HomeMy WebLinkAboutSKYHILLS PH 1 BLK 1 LT 9 Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825'L" Sb'eet Room 502
P.O. Box 196650 Anchorage, AK 99519-6650 Page I of 3
www.ci.anchorage.ak.us (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW000250 PID Number: 011-122-20
Ha~mo~r ~nn~frHrfion ~n Wastewater System: [] New [] Upgrade
~O4 Cl~.v~lnnd AvE..c:;.ito ~O4. 99517 ABSORPTION FIELD
LEGAL DESCRIPTION ~"'"""~
1 ~ $kv Hills 4,5 ~,. ~,~
0
Well: ~ New ~ Upgrade *"~ 3 ~.
Exlstinq A~U .. ~, 1013 ~ F810/3034 PVC
., Ha~emeier Co. 11110/2000
~, TANK
SEPARATION DISTANCES ~ sep~c D Holding D S.T.E.P. D ~er:
~ Sep~c ~sorption Uti Holding Pu~d~ ~n~: ~:
Tank Field Station Tank S~U.. Anchorage Tank 1500~.~.
w. 200+ 200+ 200+ Steel 2
s~w.,, i 100+ 100+ ~ LIFT STATION
c~,. ~.,. 100+ 100 ~"~"* ~"
"~" BENCH MARK
Back Door Threshold
100.0
Enginee¢s Stamp
Inspections ~dormed by: Pannone Enq. Svc Dates: 1"11/10/2000
~..;.~.~I.....~. . ~.: ......... :,.....~
2~ ~l~OI2000
~...~.....
Depa~mont o[ Hoalth and Human 8o~icos approval
~ ~'*, ~Jr~.C[ ~149 ,~
,
PERMIT NO, SV80-250
AS-BUILT
WASTEV/ATER ABSF1RPTION SYSTEM
LOT 9 BLOCK 1 SKYHILLS S/I)
..~.. k.~
P,I.B. NO' 011-12P-20
RESERVl
NE
RIMARY FIELD
~7,5' EFF,
NOTEI
1) SU8~. IS SERV
ARE NO WELLS ~
THE PROPOSED Ih
C,\Work\13-3SKYH
~C
EW ~
TIC TANK ../
'C
NOW-,,4 DR PROPOSED
DUSE ................... ER SER
:']3 ]~Y A;/WU. THERE
[THIN 200 FEET OF
~TALLATION.
~FC 1~.2 I~ C
~ T1 18.5 12.9
~ TP ~8.9 10,7
~ C1 33.8 12.8
~ C~ 37.1 15.2
~ C3 44,8 23.4 60,5
MT 21.5 32.7
C4 13.8
C3-C4=67.5'
SEPTIC
AREA
AS-BUILT,
PERC RATE, PO MIN/INCH
SOIL RATING, 0.6 GPI]/SF
250 SF/BE]]ROOM, 4 ]]EBROFIM
1000 SF REQUIREI30 1P50g S,T,E,P. TANK
DEEP TRENCH, 7.5' EFFECTIVE
11-12' TBTAL I]EPTH0 67.5 LF
2-3' ~,/I]]E0 1013 SF TOTAL
PREPARED FOR~
John H~gmeler
John H~gmele~ Co.
2204 CLevet~nd Ave, Suite 204
Anchorage, AK 99517
(907) 248-~789
PANNDNE ENG. SVC, LLC
P. 0. BOX 102954
ANCHORAGE, ALASKA 99510
272-8218 Phone & F~x
DATE, 11-17-00 IAS-BUILT
SCALE,
PERMIT NO' S;/O00E50
AS-BUILT DETAILS
WASTEWATER ABSORPTION SYSTEM
LOT 9 BLOCK 1 SKYHILLS S/B
P.I,~. NO' 011-122-20
Z
0
W
C~¥,/ork\t3 -3SKYH.D~/G
PREPARED FDR~
, John Hagneler
John H~meler Co.
