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HomeMy WebLinkAboutMOUNTAINSIDE VILLAGE BLK 1 LT 4Mountainside Village Block 1 Lot 4 #020-172-16 MUNICIPALITY OF ANCHORAGE n �� • DL iTMENT OF HEALTH AND HUMAN SER ES • Environmental Health Division e A 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 • ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES SEPTIC ABSORPTION WELL Address FROM TANK FIELD -7-72-.Lk W ler" vJ�Lc Phone(s) Permit No. No. of Bedrooms WELL Npr 103 1 LOT LINE (o(a y 338- x{'150 9b03 I LEGAL DESCRIPTION Lot Block I Million ► FOUNDATION Za { 1 Township. Range, Section '5 A$ -BUILT DIAGRAM t5ndw location of wen. septic system. property tines, lounoauon, W • T 1 Dili, a,. are, booms. etc) TANKS SEPTIC ❑ HOLDING Manulaoum Capauty In ganons Material No. OI Companmenls two •l fP-9 r f'� Z TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER 6 Go Depth 10 Pipe bottom hOm Total depth hom Original gnaoe 0 onginai grade , FT 10.0 FT fill added auum ongmal glade Gravel depth beneath pipe O— (i FT (a0 FT Gavel leng:n Gravel w1oth SI.O FT ZLS FT X el, Ce Total absorption area (Distance between lines lo1Z SO FTJ A FT 1 , :. s Numb9 of lines Swl raling Hpe matalal 11 150 SO Fr Gam. tr3a- K mstane,staued 45>10i O L 4-VX;—ZD _5?)� t WELLS 1 PRIVATE ❑ OTHER (Identitv) A (,Ia»JRehOn IA.B.CI Iola, Depth (.aae0 to 5 . Fi FT „ Instauel Date InsMned •rT I v.y REMARKS: Scale: I s CST �1.•1? yInspections Performed bya�sL /� a•A•• •aaA % 'J .• ¢JiL. 1 Dale Gi f�i� / R Q�f. t i •,..•• •A.•SA.Yx 3 8i S ENGINEERING f Bendy that this Impeclim was performed according to all RobM ��I• •." . Pb t4874i t,•n� Mumcip3GAGk14 WR;IAK99! 2Z 8 +�+9F�••..,•,;,ar e�bar PROPE"SIO�.� (1/ kA Date. Health Department Approval: 72-019 (9,85) MIJN I L 3 FAL I 'i Y 17F= ANCI JF�AGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 L STREET, ANCHORAGE, AK 99501 264-4720 CIN—E3I 1'E SI=W1=F1 tz WELL F'L=-FiMII PERMIT NO: 860341 DATE ISSUED: 09/13/06 APPLICANT: JOHN MCKEAVER ADDRESS: S&S ENGINEERING SRD 196X EAGLE RIVER, AK 99577 CONTACT PHONE: 694-2979 LEGAL DESCRIP: SUBDIVISION: MOUNTAINSIDE VILLAGE LOT: 4 SECTION: 11 TOWNSHIP:11N RANGE: 3W LOT SIZE: 4 FoptAns (T. OR ACRES) MAX BEDROOMS: Listed below a e tavailable to you in designing system. Choose the option that best fits your site. BLOCK: 1 your septic W. DFZAIN 4.0 3.5 7.5 5.0 49.0 36 1,000.0 +�* 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: I. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED AP'P'LICANT ISSUED BY DATE: DATE: F F�ENCI-1 FLED DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 GRAVEL DEPTH (FT.) 6.0 0.5 TOTAL DEPTH (FT,.) 10.0 4.5 GRAVEL WIDTH (FT.) 2.5 19.0 gRAVEL LENGTH (FT.) 8 +YS \' 36.0 ,RAVEL VOLUME (CU.YDS.) 22.9 �l 25.4 Th•K SIZE (GALS) 1,000.0 1,000.0 SOL—RATING (SU.FT./DR) 150 150 BLOCK: 1 your septic W. DFZAIN 4.0 3.5 7.5 5.0 49.0 36 1,000.0 +�* 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: I. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED AP'P'LICANT ISSUED BY DATE: DATE: I• _VYIP[ M %qd r ,pro b+l aL) a i Ilk r. •a'� r '�i l t+ ynw U� I � 2 / :t 1 -WH I \ a •cr,•» �c��l'� (crs��• (`�� mac' —�us3j,poSA �71c"'9% �%�� •�1�49 4061 1 s 6 4t / US --/i Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 { SOILS LOG — PERCOLATION TEST �.,• F• PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: L- Township, Range, Section: REPW V) L.3"P,4& SLOPE SITE PLS 15 16 17 18 19 20 COMMENTS GIQ — faW Ir.1 y t1T' s11_T WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water k1ter Monitoring? a WAO"atc '1-1.'