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HomeMy WebLinkAboutBEAR PARK LT 14Bear Park Lot 14 #051-042-90 Municipality of Anchorage e Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 2 www.cl.anchorage.sk.us (907) 543-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO60106 PID Number. 051.042.90 Is Wastewater System: ® New ❑ Upgrade " ABSORPTION FIELD Ptwr rMaro.r a e.aaam. 332-1913Sad Cl Dep TnrxJt ®SMtyw Trerph O 80 O Movq O Oear LEGAL DESCRIPTION R a Taao.paeana a.e. 1.2 GPDrFI� 6.5..5 Ft. BbQ to 5,6d o.rt Depth to ppe loran can woo! peee Grana e.M D"r"h Pq 14 BEAR PARK 3.4 Ft. 3.1 Ft Tawe %%, Rargo Seam Fi ataa appve a"prW pae. Gravy Lorpm 15N 1W 4 0.5 Ft. 44 Ft. Well: ❑ New ❑ Upgrade r","�"�"hr" Dote Hoar.« wr. 5 Ft. 1 0 Ft Cla"rbralan (Pi w is. A B. CY 70m Depth. Caren ro 70a ae.arpoon "w Ppe Mat" COMMUNITY WATER Fl. Ft 375 FP ASTM 3034 paw Dae DMW Steno W"« L" Munn Da. aala40 Ft OWNER INSTALL 8)7/2006 yr"e Pure Baa C&" "a,n" �oov. GroMra TANK GPM FI. FL SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding ubicmmrete ea w GREER '✓ 1000 From Tank Field Station Tank Sewer Line ca Ma«w N,.nO.r a Cmq«tm«e. Well — — — — STEEL 2 Su+.cowa« +100' +100' — — LIFT STATION Lu Lot +5, +10' — — Sao NO LIFT c ca aaa« +5' +10' — — 'Fury ori rwt a 'Pure air lova a Hph rotor am a y FaM.tm In in k +50' +50' — — Pump "o a Moen El«uaal aapeame p«tanra by Cannot Dran R""YMe BENCH MARK Lmalm.rie D."awm FLASHING AT BASE OF HOUSE M..uon 100 Ft E Inspections performed by: CHARLES BALZARINI Dates: 1" 814/2006 2nd 817/2006 t? % 9� ; Development Services Department Approval Conditional Approval Date: _ g �7 gITOPHER R WOOD : T CE:1038T d Reviewed and approved by: Date:. W�t S.. ... (tom wat cS�' Permit No. SW060106 Page 2 of 2 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ON—SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: BEAR PARK LOT 14 051-042-90 C 18.2' 38.0' 15' SLOPE 31.0' 398 BREAK 4–.D ALE 1'-3a' 1000 GAL. SEPTIC TANK AB31 � HOUSE 11' APPROX. WATER LINE 0 O i O — —KEY I Z ;, OX TH • 5'x44' ------------- —o—.---DBINFIELD — 15' UTILITY EASEMENT RESERVE SITE N 89'56'58"W 159.91' 0 - CLEANOUT 25 - WELL ARMAS_ DRIVE L1fLASHING AT RASE 0r HOUSE - "'(; ELEVATIONS Motio"�uBe ��ROUN EIIZCL VATION-1 1 03/2006 CNOT TO SCALE) OR GROUND E LEVEL AT, 97.7 NpNEER'S SEAL 000�Opp �F LL MT -2 �TH-1 o �� •A..goap So YPA a �e p.... ..... ... x-94.3 v q9091.2 o• R91..794.3i 96.1 o o Lp. oo 0 NO .V.T. O . ................ O . CHPoSTOPHER R. MOOO� O 83.7 OQO�'� '• CE -10387 DO 91. ND", ;r'`.'•. r.... O BOTTOM OF T.H. ��p " o d4 PROFESS 91.2 91.2 �DOD0000�oo MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water B Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SWO60106 Legal Description: BEAR PARK LOT 14 Design Engineer: 0848 EAGLE RIVER ENGINEERING SEI Owner Name: JAMES & XLENE LEWIS Owner Address: PO BOX 772423 EAGLE RIVER. AK 99577 - Date Issued: May 19, 2006 Expiration Date: May 19, 2007 Parcel ID: 051-042-90 Site Address: NHN ARMAS DRIVE Lot Size: 46374 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: Q 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. 5. The following special provisions. THE BOTTOM OF ABSORBTION FIELD WILL MAINTAIN 6 FOOT VERTICAL SEPARATION FROM IMPERMEABLE LAYER OR A LAYER WITH A PERC RATE GREATER THAN 60 MIN/IN. Received By. Issued By: Date: 5-/). -A /0( , Date: Municipality of Anchorage Development Services Department � = == Building Safety Division e On -Site Water and Wastewater Program S A, ( T. �— 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEPTICIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 651_6q12 '90 Property owner(s)�l�m-r �— l / A Day phone lo3a oY7 0 Mailing address PO Box-7-7rl-`I-2-3 C-aaec 12i�� '4V- Zip Code 19671--2 X3 Site address P �*� ^^ DV_-,c4xA•4 en c �_Zip Code Legal description (Sub'd, Block &Lot) 19cAq_ Pavr.AL I-0-1— 14� Legal description (Township, Section & Range) Lot Size N6 3"7 4 Sq. Ft. THIS APPLICATION IS FOR (®all that apply) Absorption Field Q" Septic Tank ell Holding Tank ❑ Privy ❑ Private Well Water Storage ❑ ZSA/ eC/Dt1 S<c N - Number of Bedrooms THIS APPLICATION IS AN: Initial Upgrade Renewal I certify that the above information is correct. I further certify that this application is being made for a Single Family.pwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized Permit/Rush Fees: q&0 '6D •1-1 qij .UD Waiver Fees: Date of Payment: 0Il u IOU Date of Payment: Receipt Number: 0 c I l ? Receipt Number: (Rev. 11/05) Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW RD. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax May 8, 2006 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Bear Park 14 Narrative & Permit Application Dear Mr. Roth: Eagle River Engineering Services (ERES) was contracted to design a 4 bedroom well and septic system at the above referenced property. A test hole and soils percolation test has yielded a clean, well graded sand and gravel mix with a percolation rate of faster than I minute per inch, and no water table. The soil type appears adequate to support a primary and replacement 4 bedroom septic system. Due to the fast percolation rate, a 2' filter sand layer shall be required beneath the sewer rock. There is a steep slope approximately 35 feet from the proposed septic system site. However, the slope does not exceed 25% until 50' distance from the proposed leachfield locations. The area in which the proposed leachfields are to be installed is at a less than 3% slope, and virtually flat for the southern half of the proposed primary and replacement leachfields. Due to the gentle nature of the slope, we are proposing to orient the leachfields perpendicular to the gentle slope contours and the steep slope contour 35-50 feet away. The proposed 4 bedroom septic system and well will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, so there is room for wells, septic systems and alternate sites. 2. Immediate neighboring septic systems are all +20' distance, and no private (or community) wells within 100' of the proposed septic system. 4. Drainage will not be affected and is not a major consideration in our design. \2003\06.01 2SEPTICNARRATI V E Installation of this 4 bedroom upgrade, to our best available knowledge, will not adversely affect the wells or septic systems or reserve areas on adjacent lots. If you have any questions please call our office at 694-5195. Sincerely, EAGLE RI R E G EERI G SERVICES Christopher R. oo , .E. Principal \2003\06-012SEPTICNARRATI V E 1 sEPnc+3 LOT 10 ' N 63234 100. Q0. O O O M M WELL+200' SEPTIC+30' 1. NO KNOWN SURFACE WATER +100'. 2. NO KNOWN CURTAIN DRAINS LOT 9 3. NO SEPTICS WITHIN 30' UNLESS NOTED 4. NO WELLS WITHIN 200' UNLESS NOTED +w �'-- _--ARMAS DRIVE 3 iU-) O O O ii LOT 15 1 1 I I SEPTIC AREA 1 M \ mnEID \ — TEST HOLE \ — MONITOR TUE� _ SEWER CLEAN pUT WELL \ — — EASEMENT PROPOSED LEACH FIEW EXISTING LEACH FIELD, © — DRNEWAY ` WELL/SEPTIC SITE PLAN OF 144 LEGAL: BEAR PARK LOT 14 S 1 OWNER: JAMES LEWIS S� •' 9 L CONTRACTOR: UNKNOWN 00.'.. • • . JOB 06-012 DATE: 1/10/06 SCALE 1"=40' ... .. .. .... 0 i^ %CHRISTOPHER R. WOOD•• � 0 AEAGLE RIVER ENGINEERING SERVICES �� s CE -10387 �,: P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 - - - - f TRACT T LOT 14WELL+ `. 200 SEPTIC+30' / o \ '(D13' SLOPE BREAK O INST/ ANEW 1250 C TANK SEP I Z PROPOSED I I WELL+200' 10 WELL W O y I SEPTIC+30' PROPOSED NIN I f— HOUSE 1 1 \ I / N < 10' 7Y TH I 10' IN 10' A IID, WELL+200• N 89'56'5WW 159.91' SEPTIC+30' 23' 25' �'-- _--ARMAS DRIVE 3 iU-) O O O ii LOT 15 1 1 I I SEPTIC AREA 1 M \ mnEID \ — TEST HOLE \ — MONITOR TUE� _ SEWER CLEAN pUT WELL \ — — EASEMENT PROPOSED LEACH FIEW EXISTING LEACH FIELD, © — DRNEWAY ` WELL/SEPTIC SITE PLAN OF 144 LEGAL: BEAR PARK LOT 14 S 1 OWNER: JAMES LEWIS S� •' 9 L CONTRACTOR: UNKNOWN 00.'.. • • . JOB 06-012 DATE: 1/10/06 SCALE 1"=40' ... .. .. .... 0 i^ %CHRISTOPHER R. WOOD•• � 0 AEAGLE RIVER ENGINEERING SERVICES �� s CE -10387 �,: P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW Rd. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Bear Park Lot 14 October 27, 2005 A. GENERAL 1. The well and septic plan is for a 4 bedroom single family residence only. 2. The drawing and or site plan shall be apart of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservatbn requirements. 