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Home My WebLink AboutHERITAGE PARK BLK 1 LT 12Onsite File Heritage Park Block 1 Lot 12 #050-211-40 (Nev ub/UL/i 6) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201489 PID Number: 050-211-40 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name BILLIE & DONNA HICKS ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 19745 IVY HOME CIRCLE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. HERITAGE PARK 1 12 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Fe Ft. Well 200'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 1001+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer JRS Drainfield CO/MT 3034. Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1�t 12/11/2020 1/8/2021 Location and description 2nd 3`d 4'h BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF A • Conditional Approval: Date ,dMW,�Q ' ' • g TH .. . V"_ " " " " " " " k • . Curtis Huffman ' •� Septic System A p rov w- Date -Z ��•• CE 128991 /� ��islF�•. 1/8/2021.. . FOp ROFESSI�N��-� Note: this approval does not include well permit requirements. �\ROFiSV + (Nev ub/UL/i 6) PID: 050-211-40 PERMIT: OSP201489 1 LOT 12 sy"D BLK 1 76. 0 Do 0 NEW 1250 -GAL ' HDPE GREER TANK SUMP & RECONNECTED >I TO EXISTING FIELD _ r\f LOT 11 ' \� MH CO DCO I 0 \� B ® E D I w I d \� FCO C i :3 = Ljjn �- ss)• �3oy W � SUMP I p r O C/s A > 00 O Z ' COVERED ( Z O GQ? ' ENTRY^�O O ( v � oF` � ' A PRO LINE C ?sp• PAVED PARKING A -C=34.6' B -C=36.6' A -D=36.1' B -D=40.8' A -E=37.0' B -E=43.1' PAVED f- D/W a \+ SCALES 1' = 30 SEPTIC SECTION SCALES NTS HERITAGE PARK BLOCK 1, LOT 12 SUF'FL)KI SLKVictS: PREPARED FOR: �� OF ��4� BILLIE & DONNA HICKS LIVING TRUST 19745 IVY HOME CIRCLE C 9 TH EAGLE RIVER, AK 99577 FIRST WATER CONSULTING , PATE: 01/08/2021 �tis Huffman SURVEY: JLS 2021 CE 128991 13030 SUES WAY DRAWN: FWCS 1/08/2021�� ANCHORAGE, AK 99516 SCALE: 1' = 30' '°hbssto��' 907-350-9566 firstwaterAK®gmoil.com LOT 11 ' +\ w I \+ Z10' rn O� Z COVERED ENTRY. i R IVY HOME CIRCLE LOT 9 s yF0 16 0 I I SEPTIC VENT (trp)j Of LOT 12 BLK 1 F � O GP .�' O <2 r'6Q PAYED PARKING \� PAVED •�, -l' 1 0' D/w \ „ 3 9 EYBOX LOT 13 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HERITAGE PARK®O = FND 5/8" REBAR LOT 512 BLOCK 1 PLAT 82-39 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property.as shown.on this drawing and that the ��,�`S , • <Q�� { improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should *CQ 4� any information on this drawing be used for construction of fences, - i TH W structures, improvements, or for establishing boundary lines. ® ; �,� EXCLUSION NOTES: It is the owners responsibility to determine V .. ' . ' ' ' . ' ' ' ' ' ' ' ' ' ' ' ' . •c m . the existence of any easements, covenants, or restrictions which � ,o. JOHN LSCHULLER: �•�°,, do not appear on the recorded subdivision plat. It �; LS 110408 A WORK ORDER NUMBER: DATE SCALE: E -Nay Pp A ry> y, �� ®® JAN 12, 2021 1 "=30' �� 20-088-2 DRAWN BY: CNEC%ED BY GRID NUMBER: BOOK AOE ��rOfeSSlOnO, JLS NW0055 210112 J ®k io,i'�'°® 2'x26' CANT IU) 0 �7�i J r S UR LSD v a r 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax 12/08/2020 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-211-40 Property owner(s) BILLIE & DONNA HICKS LIV. TRUST... Day phone 907-632-4539 Mailing address PO BOX 