-115b or Fkmk Gross Reading Data Time PERCOLATION RATE TEST RUN BETWEEN 6"* 0.0 - bed A. LAifor 2 O V ;16Z • : s`"�t 3 'T 4 i� 5 6 0. 0. 8- 9 9 a 10 6 t 11 _{0 2 12- a i 13 13 c o„ ,D 14 15 16 17 18 19 20 COMMENTS GIQ — faW Ir.1 y t1T' s11_T WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water k1ter Monitoring? a WAO"atc '1-1.'-115b or Fkmk Gross Reading Data Time PERCOLATION RATE TEST RUN BETWEEN 6"* 0.0 - bed A. LAifor ;16Z lie. 1 ts7l : s`"�t Net Depth to Time I Water (mmutes/mch) PERC HOLE DIAMETER FT AND FT Net Drop PERFORMED 8 CERTIFY THAT TM!'; TEST AS PERFORMED IN r ACCORDANCE WITH !ALLSTATE AND MUNICIPAL GUIDE S I EFFECT ON THIS GATE. DATE: �6 72-008 (Rev. 4/851 . TIF'. UEPTIf r0lFUT[I:N -9441--/,�-./+/�'1'1/l1L_ �iQ_.��.tj� sgrl.� ►�D'':r 17/0 ��'cc�_Ci_�.i �J,_ S. pff 1L'C _.—�^'�-�1._.��•lt��L� �c/' Eli t�t1F/.tcTr�[e %G/�f 1.C1 II. �3 A l--' 7tt'96 =s�o�r.=— �:c//Pic/: ;+ ut ! it, ,'rMPRF:Y Z't Fr:, i 1-1 , — / ��.///�OC/.� :J3 %►r 1.P�.b _�.v Ss.c� Ci f �tsllvat= .._—.. ir l �J�r llrt�l,,voT� • T� I —.—1 1-'o gg649) Dtrt�»-iXA� btfTll'r: Ilifiir i • i ARM - %4 U11011' NJEPM NOW Pr?rlt Pl Upil �Ic:A;lt.tl�::. !1 _r Eit1:F1 -ff'L::_fiL neilm 'T7l QTY; .C'a✓�ev�1,r B.:7/c AlelAl ! I I IC,4:.'LVLL PACE./,(Ile rjo xlQ t i ::v • : ::! s ' l t . ✓.,�-cam.. .r,.��= 7 =�G 41 "`tea NJI Lil , - ,,� ia, �'LV r +... ''`• { ?°� 1'.> i n s , z a. y�. Ak j \ 3 rl �a i T Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. — 020.172-16 1. GENERAL INFORMATION COSA# N0y81 Expiration Date: 15-k-7 Complete legal description Lot 4, Block 1, Mountainside Village Subdivision Location (site address) 17510 Snow Crest Lane Anchorage, AK 99516 Current Property owner(s) John S. and Lome McKeever Day phone 952-7261 Mailing address 17510 Snow Crest Lane Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD /or pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ID Individual On-site ❑r Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On-Sfte Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of OnSfte Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date 10/1/2006 bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 0 (Rw 1IMS) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water 6 Wastewater Program 4700 Bragaw Street P.D. Box 196650 Anchorage, AK 99519-650 www.rnuni.org/onstte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Descnipbon: _Lot 4, Block 1, Mountainside Visage Subdivision Parcel ID: 020-172-16 A. WELL DATA Well type Private K A, B, or C provide PWSID # Date completed 10/7!1988 Sanitary seal (YIN) Y Total depth i72 ft. Cased to 40 ft. FROM WELL LOG Date of test 10/7/1986 Static water level 22 ft. Well production 75.100 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 1.80 mg/L Arsenic: N/D mgA Date of sample: 9/152008 B. SEPTICIHOLDING TANK DATA Tank Type/Material SeytldSteel Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout (Y/N) V Date of pumping 8117/2008 C. ABSORPTION FIELD DATA Well Log (YIN) Y Wires party protected (YM) Y Casing height (above ground) 18 in. AT INSPECTION 9/12/2008 15.8 ft. 5.2 g.p.m. Other bacteria 0 colonies/100 mL Collected by: F. LeDoux Date installed 9/14/1986 Cleanouts (Y/N) Y Depression over tank (YM) N High water alarm (Y/N) N Pumper A Plus Home Services Date installed Or" ON Soil rating (g.p.d./R' or ft2/bdmr)150 SF/BORM System type Deep Trench Length 51 ft. Width 2.5 ft. Gravel below pipe 6 R Total depth _12 --ft. Eft. absorption area 11-211:2 Monitoring tube Y Depression over field N Date of adequacy test 9/12/2008 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water ceded 620 gal. New depth 8.5 in. Elapsed Tlme: 125 min. Final fluid depth 4.0 in. Absorption rate >= SW g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION vj Date installed Size in gallons 'Pump on' level at _ in. 