HomeMy WebLinkAboutKIJIK LT 3Kijik
Lot 3
#017-092-19
On -Site Wastewater Disposal 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: OSP151091
Tax Code Number: 01709219000
Work Type: Septic Upgrade
Permit Effective Dates: May 01, 2015 to April 30, 2016
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: KIJIK
Site Legal Address: KIJIK LT 3 G:3038
Owner/Address: HUGHES CHARLES & INA
PO BOX 110693 ANCHORAGE AK 995110693
Site Mailing Address: 6201 E 142ND AVE, Anchorage
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy
Lot Size in Sq Ft: 90000
Total Bedrooms: 3
N 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 By:
US-
Issued By: Lz:// Date:
sillsol-S
MITRAL
APR 2 4 2015
MUNICIPALITY OF ANCHORAGE Gr®tch,, Stubir
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. 017-092-19
Property owner(s) Charles & Ina Hughes Day phone None Available
Mailing address 6201 E 142nd Avenue, Anchorage, AK 99511
Site address 6201 E 142nd Avenue, Anchorage, AK 99511
Legal description (Sub'd., Block & Lot) K1JIK L3
Legal description (Township, Range & Section)
Lot Size 90000 Sq. Ft.
APPLICATION IS FOR:
(N all that apply)
Absorption Field ❑X
Septic Tank
❑x
Holding Tank
❑
Privy -
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms 3
APPLICATION IS AN: TYPE OF DWELLING:
Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Upgrade 1ZDuplex (D) F1Renewal ElDuplex
Dwellings ❑
(SF and/or D)
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number: Q�Y%
Permit No. �sp�s�ix�r
Permit App_::- ::'-.-Cl
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Pannone Engineering Services etc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panenRak.com
22 April 2015
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road
P. O. Box 196650
Anchorage, Alaska 99519
Subject: KUIK L3
Septic System Upgrade Permit Request
Ladies and Gentlemen:
am writing to request a permit to install an upgrade septic system be issued for this property. The
proposed systems will serve an existing three (3) bedroom house. Currently the existing seepage pit is in
failure. The existing 1250g septic tank will be verified and replaced if necessary. A new field will be
installed and the existing seepage pit will be used in reserve. This lot is served by a private well. The
surrounding lots are also served by private wells. There are no wells within 200' of this system, "W�
CAAVA � Shd)N
Soils. Pannone Engineering performed one test hole on this lot in April of 2015, and groundwater was
monitored for at least seven days. The test hole monitor tube was dry after the seven day monitoring
period. It is my opinion, based on the results of the soils tests and overall soils appearance; an application
rate of 0.6 gallon/day/square feet should be used for a conventional wastewater system.
1. Soil Absorption System Design.
a. - See Sheet 2 of the design package.
2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain
field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
3. Topography: The proposed drain field is located on the western portion of the lot. The
surrounding topography generally slopes from east to west at approximately 12%. There are no steep
slopes within 50 feet of the proposed drain field.
4. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification
that the review is complete and that there are no further comments is received from MoA On -Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
The proposed installation will not affect the future development of the surrounding or existing lots.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner7Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
E c
95
12509 TANK W/ DCO AND DV
SEEPAGE PIT E TO BE
REUSED AS RESERVE FII
59.2
� :os
o\
DRAINFIELD P
62.5LF• 2.5W, 6'ED,
NO WELLS W/1200' OF
PROPOSED SEPTIC
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10' 101
-----
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NOTES:PANNONE ENG SVC, LLC -�'OFq
A� oi3a�,5
FOR CONSTRUCTION - P.O. BOX 100217 ANCHORAGE, AK 99510 r '��'•'"..... ((t
PHONE (907) 272-8218 FAX (907) 272-8211 % �yt+ Scale
"•' „" P.I.D. NO
KIJIK 13 " ...... .R..Pane on e. 17 092
CHARLES & INA HUGHES / PERMIT NO.
DRAWN JRL I�PCT CE 8149 �OSPXXXXXX
6201 E. 142ND AVE
Sheet
PLAN ANCHORAGE, AK 99511 ��1% S9oN` -T 1 OF 3
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS.
3. SCOPE OF WORK: VERIFY INTEGRITY OF EXISTING 1250g SEPTIC TANK, REPLACE IF NECESSARY AND INSTALL NEW DRAIN
FIELD.
