.....,�,� h LPL Asw D �l 100 ........ ....... ............ / / a n n / c� HN L. SCHULLER.• N LS-10408 ��, ' • �� / 1831 Talkeetna Street �o, • •1' .. a Anchorage, Alaska 99508 `\ O fes nab �. 'a' (907) 227-1455 office ��\ si `�'►�` (907) 274-4992 fax , 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: ,..~I,Y/~,~O"~ PID Number: O/~ Name: Wastewater System: D New ~ Upgrade Address: I , ~ ~0 L/~ ~.~ ~;'~ ABSORPTION FIELD Phone: I No. of Bedrooms: ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other ~ . LEGAL DESCRIPTION so, Rating: O, ~ GPD/Sq. Ft. Total Depth from/ooriginal~ grade; Depth to pipe bottom from original grade: Gravel depth beneath pip~ Lot: Block: Subdiv~ion: ~ ~ i~ ~ ~c~HI~L Ft ~. Township: Range: Section: Fill added above original grade: Gravel tength: Number of lines: Distance between lines: WELL: ~New D Upgrade ~ravel width: ~ Ft. l ' -- Ft. Classification ~ ~* V~+~~vate' A,B,C~: Total~Depth: Ft. Cased~oTo: Ft. Total absorption a~a~ SQ. Ft. Pipe~o.~materia~: Date inst8lled~ Date Drilled: Static Water Level: Installer: Pump Set at~ Casing Height Above Ground: Yield: ~ ~"~ ~e ~O~ ~' ~ ~. TANK SEPARATION DISTANCES ~eptic ~ Holding D S.T.E.P. To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ ~ WelF /O ~ i /O ~ ~,,~ ~, ~ ~ [~ ~ Material: Number of CompaAments: Su,ac~ -- LIFT STATION Water ~ 0 ~ ~ LineL°t /~ ~ ~ '~ j ., ~ Size in gallons: Manufacturer: ~ ~ ~ High water alarm at: Foundation ~ I ~t ~ "Pump on" level at: "Pump off" level at: Cu~ainDrain ~ ~ ~ ~ ~ Pump Make & Model ~ Electricel Inspections pedormed by: Remarks: BENCH MARK ~ ~ ~ ~~ ~ Location and Description~ ~, ~ ~ ~ ~~ ~~ [~'~ ~ I~u~eUE,~va~,on: /~t, Inspections performed by: ~ ~ ,-. Dates: 1st ~z - ~,,.~,o~ ~,, ~ 'd~ Department of He~l :h and/~ ~h Se~ices approval ":~'~' ~, ~,~<;~"~.~0 Reviewed and approved by ~ Date: '~-~-~ : 49~h SPURKLAN No, CE-~25 I I , / 0 25 / / FL 100 150 I I ITR½NCH I I TOBBEN SPURKLAND P.E. 203 W 15TH, AVENUE ANCH. AK. 99501 LOT 15, BLOCK 2 ROCKHILL S/B 6550 LIk(ESTONE CIR. GENE DESJALAIS SEPTIC SYSTEM AS BUILT DATE: MAY lO, 1596 SHEET: 2/3 GRID: 2438 0 /v/on/¢or 94 Cleon Cleon P£IivlA£Y T£EtVCH 2' V/de 94' Lan9 6' Sewer rock 5" EP£ec~ive 4,5' Cover' Plon/~or Cleon Cleon lTu~ /~EPLACEMENT ?BENCH /VD SCALE Cieonoutys /V/oni~or- 94~_ /:-oundoiz/on Cleon ouiz N/r'o Pi ] 40 83,6 6 P~C o£ Sep~c/c Rock ND SCALE $3,4 Bo~$or9 fe~$ho~e -- in v,Et e ~ __ ~oub{e Cleon mv, elev, 90,1 TBgBEN SPURKLAN~ P,E, 203 W15th Ave Anchorage Ak 99501 LZ7? IS,, ~LZI£K £ £/2CKHILL 6S50 LIMESTI~NE CIRCLE EU6ENE BESJA£LAIS SEPTIE SYSTEM AS BUILT SHEET: 3/3 ORID £435 LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD BOROUGH sUBOlV,S,o" LOT BLOCK SECTION QTRs sECTIoN ,~ TOWNSHIP RANGE · []'N []E []S E~W MERIDIAN LOCATION/SKETCH: DEPTHS MEASURED FROM:(~casing top []ground surface ~lJ Material Type and Color Fro o RECE! CONTRACTOR 1996 Regi: Business Name of Date WELL OWNER: W/ELL DEPTH: ('/ Depth of hole: ~ Depth of casing: DATE OF COMPLETION ft ft ~, I~'~ / I~ DEPTH TO STATIC WATER LEVEL: · ~/~' ft below ,[~ top of casing Date: [] ground surface METHOD OF DRILLING: [~air rotary [] cable tool [] other USE OF WELL: [~ domestic [] irrigation [] monitor [] public supply [] other CASING STICK-UP: ~ ft, Diam: ~-~ in. to'Oft Casing type: ~ C~'~. to ~() ft WELL INTAKE OPENING TYPE: [] open end [] screened /~ perforated [] open hole Depths of openings: ,-~7 to ~ ft SCREEN TYPE: ~--~, Diam: in. Slot/Mesh Size: '~'J..engt h: ft GRAVEL PACK TYPE:~,,~ Volume used: "~ Depth to top: GROUT TYPE: ~ Volume: Depth: from ~- ft to DEVELOPMENT METHOD: Duration: ,.*.