2204 Cleveland Ave, ~ulte 204
Anchor~e, AK 99517
(9~7) ~4B-6789
W
PANNDNE ENG. SVC.,' LLC
P. 0. BOX 102954
ANCHORAGE, ALASKA 99510
272-8218 PHONE & FAX
DATEm 11-17-00
NOT TO SCALE AS-BUILT
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
I/- lo-do ?; 3
I I '" O0
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jul 20, 2000
Expiration Date: Jul 20, 2001
Permit Number: SW000250
Legal Description: SKYHILLS PH 1 BLK 1 LT 9
Design Engineer:. 0062 Pannone Engineering Services
Owner Name: John Hagmeier Co.
Owner Address: 2204 Cleveland Ave., Suite 204
Anchorage, AK 99517-
Parcel ID: 011-122-20
Site Address:
Lot Size: 40464 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
Ail 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 ( 18MC72 ) and Drinking Water Regulations ( 18MCS0 ).
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
Issued By: ..~_~:~,~,~
Date:
Date: '~-~,. I-<DO
Consulting Engineer
(907) 272-8218
P.O. Box 142025
Anchorage, Alaska, 99514
(907)272-8218Fax
July 2. 1999
Municipality of Anchorage
Dept. of llealth & I-luman Services
On-Site Services Section
P. O. Box 196650
Anchorage. Alaska 99519
Subject:
Lot 9. Block 1 Sky llills Subdivision.
Septic System Permit
Gentlemen:
My firm was contacted to design and install a new septic system for the referenced lot. We conducted a field
investigation to locate existing wells and septic system before designing the proposed system. Two test holes
were excavated on August 6. 1998 for the system design, which is on file with your department. No ground
water was encountered. No bedrock was encountered in the test hole.
Thc lot is approximately 0.95 acres in size. Lot s 9 slopes to the southeast at a rate of approximately 10-12
percent. The proposed installation will be located on the northern portion of the lot in a relatively fiat area. A
S.T.E.P. tank will be installed to lift tile effluent to the drain field. The proposed location is greater than 200
feet away from any wells. This lot is served by AWWU water service. The proposed system will be greater than
I0 feet from tile water service lines. The proposed installation will not affect the future development of the
surrounding or existing lots. See the attached design.
Please contact me at 272-8218 or 227-3522 if you have any questions about the proposed installation.
Sincerely.
Steven R. Pannone, P.E.
Attachments:
C:\W(.)R K~L171'1'1 ~RS&- I SKYI I n .Lc,.00 I.I)(.)C
P~-RMIT NC), ~g P.I.I).' ND'
DESIGN DETAILS
~/ASTEWATER ABSDRPTIDN SYSTEM
LDT 9 BLOCK Z SKYHILLS S/I)
Z
C,\~/opk\13 -3SKYH.I)~/G
PREPARED FDR~
John Hm~eler
John Hmgmeler Co.
~04 Cteve(~nd Ave~ ~ulte ~04
Anchoroge, AK 99517
(907) 248-6789
Ed
PANNDNE ENG. SVC.0 LLC
P, O. I30X 102954
ANCHDRAGE, ALASKA 99510
P72-SP18 PHONE & FAX
NDT TD SCALEI DESIGN
PERMIT NO' SV
DESIGN
~/ASTEWATER ABSORPTION SYSTEM
LOT 9 BLOCK 1 SKYHILLS
RESER FIEL~
D~AIN
11' TD
PROPOSED
ER SER
NOTE,
1) SUBB. IS
ARE NO WELLS
THE PROPOSED
~ROPOSED 1850Q
S.T.E.P.
(LIFT STATION)
BY AVVU. THERE
ITHIN 800 FEET OF
STALLATION.
PROPOSED
4 BE
AREA
C,\~,/o~'k\13-3SKYH. :WG
DESIGN'
PERC RATE, 80 MIN/INCH
SOIL RATING, 0.6 GPD/SF
850 SF/BEDROOM, 4 I~EDROOM
1000 SF REQUIREB, 1850g S.T.E.P. TANK
DEEP TRENCH, 7.5' EFFECTIVE
11-12' TOTAL DEPTH, 67 LF
8-3' WII]E, 1005 SF TOTAL
PREPARED FOR:
John H~gmele~
John HmgMelep Co.
8804 Ctevet~n~ Ave, Suite 204
Anchorage, AK 99517
(907) 848-6789
PANNDNE ENG, SVC,, LLC
P. D. BOX 102954
ANCHDRAGE0 ALASKA 99510
878-8818 Phone & F~x
IATE, 7-8-00 1
DESIGN
1
Munlclpa~ty OI Anchorite.
