Loading...
HomeMy WebLinkAboutSOUTHPARK #1 BLK 3 LT 14 /--~, MUNICIPALITY OF ANCHORAGE D£ ~TMENT OF HEALTH AND HUMAN SER Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N~ DISTANCES ___~. TO SEPTIC ABSORPTION WELL Address Permit NO. No. of BeSeems Township, Range, Section TII~ ~3W; ~'on 3 ~rw~wa~~AS~BU~~T"~AG"AM~Sh~w~~ca~~~n~~we~~~sep~~csy~~em~p~~pedyh"e~~~~unda~~~"~water bodies, etc) ~E PTIC ~ HOLDING~ ~--TY~ OF SYSTEM N o ~ ~, Depth to p,pe boltom from Total depth from original grade G,ave, ,engg~ Gravel w,dth ~ d ~ ~ I WELLS~' ~ PRIVATE ~ OTHER fldentifv) ~l~sllit~hon-(A,B,Cj ~olal Depth FT caseo ~oFT e) ~ ~. ': Municipal and Slate ~i~elines in ellect on Ibis dat~: HeallhDepaflmentApprova,: ' ~ Date: 4- -87 ' ..~ 72-013 (3/85) · [cirt, h !::ly 'Lhc. Hu~n:ic:i, palit:y [:ii' (~r'Hzl'-<)raOce (I"IOA) al'id t.h~:.) State oi 2,, :I: w:i.i]. :i.n~s't,a:l.l 'M"~c.) ~;y¢;?t:.(~,)lil :i.l'l ac:coi"clal']c:e i~,'l:.lt a:!.:!, Ifll]~g i::;od~:,~[~ and SE~E~ 8YSTE~ LOCATIO~ ;~ ~: ~ TH / ~m~ I DIMENSIONS INDICATED HAVE BEEN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 13 14- 16 17 18 19 2O DATE PERFORMED: Township, Range, Section: T } I ~ PLAN ' SLOPE GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ ~) DEPTH? P Depth to Waler After Monitoring? /~ I~'~.O -~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~1' '~ (minutes/inch) PERC HOLE DIAMETER ~Z~ I/ /.A I/ t* / I TEST RUN ~ETWEEN 5'~ FTAND ~:),~)FT I I In / rB ~'3n ~ GERT FY THAT THIS TEST WAS PERFORMED N ACCORDANCE WITH ALL STATE AND MUNICIPAL QUlDELINES IN EFFECT ON THIS DATE. DA~E: 72-008 (Rev. 4/85) Alaska Testlab 4040 "B" Street Anchorage, Alaska 99503 March 15, 1984 W.O. #A19741 Mr. Keith Bandt Environmental Engineering Manaqer Municipality of Anchorage Department of Health and Environmental Protection 825 "L" Street Anchorage, Alaska 99502 Re: Percolation ~e~st-~Lot S~thpark Subdivision Addition No. Dear Mr. Bandt: Telepho.ne (907) 562-2000 1his lette~ is to confirm our phone conversation of this afternoon in reference to the soils test on the above referenced lot and contained in our soils report dated June 5, 1981. The Following points are clarified below. The layer From 6.0' to 7.0' that is described as wet to saturated, we do not feel is reflective of a water table. This was an area of slight seepage associated with the spring thaw. This is verified by the water level readings we took on May 1, 1981 and May 27, 1981 and which are included on Test Boring 2C. This percolation rate of 20 minutes/inch was For the layer below 7.0'; however, the soils From 1.0' to 6.0' are similar and the soils from 6.0' to 7.0' are cleaner. Therefore, we Feel that the 20 minutes/inch percolation rate can be safely applied to all the soils below 1.0' in lest Boring IF you have any questions, please feel Free to contact us. Very sincerely, ALASKA IESILAB Melvin R. Nichols, P.E. President MRN:k: cc: Joh Test Hole ~2c Lot 14~ Block 3 TABLE G W.O. f~A19741 Date: 4/30/81 Logged by: OlViH De'pth in Feet From To 0.0 1.0 1.0 6.0 6.0 7.0 7.0 16.0 Soil Description Brown Peat, (Pt) F-3, brown Gravelly very Silty Sand, (SM), moist, medium dense, p.g., 3"+ F-l, brown Silty Sandy Gravel, (GM), occasional cobbles, wet to saturated, medium dense, p.g., 6"+ FI3, brown Gravelly very Silty Sand, (SM), moist, medium dense, p.g., 3"+ Set 3/4" perforated PVC pipe to run perc test and to monitor water table elevation Perc rate = 20 minutes/inch Bottom of Test Hole: Frost Line: Free Water Level: 16.0 Feet None Observed None Observed Sa. No. Depth 1 2 10~ 3 15' 5/1/81 - 11.75 Feet L5/27/817- None Observed (to 14 feet) Type of Dry Temp. ~31ows/6" M% Sample Strength Group Unified °F G SM G SM G SM Remarks: 1. Type of Sample, G=Grab, SPT = Standard Penetration, U = Undisturbed. 2. Dry Strength, N=None, L=Low, M=Medium, H=High. 3. Group rel'ers to similar mat. erial, this study, only. 4. General Information~ see Sheet 1, 5. Frost an~J -fextural Classification, see Sheet 2. 6. Unified Classification, see Si~eet 3. 2T i& S r ,~ 17 16 o I0 8 ' ']~ST F :E. GURE I ' · f4 T.H.? II II 12 O0 9 (30664} 13 18 .7' H. 5. 16 (~46491 .~.1t 4 Co 8 9 70 % • `\r wairrairrur rMunicipality of Anchor:`;:BSEP 0 6 2011 ¢? On-Site Water and Wastewater Progr (907) 343-7904 ti ' SA EET?A Q ti Certificate of On-Site Systems Appr�i aI 6 B z g Parcel I.D. 020-491-40 Expiration Date: 61 "11 1. GENERAL INFORMATION: Complete legal description Southoark#1, Lot 14, Block 3 Location (site address) 16241 Baugh Circle*Anchoraae.AK Current Property owner(s) Brian&Salina Vreelino Day phone Mailing address Real Estate Agent Heidi Stover Day phone 830-8319 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for: Distance: l_ Received by: / Date: `il (C9- COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 524 Waiver Fee $ Date of Payment 41q--1fr Date of Payment Receipt Number Receipt Number COSA# 051r-!y40 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road,Suite 101-Anchorage, Alaska 99507 irt Engineer's Printed Name: Jeffrey A. Garness Date: ► � 4��Qgp0�4 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A 4�Q in accordance with the guidelines and regulations established by the Municipality of Anchorage and '��•.