HomeMy WebLinkAboutWOODED HOLLOW LT 1
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP241067 PID Number: 051-521-28
Dwelling: FN Single Family (SF) El with ADU F Duplex (D) El Two Single Family Project: F-1 New FE Upgrade
Name
Daniel & Carolyn Venhaus
ABSORPTION FIELD
F Deep Trench 0Wide Trench F Bed El Mound
Site Address
23620 Hilltop Dr I
El Other
Phone
(907)230-6146
Number of Bedrooms
Five(5)
Soil Rating
0.8
JTotal depth from original grade
6.0 / 6.0
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.0/2.0 Ft.
Gravel depth beneath pipe
4.0 / 4.0 Ft.
Subdivision Block Lot
Wooded Hollow 1
Fill added above original grade
1.1/1.3 Ft.
Gravel length
50 / 50 Ft.
Township Range Section
Gravel width
5.0/5-0 Ft.
Beds: Number of Lines
n a
Distance between lines
n/a Ft.
SEPARATION
DISTANCES
To
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
1000
Number of trenches
Two(2)
Dist. between trenches
>8.0
From
Ft2
Ft.
Well
>100'
>100'
N/A
N/A
>25
TANK RI Septic 0 S.T.E.P. 1771 Holding El Other
Manufacturer
Infiltrator
Capacity
1,530 Gal.
Surface Water
>1 00'
>1 00'
N/A
N/A
Material
Plastic
Number of compartments
Two(2)
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>10'
>10'
N/A
N/A
ti91,,STATION
Manufacture
Capacity
Remarks Trenches listed south / north
Gal.
Alarm location
Elec tailed by
PIPE MATERIAL House totank D3034 drainfield Tankto D3034
Installer
Precision General Contractors
Drainfield D3034 CO/MT D3034
Inspector J. Ophiern / M. Jakubisin
BENCH MARK (Assumed elevation) 100 ft
ection 15t 5/10/24 5/24/24
Inspdates:
Location and description
2 nd
rd th
Garage Slab
3 4
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
F A4.4
Conditional Approval: Date
Aw
AV' A
4 TH
9—
Benjamiln tchiller
Septic System
Approved (A�
CE 12592
J Date
117 4
Note: this approval does not include well requirements.
permit
Kev ut)/uz/ its)
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Benjamin Schiller
CE 12592
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ISTEREDPROFE S S I O N A L E N GINEER
1"=50'
(2) 50' LONG x 5' WIDE, 4'
EFFECTIVE DEPTH
ABSORPTION TRENCHES
1500-GAL SEPTIC TANK
W/ 20" MANWAY
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH#1
PERMIT # OSP241067 PID # 051-521-28
WOODED HOLLOW, LOT 1
A
B
FEET
0 50 100
5-BDRM HOME470
PLAN AS-BUILT
6/21/24
COOP
SHED
WORKSHOP
15' T&E EASEMENT
15' T&E EASEMENT
460
450
460
450
440
2CO
FS
EXISTING WELL
WITH 100' RADIUS
WO
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C
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TH#2
MT2
MT4
MT1
MT3
CO1
CO3
CO4
CO2
A B
MH 102.0
SV 109.9
2CO 109.3
FS 154.2
CO1 117.2
MT1 118.3
108.0
116.9
120.2
217.9
176.2
178.2
CO2 155.6
MT2 150.4
CO3 127.1
MT3 131.2
220.6
214.7
182.9
187.4
SV
MH
CO4 163.4
MT4 157.4
226.3
219.9
PROFILE AS-BUILT
(NO SCALE)
91.2
87.0
91.9
94.4
FC
O
MH SV
PERMIT # OSP241067 PID # 051-521-28
WOODED HOLLOW, LOT 1
86.6 FINISH GRADE
50'
DRAINFIELD ROCK
MT
2
TH
#
2
NO GROUNDWATER 5/16/24
79.5
83.5
CO
2
CO
1
73.5
79.5
83.5
85.5 ORIGINAL GRADE MT
1
2C
O
91.0
Benjamin Schiller
CE 12592
R
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GISTEREDPROFE S S I O N A L E N GINEER
5/30/24
1530 GAL PLASTIC
SEPTIC TANK
2" FOAM INSULATION
SOUTH TRENCH
86.8 FINISH GRADE
50'
DRAINFIELD ROCK
MT
4
TH
#
2
NO GROUNDWATER 5/16/24
79.5
83.5
CO
4
CO
3
73.5
79.5
83.5
85.5 ORIGINAL GRADE MT
3
NORTH TRENCH
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SUBD
Taylor L. Dosch
No. 189892
R
E
GISTEREDPROFESSIO N A L L A N D S URVEYOR
MUNICIPALITY OF ANCHORAGE �JI,cn f"
On -Site Water & Wastewater Program � V `. 'IS'
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 ^J
http://www.muni.org/onsite.
