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Home My WebLink AboutTRAILS END BLK 4 LT 2 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 [] UPGRADE IMA'"NG ; ,EGAL DESCRIPTION DISTANCE TO: I~ff IF HOME.DE: ~ Inside length W dth Liquid depth DISTANCE TO: Well ] Dwelling PERMIT NO. DISTANCE TO: No. of lines To,al length of lines Trench width Length Width ~pth PERMIT Type of crib Crib diameter Crib depth Well DISTANCE TO: Class Depth DISTANCE TO: Building foundation OTHER PIPE MATERIALS Building foundation Sewer line I Nearest lot line Distance to lot line Septic tank INSTALLER I I / 72~13 (Rev. 3/78) DATE LEGAL Permit ~,.,,MUNICIPALITY OF ANCHORAGE~, Department f Health and Environmenta ~rotection 825 '~ Street, Anchorage, AK. ~9501 264-4?20-- * * * HANDWRITTEN PERMIT * * * WELL AND/~ ON-SITE SEWER PERMIT ~--4~n~ ~-r- Mailing Address: v Applicant: Location: Z~;-~ ~ 4 7-~&$~ ~ Phone Number: Legal Description: ~ Lot Size: Type of Soil ~sorption System Is: Trench: Drainfield: Seepage Bed~ / Holding Tank: Max~ N~er of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil ~sorption System Is: ' DEPTH ~ z LENGTH ,~4/ GRAVEL DEPTH ~ WIDTH The length di/nension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE TM /~O0 GALLONS * # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the nu/nber of residences that the well will serve. * * * TW0(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection.and approval by this departmen will be subject to prosecution. Minimu/n distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * # * PERMIT EXPIRES DECEMBER 31,, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlar~ement if th_~e/ the bedroom esidence is remodeled to include more Signer: ~3 Issued by: Applicant ~ Date: 7 SW-P/024(1/81) MUNICIPALITY OF ANCHORAGE DEPARTMEN. T OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG PERCOLATION TEST DATE PEnFORMED: .~--/¢--~'/ LEGAL DESCRIPTION: 2 3 4 5 6 7 8 9 10- Ck .,., I SLOPE 11- 12 13 14¸ 15- 16 17¸ 18- 19 20, COMMENTS SITE PLAN WASGROUNDWATER ~ ENCOUNTERED? 7~$ ~ E IF YES, AT WHAT Reading Dale Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BE'FWEEN ~(r~ ~-~/1~. ~2.oo8 ~6~7g~ /~ ALASKA 6RUIROI mI FITAL COFITROL S6RUIC6S, (~n(ji~rin(j ~ ~nuironm~nlol $1u~i~$ SPECIFICATIONS FOR SEEPAOE BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM - TRAILS END SUBDIVISION, LOT 2, BLK 1.0 GENERAL 1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERMIT. 2.0 LIFT STATION (NOT USED). 3.0 SEEPAGE BED 3.1 THE GRAVEL FOR TIlE E:ED SHALL BE SIZED BETWEEN 0.5 TO 1.S INCH AND RELATIVELY FREE FROM SILT OR SAND* 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL E:E PLUS OR MINUS 2'. 3.3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE F'IPES SHALL BE LAID LEVEL. 3.4 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL E:E RIGID PVC, ASTM 3033 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED HOLES ~ 6 INCH CENTERS ON DPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF REGULAR PERFORATEED DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN- CAP (JIMCAP OR EQUAL) SH~LL E:E PLACED ON THE TOP THE PIPE. 3.5 THE CRAVEL SHALL E:E COVERED WITH A LAYER OF UNTREATED BUILDING PAPER OR A NONNOVEN FABRIC SUCH AS MIRAFAR FIBRETEX 200 GRADE, OR POLY-FILTER X OR EQUAL, 3.6 THE TOP OF THE E:ED SHOULD BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. ALASKA ENVIRONMENTAL CONTROL SERVICE~'~IC. 1220 West 25th Av', g · ANC.HORAGE. ALASKA 99503 Phone 276-1361 SCALE WATER WELL RECORD STATE OF ALASKA .DEPARTMENT OF NATURAL RESOURES Division of Geologicol 8, GeophysicDI Surveys ~,~,¢. T (~AI~6 (~0 '~. '~r --of--el--of-- sO wi-il I-~.JDISTANCE ANODIRECTION FROM ROAD INTERSECTIONS ~. OWNER OF WELL: Feel Below 4. W~LL DEPTH: [fl~ol) ~. OATE OF COMPLETION ( Os"b'- O"' Oc'~'"""~ O ,,,..,: (~/~ 7/h,~A/~~ ~ 0.,.: ~ ~0'~ ~Z Parcel I.D. # 1. 