'Pump air level at _ in. Datum Cycles tested i E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanli ift station on lot >I00' Absorption field on lot >IW Public sewer main WA Sewer /septic service One >25' ManholelAecess (Y/N) High water alarm level at in. Masts alarm & ci cult requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manholelcieanout WA Holding tank WA Animal containment areas None Manurelanimal excrete storage areas None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >9 Absorption field >6 Water main NIA Water service One >IV Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >IV Building foundation >10' Water mein NA Water Service Ona >10' Surface water >I W Driveway, paAwphrehc* storape >25 Curtain drain Now Noted Wells on adjacent lob >100' F. COMMENTS: G. ENGINEER'S CERTIFICATION I certdy, Mat I have determined Ihrrwgh field inspections and review of Municipal records that Me above systems ane in conformance with MOA COSA guitlednes in effect on this dale. Engineer's Printed Name Michael E. Anderson, P.E. Date 9/27/2000 'b.;� r� s� •� COSA Fee $ Eia U Waiver Fee $ Date of Payment 6A/�o Date of Payment Receipt Number 868.53 Receipt Number (Rev. 11X15) :T V x O o c J N O N + J A O N W r W N N J N O 0 N W+ c t A 0 C" W ICU3 CO N+000 0 O 0 O` N 3 3 b f cninw3 = CD O1 (D c S ,N NN C)0 N + (D A OD N 007 C" MD CA C A O N CL m x O) J 7 c Dv �m vO 7 O� a E. 0co 3 O O N y m NOND Z cn ;f ❑ IN i o D A N W O 1 N++ O (D O N N N p y n � Cl) y O N N N+ j GI 3 d O 3 n a�yo ;. > 3 I v . CD s(DM m m J. :T V x O o c J N O N + J A O N W r W N N J N O 0 N W+ c t A 0 C" W ICU3 CO N+000 0 O 0 O` N 3 3 b f D = CD O1 (D c 0 A N O. ,N NN W N + N W A OD N 007 C" MD CA C A O y� b CL m x 7 c Dv �m vO 7 O� a E. 0co 3 O > >• a m r� ❑ IN +O N W 0 A N W O 1 N++ O (D O N N N p y n � A Co O N N N+ 0 0 0 O O :T V x O o A J N O N + J A O N W J W O 00 N W W N N J N O 0 N W+ O 0 N t A 0 C" W ICU3 CO N+000 0 O 0 O` + 3 3 b D kkk1 ,N NN W N + N W A OD N 007 C" MD V vO 7 U +O N W O> N A N W O N N N++ O A O N p y n � A Co O N N N+ OD O O 3 n I v . S E O NN NNNNNNNN r"y OD V V M Cn A A W Nit _sl U A 0 -+ Q1 + CO G1 O N V COpl, N O D n y Q + 00L"0N0oo> + J N J + Ir' N 0 0�bll 0 n N N N N+ C j W i O I > C, D m E i Z D =rC N 4 N '� N Z3Oo D c "a S m a w y 0 D = y D D<_� A A A W W W W W N W W+N(WDA OOWpp A d1 W N COv N (NO A+ A co W J W coo W j �0 CL m 0� OL u y pn m y +� 3 > c) f m u O T V' (D � N O F 3 D m 0 m r r O � . 0 OR m rtr�T 0 Gw z m 3. C r; Z v • J + N N co E] (x x C C. d 3 ❑ El N ❑ x O o A Tj Q 0 c W m 0' n fu A 0 n m X 00 v� fZi� m o 0 `m -0i # O to -1 0 m . 0 x O o A Tj Q 0 c W Fr :;r to m ,N U a a 0� 0 � N 99LD c y Al O ® /7'/7 V1 L+� ' V p 4 00 00 I ' > ,a N 7 a N � � w IN oN�t-t y m t� y �b tj Q V a i r o L N J m i, ('1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ALIO OF ON-SITE SEWER AND WATER FACILITY 2644720 Application Date 12-110-86 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name 7ar•k McKeaver Telephone: Home 3AA-4581 Business 345-18 5 Applicant Address 7724 Boundary 11rnchorage, AIC 99504 (c) Applicant is (check one): Lending Institution O ; Owner/builder Q; Buyer O ;Other O (explain); (d) Lending Institution — I ct- Feral Bank Telephone Address Northern Lights Blvd. & Arctic (e) Real Estate Company and Agent Dionsa Address Telephone (f)e HAA to the following address: S & S ENGINEERING SR 196X EAGLE RIVER, AK "Sn 2. TYPE