Department
On -Site Wastewater Disposal System Permit
Permit Number: OSP241067 Effective Date: 5/2/2024
Work Type: Septic Initial Expiration Date: 5/2/2025
Tax Code Number: 05152128000
Site Legal Address: WOODED HOLLOW LT 1 G:1360
Site Mailing Address: 23620 HILLTOP DR, Chugiak
Owner: VENHAUS DANIEL E & CAROLYN C Lot Size in Sq Ft: 99296
Design Engineer: FORGE ENGINEERING Total Bedrooms: 5
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private 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. Provide notification by calling (907) 343-7904 (24/7).
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
C� V_ J_ �L -I- ( ZjV L ;r
/V1,0 vr--D '71"i c 9- " coo
Received By: Date:
1
Issued By: Date:
I ,
MUNICIPALITY OF ANCHORAGE
Community Development DepartmentPhone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON -SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-521-28
Property owner(s) Daniel & Carolyn Venhaus
Mailing address PO Box 672521, Chugiak, AK 99567
Day phone (907) 230-6146
Site address 23620 Hilltop Drive, Chugiak, AK 99567
Legal description (Sub'd., Block & Lot) Wooded Hollow Lot 1
Legal description (Township, Range & Section)
Lot Size 99,296 Sq. Ft. Number of Bedrooms
5
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field ❑X Initial ❑x
Single Family (SF) ❑X
Septic Tank ❑X Upgrade ❑
(w/wo ADU)
Holding Tank ElRenewal ElDuplex
(D) ❑
Privy ❑
Multiple Dwellings ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
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: g s- Waiver Fees:
Date of Payment: Z % 20 ZY Date of Payment:
Receint NumhPr Rece• t N b
Permit No. 0 5 p Z `� / ob( -
Ip um er.
Waiver No.
Permit App_ '- : . -.,:c
April 24, 2024
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Wooded Hollow L1 – 23620 Hilltop Dr
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot needs to replace his septic tank and upgrade the size of his system. The
attached site plan identifies the location of the home as well as the existing well and septic location
and proposed site. No conflicts exist between this proposed system and any other well or septic
system, whether on this lot or adjacent lots.
The ground surface on the lot slopes toward the road moderately down from the center where the
home is located at about 5-15%. There are no slopes greater than 25% within 50 feet downslope
of either the primary or alternate site. Contours are shown on the site plan showing the grade and
direction of flow. Stormwater drainage will not impact this septic system. The new trenches will
be constructed parallel to the slope as much as possible.
The existing well is an older one that is inside the home. The new system will be a minimum of
100’ from that well and surface water, and more than 5’ away from the septic tank. The existing
tank will be removed and the trench abandoned. There are also some pipes on the south side of the
home that might be from an older abandoned system. Those will be investigated and removed.