DEPARTMENT OF HEALTH & HUMAN ~ERVICF$
625 "t." -'ctre~t. A~,cho~'a~e, AJa&ka e9502-(~50
SOILS LOG -- PERCOLATION TEST
1
2
3,
4,,
G-
g,
10.
11
£N¢~JNTEREDt
,, YES. AT I/¥HAT ~ ~
ii,
Mun~lp&llty et Anc~eta~. i
DEPARTMENt' OF HEALTH & HUMAN SERVICES
SOILS LO~ -- P£ROOLATION TEST
eNCOUnTERED? -
/w
I t,I
11.
14,
IS.
FERCC~TION RAT8 ~ I~t~ek~cnl e~flO BO[~ O~A~TER ,~ ~'
1EST~BETw~ , ~ ~t~O ~ F*
~:LcA*e,L ~.'. Andetsor.
[C_ Municipality of Anchorage
On-Site Water and Wastewater Program r
(907) 343-7904 n S`/1 E E T Y
J J
Certificate of On-Site Systems Approval \.<< vI
Parcel I.D. 0, 10.0v,„
• 011-122-20 16 :,`
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Skyhills Ph 1 Block 1 Lot 9
Location (site address) 6820 Sky Circle
Current Property owner(s) William & Heather Earl Day phone
Mailing address 676 W. Sandstone Ct. Boise, ID 83702
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Q 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
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Zip 'L y ►�d Date: .'/a2//
COSA to be released to the engineer,unless otherwise r#ted by th engineer.e e gineer.
COSA Fee $ ,2/07,56 Waiver Fee $
Date of Payment Ng 1/� Date of Payment
Receipt Number 0(10Y06 Receipt Number
COSA# 10?t Waiver#
5. 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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe 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 soil
condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 3/8/2018
OF C �1
%* 49 TH 1\ _**�/�
6. DSD SIGNATURE ")
System #1 Approved for bedrooms i••.S{even R..'annone /
• CE-8149 k
System #2 Approved for bedrooms l ig1*' •• ^r
Disapproved �PROFESSiaNy�
\NNN.
Conditional approval for bedrooms, with the following stipulations:
46v. ANciio
wp,-RoGik0
p <4;�
'4r_ JT
.06 Original Certificate Date: -26 `t
_
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS: •
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Skyhills Ph 1 Block 1 Lot 9 Parcel ID:011-122-20
A. WELL DATA
Well type Public If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/SteelDate installed 11/10/2000
Tank size 1500gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A
3 -12-1 ? PumperA+ Home Services
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
7/26/2016 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Deep Trench
Length 60 ft. Width 2.5 ft. Gravel below pipe 8.0 ft.
Total depth 13.0 ft. Eff. absorption area 960 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results(Pass/Fail) For 4 bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at_ in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 7.8 Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION +~
I certify that I have determined through field inspections and `�` 1.1+��
review of Municipal records that the above systems are in 0*; - • 71-1 )' •,*
conformance with MOA COSA guidelines in effect on this date. •• ®—`•4 ' •
Engineer's Printed Name Steven Pannone / ":S�evei�2.•'onnoie ••e
Date 3/8/2018 �fig• CE-8149
k‘‘‘ZIN-SZZ'l
COSA canary sheet_2-6-15.doc
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AS-BUILT NO CORNERS SET THIS DATE
� I hereby certify that I have performed a Mortgagee's inspection
Notes: �,%:%.%OF \ 1 of the following described property: LOT 9. BLOCK 1.
1. Asphalt location is approximate
4:b OF
• . . •. A 1 SKY HILLS. PHASE 1
due to snow and ice. ,`P.' .S/. S,
2. This lot is served by public water system. - 2).• 49th ��� ••. Anchorage Recording District,Alaska,and that the
/ /\ improvements situated thereon are within the property lines
/ •�, and do not overlap or encroach on the property lying
/ •• adjacent thereto,that no improvements on the property lying
/i�. / adjacent thereto encroach on the premises in question and •
Fred Wolatka• / that there are no roadways,transmission lines or other
SCALE: 1 - 50' i visible easements on said property except as indicated
a `PI,•• 3255 – S .•s)�, hereon.