OF RESIDENCE Single -Family &) Multi -Family O Other Number of Bedrooms 4/ 3. WATER SUPPLY Individual Well IR Community O Public[3 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL " Onsite Q Public O Community O Holding Tank O 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 72-025 01.84) 5. ENGINEERING FIRM PROVIDINI to INSPECTIONS, TESTS, FILE SEARCH, DAe A 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. l 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 4 SING Telephone ii9 �? p79 Address s 196X Date c a s i;4r6MitX7_j?A 'K 99577 f��i�/B C SR B 196X EAGLE RIVER, AK 99577 6. DHEP`APPROVAL Approved for bedrooms by �. Approved '�� ' Disapprove Terms of Conditional Approval I ?ate d Conditional CAUTION ter, 1 At 1h •• l= A shier •. Na 1u74 The Muncipality, of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/54) MUNICIPALITY OF ANCHORAGE (MO^) MUNICIPALITY OF AN";V AUTHORITY APPROVAL (HAA) CEFT. CF HEALTH & CHECKLIST - FEBRUARY 1984 CUFZONJ.ENTAL PROTECTION 264-4720 `DEC 151986 Legal Description: Lot 4 Block 1 Mtn. Side Village A. WELL DATA RECEIVED Well Classification _Private If A. B, C. O.E.C. Approved (Y/N) _N/A Well Log PresenION) Yes Date Completed 10-6-86 Yield -5 G.P.M-+ Total Depth 172' Cased to _40'+ Depth of Grouting Static Water Level 22' Pump Set At UK Casing Height Above Ground 1211+ Sanitary Seal on Casing ON) Yes Electrical Wiring in ConduitON) Yes Depression Around Wellhead (Y© No Separation Distances from Well To Septic/Holding Tank on Lot —1001+ ;On Adjoining Lots 1001+ To Nearest Edge of Absorption Field on Lot 100'+ ; On Adjoining Lots 100'+ To Nearest Public Sewer Line _N/A To Nearest Public Sewer Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot 301+ Water Sample Collected by S&S EWineerina ; Date 12-11-86 Water Sample Test Results Satisfactory Comments '54 1e/ -'c-0 TEs7 CQ6eW4.= 7Fa 4L1-ii1B ! B. SEPTIC/HOLDING TANK DATA Date Installed 9-22-86 Size 1250 No. of Compartments 2 Standpipes (Y/N) Yes Air -tight Caps (Y/N) Yes Foundation Cleanout (Y/N) Yes Depression over Tank (Y/N) No Date Last Pumped New Pumping/Maintenance Contract on File (Y/N) _N/A ; for Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) N/A Separation Distances from Septic/Holding Tank: To Water -Supply Well 1001+ To Building Foundation R' To Property Line 66' To Disposal Field 51+ To Weter-Atam/Service Line 301+ To Stream, Pond, Lake, or Major Drainage Course N/A _- Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 15Osg.ft./Br. Type of System Design 'french Date Installed 9-22-86 Length of Field 51' Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 612 Standpipes Present(Y N) YeS Depression over Field (Y& No Date of Last Adequacy Test New Results of Last Adequacy Test Separation Distance from Absorption Field To Water -Supply Well 1001+ To Property Line 10' To Building Foundation 24' To Existing or Abandoned System on Lot —N/A : On Adjoining Lots 30'+ To Water-Mein/Service Line M1+ To Cutbank (it present) N/A To Stream/Pond/Lake/or Major Drainage Course N/A To Driveway, Parking Area, or Vehicle Storage Area Comments D. t"FT-STAT"M Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at _ Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) 'Pump Off' Level at •' Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guideli nes in effect on the date of this inspection. Signed SR& S ENGINEERING Date ��f� 6 _ Comparut _ B 196X 995MOA No. 74 -00 1 EA r Receipt No. r- (,n Date of Payment Amount: $ C � � �` a3AMH Page 2 of 2 'M 9.1 MOIL-91O3d T/1NDV4MIAN3 22-026 (11,84) S H11V3N dO Wila 30Y30HDW do AYW1I 1NfW