HomeMy WebLinkAboutT12N R3W SEC 22 LT 9 S2S2T12N, R3W,
Section 22
Lot 9
$2, $2
#015-141-29
Date of Issue: __
?arcei !dentific,~don Number:__
Municipality of Anchorage Page I of -~
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
Name: ~ ~ ;~ ~ ~/,tg~ ~ q Wastewater System: ~ New ~Upgrade
Address:
~o ~o~ ~ ABSORPTION FIELD
Phone: ~_ ~ ~ IN°'°fB~rOOms: ~eep Trench ~ Shallow Trench ~Bed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION soi'"~""* .~ ~/sq.F~. ?-
WELL:~ New ~ Upgrade Gravel~: ~i~ Numberoflines: ~Distancebe~eenHnes:
~ Ft. ~ ~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller: Date Drilled: Static Water Level:
Installer: Date installed:
Yield: GPM ~ Pump Set at: Ft. ~ Casing Height Above Ground:Ft. TANK
I
SEPARATION DISTANCES ~pticB Holding ~ S.T.E.P.
To Septic Absorption Li~ He,ding )ublic/Pdvate Manufacturer: Capacity in gaffons:
From Tank F~erd Station Tank SewerLines ~~ ~1~ J~ ~
Number of Compadments:
Su,aCewater ~1~ ~/~ LIFT STATION
Lot ~ ~ ~ ~ Size in gallons:~ Manufacturer:
Line
Remarks: BENCH MARK
Inspections performed by: ~. ~ Dates: 1st
2nd
ReViewed and approVed by:/~ ~/~ Date:/~-~ -~2 -~,:,~.: ~
72-013 (1/91) MOA 25
I
~ S*urk[and
B£THINSTALLE~ FUTURE
UPGRABEHAVESEEN FOR
ENCR£ACHMENTDFDLD TRENCH
~0 ?~ 100 185
SCALE: 1' = 50 FT.
TDBBEN SPURKLAND P,E.
~03 ~ 15TH, AVENUE
ANCH. AK. 99501
$I/~ S1/2 LgT 9
SECTION ££ TI2N R3V
FRAN£I$ E. SMITH J~.
SEPTIC SYSTEM ASBUILT
I)ATE, SEPT, 17, 199,2
SHEET~ ,2/3 GRID, ,2636
S~;ondard Trench;
3' Wide
90' L
9' Deep
6' Sewer rock
3' Cover
CDNNECT TD EXIST, LINE
1250 ga! Sep$~ Sank
SCALE
94, 7
Miro£! 140
6 £t o£ Septic Rock
~j~ ~Cle]nouts
.Z. x C6veT'
ND £CALE
Mond;or
85, 8
Exls~, Ground
~ 4' Mm Cover
~ ~-over Tank
I250 got septic ~ank
TJ?M, MAIN ENTRANCE
ASSUMED ELEV. 100.00
TDBBEN SPURKLAND P,E,
~03 ~ISth Ave
Anchorage Ak 99501
S~/2 S~/2 LOT 9
SECTILTN 22 TI2N £3~/
CHA SMITH
SEPTIC SYSTEM ASBUILT
DATE, SEP~ IX 1998
SHEET, 3/3 ORID,£636
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE)
PERMIT NUMBER:SW920282
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:SMITH ELIZABETH CHA
OWNER ADDRESS:10950 OUR RD
ANCHORAGE, AK 99516
PAGE 1 OF 1
I¢- ?2__
PERMIT
DATE ISSUED: 9/14/92
EXPIRATION DATE: 9/14/93
PARCEL ID:01514129
LEGAL DESCRIPTION: T12N R3W SEC 22 LT 9 S2S2
LOT SIZE: 56100 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD 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 (18AACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
PERMIT REQUEST IS FOR 4 BEDROOMS, ORIGINAL INSTALLATION
WAS FOR 3 BEDROOMS, ENGINEER MUST PROVIDE ADDITIONAL TEST
HOLE IN AREA OF FUTURE UPGRADE.