•.•... industry practices. The reported results describe the condition of the system/s on the date/s of the p Q ' , Qn • evaluation. Separation distances were measured to readily identifiable features. Hidden defects or C Thi 1 � v encroachments may exist that were not identified during the evaluation. The operational life of all wells * % * Q and septic systems depend upon a variety of variables, including but not limited to, soil conditions, g VA groundwater levels (that may fluctuate during the year), quality of construction (materials and D workmanship),and•the water usage of the family utilizing the system/s. These conditions can vary,and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the an Je f - G. ness.: 0 systemis; therefore, GEG makes no warranty (express or implied) regarding the future performance of un CE 7• the well or septic system. GEG makes no representation whether an alternative well or septic system �s ;Opp can be installed on the property in the event either of the current systems fail to perform adequately in QQe, •'9j..R'• the future. The content of this report is for the sole benefit of the person/party that retained GEG to Pr o f es s on°c4 perform the evaluation. Reliance upon the information provided in this report by any other person or ��OOOpo� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE X- System #1 Approved for J bedrooms System #2 Approved for bedrooms Disapproved `��PpLITY Conditional approval forbedrooms, with the f>90owinw?i It 1(ts: 2 wASi AND g m pRo"'rER r / / ' Original Certificate Date: �-( ( 7 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-t 0-t 2.doc If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Southpark #1; Lot 14, Block 3 Parcel ID: 020-491-40 A. WELL DATA AWWU Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (abo - .round) in. FROM WELL LOG AT IN • TION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESU .. Coliform colonies/100 ml. Nitrate mg./L. Collected by: A • ic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA *See BioCycle inspection report. Biocycle/Fiberglass 7/1/2004 Tank Type/Material Septic/Steel Date installed 3/30/2015 1500 Tank size 1500 gal. Number of Compartments 4/2 Cleanouts (Y/N) Yes/Yes Foundation cleanout (YIN) Yes Depression over tank (Y/N) No High water alarm (YIN) *Yes Date of pumping 8/29/2017 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA 'Below Existing Grade Date installed 6/30-7/1/2004 Soil rating ..p.d.If 'or ft`/bdrm) 4.0 System type Bed Length 25 ft. Width 10 ft. Gravel below pipe 0.5 ft. Total depth *3+ ft. Eff. absorption area 250 ft'' Monitoring tube Yes Depression over field No Date of adequacy test 8/30/2017 Results (Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test 0 in. Water added 885 gal. New depth 0 in. Elapsed Time: 175 min. Final fluid depth 0 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date — Two—thousand thirty—five (2,035) gallons of water were introduced for a pre—soak on 8/29/2017 *Per 2004 inspection report by Ted Moore, P.E. **Per BioCycle maintenance report. D. LIFT STATION ***Per MOA 7/2/2004 electrical inspection report. Date installed 7/1/2004 Size in gallons 1500 Manhole/Access (Y/N) Yes "Pump on" level at*23.125 in. "Pump off" level at*5.125 in. High water alarm level at *26.5 in. Datum Bottom of Tank Cycles tested ** Meets alarm & circuit requirements? "Yes E. SEPARATION DISTANCES AWWIJ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main '-: ewer manhole/cleanout Sewer/septic service line Holding tank A•'••. s ainment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'1- Wells 00'+Wells on adjacent lots 100'+ Private/200'+ Public SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line **5 Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain None Known Wells on adjacent lots 100'+ Private/200'+ Public F. COMMENTS **WR#040025 G. ENGINEER'S CERTIFICATION �F..A �sA I certify that have determined through field inspections and * ' • H f %�,��0 review of Municipal records that the above systems are in 9 conformance with MOA COSA guidelines in effect on this date. J J= ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND �42,1`ev," . S ca4- THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this 114" Day of S eckiNiswe of 20('-,by and between .1e,ctwwy ). 