HomeMy WebLinkAboutSLEEPY HOLLOW #1 BLK 2 LT 6Sleepy Hollow
#1
Block 2
Lot 6
#051-501-11
Municipality of Anchorage `�'
•
Development Services Department
Building Safety Division
- On -Site Water and Wastewater Program, 4700 S. Bragaw Sl.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.cl.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW990310 PID Number. 051.501.11
N s
a Gore
Wastewater System: ® New ❑ Upgrade
Adaefs: iada Drive, Chligiak. AK 99567
ABSORPTION FIELD
p1m*: N~ Of Be 11:
O Deep Trwxh® Shah" Twch O Bed 0MWM othr:
Sa Raleq
Taal Depth van ongnr pale:
LEGAL DESCRIPTION
1.2 GpolF?
6.54 Fl.
SINX Lot swdmenn:
Depth W pw baton ham orpnal Waft:
Gavel depth beneath p"
2 6 Sleepy Hollow#1
2.24 Ft.
4.30 FI
Tpensh9: Range: seam:
FA added tl ageal Waft.
Gravel Length:
50
0,23 Ft.
Fl.
Well: r-1New❑ Upgrade
GrMl,e,ddl'.
5
NumbersWs:
1
Drrea tMlwNnYrW:
alNA Ft
Fl.
clew"M tp M*. A B. CI
Tar Depox Caved a-.
Tar ansom" rN.
500
Poe Mgmal'.
D3034 & F810
A 213522
Ft. Ft
FT
Drager.
Dale Meted, $IalC Welr L":
"Mier..
Everett Caulkins
Dale crawled'.
1011111999
Ft
pump Sol al'.
ca" H -q* Above Graaet.
TANK
GPM
FI.
Ft
SEPARATION DISTANCES
0 Septic ❑ Holding ❑ S.T.E.P. ❑ other.
To
Septic
Absorption
Lift
Holding
Pubditlprivat
ed...
Anchorage Tank
aD�v
1250 Gal.
From
Tank
Field
Station
Tank
Sewer Lane
MrrW:
Number a canprvneas.
well
2001+
200'+
NA
NA
25'.
Steel
2
1001+
1004
NA
NA
LIFT STATION
Safari wider
5'+
10'+
NA
NA
Gr.
La Lia
5'+
10'+
NA
NA
'Pump m' lour M'.
'Pump ow level al
Hqh ran. •arm M.
et
FaMel�m
L,.
„_
NA
a50'+
NA
NA
Pump Melee a Model
EadnW m vrpedaprfaned by
C~ Drain
Rrnr.s:
BENCH MARK
*none known
Loulm and D•aapbat
Top of foundation
100 FL
Engineers Stamp
OF At \I
Inspections performed by: KND Engineering Dates: 1" 1011111999
OF * i� ►1 a t,9
2nd 1011411999
• • • NN•NNN •NNN •N t I J
Development Services Department Approval 03/3010,
-
NKenneth M. Du'
Date: y -.Z 3- o I
,I0,F ; OE 7116
Vagi .
Reviewed and approved by "1, 5;
•••:
t`41\RO
ran llbo)
ES �P`+�
S81.55'10•E 349,14
487.3
ETER*SPOT EL '/ CREEK muort
dl
"SLOT 6
co BLOCK 2
SLEEPY
W �!. HOLLOW
SUBD
,
a \
0
2 e* \50 LOT 4 No9.9
of
0197
12' WIDE \
ORNNAY �SOSJ
FOUNDATION V\
NEW HOUSE
F.F. 301.5
LOT S
d
� k
n
0
N
LOT 7
Z
�J
TRUE N VA,V[TS
NOTES
1. SPOT ELEVATIONS ARE ON AN ASSUMED LOCAL
DATUM.
2. WATER SERVICE FOR LOT 6 IS BY CLASS 'C'
COMMUNITY WELL LOCATED APPROX. 700' TO
THE SOUTH—WEST.