Please refer to the attached test hole log, plan and profile pages for the septic design. If this design
is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241067, Curtis Townsend, 05/02/24
WOODED HOLLOW, LOT 1
C-J"
j 15' T&E EASEMENT
(2)50'LONGx5'WIDE 4!" ... 4
EFFECTIVE DEPTH 50 CQOP I NEW 1500-GAL SEPTIC TANK,
ABSORPTION TRENCHES •Ca'• DECOMMISSION AND REMOVE -�
_ 2C0 _ _ _ EXISTING TANK�PER CODE \�
Ii SHED \
DECOMMISSION EXISTING
T •�::: .......i/ .. .. .' �.. .. \\
— •. :'� \ DRENCH
460 \ \
LOT 1\
EXISTING WELL • ' .' . ? \ �//
I i WITH 100'YADIUS ►� FCO
5-BDRM HOME
L
REMOVE PIPES FROM OLD \ 1/
SYSTEM \ — i OT 2A
�VACANT ENCROACHMENT LOT _
WORKSHOP
160
— j LOT 3A/ /
\\ \\ ^�450
15' T&E EASEMENT
:F 440
r E
/
+,4j�_�k�1 LEGEND
„&P.•'' '�9• CO - CLEANOUT
�(b• •9 �� 2CO - DOUBLE CLEANOUT
*: 49 TM+ • • :':* SEPTIC PLAN FCO -FOUNDATION CLEAN(
FS - FLOW SPLITTER VALVE
Benja i Schiller / MH - MANHOLE
CE 2592 0 50 100 MT -MONITORING TUBE
51624 ,.•�� r FEET
"PROFESS10NPti ' SV - SEPTIC VENT
� 1 =50 TH - TEST HOLE
WOODED HOLLOW, LOT 1 Co o l
DESIGN FACTORS- SYSTEM REQUIREMENTS:
750 GPD PEAK FLOW 5' WIDE TRENCH SYSTEM
PERK RATE: 7.4 MIN/IN 1500-GAL SEPTIC TANK
APPLICATION RATE: 0.8 GPD/SF
750 GPD / 0.8 GPD/SF / S WIDE * 0.5 RED FACTOR [4 DEEP] = 93.8 LF TRENCH REQUIRED (100 LF
SPECIFIED)
BOTTOM OF TRENCH: 6' BELOW GRADE
FLOW LINE ELEVATION: 2' BELOW GRADE
"-"""'r ADDITIONAL FILL TO
FOR SETTLEMENT
JSULATION
iEOTEXTILE FABRIC
" PERFORATED PVC (HOLES DOWN)
RAINFIELD ROCK
F
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
(7- 7
���FURGE
Or:
• ... ... �.....
..........
. .. Benja. 'n Schiller ..........
'
Pee1'F ••. CE 12592
�i\., PROFESSIONP
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
0.1
4/3 1
2
3
4
5
6GC (SILTY GRAVEL)
Professional Engineers Stamp:
NO
WOODED HOLLOW LOT 1
4/3/2024 051-521-28
PRECISION CONTRACTING
11:59 1 0
16
1' OB
0:18
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
PERC TEST LOCATION
TECHNICIAN: J. OPHEIM
7 0
16
-
NONE
4/10/2024
COMMENTS:
SITE PLAN
6 0
16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
4/10/24
1 0
160:32 7 0
16 6 0
16
1 0
160:37 7 0
16 6 0
16
1 0
160:36 7 0
16 6 0
16
1 0
160:30 7 0
16 6 0
16
1 0
160:37 7 0
16 6 0
16
12:00
12:00
12:01
12:02
12:02
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241067, Curtis Townsend, 05/02/24
DEPTH
(feet)
1-
2-
3-
4
5
6
7
8
9
1
11
12
13
14
15
16
17
1
1
co 01
SOILS LOG AND PERCOLATION TEST
E N G I N E E 0. 1 N G
LEGAL DESCRIPTION: WOODED HOLLOW LOT I
PERFORMED FOR: PRECISION CONTRACTING
DATE: 5/9/24 PARCEL ID#: 051-521-28
TEST HOLE 2
1' OB
.