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 GENERAL INFORMATION Complete legal description T-r, C.t Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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. Address ~) ,'5 c~' /~,-~C~/ Engineer's signature "~-~ Date Se DHHS SIGNATURE /~ Approved for ~ Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: ~'~;~)~; LI/~-~'[5 ~ ParcelI.D. O/5"'-' A. WELL DATA Well type '~ If A,>or C, attach ADEC letter. ADEC'water system number I.//A Log present (Y/N) .~/ Date completed q[~,/~E~ /'/' Driller ~Z/.Id, t..~?G; Total depth t u~. Cased to ' I.J- - Casing height /~' ~ ~ Sanitary seal (Y/N) "/ Wires properly protected (Y/N) X FROM WELL LOG AT INSPECTION Static water level Pump level SEPARATION DISTANCES FROM WELL TO: ~.- , Septic/holding tank on lot I Absorption field on lot 1 5o +-- Public sewer main r"//,~ Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE, RESULTS: Coliform ~ Nitrate Date of sample: ~/I¥~/-~ Collected by: Other bacteria' B. SEPTIC/HOLDING TANK DATA Date installed I,Js[~,~ / Tanksize Cleanouts (Y/N) "// Foundation cleanout (Y/N) Compartments High water alarm (Y/N) tw/,~,/ Alarm tested (Y/N) '"' ..... '"" A Date of pumping , O 2- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I¢c~ / On adjacent lots ~,/~-c, ~'Foundation To property line ,> ' ~> Absorption field Surface water/drainage I'-[ /c, " .~' " Depression (Y/N) Water main/service line 72-026 (Rev. 7~91)F,~t CONTINUED ON BACK PAGE C. LIFT STATION · Date installed Manufacturer ~-~.~ ~/'~'~'~ ~[J" Manhole/Access (Y/N) ~ · ,',- . , ' · ' · '~'Pum~ off"level at Cycles tested ~ //3 Size in gallons High water alarm level Meets MOA. electrical codes (Y/N) SEI~ARATION DISTANCE FROM LIFT STATION TO: Well on lot >-~ J I D On adjacent 10{s! ~> /c-o · ' ' [1:) r---- Surface water .f I urn' System type Gravelthickness : ~-' ~ cleanouts prese, nt (Y/N) Date of adequacy test ' If yesl give date On adjacent Pots ~/t.~. Property line To existing or abandoned system on lot Cutbank ~0 ~ Water main/se~iceline Driveway parking/vehicle storage area D. ABSORPTION FI~[LD DATA Date installed I ~, ~ Soil rating Le'n~th Z~C) ~' Width / Total absorption area De~ressipn over field (Y/N~ . Results (pass/fail) ~ ' '~ for /Peroxide treatment (past 12 months) (Y/N) ~:SEPARA~ION DISTANCE FROM ABSORPTION FIELD TO: ;; Well on lot ' ~//~ ~:'I TO b~ildi~joundation ::Onadjacent ots ~ ~0 Sudace water Cu~ain drain Eo ENGINEER'S CERTIFICATION Total depth ~ ' ,./ bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA Date ~ '/~1 1~ HAA Fee $ / 7 Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Chemlab [ef.! :93.1029-1 Client Sample ID :2/4 ~EPO~T o! iHALYSI$ Prelect Hame : PW$ID :UA Collected :03/14/93 I 11:30 ~ecetved :03/15/93 ! 11:05 WOrK Order :63995 Keport Cougleted :03/17193 Tschmical Dtzector :~E~]~H C. EDE ROUTI~ MPLE COLLECTED BY: T.S. OC llloveble E~tract Analysis Parameter Results Qual. Omits Method Limttm Date Date InAt HII~ATE-R 2.94 ~/1 EPA 353.2/300.0 lO 03/17/93 )iCE · See Special lnftructions Above UA - Unavailable " See ~am~le Semazkl Above HA - Hot Analyzed U - Un~etected, ~eported value is the practical quantification limit. L! - Less Than D - Seco~a~7 dilution. ~ "GReater ~S~S Member of the SGS G,oup (Social6 GOn~,rale de Surveillance) /~J'.'. "' COMMERCIAL TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 5633 B Street Anchorage. Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [~/PRIVATE WATER SYSTEM Mo. Day Year RoLE 'IYPE: utlne [] Check Sample (for routine sample wlth lab tel. no. [] Special Purpose ) I"] Treated Water I~'/Untrsated Water SAMPLE Time Collected No. LOCATION Collected By , I~¢ T',~7.£,~,~ I l~z~' T:'.