4. GROUNDWATER WAS NOT ENCOUNTERED AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS
OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 16.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER
IMMEDIATELY. FILTER FABRIC
4" 0 DRAIN PIPE
TH-1 ``DRAIN ROCK 6" ABOVE PIPE INV
4.0
GM
-3.0
s.o
SM
6.0
-16.0 1
SECTION
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM
NO. BEDROOM: 3 (450 gpd)
TANK SIZE: 12508
PERC RATE = 19.5 MPI
SOIL RATING: 0.6 GPD/SF
AREA RQD: 750 SF
SYS. TYPE: DEEP TRENCH 6.0' E.D.
MIN LENGTH: 62.5 LF
USE:
62.5 LF X 2.5' WIDE, 6' E.D., 10.0' TO
TOTAL AREA: 750 SF
PROFILE
LEGEND
---- WATER LINE/
WELL RADIUS
---F— ----- NEW SEPTIC
NOTES: PANNONE ENG SVC, LLC
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510.
PHONE (907) 272-8218 FAX (907) 272-8211
KIJIK L3
DRAWN 1 JRL CHARLES & INA HUGHES
6201 E. 142ND AVE
DESIGN NOTES ANCHORAGE, AK 99511
ABBREVIATIONS
CU
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
M#
MONITOR TUBE NO.
R.I.
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
BEG
BELOW FINISH GRADE
OG
ORIGINAL GRADE
FG
FINISH GRADE
TS&V
TOPSOIL & VEGETATE
E
EXISTING
P
PROPOSED
Date
OF. AL�sl� 04/30/15
r.- F '+ Scale
yam' '9 �II NTS
" V'y")"' P.LD. 2
�\ /�\/ � 17-092-1!
�F•. CE 8149
,I11���OFESSIONP�-�
'ERMIT NO.
2 OF
TEST HOLE 1
SOILS LOG - PERCOLATION TEST
SLOPE
TEST
HOLE -
WAS GROUND WA
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
DEPTH TO WATER
MONITORING? -
DATE: 0
READING DATE
CLOCK
NET TIME
WATER
LEVEL
READING
2
MPIE
GM
ORANGESAND
5.185"
&GRAVEL
3
WMIN
7811"
2636"
4
3
1103
5.185"
5
4
1133
30MIN
6
1.825"
16.44
5
1134
7
5.185"
6
8
30MIN
6.725"
t549'
19.48
9
12:05
SM
SILTY SAND
10
8
12:35
1 30 MIN
6.725"
11
19.48
12
13
14
15
16
BOH
NO GROUND WATER
DATE PERFORMED: 04/14/2015
SOILS LOG - PERCOLATION TEST
SLOPE
TEST
HOLE -
WAS GROUND WA
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
DEPTH TO WATER
MONITORING? -
DATE: 0
READING DATE
CLOCK
NET TIME
WATER
LEVEL
READING
NET DROP
MPIE
1 N114115
1031
5.185"
2
1101
WMIN
7811"
2636"
1138
3
1103
5.185"
4
1133
30MIN
7010"
1.825"
16.44
5
1134
5.185"
6
12:N
30MIN
6.725"
t549'
19.48
7
12:05
5.185"
8
12:35
1 30 MIN
6.725"
1.540"
19.48
PEROLATION RATE 19.5 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 4 FT AND 5 FT
COMMENTS: Test hole excavated by Pannone Enaineerina Svc. Test Hole was Dresoaked'before Derc test
PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES: PANNONE ENG SVC, LLC of a� �>>t Date
04/30/1
-OR CONSTRUCTION. - - P.O. BOX 102954 ANCHORAGE, AK 99510 �Q'�� '•'9S�(
PHONE (907) 272-8218 FAX (907) 272-8211 iCb." —# Scale
DRAWN I JRL
SOILS LOG
KIJIK L3
CHARLES & INA HUGHES
6201 E. 142ND AVE
ANCHORAGE, AK 99511
*. •*f� NTS
..... ..:.. . . ..P.I.O. NO
... 017-092-1
Steven f2. an / PERMIT NO.