4. All soil tests arc advisory to the design and arc to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be vcriricd in the field by the contractor to meet Municipality of Anchorage, Depirtmcnt of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or casements and to locate any adjacent multifamily wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed. B. SEPTIC TANK 1. The sewer piping from the house shall be 4" PVC 3034 laid at 2% grade maximum — 1% minimum and insulated with 2" of burial foam if shallower than 3 ft., with 2 ft. minimum. 2. Septic Tank shall be a minimum of 1,250 gallon tank of MOA approved construction, insulated, or place with 4' of soil cover, min. C. DRAiNFIELD 1. The drainftcld is to be placed as shown on the site plan. Contractor shall take extreme care ensure that I O'separtation distance is maintained bctwecnthc house and from the lot line. 2. Two feet of filter sand shall be installed below 4' of sewer rock 3. The bottom of the drainfteld excavation shall be level, plus or torus 1.5", prior to placing filter sand. 4. The top of the filter sand layer shall be level, plus or minus 1.5", prior to placing sewer rock. 5. The total depth of the drainfrcld excavation shall not exceed 10 ft. at any point in relation to natural ground surface, prior to placement of the sand layer. 6. The drainfteld gravel shall be covered with typar fabric material. 7. Soil or a combination of soil and extruded board insulation to at depth of 3' or equivalent is to be placed over the leachficld. 8. The area over the drainrield is to be finish graded or mounded to prevent ponding of surface water runoff. 9. The septic tank and Icachticld must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. \\E•reskdocs\WPDOCS\2006\06-012drainricld- spec.duc Eagle River Engineering Services Christopher R. Wood, P.E. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH = 10' GRAVEL DEPTII = 4' under pipe, 2" over pipe (3.5' total) FILTER SAND LAYER= 2' DRAINFIELDLENGTII-50 DRAINFIELDWIDTH= 5' SOIL RATING = 1.2 GPD1W BEDROOM CAPACITY= 4 total SEPTIC TANK = 1250 gallons min. Twenty-four (24) hours notice required for all inspections \\Eres\docs\WPDOCS\2W6\06-012drainfield- spec.doc Municipality of Anchorage Development Services Department Building Safety Division • a.L� On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 mvw.d. anchomae. sk.us (907) 343.79G4 Soils Log - Percolation Test Performed For. _T- /Ai L -F WJ S Date Perfc Legal Description: _ -13E A r PA P N 1 07 - I y Township, Range, Section: T / S /ll 12164 S LI Depth ria" I oR4►16g loPfOTL z OQ" GP-sP 1- ► e � gRvl�r1 lovSE p i5Ambr-6QAJti. mrX 15-I 160M ^t uF rC5T I{o 1-6 16-1 1 NO AZO 17- ND eagocK COMMENTS PERFORMED BY: PERFORMED IN P it WAS GROUND WATER ENCOUNTERED? A10 6 1F*S.ATWHATDEPn1f /j/4 L Depth to Water After o Monitarlrq?A/OIvE e Date: 4&Z /n 6 Reading Date Gross Time Nel Time Depth to Water Net Drop Pil 7 A r R M -'-Jt-t)H f T'Al 30 SLcvAJ D �....,,,.�.,�� rent,"ULE VW ETER p TESTRUNBETWEEN dy FT AND FT )Oob t CERTIFY THAT THIS TESTWAA ALLSTATE AND MUNICIPA GUIDELINES IN EFFECT ON HIS DATE. DATE: 3 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907)694-5195 ERES Project No.: 06-012 Calculated By: CW Date: 5/82006 Legal: Bear Park Lot 14 TEST HOLE 1 Single Family 4 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 gallons Percolation rate = 1 minutes per Inch Wastewater application rate = 1.2 gallons per day per square foot Required absorption area = 500 square feet Trench width (W) - 5 feet Gravel depth (D) = 4 feet Required length = Shallow trench factor • Required absorption area I W Shallow trench factor= (W+2)/(W+1+2 D) Ip '41 Shallow trench factor= 0.50 Total Excavation Depth = J�leet Required length = 50 feet 06-012Drainlield Calc 10:27 AM5/82006 \ Municipality of Anchorage .. Development Services Department Building Safety Division Onsite 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 SEWER/WELL SUBMITTAL COMMENT SHEET To: ERES Legal description: BEAR PARK LOT 14 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. ❑ Additional soils information needed. ❑ Water monitoring results inadequate. ❑ Discrepancy in information submitted. ❑ Topographic information missing or inadequate. ❑ Incomplete; missing ❑ Incomplete; missing ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _. ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field.— [D Other. THE BOTTOM OF ABSORBTION FIELD WILL MAINTAIN 6 FOOT VERTICAL SEPARATION FROM IMPERMEABLE LAYER OR A LAYER WITH A PERC RATE GREATER THAN 60 MINIIN. Name of reviewer. JOE GOODALL Date: 5/17/2006 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK ,?REvr wes7ir.&O \ Municipality of Anchorage 1 .^t YB4 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.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-042-90 COSA # (,�S(' Expiration Date: 1. GENERAL INFORMATION Complete legal description BEAR PARK LOT 14 Location (site address) 22015 ARMAS DRIVE, PETERS CREEK, AK 99567 Current Property owner(s) TAMES & T'LENE LEWIS Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address PO BOX 33583 TUNEAU, AK 99803 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site 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 -Site 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 Onsite 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. 1 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 ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 03/17/2010 Engineer's Comments: This Investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OF encroachments, deficiencies or discrepancies exist axxr v ntn !i. DSD SIGNATURE + �� _,effo' Approved for _� bedrooms.,,,oN� Disapproved. Conditional approval for bedrooms, with the following stipulations: Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineer's Report Other By: O Original Certificate Date:_ ? — 3 —/ O (Rev 1105) Municipality of Anchorage _ ,.•r i • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 VAYMmuni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST _ Legal Description: BEAR PARK LOT 14 Parcel ID: 051-M-90 A. WELL DATA Well type A If A. B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth _it. Cased to _ft. Casing height (above ground) In. FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform _colonies/100mL Nitrate mg1L Other bacteria Arsenic: _mgA Date of sample: Collected by, B.. SEPTICIHOLDING TANK DATA ft. g.p.m. colonies/100 mL Tank Type/Material Septic/Steel Date Installed 81712006 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YM) N High water alarm (Y/N) N Date of pumping 3 15L20o6 Pumper RMI Flmh I ' C. ABSORPTION FIELD DATA Date Installed tV7 2006 Soil rating (g.p.d.Ht2 or fetbdrm)1.2 System type 5' Wide Trench Length 44 ft. Width 5 ft. Gravel below pipe 3.1 ft. Total depth 7A ft. (measured 3/162010) Eff. absorption area 375 ftp Monitoring tube Y Depression over field IN Date of adequacy test 3/162010 Results (Pass/Fail) Pass ,For 3 bedrooms Fluid depth In absorption field before test 0 in. Water added 480 gal. New depth 5.4—In. Elapsed Time: 20 min. Final fluid depth 0 In. Absorption rate >= 450+g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date Installed 'Pump on' level at _in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) 'Pump off" level at _in. High water alarm level at _in. Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1. ' Building foundation 5'+ Property line 51+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surfacewater 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 101+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage "10'+ Curtain drain - 50'+ (None Known) Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION �ft , I certify that I have determined through field inspections and %.�Q' review sf- of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNEPH M. DUMCI Of FFUS �`OF —��4KMXMH U. Ind Cr 7 Date 03/17/2010 r711e �RYasstoMN'.i . COSA Fee $490.00 Date of Payment Receipt Number 0 y53 O L (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ASBUILT 0 h h 14 I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: .dF�s3C /.9>I,F SUB Lor/fes ' AND THAT NO ENCR04CHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THS EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. i SEWARD & ASSOCIATES LAND SURVEYING 69 SCALE:/ �. : r pF' At DATE , GRID: FB: oma... Mark S.w.,d ik BnP AV DRAWN:A> va tiw T- v�f