> ,I I 41 I si I TO BE COMPLETED BY LABORATORY Analyst? shows this Water SAMPLE to be: /~atisfactory Unsatisfactory Sample too ling in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane FlEer No. of oolonies/lO0 mi. Lab Ref. No. ~,1029 -Z I I READ INSTRUCTIONS BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count (~ Collform/100 mi Verification: LSB BGB Fecal Coliform confirmation BEFORE COLLECTING SAMPLE Final Membran* FiJ. ta~Re,ulta .,po.ed By TNTC = Too Numerous To Count Coliform/100 mi Time: / ;; c~O _ ..m. OB = Other Bacteria PART ONE OF TWO REMAINDER TO FOLLOW HUNICIPALITY OF ~,.~CHORAGE DIVISION OF ENVIRONMENTAL HEALTlt DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION POK I~ALTH AUTHORITY APPROVAL CEKTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2 Block 4 Trails End Subdivision Location (address or directions) (b) Applicants Name Chris Fe~es Telephone - Home Business Applicants Address 6730 Samuel Court Anchoraqe (c) Applicant is (check one) Lending Institution ~-~ ; 0wner/builder~ Otber (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent llelen Morgan, Banner'Realty 'Address 6917 Old Seward llighway, Anchorage 99502 (f) Telephone 349-6691 Mail the HAA to the following address: Hold for pickup 2. Type of Residence Singie-Famlly~ Number of Bedrooms 3. Water Supply - Individual Well~-X~ Multi-Family~--q three Communlty~ Other (describe) Public~--~ Note: If community well system, must ha%e written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal 0nsite ~ Public ~ Community ~--~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. En~ineerin~ Firm Providin~ Inspections~ Tests~ File Search~ Data and Information ® 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 for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Panicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance %rlth all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Telephone Address Date (ENGINEER SEAL) This Department has received · written confirmation from the engineer(A.E.C.S) that the conditions of approval have been met. Therefore, this property is now fully approved. DtIEP Approval Approved for Approved ~ bedrooms Disapproved -- Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ~NCHORAGE DEPARTMENT OF HMALTH AND ENVIROnmeNTAL PROTECTION (DHEP) ISSUES H~%LTR AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TEE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY ~N INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF-ALASKA. TEE ~iEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES &~D THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~ND STATE REQULRE- MEI~S. EMPLOYEES OF DHEP DO NOT .COndUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ~NCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN TII PROFESSIONAL ENGINEER'S WORK. (DH~P SEAL) RR4/el/D18 [Page 2 of 2] 7-19-84 ALASKA ,i dlROI]ITleI TAL COI TROL ~nclin~¢rinq ~ ~nuironm~nl~J Sl~i~$ Sl huICl S, IllC. Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99503 August 23, 1984 ~.,~UNICIP,%LITY OF ANCHORAGE D[PT. OF HE,~.I.TH & ENViROi~%,,r. NTAL PROTECTION AUG ~, ~ ~fla RECEIVED Attention: Robbie Robinson Subject: Trails End Suh~lvision, Lot 2 - Block 4 Dear Mr. Robinson, On August 22, 1984, this office visits1 the above subject lot and found the wires for the w~.ll e~,asecl in conduit and buried in the ground. This should satisfy the conditional approval requested March 5, 1984. If you have any further questions, pleasg feel free to contact this office. Sincerely, Engineering Techn [elan Approved By: ~/Jr. , Phd, P.E. MUNICIPALITY OF ANCHORAGE DMSION OF ~VI~ HEatH DEPARIMENT OF HEALTH AND ~NVIgf~T~IAL PROTEC£iON APPLICATION FOR HEALTH AUTHOP/TY APPROVAL CERTIFICATE 1. General Info~,'~ation Application Date 2/24/8~ (a) LeGal Description (include lot, block, subdivision, section, tcw~hip, range) Lot 2t BJock 4 lraiJs End SubdivisiOn Location (address c~ di_~ectior-~) Zno House On 8rowder Avenue, Off Corner Of 8rowder (b) Appli6ants ~ £hris Feje$ Telepho~e~4~.