1�19Fc� CE 8149, OSPXXXXXX
`tli'g OFFS`==�' Sheet
3eOF 3
GREY' R ANCHORAGE AREA BOR"FIGH
/ Department of Environmental Quality
UNN
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME MAILING ADDRESS/PHONE
LOCATION LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE�j NUMBER OF I
FROM WELL M l MANUFACTURER f ;% MATERIAL COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH J LIQUID DEPTH — LIQUID CAPACITY / 'l' GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER - OR WIDTH 17LENGTH'Z6 DEPTH Z�
LINING MATERIAL,40 44"L CRIB SIZE: DIAMETER _DEPTH DISTANCE FROM: WELL
f. Gjf TOTAL EFFECTIVE
BUILDING FOUNDATION, NEAREST LOT LINE aABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL: J ��
�����T CONSTRUCTION l�/L//�O DEPTH / f/�A�dY�/�
TYPE DISTANCE FROM:
BUILDING / NEAREST NEAREST SEPTIC y SEEPAGE
FOUNDATION l s LOT LINE "2 I t SEWER LIN//E /Q I� TANK /GtP/ SYSTEM /Od
CESSPOOL OTHER SOURCES
APPROVED — DISAPPROVED REMARKS
DISTANCES: Shdt�l/rr
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE: TG .SJUT� Q
REMARKS:
DIAGRAM OF SYSTEM
��E.d�fl OCl ,ZS'
S'IV
�nC� f0 vslt� a
,lli�ue�ln%9 / /j l
0Y«�
a
DATE /gZf APPROVED
G.A.A.B.
Form No. EQ -031
LwcxvLLVL
3� �r
�W¢Lo N+`�D•
.F. L
GREATER ANCHORAGE AREA BOROUGH
PERMIT NO.
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
p
NAME OF APPLICANT
0.,;t V(Vr MAILING ADDRESS � �' _ / f f'PHO E 66 �v
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
r7
SEEPAGE PIT
n !1
DRAIN FIELD. , OTHER ,
L_/TO BE INSTALLED Y an_
I _
SOIL TEST
RE LTs lD - �a , //`✓y / ��` NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE / l v r TYPE EEPAGE AREA SIZE �ry
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK 5
FOUNDATION TO SEEPAGE PIT L/ -L) L DRAIN FIELD /!/ '
SEPTIC TANK TO SEEPAGE PIT WALL /✓
SEPTIC TANK `� SEEPAGE PIT �?o DRAIN FIELD
TO NEAREST LOT LINE. � y
WELL TO SEPTIC TANK /C!U SEEPAGE PIT 019
DRAIN FIELD lf) , ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK T SEEPAGE PIT /0
DRAIN FIELD I ./0--
,, �n7 //ll �
1 /��) 1
0
SEPTIC TANK, . SEEPAGE PIT ('UV DRAIN FIELD .
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
jjo,,/(3 &-j I �_v
G.A.A.B.
OR
LICENSED DESIG
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE - / APPLICANT'S SIGNATURE
cL�eu vn F_(]-016
_
(
7
'
k
I
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE - / APPLICANT'S SIGNATURE
cL�eu vn F_(]-016
Performed for_,
Legal Description: _/,71-
This form reports: Soils
Depth
Feet
UI\"HILI\ nl\VIIVf\MUL MINLM UVnVUV
'Department of Environmental Qua -f -,Ay
3330 IIC11 Street
Anchorage, Alaska 99503
SOILS LOG - PEROLATION TEST
2_
3
4 - SaN'JS
5-
6 -. ^
7-
9-
10 -
S/,o
Date Performed 91—cy-° i V
rcolation test
12 -
13 -
14 •-
4as ground water encountered? �}1L3 _ _ If yes, at what depth?
Reading Date Gross Time Net Time Depth to Water Net Drop
Percolation rate minute.
Proposed installation: Seepage Pit Drain Field _
Depth of Inlet _ _ ^ _ _ _ Depth to bottom of pit or trench _
WITIENTS : ---- -- ----- --
Performed Qy:C�h�tR__Certified
EQ-040 (6/74)
to-- - - -- ---
_ �-��
�`"`' `�` '`j�
��
�� ��
`�--�
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
l,o f 3J t y ) •k s lb
Location (address or directions)
K201 C Ig2 nd Ac"e CSF 601del7tl(ecv
(b) Applicant Name C6arkf 4u 4 --r Telephone: Home 3 Y,5--- 13Y 7 Business
Applicant Address G� 1' y ! nct /ua , Glipi care /'} k W' 70�
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder"; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution First Interstate Bank Telephone 264-5565
Address 3230 110 St 2nd Floor Anchorage AK 99503
(e) Real Estate Company and Agent _n/a
Address
Telephone
(f) Mail the HAA to the following address: Please call either owner or Dawn @ First Interstate
for pick—up.