771666, EAGLE RIVER, AK 99577 Site address 19745 IVY HOME CIRCLE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) HERITAGE PARK BLOCK 1, LOT 12 Legal description (Township, Range & Section) Lot Size 20179 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank I—XI Upgrade Q (D) F-1❑ Holding Tank ❑ RenewalDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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: �b ,G a. 7,5(60VO - l 1) Waiver Fees: Date of Payment: CaO Date of Payment: Receipt Number: ( q 9 2, 2, Permit No. (zl S Pa C) g Ci Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 411 FIF51 Water +. CONSULTING WAIF R1W ASI [WATER 3UPP0NT&PtANNIN4 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com November 25, 2020 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: HERITAGE PARK BLOCK 1, LOT 12 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201489, Rebecca Carroll, 12108120 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250 -gallon HDPE tank to serve the existing 4 -bedroom residence. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffinan, P.E. • Fjrsr Water SERVICES WAIER/WA SI EWAIEA ��CUNSULTINC SXPPO RIBXNINA PLA Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COM OSP201489, Rebecca Carroll DESIGN CRITERIA: DECOMMISSION EXISITING SEPTIC TANK & INSTALL NEW 1250—GAL HDPE GREER SEPTIC TANK. MAINTAIN 10'+ FROM FOUNDATION, 200' TO WELLS, 5' TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR INSULATION. STAKE WATER LINE PRIOR TO CONSTRUCTION. INSTALL PER AMC 15.65, 15.55, & MASS... TANK BEDDING, SEPARATIONS, MATERIALS, I \ 779,34, LOT 9 I o LOT 12 SyFO I BILK 1 , _ I Iso• LOT & AREA SERVED O BY PUBLIC WATER DECOMMISSION EXISTING S.T. I i ^ & INSTALL NEW 1250—GAL SUMP HDPE GREER TANK W/ REQUIRED BEDDING & DCOs. LOT 11I \+ MH CO DCO O O I\+\ � O FCO + J p CONNECT TO I \+ yo � EXISTING FIELD W iU-) LLJ 3 7 o iS ��y'41, SUMP I o CSS> o z I COVERED ENTRY I Z O z GQ� I h• a I LOCATE WATER LINE PRIOR TO PAVED CONSTRUCTION PARKING I � \ r' PAVED �\ \ D/W e O IVY HOME EYBOX N6�62I CIRCLE �N6S�0 HERITAGE PARK BLOCK 1, LOT 12 SUPPORTIIIISERVICES: �\\ PREPARED FOR: - OF Ar�`�.`�� 1 �� 1 BILLIE & DONNA HICKS LIVING TRUST 19745 IVY HOME CIRCLE EAGLE RIVER, AK 99577 �* 9 TH* / FIRST WATER CONSULTING DATE: 11/25/2020 SURVEY: JLS 2020 ` rtis Huffman wx 04 ✓�, CE 128991 `v 13030 SUES WAY DRAWN: FWCS 1 .11/2 2020 G� / / d' w 1 / ANCHORAGE, AK 99516 SCALE: 1" = 30' Ati � FESSIO� Idw 907-350-9566 firstwaterAK®gmoil. com _0111111111 LIANCE 12108120 00 O� �E LOT 9 IVY HOME CIRCLE 1 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HERITAGE PARK LOT 512 BLOCK 1 PLAT 82-39 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 should 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: DALE: SCALE —MAIL• NOV 23, 2020 1"=30' 20-088 DRANK BY: CHECKED BY GRID NUMBER: BOOK AGE JLS NW0055 200248 :i PAVED D/W * = FND 5/8" REBAR PAVED PARKING + 9 1�9�Ri LOT 13 �Am% OF .AL��11 49TH .. ..f ".J HN L. SCHULLER.: 0 LS -10408 10 `,It� fessionot L "W v� ALD LAND L) o r a• ...01"""r 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax LOT 12 SEPTIC . BLK 1 VENT (typ) + \+\ IN ( 00 LOT 11 o \+ It�,-� r- � J Uj /ST 00 � �C • N S�` 2•x26• r_ p' Z CANT 00 O COVERED ENTRY Z Q z IVY HOME CIRCLE 1 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HERITAGE PARK LOT 512 BLOCK 1 PLAT 82-39 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 should 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: DALE: SCALE —MAIL• NOV 23, 2020 1"=30' 20-088 DRANK BY: CHECKED BY GRID NUMBER: BOOK AGE JLS NW0055 200248 :i PAVED D/W * = FND 5/8" REBAR PAVED PARKING + 9 1�9�Ri LOT 13 �Am% OF .AL��11 49TH .. ..f ".J HN L. SCHULLER.: 0 LS -10408 10 `,It� fessionot L "W v� ALD LAND L) o r a• ...01"""r 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax .~ [~_.., MUNICIPALITY OF ANCHORAGE ,~ / DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [~NEW :') £y£o z,' , LEGAL DESCRIPTIO~ We I Absorption area Dwelling PERMIT NO, D~STANCE TO: J .~ --~ Manufacturer ~ ,I Materia,.~,/~ No. of comp~'tments ,E.OMEMADE: Liq. c pa i in ~allons ' Inside length Width Liquid depth ~,t~ ;~ DISTANCE TO: Well Dwelling PERMIT NO. --~ ~ Manufacturer Material Liquid capacity in gallons t~ Well Foundation Nearest lot _~ ~. ~ No. of lines Length of ea~:~ [u:)eJ Total length 9f~li~ll~ [ Trench wid.~h~:[~ Distance between _~ u~ /'?O ~' ,-~ ~ inches HI/'~' ~' ~ ~- Top of tile to finish grade ! Material beneath tile Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s} ~ DISTANCE TO: OTHER SOIL ~E~T R~TING~ INSTALL ~ ~ t REMARKS ~ r78) ~ - ,--, t'--~S I T E PERMIT NFL ,:: :--:202:--:0 ) FIPPLiC:RNT E:,E',,,'CFIN ENT. INC. ._4i± OLD SEWRRD HW"r'. L OF:FtT I ON LEGFlL ' LAT "12 E:LK -1 HEF. ITH~E' - -' F'RRK _'-%lIB_LOT SIZE E:,EPFIRTMENT ~., /. HERLTH FIND EN'v'IRONMENTRL .,.,_.,OTECTION HN_.Hu. , o.¢..- "' L?' STF.'.EET, - F' - RFtljE RE. 9951.~1± :.;.'¢-,4 - 4 ,.- ;~ ~'~ ~ b.'l -:L M,_-,,=: 99999 SQUFlRE FEET T'¢F'E OF SOIL FIESOF.'F'TIAN SYSTEM IS: TRENF:H MRk-:IMUM NUMBER OF BEDROOMS = ~ SOIL F.'.RTING ,:.".'-%Q FT,-'BF.:)= THE F.:EI..]UIRED SIZE OF THE SFIIL FlBSORPTIAN _-'-;YSTEM IS: [:~FF"TH= :1. C-~ LEt'-&GTH = --~-=: '-'~- i]RR%-"EL [:~ E F' l- ~-t = ¢-_-; THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF Ft TRENCH OR PIT IS THE DISTFtNCE BETWEEN THE SLIRFFICE OF THE GROUND FIND THE BOTTOM OF THE E)~:CRYFlTION (IN 'FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRR',.,'EL DEPTH IS THE MINIMUM DEPTH OF GRFlVEL BETWEEN THE OUTF'FILL PIPE FIND THE BOTTOM OF THE EXCFI'¢FtTION (IN FEET). F'EF.:MIT MFFLI_.HNT- ' ' F'-HRS THE F.E-,F_N_-,)E, ILITT' '- '- '- ' ' "TEl INFORM THIS DEF'RRTMENT DURING THE INSTRLLRTION IN_-,FEL. TILN:, OF RN'T' WELL'"'] RDJRCENT TO THIS F'ROF'EF.:TY RND THE NUMBEF.: OF F.:E:,I[:ENL. E-', THRT THE WELL WILL -,ER,E. - I-I - EIY BRI]:KFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RN[:, HFFR_,,HI_ THIS DEPRRTMENT WILL BE SUBJECT TO F'RI]SECUTION. MINIMUM DISTRNC:E BETWEEN R WELL FIND RNY ON-SITE SEWRGE DISPOSFIL SYSTEM IS ±00 FEET FOR R PRIVFlTE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIYRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRiLRBLE TO INSURE PROPER INSTRLLRTION. i CERTIFY THRT i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE COPES. z.: I UN[.,EF.~TMN[., THHT THE UN-:,ITE =,EWER :,m_,TEId I1Mz RE(..UIRE ENLHRbEfIENT IF THE RESIDENCE/IS REHO[:,ELE[:, TO INCLU[:,E MORE THRN 5: BE[:,ROOMS. ...... ........ , _ PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 5 6 7 8 9 11 12 13 14 15- 16- COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG ~JJ PERCOLATION TEST 111}~ VCOF~ ove~- burae~ Se,' SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Gros~ Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT CERTIFIED BY --' 72-008 (6/79) Development Services Department On -Site Water & Wastewater Section Certificate of On -Site Systems Approval Parcel I. D. 050-211-40 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: JI- j _` ^) 0 z Z Complete legal description HERITAGE PARK BLOCK 1, LOT 12 Location (site address) 19745 IVY HOME CIRCLE, EAGLE RIVER, AK 99577 Current property owner(s) BILLIE & DONNA HICKS TRUST... Day phone Mailing address Real estate agent PO BOX 771666. EAGLE RIVER. AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 412.50 COVIID Date of Payment I �/so/�02 Receipt Number 3 Waiver Fee $ Date of Payment Receipt Number COSA # OSC201703 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE 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 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 & fWCS 6. DSD SIGNATURE XSystem #1 Approved for _�_ bedrooms System #2 Approved for bedrooms Disapproved Date 12/30/2020 *: 49 TH . Curtis Huffman •CE 128991 12/30(202�.��/ PROFE SI`�4� \\tea Conditional approval for bedrooms, with the following stipulations: J= Old -SITE � WATER A 7 .AIA T!_10TERM_ PRbGkAM Z�� l By: Original Certificate Date: 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 Legal Description: HERITAGE PARK BLOCK 1 LOT 12 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA — PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth _ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _in. Date of flow test for COSA Static water level at beginning of test _ft. Comments B. TANK DATA Age of tank(s) NEW 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NA - NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 5/9/1983 ® ALL standpipes present per record drawing Total measured depth from grade 11 ft (max) Parcel ID: 050-211-40 Structure served by this system _ Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate _mg/L ❑ Nitrate less than MRL (ND) Arsenic _ ug/L ❑ Arsenic less than MRL (ND) Collected by, Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 11/19/2020 Results Z Pass For 4 bedrooms Fluid depth prior to test 34 in Measured depth to pipe invert from grade 5.8 ft (min) Water added 680 gal ❑ N/A — pressurized field New depth 49 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective * 5.2' INTO THE 6' ED Elapsed time 1220 min ® Code -required soil cover over field Final fluid depth 32 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date FC kS Comments/Deficiencies:. *PER SUMP INVERT / BOTTOM OF MT VISUAL MEASUREMENTS AT TIME OF TEST. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) — NA PUBLIC WATER Septic Tank/Lift Station on Lot > 100' ® Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No _ Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' F. ENGINEER'S COMMENTS Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No _ From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 5.5+ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 'OF At I certify that 1 have determined through field inspections and review ®�P' • �� of Municipal records that the above systems are in conformance '• TH ••q�) with MOA COSH guidelines in effect on this date. • , , ,v, Curtis Huffman �� FFG' •. CE 128991 �� /lF�• l/,4/2020 , . •��.� ft ft