RECEIVED BY: ~ --
Sl/2
(907) 279-~916
SEPTIC SYSTEM DESIBN
S1/2 SEC 22 T12N RSW
CHA SMITH
No Gr-ound Water' or" Impervious Layer' to 15 ft.
Use Standard Tr"ench
Soil Rating. From test Aug. 20~ 1992
50 min/in = .6 gal/sq.~t.
Required Area per Bedr'c)om~
150/.6 = 250 sq.~t..
Rock Depth
Length (:)f Tr'ench 250 x 4 / 12 = 83.3
S¥'S~E~
· f t
STANDARD TRENCH
TOTAL LENSTH 85 FT.~
TOTAL WIDTH 5 FT.
TOTAL DEPTH 9 FT. ~
ROCK DEPTH ~ FT. ~
COVER 5 FT.
SEPTIC TANK 1250 SAL.
ABANDON EXISTING SYSTEM
PUMP AND CRUSH EXISTING TANK
PUMP~ CRUSH, AND BACKFILL
EXISTIN~ PIT
The J. nsta:l, latic~n o'F this sept:~c system will not prevent wells
~r'om be :i. nsta].led on the adjacent, lots.
courses on thJ. s or" the adjacent lots.
The pr'oposed sep'tiic: system will not char;ge the general slope o~
the area. Pond:i. ng and/or- c:oncentrat:~on o¥ surface runo~ will not
result 'from th:is irlstallation.
S]./2 S1/2 t,.c~t: 9 Sec 22 T12N R3W
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4-
5-
6-
7
8
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
Township, Range, Section: ~e.~. ~,~,
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water Ai~er
Monilodn:? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE .~ ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN E~ETWEEN ~ FT AND ~ Y~-- FT ~
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Township, Range, Section: ~-~.~ X~, TI,¢~.. N, ~"~ ~:~ ~,/
SLOPE SITE PLAN
NlC. S
HL
WAS GROUND WATER
ENCOUNTERED?
IF YES, ATWHAT
DEPTH? pO
E
Depth le Water Artier ~
Monitoring7 d ',~- ~-/ Dote:
Gross Net Depth to Net
Reading Date Time Time Water Drop
a
PERCOLATION RATE I I (minutes/inch) PERC HOLE DIAMETER
TESTR~N ~ETWEE" 4"~ FT^NO 7 F' ~
PERFORMED BY: ,.-'-'-'-'-'-'-'-'~d¢.~' al-/~Y'~ I ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE, DATE:
72-008 (Rev, 4/85)
LOT
N~/2 LOT g
+ Well
LOf
0 Well
0
LOT 24A
£.50 SO0
TDBBEN SPURKLAND P.E.
~03 W 13TH, AVENUE
ANCH. AK, 99501
SM£ SM2 LOT 9
SECTION £~. Ti2N
FRANCIS E, SMITH JR.
SEPTIC SYSTEM DESIGN
DATD SEP[, 6, 1998
SHEET~ 1/$ GRID, 2636
0
0
+ ~ell
CRIB
1£50 GAL SEPTIC TANK ~
~/el!
TOBBEN SPURKLAND P,E.
203 W 15TH, AVENUE
ANCH, AK, 9950t
SI/~ Si/~ LOT 9
SECT]ON £2, TI£N £3lg
FRANCIS E. SNITH JR.
SEPTIC SYSTEM DESIGN
DATE: SEP~ ~ 1998
SHEET, 2/3 GRID, 2636
Standard ~rench:
3'
8~' Lon9
9' Beep
6' Server rock
3' Cover
CONNECT TO EXIST. LINE
I250 gol Septic tank
NO SCALE
Cleonomts
4' Topsoi!