3,q9 3��a x 4S 1
C` � \ �� 6 M K cx d"a l
2. TYPE OF RESIDENCE
Single -Family R Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well JR Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
*At'G
Note: If community Wl system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
1.1
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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
fort he 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm (=lcc/�or-Fechnr cat Sery'tcd1 Telephone Sys
Address Pi_6-3G Ccho .Sid 0 AnC%?a 2 %t'C
Date
o c,NV At
�¢L� •••� /Ari `. ��t
4carH
cif •"•�..?:.....:..
THEODORE F. fA00RE 01 Engineer's Seal
i
�•. ;
••,• CE - 3589
DHEP APPROVAL
Approved for bedrooms by ate 1 ��
Approved Disapproved Conditional
Terms of Conditional Approval
dhep
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA) „f�K i tflaO
HEALTH AUTHORITY APPROVAL (HAA) �V
7
CHECKLIST - FEBRUARY 984 RECEIVED
264-4720
Legal Description: i -o 1L
3 S/0
A. WELL DATA
Well Classification P riyicer'(: If A, B, C, D.E.C. Approved (Y/N) N,A •
Well Log Present (Y/N) Y Date Completed ���`% 7y Yield�P �✓��e'�'�
Total Depth 1 ��� Cased to 0 'Az Depth of Grouting Nei •
Static Water Level 16!� Pump Set At
Casing Height Above Ground —
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
Sanitary Seal on Casing (Y/N) —
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot 1 IO ` le7 C-0, ; On Adjoining Lots > &l)o f
To Nearest Edge of Absorption Field on Lot r ; On Adjoining Lots 7 too
To Nearest Public Sewer Line NeA• To Nearest Public Sewer
Cleanout/Manhole MWN• To Nearest Sewer Service Line on Lot Ne 7}•
Water Sample Collected by %=M ; Date
Water Sample Test Results _$ cc c-ole1®rm ✓jam[%/ r'clr
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 9124_17y SizeI y e? I No. of Compartments
Standpipes (Y/N) r Air -tight Caps (Y/N) }r Foundation Cleanout (Y/N)
Depression over Tank (Y/N) N Date Last Pumped 412-8 /8e
Pumping/Maintenance Contract on File (Y/N) Ne it. ; for /Vr/f
Holding Tank High -Water Alarm (Y/N) NA Temporary Holding Tank Permit (Y/N) At, 4
Separation Distances from Septic/Holding Tank:
To Water -Supply Well I I Or9in C• C'• To Building Foundation
To Property Line 5—d' To Disposal Field —
To Water Main/Service Line
Course �> 100'
Comments
Page 1 of 2
72-026(11/84)
yqe
16-1
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1 2,5.0'63 dr -r" Type of System Design -been
Date Installed 2 18,5`1 % y Length of Field 2 0
Width of Field f .' Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area 3 to 0' Standpipes Present (Y/N) Y
Depression over Field (Y/N) N Date of Last Adequacy Test -a/ 2l /��
Results of Last Adequacy Test Met V
Jaetfi cele feecee%P _4�pr -3 be? cerooml
Separation Distance from Absorption Field:
To Water -Supply Well 1.36' To Property Line S
To Building Foundations To Existing or Abandoned System on
Lot N,µ. ; On Adjoining Lots > 36 e
To Water Main/Service Line NeA. To Cutbank (if present) Iv, it
To Stream/Pond/Lake/or Major Drainage Course 2' l�G'
To Driveway, Parking Area, or Vehicle Storage Area ^ 1��''
Comments .50- -e Waee is 1530 c alluAw An sure ccecetes -Rut'd
later c lT eelo '11) s kw 1:c err I?-ee r nMy �elld v f I i Fe
D. LIFT STATION NA
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
** Check Permitted Bedroom Rating Against HAA Request **
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date2�C21186,
Company F&Mr_ c4reieul Sum MOA No.
Receipt No. i c) % 5 `3 FIN
Date of Payment �%�
....,
r
Amount: $�� .0 Co a\y�� '• e!� ®4 Engineer's Seal
O...........
Page 2 of 2 A a 1.......1
I •. THEODORE F. MOORE ,•
rj > CE - 3589 w+ AV
72-026 (1vsa)