PERC TEST LOCATION
GM (SILTY GRAVEL)
f
4
NO WAS WATER ENCOUNTERED?
- IF YES n WHAT DEPTH?
DRY DEPTH TO WATER AFTER MONITORING
5/16/2024 DATE OF MONITORING
DATE
READING
START TIME
NET TIME
(MINUTES)
DEPTH To
WATER
NET DROP
(INCHES)
INCHES)
5/9/24
1
3:49
30:00
1 0
5 �s
416
2
4:19
30:00
1-1
5 -s
4 is
3
4:49
30:00
1 16
5 s
4 16
PERCOLATION RATE: 7.4 (MIN/INCH)
COMMENTS: USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
SITE PLAN
TECHNICIAN: M. JAKUBISIN
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SUBD
Taylor L. Dosch
No. 189892
R
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GISTEREDPROFESSIO N A L L A N D S U R
VEYOR
August 19, 1998
Mr. Jeffrey A. Garness, P.E.,M.S.
Alaska Water & Wastewater Consultants, Inc.
7320 East Chester Heiths Circle
Anchorage, Alaska 99504
Re: Lot 1 Wooded Hollow Subdivision
Dear Mr. Oarness:
The undocumented septic system on tile south side of the house has been abandoned.
Tank was abandoned by digging out the top of the tank mid backfilling. All plumbing
that was connected to this sysem was disconnected and rerouted to the existing
documented septic system. A clean was installed 4' from the house. Another clean out
was installed at the 90 degree turn at the back of the house leading to the documented
septic system.
If you need additional infommtion, please contact me.
S:~'frely,~ //
David Hansen
688-2879
P. O. Box 670987
Chugiak, Ak. 99567
Certificate of On -Site Systems Approval
Parcel I.D. 051-521-28
Legal description WOODED HOLLOW LT 1
Site address 23620 HILLTOP DR Chugiak AK
Current property owner(s) VENHAUS
Expiration Date: 3/26/2025
X The On -site system(s) is/are approved for 5 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
a
Original Certificate Date: 6/29/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory _
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory Arsenic Advisory _
Other
COSA Approval_June 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-521-28
Complete legal description Wooded Hollow Lot 1
Location (site address) 23620 Hilltop Dr, Chugiak, AK 99567
Current property owner(s) Daniel & Carolyn VenhauS Day phone (907) 230-6146
2. ON -SITE SYSTEMS SIZED FOR 5 BEDROOMS
3. TYPE OF WATER SUPPLY: A Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: *1 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel FE] Plastic ❑ Concrete ❑ Fiberglass
Age NEW - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $ g� /
Date of Payment ( 7 ' z
COSA # 0.5C,2. 121 Ll
Waiver Fee $
Date of Payment
Waiver #
COSA Application —June 2022
5/10/2024
N/A N/A
N/A
(907) 522-7773
Benjamin Schiller, P.E.
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
Parcel I.D. # % ).'~ ~. . ,
1, GENERAL INFORMATION
Complete legal description
Also known as
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA #
Lot 1; Wooded Hollow Subdivision
Tract A; Earl Ray Subdivision
Location (site address or directions)
20579 Wooded Hollow Circle
Chugiak, AK
David Hansen
Property owner
Moiling address
Lending agency_
Moilin~g oddress '
Agent __Arlene Myers/Country Realty
Address ' '
P,O0 Box 670987 Chuqiak,
Day phone
AK 99567
Day phone
688-2879
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. ,dl.)~3ER OF BEDROOiVI8:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well xX
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TV'25! OF WASTEWATFR DISPOSAl.:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 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 reckuJ,a, tions.,i~ ~e~g,et~or~,th~.date.c~x~is inspection.