'S cs` , herein the"OWNER,"and the Municipality of Anchorage,herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at(legal description). SauhPA L L etLI& 3 LT 1Lf 2. Defmitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On-Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On-Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations,Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS,the owner agrees to obtain an On-site. Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)maintenance, (3)adjustment(s), (4)replacement costs, and(5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality,the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor,the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 6, Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions,nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement,the only authorized representatives of the parties are: a. Owner: ,3 ej&vv.i S c+ b. Municipality: Director,Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: By: (signature) Date: 11 SeP1* i� (print name) Zi4e of nnaSP( tN�llkamsan ) SS. Counf-y ) The foregoin instrument was acknowledged before me this I day of r 20 11 ,by 5u5 A n . (Ylc r4mez. i PP- 'OTARY PUBLIC FOR A r A 1 (11SDA (l + Ten,,essee My Commission expires: My Catemiesio+Expires 3/9/2020 co , STATE .••�`ia OF TENNESSEE NOTARY �•'• PUBLIC ..14- MUNICIPALITY: ' 1 MUNICIPALITY: ,, <�'•••.......••• r • '� ,'if4/SON� ` ��,��� (signature) Date: 9 ^f q I (print name) Title: 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. # 020-051-56 HAA # 1. GENERAL INFORMATION Complete legal description Lot 14, 'R]ac~k ~, So~¢-h~lc .q./D 51 Location (site address or directions) 16241 Bauqh Circle ,"Property owner Mailing address .Lending agency Mailin. g address ~,gent Address ' ' Colony Builders/Bill Taylor Day phone 2340 Loren Circle~ Anchoraqe~ AK 99516 National Bank of Alaska/Mary Jo Pipp~y phone. PO Box 107025, Anchorage, AK 99510 Day phone 244-6233 257-3434 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well /X' Public water If. community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72*025(Rev. 1/91) Front MOA~21 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 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 S & S ENGINEERING 17034 Eagle I,tiver [.oep i~oad No. 204 Address Ea[lle River, Alaska 99577 Engineer's signature ?/~_ ,~?~:. ~ ~.. re,_--- Phone Ccl 5'- -~ ~ '? ? Date DHHS SIGNATURE ~' Approved for FO U n Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 0¢////~ ~/. //0(~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS 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, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · Legal Description: Health Authority Approval Checklist ~/ GLOcK ~ $°'j;~//p'~/~ #/ PamelI.D.: O~O -o3-/.-~-G A, WELL DATA Well type If A, B, or C, attach ADEC letter. ADE© water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMP.~U LTS: ~°la(~mple: Date completed. ~ FROM WELL LOG~ AT INSPECTION g.p.m, Nitrate Other bacteria Collected by: g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed ~/~o / ~ '7 Tank size / ~- ,S-0 Number of Compartments Foundation cleano~t (~/N) ¥'~ $ Depression (Y/~) ~'' 0 High water alarm (Y/I~) ,,-' o Date of Primping ~' l~q - ~ Pumper -- C. ABsORpTION FIELD DATA Date installed '~ / *~ o,/'~ 7 Soil rating (g.p.d./~ o~ ') (' ~-' System type Length ~"~' Width I ~' / Gravel thickness below pipe ~), ~ Total depth Effective absorpfion area ~l O ;; Monitoring Tube present ((~/N)¥¢$ Depressionoverfield(Y/~ Date of adequacy test h, / p - Results (PRes/Fail) For ~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Pero~ 72-026 (Rev. 3/96)* ~b'~'~fion rate = g.p.d. If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycle. s~- Size in gallons "Pump on" level at* ~ev~ at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~ ) 4 Septic/holding tank on lot Absorption field on lot Public sewer main Se~ Lift' station SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOTTO: Foundation ~' ~- Property line ~' ~ Absorption field Water main/service line / o f-~ .Surface water/drainage ) o o If- Wells on adjacent lots On adjacent lots Public sewer manhole/cleanout SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i 0 ~- Building foundation Property line Surface water Curtain drain F. ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots /~/4 I certify that I have determined thru field inspections and review of Municipal inconformanc°~t~l/¢~/~AA~' °l~ine~ne~ect°nthisdate' Signature Engineer's Name Date lO / "~ ~ / '~' HAAFee $ ' ~ Dateof Payment//~//~ ,~/~__ 2 Receipt Number z:~-~ ~'//~(~~D~ ] 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number .................................. ±ql n8-$¥ 390BI3 HORVB C ~OOq8 '~ lOq 'ON 'N~aV "as~s ~VdHI~OS