~Q2~ Applicants Address 6730 samuel Court, Anchoraqe, AlaSka (c) Applicant is (check one) Lending Institution ~-~; Owner/builder ~--~; Bu%~r ~; Othe~ ~_~ (explain); .. (d) Lending Institution United Sank 0f Alaska Telephone 276-1919 Address 645 G Street, Ancho~r~ge,%~l~ska (e) ~al Estate Co. & Agent Banner Realty. Helen. Mor,0an --Address:. 69~7 0Id Seward Hi§hway, Anchorage, Alaska 9950~ Telephone 349-669~ Type of ~siden~ Single-Family ~ }~,lti-Family ~ Other (describe) Number of Bedrocks 3 Water Supply Individual Wall ~ Cc~,,~nity r-~ Public ~ Note: If ua,,,.,nity ~11 system, must have written cc~.firmation f~cm the State Dapa~nt of Environmental Conservation attesting to the legality and status. Is the ~11 adequate f~ the number of bedrccms s~ecified in this HAA (Y/N) Yes Sewage Dis~al Is the wastewater disposal system adequate f(x the mm~er of b~drocms (Y/N) 0 e [Pa~ 1 of 2] 2-15-84 · 5. Engineering Firm Providing Inspections, Tests, Data and Inf~.ation ! certify that I have checked, v~rified, (~ confczT~.d to all FOA HAA Guidelines in effect on the date of this f~pectfon. Na~e of Firm .. A.E.C.S. Telephcne 56~-5U40 Address 1200 14. 33rd Avenue, Suite B, Anchorage, Alaska 99503 Recommend Condtttonal Approva! Subject To Correct!on Of Fo!!owing Deficienc!es I~hen Thaw Occurs: (1) Wires @ Wel! Need Conduit (2) Electrical Lines Not Buried (3) Nell yield resolved-see log & Flow res1 Ok after talking to driller. Well was drawn down then pumped. 6. DHEP Approval Approved ~ Disapproved ~ Conditional ~ ?,o ,r.,y, ,,' The Municipality of An. cha~age Dapa~tm~nt of Health and Envir~,=ntel Prote~tion dces not guarantee the ~--~ntinued satisfactory pe~fo~.,anoe of t~ wate~ supply a~/c~ the wastewate~ disposal system. This epp~oval indicates that, as of th~ validaticc date shown a~, based cn t~ date ar~ i~o~natic,n furnished by an engineer registered in the State of Alaska, the water supply and wastewater dispcsal system is safe and func- tioeml fc~ th~ ru~be~ of bedrooms and type cf structure indicated. (I~{EP SEAL) 7. Mail the HAA to the f01~cwing address: KB2/cLS/s [Page 2 of 2] 2-15-84 '//~ ~ItEMIC.4L & GEuLOGIC.4L L4BOR.4TORIE$ oF ~4L.45K.4, INC. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: (') See h on back LD. NO. F~v,'~o~..~( Co-'/..! £t...,'~,~ P'none No, SAMPLE TYPE: [3' Routine [3 Check Sample (for routine sample with lab ref. no. .[3 Special Purpose Treated Water /:~Untreated Water SAMPLI , I i Time Collected Collected By · TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~Satisfactory [] Unsatisfactory I-'l Sample too long In transit; sample should not be over 48 hours old at examination to Indicate reliable results. Please send new sample via special delivery mall. Date Received Time Received Analytical Method: [3 Fermentation Tube [3 Memt~rane Filter Lab Ref. No. Result* Analyst I I-F1 I ~R I ~ READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACT£RIOLOGICALWATER ANALYSIS RECORO · 47'~ ae MUNICZFALZTY OF ~%~/HORA(~ (MOA) ~[PT. OF HEALTH £NVI~ONMSNTAL P~OTEC~ON HEALTH ;V. rrPDRZTY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ; On J~djoining Lots To Nearest ~dge of ~ti~ Field ~ ~t/~ / ~ ~ ~joir~ ~ts To ~est ~blic ~= Li~ ///~ To ~est ~blic S~IC~l~ ~ ~A F~ti~ ~i~i~ ~a~ ~ Fi~ (Y~) ~/~; f~ / ~ati~ Dist~s ~ ~ptic~l~i~ Ta~: To ~te~Su~ly ~11 /~// To ~ildi~ F~ti~ To Dis~ Field To S~, ~, ~e, [Page 1 Of 2] 2-15-84 C. ABSORF.'fON FIELD ~I~TA Square Feet cf Absorption A~ea Depression over Field Results of Last Ac]sc/ua~"gbst Separation Distanos f~m Abs~ption To Water-Supply Well ~/_/O/ To Buildirg Foundation LenGth of Field Depth of Field Gravel Bed Thickness £'~ Standpipes Presen~) . of Last Ad~gu.cy T. st ~////~ / Fie/id: To P~ _~erty Lirs To ExistinG or Abandoned Systam cn D. LIFT STATION Date Installed Ma~ol~/Access ~) "Pump Off' Level at High ~ater Alarm level at ~ / Veat (Y/N) ~/.j ~ .,7~ /z; ,,, ./~. ~. T~t~ f= W/~ ~i~ C~ ~inG ~ ~st. ~ ~ ** ~ ~t~d ~ ~ti~ ~ai~t ~ ~st I ~=tffy ~t I ha~ ~ed, ~rified, ~ ~f~,~d to all ~ ~ ~i~li~s in effect on ~ ~te of. this i~=~i~. "'"' [Pa~ ~ of 2] 2-15-84