FND 5/8 V 192.82' R -J91.8• 03,32 SCALE: 1'.100'
BAR
REMP)
SURVEYED: 7/18/99
S L E E P Y C I R C L E BY: Du
DRAWN: 7/16/99
BY:M
ASB U I LD SURVEY AM EILE C.\ORAMNCS\9
LOT 6, BLOCK 2
SLEEPY HOLLOW SUBD. #1 ark�0� oqc,,
I, DAVID L LUCAS, RLS 08263, HEREBY CERTIFY THAT I HAVE SURVEYED THE ABOVE sp�*••w• m
CITED PROPERTY; AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE i •��
PROPERTY LINES AND DO NOT OVERHANG OR ENCROACH ON PROPERTY ADJACENT THERETO, ••�•••••• «
AND THAT NO IMPROVEMENTS ON ADJACENT PROPERTY OVERHANG OR ENCROACH ON THIS DAVW Lia
PROPERTY, AND THAT THERE ARE NO ROADWAY, UTILITY OR OTHER VISIBLE EASEMENTS ON
SAID PROPERTY, EXCEPT AS INDICATED HEREON.
YRUE chow,. com or Y Docwoa w o rxlr Fu .,a 8uA R.e u: P D w.acs f t� oA/�y�•_••«w•'•
TDIIC' AInOTW ¢IID%fL-/C DnD cmoil) PUllf%IAV AV nntZC-7 000 n 4
w
Im
AS—BUILT SYSTEM DETAILS/SITE PLAN Permit SW990310
SLEEPY HOLLOW S/D #1, LOT 6, BLOCK 2 PID#051-501-11
r i
#S 94-1
KND
SEPTIC
�o
T # N 9-2 TH #KND99-1
3
E PROPOSED RESERVE
C mT
C
O7WELL.. .. APPR E LOCATION
Or WATER LINE
A—C=19.9'
B—C=13.6' d FINAL GRADE
A—D=25.9' X�
B—D=20.8'
A—E=79.5' 1250 GAL
5
B—E=77.8' "-SEPT SEPTIC94.9
TANK SEWER ROCK
..................
9F 4�4's-.
KENNETH M. Ers %CE -7110
....................
ssloll" -.OF
PREPARED FOR:
EVERETT CAULKINS
(907)696-0246
FIELD BOOKS
co~m.
9ww' I UCAS
DRAW V13O
—
STAKNQ LUCAS
a10= KMD
Awu T' LUCAS—
OAM 3/30
m nm
GFAM NW1161
ACRD "L'99047.DWG
99047
SCALE, NTS
V - 50'
VM=
&U\UW ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-87361
UA
I =
ME
-('60LFj6Y2
Po�07//9-9
Permit Number. SW990310
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Legal Description: SLEEPY HOLLOW #1 BLK 2 LT 6
I��GM
M yt lc -11.11
- ?7
Date Issued: Sep 01, 1999
Expiration Date: Aug 31, 2000
Parcel ID: 051-501.11
Design Engineer. 0070 KND Engineering Site Address: 023741 SLEEPY CIR
Owner Name: Lisa Gore & Everett Caulkens Lot Size: 195425 SO. FT.
Owner Address: 20049 Tanada Drive Total Bedrooms: 4 Permit Bedrooms: 4
Chugiak , AK 99567 -
This permit Is for the construction of:
❑? Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
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 (1 SAAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either. A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:9 -' 1
Date: 9199
��ND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11/FAX (907)696-8111
August 7,1999
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage Alaska 99519-6650
Subject: ' New sewer permit — Sleepy Hollow SID t, Lot � B4 2
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit on the subject
lot. On June 16, 1999 we dug one testhole for the proposed system. The results of
this test is attached. A previous testhole was excavated in 1994 and we have attached
the results of that testhole for your reference. The general slope of this lot is from
north to south at a grade of approximately 2 - 5% for the southern two-thirds of the
property. The northern third of the property has slopes in excess of 25%. We have
designed our system utilizing the testhole we excavated for the three-bedroom
house, which is proposed for this lot. The lot will be served by a class "C" well.