3' Cover
Moni-'cor
ExJ_~;, Oround
4' Nln Cover
Tank
Mira£i i40
6 £t o£ Septic Rock
ND SCLAC
I250 got sep~c tank
SPURKLAND P,E,
203 ~lSth Ave
Anchorcge Ak 99501
S1/2 Si~2 Lgl' 9
SECT~ON 22 H2N
CNA $~ITN
SEPTIC SYSTEM DESIGN
DASD SEPT, 8, 1992
SHEET, 3/3 GRJD, 2636
G?~'~TER ANCHORAGE AREA BORO!~'~
'~- HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
ADDRESS
LEGAL DESCRIPTION
DISTANCE FROM WELL
uqu D CAPACITY
GALLONS.
MATERIAL -~
INSIDE LENGTH
NUMBER OF
COMPARTMENTS /
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER /(~// OR WIDTH
LINING MATERIAl /~ ~ DISTANCE FROM WELl 0 /
NEAREST LOT LINE ~/~) /?~ ~L TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
· LENGTH ~l'] ~ , DEPTH
, BUILDING FOUNDATIO~,J
TILE DRAIN FIELD:
DISTANCE FROM WELL Y , F~UNDATION ~LINE , oFTOTAL LENGTHLiNES
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
~./ DISTANCE FROM WATER _
WELL: TYPE DEPTH , BUILDING FOUNDATION. SAMPLE , NEAREST
NEAREST SEPTIC /~(~ ' SEEPAGE /~(~O ~' OTHER
LOT LINE ., SEWER LINE . TANK , SYSTEM , CESSPOOl , SOURCES
DISIANCES:
~' · ·
)IAGRAM OF SYSTEM
HEALTH AUTHORITY
GREATEF -'\NCHORAGE AREA ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDE.CE ADORESS
/
APPLICATION TO INSTALL: SEPTIC TANK ~ ,SEEPAGE PIT '~ ,DRAIN FIELD
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH .~t~
PERCOLATION TEST RESULTS
ANTICIPATED DATE OF COMPLETION
PHONE NO.
,OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
~/~ ~"~'~.~z~ ,PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE./'(,;'T.,~2 .TYPE .~'-'t7'~'~ SEEPAGE AREA
~ DIAGRAM OF SYSTEM
DISTANCES:
I certify that I am familiar with the requirements of Greater
above described system is in accordance with said code.
!
Was Ground Water
G~o~:s Yi me
- . ,..,e Depth ~o H20 Net Drop
Propo:~ed ~nstal.!at2on: ~;eepage Pit ~,/
Test Performed By: ~_
Dora Certified By:
L 'OF ~
INbiVlDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
Distance from well to closest existing or proposed:
1. S~wer llne
2. Septic tank
',~ 3, Seepage Area
4, CesspoolZ
5. Property Line~ ~(,.~-
6. Other sources of possible contamination, i.e., creeks, lakes,
houses~ barn, drainage 'ditch. etc.,, ~
?. $e~age ~isposal system.
Age of system
Septic tank capacity in gallons,~/~~.
Name of septic tank manufact~m~m
1. If "home made" show diagram on reverse side of this form.
Disposal field or seepage pit size and type
1. Distance to proper~y ~ine .... to house foundation
Percolation Test performed by
Diagram should include
"q Use the reverse .side of this form to show diagram,
.. ,he foJ3.owing ]nfo~mationi p.roperty iines~ ·well location, house location,
~-~-I-~ c tank location, disposal area location ~ location of percolation test
at'd direction of ground slope,
9. Tke ~
~n-?~w,~t~x~ Or~ this form is true and correct to the best of my knowledge.
. S~gnature 6f Applicant 'Date Signed
FILLED OUT BY HEALTH DEPART{.~ENT PERSONNEL
'£he above d '
......... ~,,. escrmbed sanitary f ' · ·
f_~ol~owin~ cond~ ; ac~l~t~es
Conditions:
are hereby approved, .subje. c~ ,to, the
The above described sanitary facilities are disapproved for the following
reasons:
~'ignature 0~ ~·¢
"Approval is valid for one year following the date of approval.
