HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 3 LT 10 Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage. AK S9519-6650
www.d.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number:
_ Spinell Homes
9210 VanRuard Drive
344-5678
3 10
SW01047~
Anch., AK 99507
Four (4)
LEGAL DESCRIPTION
Knik View Estates
Well: Class A Well
I
I
SEPARATION DISTANCES
T~ TO Septic Absorption Lift
Tank Field Station
~,,, >200' >200' N/A
~=w,,.>100' >100' N/A
~ >5' >10' N/A
>5' >10' N/A
None Noted
PID Number: 051-043-61
Wastewater System: New
Page I of 3
ABSORPTION FIELD
Deep Trench
1.2 o~e ~,.
4.5 FI. FI.
I ,. 51 ~,.
5 F,. I N/A ~,.
510 re ASTM D3034 PVC
Spinell Homes 1/16/02
TANK
~ Septic ri Holding r'l S.T.E.P.
Holding ~ublic/Pdvate~aanu~ac~uter:
Tank S~Une Anchorage Tank
N/A>25' Steel
N/AX / ~,. ,~.,~,~,.
N/A/~ ~
Garage Slab
ri Other.
1,250
Two (2)
LIFT STATION - NONE ON LOT
BENCH MARK
100.0
Engineer's Stamp
Inspections performed by: Tim Kimbrough Dates: 1" 1/16/02
2~ 1/16/02
Depa~ment of Health and Human Se~ices approval
Revi~ed and approved by: ~/~/ /~ ~Date: ?-~ ~
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Page 2 of 3
Permit Number SW010475
PID No. 051-043-61
A B
Sl 36.3 15.4
S2 39.1 22.3
C4 32.1 37.2
M1 31.5 35.3
C5 66.2 46.5
M2 65.1 44.8
\
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House
PLAN AS-BUILT
SCALE 1" = 40'
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW010476
PID No. 051-043-61
[-'9
98,P '
~--68.55
Ge(~t extile rob?it
D?oln~'ietd Rock
~ 01.6
51'
PROFILE
$cole: 1' ,- 10'
AS-BUILT
jr
MUNICIPALITY OF ANCHORAGE
Development Sen/ices Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650. Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Dec 03, 2001
Expiration Date: Dec 03, 2002
Permit Number: SW010475
Legal Description: KNIK ViEW ESTATES BLK 3 LT 8 & 10
Design Engineer: 0014 Anderson Engineering
Owner Name: Spinell Homes
Owner Address: 9510 Vanguard Dr.
Anchorage, AK 99507-
Parcel ID: 051-043-61
Site Address:
Lot Size: 61995 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
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 ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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.
Issued By:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWEPJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Permit Number swOIO4-7~
Property owner(s) Spinell Homes, Inc.
Day phone 344-5678
Mailing address (1) 9510 Van.quard Ddve Anchoracle, AK 99507
Mailing address (2) Zip Code
~.~. ~.~-~ __
Legal description (Lot, Block & Sub'd.) Lot 10, Block 3, Knik View Estates Subdivision -'"7 /~,/~ ~_q- /~. _'~1
.......-.~-.-
Legal description (Section, Township & Range)
Lot Size 40,131 SF
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Acres/Sq. Ft.
Number of Bedrooms Four
[] Well Only []
[] Water Storage []
Jacuzzi
Water Softening Unit
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of properly owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
~' Receipt Number:
ANDERSON ENGINEERING
P.O. BOX 240773
· ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
November 26, 2001
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Su~e~:
Lot 10, Block 3, Knik View Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:.
The owner of Lot 10, Block 3, Knik View Estates Subdivision intends to construct a new
four-bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new septic system to serve the proposed home. The attached Site
Pla.n. and backup documentation identify the Ioc.ation and.configuration of the new
septic system and the parameters .used in the design. Also identified on the plans are
the location of the water service hne on the lot and the test hole location. Existing
drainage patterns are shown and will not be altered by the development of the lot.
A test hole was placed near the location of the proposed absorption trench. This test
hole indicates clea.n well-graded gravel with yawing amounts of sand near the location
of the new absorption trench. Percolation tests in the matedal resulted in rates of less
than 1 minute per inch. The majority of the matedal in the hole will pass the No. 4
Sieve so no sand liner is necessary. No groundwater was found during the placement
of the test hole and none was noted during the monitonng period. We are therefore
proposing to place a 5' wide shallow absorption trench system with 4' of gravel beneath
the distribution pipe. The total depth of the trench will be 7'. The distribution pipe will
be placed at 3' below the ground surface to provide sufficient drop from the septic tank
to the absorption trench. The total length of the new absorption trench will be 50'. A
podion of the trench will encroach into the 100' power line easement. We have an
agreement, however, from Matanuska Electdc Association allowing placement of a
portion of the trench in the easement. A copy of that agreement is attached for your
review.
The ground surface on the lot slopes as shown on the attached Site Plan with very little
to no slope near the proposed septic system site. The new absorption trench will be
constructed on a fairly flat surface in conformance with Municipal requirements and
parallel to ground contours where possible. All components of the new septic system
will be constructed a minimum of 10' from the water service line to be constructed on
the lot.