We propose to install a 5' wide shallow trench due to the sloughing encountered
during the excavation. The lower soils strata was not percolated as it only had trace
silt noted and appeared significantly to be made of the same material. Water was not
encountered during the excavation or monitoring.
There are no public or private wells within 200' of our proposed system location
except as noted. There is no surface water within 100' of the proposed system and
there are no known curtain drains within 50'. We do not expect there to be any
adverse effect on adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
Keth
gineeringg M. Duffus, P.E.
attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN
SLEEPY HOLLOW S/D #1, LOT 6, BLOCK 2
K � D
NO PUBLIC WELLS WITHIN ew Q
PROPOSED SYSTEM.
NO PRIVATE WELLS WITHIN 200' Or
PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200' Of
PROPOSED WELL EXCEPT AS NOTED.
ia
by4W
Vacant
7
4
S! B X QTX IS $94-I
Iifl iT.
F7 Vacant
QTX a 099-I
MWrti HmnE
-WELL nF'
y4
SEPTIC
OF ALq �' 1
Q
UFFUS
16 �a
"wESS10110,
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/1.2 GPD PER SO. FT. (1.5 MIN/IN.)= 500 SO. FT
(500/5'(W)) X .50(RF) (4.0' GRAVEL) = 50 FT. TRENCH
USE 1 TRENCH - 50<L) X 5' (W) X 4'(D)
Total depth of system Is 7.0' from original grade.
Total depth of gravel below distribution pipe Is 4.0' .
NOTES:
1. USE 1250 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER.
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM.
3. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK.
4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS b SEPTICS.
PREPARED FOR,
LISA GORE
20049 TANADA DRIVE
CHUGIAK, AK
FIELD BOOKS COMPUTED.
BOUNOARri _ DRAm: KM
sAXmc _ CHECXED: KMD
ASSUlLT: _ DATE: 816/9
OK. FILE: CRUD: NW116
ACRD FILE:99047.DWG JOB N" 99047
Scale, 1'= 100'
PAGE 1 OF 2
M�JLNI IU) ENGINEERING
20441 PTARMIGAN DLVD.
EAGLE RIVER, AK 99577-8736
I
WASTEWATER DISP❑SAL SYSTEM DETAILS
SLEEPY HOLLOW S/D #1, LOT 6, BLOCK 2
L
KD
PREPARED FOR,
LISA GORE
20049 TANADA DRIVE
CHUGIAK, AK
FIELD BOOKS
eaNOMn _
STMiNG _
AS 10: _
owe. nit:
AM riLV 99047
CWF%InD:
DRAM: KMD
CHECKED: KMD
DATE: 8/6/9
GM NW1161
" Nn: 99047
S94-1
SYSTEM
D99-1
PROPOSED RES
Scale: 1'= 20'
PAGE 2 OF 2
LtLll LL)) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-6736
—6
KININ ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
Performed for:
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
I5-
16-
17-
18-
19-
20-
Depth
SOILS PERCOLATION TEST
Org.- rootmat
GP/GW —Loose, gray, slight
silt
SP/GP -mixed in layers
B.O.H.
#1 TEST HOLE # 99-1
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Groundwater encountered? NO What depth?
Depth to water after monitoring? Dry Date? 6/73/99
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
6/16/99
1:00
-
10"
-
2
1:10
10 min
3 1/4"
6 3/4"
3
1:11
-
10"
-
4
1:21
10 min
3 3/8"
6 5/8"
5
•
1:22
10-
6
132
10 min
3 3/8"
6 5/8"
7
•
133
10"
-
8
1:43
10 min
3 1/4"
6 3/4"
9
'
1:44
-
10"
-
10
1:54
10 min
33/8"
6 5/8"
11
•
1S5
-
10"
-
12
2:05
10 min
3 3/8"
6 5/8"
Percolation Rate 1.5 (min/in) Perc Hole Diameter 6"
Test Run Between 4 feet and 5 feet
HOLE PRESOAKED PRIOR TO TESTING
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and
Municipal guidelines in effect on this date.