.~ CPJ:cw
ADHW,LA~-2W
DATE
STATE OF ALASKA
OF HEALTH AND WEI~-~RE
~RTMENT
DIVISION OF PUBLIC HEALTH
BACTERIOLOGICAL WATER ANALYSIS
PUBLIC J~J SEMI'PUBLIC J~ ~JDIVIDUAL J~J OTHER.
REPORT RESULTS TO'
SAMPLE COLLECTED BY.
~)ATE COLLECTED
Sample Colle¢led From
[~ Other (List)
TIME COLLECTED
Kitchen Ta= ~ Balhroom Tap
Signature
Records in this office indicate this WATER SUPPLY to be of:
Analysis shows ]his Water SAMPLE to be:
Satisfactory [~ Questionable [] Unsatisfactory.
If an "Unsatisfaclory" or "QuesHonable" stolus is indicaled above
you should take immediate action as recommended below.
I. Noilly consumers water is' aolluted. Boll or chemically
[] drilled well [] cistern.
SANITARIAN'S REMARKS
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
em il 722
Date BeceJved Time Received pm [ab. No.
Lactose Broth IOcc IOcc I 1Otc 1Oct· J 1Oct 1.0cc O.tcc
I
24 hours
Brilliant Green
24 hours
48 hours
EMB AGAR
Lactose Broth, 24 hrs. 48 hrs.- Groin's stain
Coliform Densily .IMost probable No, per lOOcc.)
MF results
am
Reported by Date
This analysis indicates Colilorm Organisms to be: Absent
1970
~r, 1Tanc~. E. Smith
Star Rout~ ^, Ilex 1721''-~,
~nchora!;¢~ Alaska 99502
SUB.Il!CT: Sower and Water
Located oa (h~r Road
Boroui~'t i!ealth Depart¢~nt could grant approw~l for year
and water system if a sol>tic tank was installed tn con-
junotion ~,'ith the cesspool that is already i~ place.
The well is satt:~rnctor7 but the ~,'ell casing shoald be extended
to at least 12" alm~te the sur.face of tho
n,stallatxon of the septic tm~k, a polmit to install.
Prior to '"
~ust be obtained fro~ our o£fice.
Silmere 1},,
?,lminstrative Director
Salli t arJ. ar.~
Jl{L:rn
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Si[e Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(§07) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
015-141-29
1. GENERAL INFORMATION
Complete legal description T12N. RSW. SEC 22. LOT 9. S 1/2. S 1/2
Location (site addressordirections) 10950 OUR ROAD. ANCHORAGE. AK 99516
Property owner
Mailing address
Lending agency
Mailing address
ELIZABETH CHA SMITH
10950 OUR ROAD. ANCHORAGE. AK 99516
Dayphone (907) 546-1689
Day phone
Agent RAY DAHL Day phone (907) 261-7600
Address DYNAMIC PROPERTIES, 5111 "C" STREET, ANCHORAGE, AK 99505
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding Tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
lng to the legality and status of system.
72q325 (Rev. 1/91 ) Front MOA #21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,000.00 at,
or prior to, closing for the engineering services provided.
5. STATEMI=NT OF INSPECTION BY ENGINEER
As cedified 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 ins@ebfion, the on-site water supply and/or wastewater
disposal system is in compliance with all Munici~p~tl/~nd State codes, ordinances, and regulations in effect
on the date of this inspection. ~'//~" ]
//.'//,'
Name of Firm ALASKA WATERI& ;W $'rE~ATIER CONSULTANTS, INC. Phone (907)337-6179
/ /, /
Address. 6901DEBARR C~, ,~3L~t'~ 2E~ANCI~ORAGE, ALASKA 99504 , /
Engineer'sS/gnature "j-'~/~, //~ -~ Date ,o/~,~,~/
In conducting this evaluation, AWWC, lnC a¢emt =,d to p'~vide a thorough, conscientious engineering analysis of the
system in accordance with ADEC and MOA 'DHh ~ Guidelines & Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the water .~..~..
usage of the family being served by the system. These conditions are outside the control of
theevaluatorofthesystem. Satisfactorytestresultsdonotguaranteefutureperformance
of the system, nor do they guarentee that there are no hidden defects or encroachments.