7320 East Cheztez' ~ Ch'die Phone
Address *~-1,/~ '~'o~ ,,/
Engineer's signature '~;" ';~7/;~'~ ........ ~ r /
Alaska Water & Wastewater Consultants, Inc.
is to be paid $650.00 at closing for services
performed.
DHHS o G'
[// /\pproved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with th-e following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHI4S) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional en gin ear 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
conduc~ inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
rss;;o~:.~Jbl3 for r:rrors or omissions in the professional engineer's work.
DEPARTMENT OF HEALTFI & FIUMAN SERVICES
· MUNICIPALH¥ OF
Environmental Services Division ,,,~, ~ ~,,~
I rONMENTAI SERVICES
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-474~-
Health Authority Approval Checklist
LegalDescription: L~,'r I~, b',}oOO[~O ~'~o¢~ ~/'O_ Parcel I.D.:
A, WELL DATA
~ell type ~ ~4 ~,r~ If A, B, or C. attach ADEC letter. ADEC water system number
Log present (Y,~ /'~',o Date completed
Total depth ~J, ¥- ~ Cased to ~Ol ~
Sanitary seal ~'N) '~'~[~
Casing height (above ground)
Wires properly protected (~N)
Date of test
Static water level
Well production
FROM WELL LOG
AT INSPECTION
g.p.m. ..~', '-/'7 g.p.rr
WATER SAMPLE RESULTS:
Coliform ~2) Nitrate
Date of sample:
B, SEPTIC/HOLDING TANK DATA
Date installed :'7/'Z5/'7 ~__ Tank size
Foundation cleanout (Y~;'
Date of Pumping , ~/7,
· ~' (-' { Other bacteria ¢2~
Collected by: ~-¢-.c¢uJA'~. ~.~vz.'c~v~-r_%.~ i~.,
Number of Comoartrnents
Depression (Y/~ _&Jo High water alarm (Y/~:¢~ p. Jo
Pumper -..~ ¢,, Cu~,Pig ~
C. ABSORPTION FIFLD DATA
Date installed __ ~7/~-¢/"'/~ Soilrating (¢or~d'~ 'Z.o~; Systemtype
Length Width ~ ~ '~ Gravel thickness below pipe f~ tTotal depth
Effective absorption area (~1.6 ~/ Monitoring Tube present ~/N) ~"~ Depression over field (Y~l) /'Jo
Date of adequacy test 6/5'/~1 0 Results (L¢~'~'~ ¢)/~,-~ For 3:~ bedrooms
Fluid depth in absorption field before test (in,);
Fluid depth 5'1--~;"~ (ins) Minutes later:
Peroxide treatment (past 12 morons)
¥~. =' Immediately after ~,3,~ gal. water added (in.):
-~ Absorption rate = /..¢.~ -4- g.p.d.
~l~ ~(~0,5 If yes, give date ~ '
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in gallons
Man~ "P mp~Pump off" leve, at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ~¢..)O! 'P
Absorption field on lot IOo
Public sewer main I~/~ 1',)//~-
Sewer/septic service line Z~ I
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ....~ ~.F- Property line ~ I+ Absorption field
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
Water main/service line IO1~ Sudace wateddrainage
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
I E~ ['J" Building foundation J o
Property line
Surface water { cot '(-
Curtain drain t',J opE.
Wells on adjacent lots 14, o
Water main/service line Io
F. ENGINEER'S CERTIFIC~/I')/01
I certify that l h~-'~, ~i~eQ
in conformanc~b with ~ ~/~'¢A/
Signature L~/ ~'~-
Engineer's Name; t' , [/ [,
Date ~C/~'~l ~S
Driveway, parking/vehicle storage area
· I
Wells on adjacent lots
~¢gt~inspoctions and roviow of Municl~a/¢i~ ~g~_~o~t~s are
..~
HAAFee $ 4'~ ~ '
Date o, Payment
Rece ptNumber
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number