OW
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502.0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: CL`rr��t& �-� ���, �'1'`,3.�_u•�T��jJ� DATE PER
LEGAL DESCRIPTION: t& t /%�N�W �y OWnShip, Range, Section:
il
ORct1+KS
2
FINE. '_Prjo
3
4- sok �TT1A11F(1-y $Fwo J6
' Q CAr oy 6;vw A-
6
6
8
9 I I I I ti7W, (�Aot3r> Si�Ty
10
11
12
13
14
15
16
17
18
19
IX..
(L(GH7 SVC? WAS GROUND WATER PG
L r4LFX.. ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Ilt3A.N,
mw Y ? ua
MaWaNnT otic
-41
NNEEMEMEN ®=mm
WE®
! i
IA t... , oe�,��ssF�a��.
2D-{
IL— JI PERCOLATION RATE ''°lZlrr (mmutwmtf•) PERC HOLE DIAMETER
TEST PUN BETWEEN D FT
COMMENTS TAU X A 6O h16
PERFORMEY &`Ij '/
ACCORDAI�ppIi,�,D,i irosLl�M'W RR9119M�iO4"OEL
72-M (Rev Poe River, Alaska 97577
CERTIFY THAT THIS TEST WAS PERFORMED IN
ON THIS DATE. DATE:
KINID ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS PERCOLATION TEST
Performed for: Lisa Gore Date Performed: 10/11/99
Project•. Sleepy Hollow #1, Block 2, Lot 6 TEST HOLE # 99-2
Depth
(Feet) SEE ATTACHED SITE PLAN
1 -
Material consistent with T1199-1
2 -
Percolation test performed
3- at bottom of trench during
installation.
4 -
Water monitoring-TH99-1
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19 -
HOLE PRESOAKED
20- PRIOR TO TEST
FOR HOLE LOCATION
Was Groundwater encountered? NO What depth? NA
Depth to water after monitoring? Dry Date? 6/23/99
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
10/11/99
0:00
-
8"
-
2
0:10
10 min
310/16"
46/16"
3
'
0:11
-
8"
-
4
0:21
10 min
312/16"
44/16"
5
•
0:22
-
8"
-
6
0:32
10 min
315/16"
41/16"
7
0:33
8"
-
8
0:43
10 min
41/16"
315/16"
9
•
0:44
8"
-
10
0:54
10 min
41/16"
315/16"
11
•
0:55
-
8"
-
12
1:05
10 min
41/16"
315/16"
•
Water
Added
Percolation Rate 2.54 (min/in) Pere Hole Diameter 6"
Test Run Between 6.5 feet and 7.5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
lqlu-lieipality of Anehorage
Department of Health and Human Services
825 "L' Street
Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor http://www.ci.anchorage.ak.us
June 7, 2000
Lisa Gore
PO Box 671129
Chugiak, AK 99567
Subject: Sleepy Hollow #1, Block 2, Lot 6
Permit # SW990310 PID # 051-501-11
The subject permit 9SW990310 issued by this office for a single family well and/or on-
site wastewater system, is due to expire 365 days after it's issuance on Sept. 1, 1999.
If this is a well permit and you have drilled the well, a well log must be sent to this office
for documentation of the installation and to close the permit.
If this is an on-site wastewater system and a licensed Professional Engineer has inspected
the installation, the original as -built inspection report must be sent to this office for
review, approval and documentation. All inspection reports must be submitted within 30
days of construction completion.
A new permit must be obtained from this office for a well and/or on-site wastewater
system NOT installed by the expiration date. However a new permit can be issued free of
charge for a second year if the application for the renewal is received on or before the
date of expiration of the original permit for which a fee was paid.