AWWC, Inc. canthareforenotprot4deanywarrantyforfutureestimateofhowlongthe t~ ~H_/~
systemwfllcontinuetomeettheoperetionalrequirementsoftheADECorMOADHHS.
The content of this report is for the sole benefit of the owner listed above. A~y
reliance upon or use of this report by any other person or party is not authorized, .
f~ y A. Oarn ess..:
VcE-7953
· . ........... ..
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
/ Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Se~¥ices (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 safisfy 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 Computer Vemion
Health Authority Approval Checklist
Legal Description: T12N, RSW, SEC 22, LOT 9, S 1/2, S 1/2 Parcel I.D.:
A. WELL DATA
Well Type PRIVATE
Log present (Y/N)
RECEIVED
Municipality of Anchorage ~
DEPARTMENT OF HEALTH & HUMAN SERVICESocT 2 5 Z0
Environmental Services Division
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
MUNICIPALITY OF ANCh'OEAb~
ENVIRONMENTAL SERVICES DIVISION
IfA, B, or C, attach ADEC letter. ^DEC water system number
NO Date completed N/A
Total depth 285'+ Cased to
Sanitary seal (Y/N) YES
40'+
FROM WELL LOG
N/^
N/^
N/A g.p.m.
Nitrate
Date of test
Static water level
Well production
WATER SAMPLE RESULT~
Coliform
/
Collected by:
Casing height (above ground)
Wires propedy protected (Y/N).
AT INSPECTION
10/20/2000
284'
4,8
015-141--29
Other bacteria
A.W.W.C., INC.
Date of sample: 10/23/2000
B. SEPTIC/HOLDING TANK DATA
Date installed 9/14/92 Tank size
Foundation cleanout (Y/N) YES
N/A
18"+
YES
g.p.m.
1250 Number of Compartments 2 Cleanouts(y/N). YES
Depression (y/N) NO High water alarm (Y/N) N/A
Date of Pumping 10/20/2000 Pumper ISACCS
C. ABSORPTION FIELD DATA
Date installed 9/14/92 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 System type
Length 90' Width 3' Gravel thickness below pipe 6' Total depth
Effective absorption area 1080 Monitoring Tube present (Y/N) YES Depression over field (Y/N)
Date of adequacy test 10/20/2000 Results (Pass/Fail) PASS For 4
Fluid depth in absorption field before test (in.); 24" Immediately after 857
Fluid depth 33.5" (ins) Minutes later: 200 Absorption rate =
Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date
72-026 (Rev. 3/96)* Computer Version
TRENCH
9'
NO
Bedmoms
gal. wataradded(in.): 37.5"
6OO+ GPD
D. LIFT STATION
Data installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons ~
"Pump on~ off" level at*
~atum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 100'+
Absorption field on lot. 100'+
Public sewer main N/A
Sewer/septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+
Water main/service line 10'+ Surface water/drainage. 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation
Surface water 100%
Curtain drain NONE KNOWN
F. ENG .EER'S CERT F C^T O.//
I certify tha, I ha)~et/~ni~d~ru field inspections and review
of Municipal re, gord~ t~t ~.~b~ve systems are in conformance
Signature
Engineer's Name JEFFREY A. GARNESS
Absorption field
.Wells on adjacent lots
5'+
100'+
10'+ Water main/service line 10'+
Driveway, parking/vehicle storage area 10'+
Wells on adjacent lots 100'+
HAA Fee $
Date of Payment
Receipt Number
72.020 (ROY. ~/96)' Computor
Waiver Fee $
Date of Payment
Receipt Number