~,~.,~. PUMPING LEVEL AND YIELD: ~(~ ft after ~ hrs pumping ~ gpm PUMP INTAKE DEPTH: ft Horsepower: __ WELL DISINFECTED UPON COMPLETION? '[~YES [] NO REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: DNR/DIVISION OF MINING &WATER MGMT 3601 C St, Suite 800 Anchorage, Ak 99503-5935 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.0. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 0N-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950039 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:DESJARLAIS EUGENE B & OWNER ADDRESS:6550 LIMESTONE CIR DATE ISSUED: 3/31/95 EXPIRATION DATE: 3/31/96 PARCEL ID:01536227 LEGAL DESCRIPTION: ROCKHILL BLK 2 LT 15 LOT SIZE: 50263 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 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. SPECIAL PROVISIONS: IT IS RECOMMENDED THAT THE SEPTIC TANK EFFLUENT ENTER THE TRENCH AT THE T~IDPOINT O~F T~TRENCH. RECEIVED BY: ~/~-- <~ ~ ISSUED BY: ~~ '" ~ DATE: DATE 203 W 15th. Avenue, Suite 203 Anchorage, Alaska 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 15, BLOCK 2 ROCKHILL S/D EUGENE DESJARLAIS No Ground Water or Impervious Layer to 17 ft. Use Standard Trench Soil Rating. From test March 10, 1995 <5 min/in = 1.2 gal / sq. ft. Use 0.8 gal / sq.ft. No. of Bedrooms 5 Required Area per Bedroom: 150/.8 = 187.5 sq.ff.. Total area required: 5 x 187.5 = 937.5 sq. ft. Finish Floor Elevation Ground Elevation at Absorption Field Testhole Total Depth 16. Ft Less 6 feet 10 Less 5 feet Cover 5 Rock Depth 5 110.00 Ft. (Assumed) 110.00 Length of Trench 937.5 / (2 x 5) = 93.75 [FT.] SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 94 FT. TOTAL WIDTH 2 FT. TOTAL DEPTH 10 FT. ROCK DEPTH 5 FT. COVER 4.5 FT. SEPTIC TANK 1500 GAL. The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface rtmoff will not result from this installation. Septic System Design Lot Block / / TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 L~T l~ * L I~T 9 iii1- 50 o ~0 ]00 ]~0 £00 250 300 LOT 15, BLOCK 2 ROCKHILL 6550 LMESFONE CIR, GENE DESJALAIS SEPTIC SYSTEM DESIGN DATE: A4ARCH 7, 1995 SHEET: 1/3 GRID: 2438 // 0 B5 FI-, EN SPURKLAN dO, CE-aBa5 I I TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99,501 (907'~ 2:79-~916 LOT 15, BLOCK 2 ROCKHILL S/D 6550 LIMESTONE CIR. GENE DESJALAIS SEPTIC SYSTEM DESIGN DATE: MARCH 7, 1995 SHEET: 2/3 GRID: 2438 94 _1 Cleon Cleon Dut ?£IP/A£Y TRENCH £' W/de 94' Lon$ ]0' Deep S' Semmr rook d,:' Cover i4 Cleon [Tull_ /V/onltor Cleon REPLACEMENT TRENCH ND SCALE C{eonou~g )4oni~om 4" ?op'~oll 4,5' Cover 0 Cleon out 1500 20{ £ept/a tank Ex/st 6fauna! 4' M/n Co vet ?onk Nlm o P/ 14 $ ND SCALE Z500 2oL septic tank TBBBEN SPURKLAND P,E, 203 Wl5th Ave Anchorage Ak 99501 L g ? 1~ ~L/7£/C 2 £/TCHHiL L 6550 LIMESTZINE CIRCLE EUGENE DESJARLAIS SEPTIC SYSTEM DESIGN SHEET: 3/3 oRI]> 2438 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL 3 4 6 ~0- 14- 15- 16- -To~ o~ 17 18 19 WAS GROUND WATER ENCOUNTERED? 20 Township, Range, Section: SLOPE SITE PLAN S L IF YES, AT WHAT O DEPTH? p E Depth to Water After / Moniloring? ~,r~/ Dale: Gross Net Depth to Net Reading Date Time Time Water Drop ,~Yz.. //s to .- q 3-o ~ 0 IO ,, ~ PERCOLATION RATE /~ .-~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND 7' FT COMMENTS PERFORMED BY: ~ ''~ I ~ ~ CERTIFY TH,'~T THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '"~/~ Z.,/~,.~- 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ' '{ENGINEER'SS'EA.L.) PERFORMED FOR: LEGAL DESCRIPTION: 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- DATE PERFORMED: Township, Range, Section: WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN S IF YES, AT WHAT ~ DEPTH? p E Depth to Water Alter_j ' MonitorinD? oz ,~-/ Dale: I Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER __ __ FT AND ~ FT COMMENTS PERFORMED BY; '~' -~ , '~- 5 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '~..t'f.