When applying for a new permit after the original permit has expired or for more than a
second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well
permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
J es Cross, PE
Program Manager
On-site Services
enc: Copy of Permit
A
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
RUS
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-501-11 Expiration Date: 7//F 3
1. GENERAL INFORMATION
Complete legal description SLEEPY HOLLOW #1; BLOCK 2, LOT 6
Location (site address) 23741 SLEEPY CIRCLE *CHUGIAK, AK 99567
Current Property owner(s) LISA GORE Day phone C/O AGENT
Mailing address 23741 SLEEPY CIRCLE *CHUGIAK. AK 99567
Real Estate Agent SHELDON FINIS Day phone 688-3263
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
N
Individual Water Storage
❑
Individual Holding tank
❑
Community ClassAr� Well
N
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by: Date: 3 1
COSA to be released to the engineer, unless otherwse requested by the engineer.
COSA Fee $q!vU5
Date of Payment 9 3
Receipt Number
0(0gi-,3G
COSA# 05CXt 1133
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Phone
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD 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, groundwater 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 the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD, can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for 1 _ bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following
337-6179
Y !-7 13
o�F •F.q.. s4�0
. g H T*I
I .... .... ..... .....
•.J f e A. Garne a. -
E -79
:E-79 3 v�
�4e0'frofessl0o'
OWSiTE �
fOnsWATER ASO
a WASTEWATER 0-,
Original Certificate Date: y//F,
Thl_f Gnicipality or Anchorage D<welop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage rs not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist _kx_�_
Septic System Ad isory
Well Flow Advisoi
(Rev. 11105)
Nitrate Advisory
Arsenic Advisory -
Other 1.t
t
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: SLEEPY HOLLOW #1• BLOCK 2, LOT 6 Parcel ID: 051-501-11
A. WELL DATA rNn t- CIoSS <k �
ii SG9 o -s- cr+s=o OEc ��tt-o
Well type C If A, B, or C provide PWSID# Well Log (YIN)
Date completed Sanitary seal (YIN)_ Wires properlyprotected
Total depth ft. Cased to ft. Casing h above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well pr ion g.p.m. 9 -
p.m -WATER SAMPLE RESULTS:
Coliform '&- colonies/100 ml. Nitrate 3` i6 mg./L. Collected by: GEG, Ltd.
Arsenic: NO ug./L. Date of sample: 4/8/13
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Dateinstalled 10/11/99-3/30/01
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 5/22/12 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 10/11/99-3/30/01 Soil rating .�orft/bdrm) 1_2 Systemtype SHALLOW TRENCH
Length 50 ft. Width 5 ft. Gravel below pipe 4.30 ft.
Total depth *8.08 ft. Eff. absorption area 500 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test **4/3/13 Results (Pass/Fail) PASS For E bedrooms
Fluid depth in absorption field before test 0 in. Water added 2600gal. New depth E in.
Elapsed Time: E min. Final fluid depth E in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date -
**PRE-SOAKED AND TESTED ON SAME DAY
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access
"Pump off' level 'nigh water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtft station on lot On adjacent
Absorption field on lot On adjacent lots
Public sewer main
Sewer /septic service line
areas
manholetcleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
'+ Absorption Building foundation 5'+ property line 5field 5'+
Water main 10'+ Water service line *10'+ Surface water 100'+
Wells on adjacent lots 1go, +PVT/200'+PUBLIC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line 10'+ Building foundation 10'+ Water main 10'+
P
Water service line *10'+ Surface water 100'+ Driveway, paridng/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent Iots100'+PVT/200'+PUBLIC
F. COMMENTS
*PER KEN DUFFUS P.E. INSPECTION REPORT
G. ENGINEER'S CERTIFICATION
1 oeriify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineers Printed Name JEFFREY A. GARNESS
Date u�v 7 %3
(Rev. 11105)