If the system Is constructed In accordance with our design the following statements
Lot 10, Block 3, Knlk View Est. Subdivision
November 26, 2001
Page Two
apply:
t. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
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JUDD
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Circle
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$0.00
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205.00
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THIS PROJECT
1" = 100'
AREA MAP
J~,,01.,90o00 N
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Fou~
Bedroom
Hous~
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SITE PLAN
- SCALE 1' =40'
LOT 10, BLOCK 3, KNIK VIEW ESTATES
SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home
Perc. Rate: <1 MinJInch
Application Rate: 1.2 GPDISF
5' Wide Trench System
1,500 Gallon Septic Tank
4' Drainfield Rock
4 Bedrooms X 150 GPD 11.2 GPD/SF = 500 SF of Absorption Area
500 SFI5 LF (Wldth)*.5 (Red. Factor) = 50 LF Trench Length
Therefore: Construct a 50' Long X 5' Wide X 4' Effective Depth Absorption Trench.
Flowline Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be 7'
Below Existing Ground. Mound Over Trench to Provide a Minimum of 3' of Cover or
Provide 2" of Direct Bury Insulation and 2' of Cover.
· ... ~ . ' ~ ..... . ... ~...~ , - .. ' ... . '.'
, 2.5 :.. ., .....
· ~" .' · ' " ! ~ Geote×ti[e.Fabric
· , ' _', - . :'~ ~ ' . . ~; . · . ... . , .'.
· . .... 5, ' '-'d/~,'''0" ~'~ ~''" : ' . - ' ' -' '-
· · .. -- , . ~ 'J~' -- _~-~'~ '.. ..
· . . -'..[ ,=~a~...~ ~. ~' ' ,~ · ' PVC. (Hole's .Down)
· .. ., ' . $' . . '.~. .... ,~ .: . . ., · ·
~ :-. _, .. ",~,~,~.~,~. , . . · .
· . ~ . -,".. w~ .. ~ '. ' . ·
· ;' "-. '' o. ~. ~ . . Dralnfiela·Rock .:.'
· -. · .,-~' .~.~. /. ~' . '~..' ...,, . . · . -.'
' ' ' ~' ~ '~;.i,'~. ~' "' '"" .... "~ ''~'" :""' '
· .'....' .. ,~. -~o..~...~. ..~ · .. ~ · . · .. .. · .
· ,. · .' ',.. ~ , .....~o,-,:.:: ~ ~ ..... .:
NOTE:
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
Grade Are,a, Over Trench to Drain Away.
Minimum 6 Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 10' Separation From Water Service Line.
PROJECT #: V0133
PERFORMED FOR:
Municipal[b/of Anchorage
Development Services Department
4700 South Bragaw Street Anchorage, AK 995196650
SOILS LOG - PERCOLATION TEST
SPINNEL HOHES
DATE PERFORMED: I1-01-01
LEGAL DESCRIPTION: LOT 101 BLK ). KNIK VIEW ESTATES SUBD.
TEST HOLE
REDISH I~ROWN
SILTY OL
1 SLOPE
LOOSE WELL GRADED GRAVELS
WITH SANDS- GW
0%
SW LENSE
: ~ . LOOSE WELL GRADED GRAVELS
6 ~ · " WITH SANDS' GW
I0--
12--
15--
16
17--
18
WAS GROUNDWATER
ENCOUNTERED') NO
IF YES, WHAT DEPTH?
DEPTH OF WATER
AFTER MONITORING:
DATE:
SLIGHTLY COHPACT[D
SANDY GRAVELS
GP
x~erc. Rate <5 Mi.n./zn.
SITE PLAN
/
None
1111'//O1
S
'L
0
P
E
READING DATE GROSS NET TiME DEPTH OF NET DROP
TIME ' (i"'llN) WATER (INCHES)
Start 11-01-01 1060 12'
1 10.63 2.S 12"
Recharge 10:/.3 12'
2 10:66 2.5 12'
Recharge 1066 12'
3 1069 2.'/5 12'
PERC RATE: ,. 1 PrIN./INCH PERC. HOLE DIAHETER: 6'
TEST RUN BETWEEN 3 S FT. AND 6 S FT.
COHMENTS:
HOLE PRESOAKED / NO IMPERHABLES ENCOUNTERED
TEST PERFOE~ED BY: T.L. KIMBROUGH I, MICHAEL E. ANi)ERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOF~ANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: Il- ~.1~ -iT I
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 10, BLOCK 3, KNIK VIEW ESTATES SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,250 gallon septic tank at the location shown on the Site Plan.
Work also includes the construction of a new 50' long X 5' wide X 4'
effective depth absorption trench at the location also shown on the
Site Plan. The distribution line in the trench will be placed at 3' below
the existing ground surface. Total depth of the trench will be 7' below
the existing ground surface. The new absorption trench must be
placed a minimum of 10' from the water service line on the lot.
Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,250-gallon septic tank must be procured from an approved
source and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall includet~o 4' cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
Lot 10, Block 3, Knik View Est. Subdivision
November 26, 2001
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover,
3. A silt barrier or geotextile fabdc must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
St
Contractor shall verify the septic tank and drainfield are a minimum
100' away from any,private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
o
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
o
A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall vedfy this condition pdor to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P,E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
' Lot 10, Block 3, Knik View Est. Subdivision
November 26, 2001
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as-built of the completed system.
6: 14.PM
FROM MEA-ROW ' 9077619322
STATEMENT OF NON-OBJECTION FOR ENCROACHMENT
WITHIN UTILITY EASEMENT
Matanuska Electric Association, Inc. (MEA) has no objection to the location of a sepii~
system leach field within the 100' powerline easement that lies within the following :,
property;.'
Lot 10, Block 3, KNIK VIEW ESTATES SUBDIVISION, according to Plat No. 86-113;
Anchorage Recording District, Alaska
Situated in Section 4, Township 15 NoAh, Range 1 West, Seward Meridian.
¢
This non-objection is conditioned by the stipulation that MEA will be held harmless from
any and all damages to the encroachment that may result from the existing and futur~
use of said easement.
This non-objection is also subject to Plat Note No. 3 on the subdivision plat that stat~s
that no leach field or standpipe~ will be allowed within 20' from the centerline of exls~ng
· powerline.
P. 2
Matanuska Electr~ Association, Inc.
General Manager or hj,f~RepresentatNe
November 14. 2001 Date
MEA ACKNOWLEDGMENT
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing agreement was acknowledged before'me this ~14 day of
November. 2001. by Robert G Ylvlseker.
' .J>.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE:
November 30, 2001
TO:
FROM:
Dan Roth
Mike Anderson, P.E~
SUBJECT:
Lot 10, Knik View Estates Subdivision
Septic System Construction Permit
A dimension has been added indicating the distance between the new house and the
proposed absorption trench. Please let me know if you have any questions or
additional information is required.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-79O4
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051.043-61
2. NUMBER OF BEDROOMS:
Expiration Date: 7- -~, ~/- O .~
GENERAL INFORMATION
Complete legal description
Location (site address or directions) Rebecca Circle
Current Properly owner(s) Spinell Homes, Inc.
Mailing address 9210 Vanguard Drive Anchoracle, AK 99507
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless othen/vise requested, HAA will be held by DSD for pickup.
Four
Lot 10. Block 3. Knik View Estates Subdivision
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class_A Well
Public Water System
Day phone 344.5678
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[--I Individual Holding tank []
[] Community On-site []
r-I Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 less than 30 days old. (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 Health Authority 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 Enaineerin(~
Address P.O. Box 240773 Anchoraae. AK 99524
Phone 522-7773
Engineer's Printed Name Michael E. Anderson. P.E.
5. DSD SIGNATURE
Approved for J-iL.
Disapproved.
Conditional approval for
bedrooms.
Date 7/24/2002
· '..':-Or ,~' ' '..
{~, ~>... ,.',-* .~
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: '7" ~ q ' 0.2.
Municipality of Anchorage __o
Development Services Department
Building Safety Division '~........,'
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lotl0, Block3. Knik View Estates
If A, B, or C provide PWSID #
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
A. WELL DATA
Well type &
Date completed
Total depth
g.p.m.
Nitrate mg.fl.
Collected by:
Number of Compartments 2_
Depression over tank (Y/N) N_
Pumper New Constn~ion
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colenies/1O0 mi.
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Se~c/Steel
Tank size 1,250 gal.
Foundation clear, ut (Y/N) Y_
Date of pumping
C. ABSORFrrlON FIELD DATA
ParcellD: 0514)43-6t
Welt Log (Y/N)
Wires property protected (Y/N)
Casing height (above ground)
AT INSPECTION
Data installed t/16/2002
Length S1
Total depth 8_ ft.
Date of adequacy test
in.
g.p,m.
colonies/lO0 mi.
Date installed t/16/2002
C~eanouts (Y/N) Y
High water alarm (Y/N) N
Fluid depth in absorption field before test __ in. Water added gal.
Elapsed Time: min. Final fluid depth in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
ff yes, give date
Soil rating (g.p.d./f~ or ft2/bdrm) 1.2 GPD/SF System type 5' Wide Shallow Trench
fl. W~dth $ fl. Gravel below pipe 4 ft.
Eft. absorption area 510 ~ Monito,'ing tube Y_. Deprassien over field N.N_
Resuits (Pass/Fall) For bedrooms
New depth in.
g.p.d.
D. UFT STATION
Date installed
"Pump on" level at __ in.
Datum
E, SEPARATION DISTANCES
Size in gallons
'Pump ~ level at __
Cyctes tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot N/A
Public sewer main N/A
Sewer/septic service line
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots N/A
On adjacent lots N/A
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main N/A Water service line >t0'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line >t0' Building foundation >t0'
Water Service line >10' Surface water >t00'
Curtain drain None Noted Wells on adjacent lots >200'
F. COMMENTS
Lot is sened by AWWU water system.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipe/ records that the above systems are in
conformance with MOA I-fAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 7r24/02
Absorption field >5'
Surface water >t 00.
Water main >10'
Driveway, parking/vehicle storage >25'
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12~oo)
7 - 02.
in.