~ ~- "/'1 jl ~ ~ ~ 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST L) PERFORMED FOR: LEGAL DESCRIPTION: 5 6 7 8 9 10- 11 12 13 14 15 16 17 18 19 20 COMMENTS ~,.~ ~. ~/.MJ, ~' .~ DATE PER FOR[~ j~.m c~J/~ .l~l'ownship, Range, Section: WAS GROUND WATER ENCOUNTERED? SLOPE S L IF YES, AT WHAT O DEPTH? p E Depth lo Water Alter Monitoring? Date: ____ SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ TEST RUN BETWEEN __ (minutes/inch) PERC HOLE DIAMETER FT AND FT PERFORMED BY: ~ ~ I ~,,, ~:> CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 915- ~,~.. 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~125 (Rev. 1/91) Front MOA #21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furthei' 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature DHHS SIGNATURE k Approved for Disapproved. Conditional approval for '~ U ~- (~"'~bed rooms. Phone bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certifioates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1/91 ) Back MOA ~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERV~E~ E IVE D Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744, MAY 31 1996 Municipality of Anchorage Dept. Health & Human Services Health Authority Approval Checklist · Legal Description: A. WELL DATA Well type ~- Log present (Y/N) Total depth LoT 15: Doc. t< ,,/ If A, B, or C, attach ADEC letter. ADEC water system number Date completed '3/I0,] // ~ L, I Cased to ~'f_,~9 Casing height (above ground) Sanita~ seal (Y/N) '7 FROM WELL LOG Date of test 5- ~/' ~ ~v Static water level Z/if i Well production ~ g.p.m. Wires properly protected (Y/N) y AT INSPECTION WATER SAMPLE RESULTS: Coliform ~/0 Nitrate Date of sample: ~ Z~/~///~/ ~, Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Date of Pumping lq Tank size /5't)O Number of Compartments ~ Cleanouts (Y/N) _ Depression (Y/N) }4 High water alarm (Y/N) Pumper ix////3, C. ABSORPTION F1ELD DATA Date installed %/q~- Length ffqi Width Effective absorption area Date of adequacy test J~ Soil rating (g.p.d./ft2 or ft2podrm) ~)~ ~ System type Gravel thickness below pipe ~.. . Total depth Monitoring Tube present(Y/N) )t Depression over field (Y/N) Results (Pass/Fail) ~' For .~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth }~4//~ (ins.) Minutes later: Peroxide treatment (past 12 months) (Y/N) Absorption rate = /~//[ g.p.d. If yes, give date LIFI' STATION Date installed NoN Manhole/Access (Y/N) Size in gallons "Pump on" level at* "Pump off' level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /O '7 t .; On adjacent lots Absorption field on lot j O '~ ; On adjacent lots Public sewer main I~ O ~ ~ Public sewer manhole/cleanout t Sewer/septic service line | O '"1 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ i Property line I O1~ [ Absorption field Water main/service line J0 t ~q Surface water/drainage ~/o vt~. Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ Water main/service line Surface water Driveway, parking/vehicle storage area ~ ~ I Wells on adjacent lots ~. /OnO Property line Curtain drain ~ 0 ~ O~ F. ENGINEER'S CERTIFICATION ,~-Lg~'~"~O[; z~'h'~l~ I certify that I have determined thrufield inspections and review ofMunicij~q~.-~.~)~..l~s thqgil~e_~t-~o~'b'}fia~ms are tn conformance wtth MOA H~g utdehnes ln e~ffiect on thts date. ~ ~ ~ .~ ~ , ,,. ,<, ,~ y ....... : : ~.~ .~ ... g~ ~ . ~: ~ ' I ' { %' -'~-',' _. u ........ :bd% , HAA Fee $ 3 ~ 0~ W~ver Fee $ Date of Payment ~ ~3/~ Date of Pament Receipt Number ~/~ Receipt Number 05/ ' Rev. 8/95 OSS: haa.wk.doc