9'o • • , . • •�o Dated at Anchorage,Alaska
EASEMENTS OF RECORD,OTHER THAN 1 :° ssio u- `� this 9th day of MARCH ,2018.
THOSE SHOWN ON THE RECORDED ' 1 t".%. FRED WALATKA&ASSOCIATES
PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors
UNLESS OTHERWISE NOTED FB 18-3, pg 3 BE 907-248-1666
MunicipaliD' of Anchorage
Department of Health and Human Services
Division cf Envircnmental Sec'vices
On ~t_ Sen/~c~s ..... an 825 'L" Roam 502
P.O Ecx 198650 A~chc~age. AK 99519~650
'~¢¢w ci.anc~crsge.ak, us
(907) 343~744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D, 011-122-20
1.
Expiration Date:
GENERAL INFORMATION
Complete legal description Lot 9, Block 1 Sky Hills Phase 1
Location (site address or directions)
Current Property owner(s), John Haqemeier Co, Day phone 248-6789
Mailing address 2204 Cleveland Ave, Suite 204, Anch AK 99517
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Day phone
Unle$$c~e.m/is¢~quested. HAA ~flbehe!dbyDHHS~rpickup. HAAp~kedupby..
2. NUMBEROFBEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual We!l
Individual Water Stcrage
Community Class
Public Water System
We!l
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank ~
.._.;
Community On-site "~
Public Sewer Y5
:is~csal a~clcr water sucmy system. CNHS ~lsc :ssues P~As uccn request ;c hcme owner5 Ce~lfic~[es cf
5. STATEMENT OF INSPECTION BY ENGINEER
AS certified by my seal affixed hereto and as cf the validation Cate s~cwn ~'e~c',v. I venfv that my ;nvesti.caticn
based.on prccecur.e,s ou. tl~nec ~n tP, e Health Autl~cnty Approval Gu~cehnes for this He-ltl3 Author;tv Approval
epclic,=ticn snows ,hat ~P,e Ch-Site water su~cly and/or wastewater disposal system is safe. fun~::cnal and
adequate for tne number cf bedrooms end type of structure indicated neretn. I further venfy that cased on the
information obtained from the Municipality of Anchorage files and from my investlgadcn and inscecticn, the Ch-
site water supply and/or wastewater disposal system is in compliance with ail applicable Muni'cipal and State
codes, ordinances, and regulations in effect at the time cf installation.
Name of Firm Pannone Enq. Svc.
Address P.O. Box 102954. Anch. AK 99510
Engineer's Printed Name Steven R. Pannone. P.E.
DHHS SIGNATURE
~ Approved fcr ~ bedrccms.
Disapproved.
Conditional approval fcr
Phone 272-8218
bedrooms, with the following stipulations:
Additional Comments
HAA. Checklist
Semic S,/s~e.,,'n .-' cviscr/
'l'~/.~!l ~!C~,;i '--,....~.*./
_..~,, =:,CC_,=~c. - ~ -- ~ ~
X
Maintenance Ag, ..m .....
SuFplementai En~cinear_=
Original
Legal Description:
A. WELL DATA
Well type AWWU
Date completed __
Total depth
Municipality of Anchorage ~ I=t" [~
Department of Health and Human Sel'~iL'~{"' E I V E
Division of Environmental Services
On-Site Services Section 825'L' Street Room 502 N0~f 2 0 2000
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-4744 MUNICIPALITY OF ANCHORAGE
ENVIRONFENTAL AERVICES DIVISION
HEALTH AUTHORITY APPROVAL CHECKLIST
9-1 Sky Hills #1
Parcel I.D.:, 011-122-20
If A, B, or C provide PWSID # Well Log
Sanitary seal Wires properly protected
ft Cased to fl Casing height (above ground), in.
FROM WELL LOG AT INSPECTION
ft ' ft
gpm g.p.m
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mi
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Nitrate mg/I Other bacteria
Collected by: S.R,PANNONE
colonies/100 mi
500 gal Number of Compartments _2
Depression over tank N High water alarm NIA
Width 3 ft
Effective absorption area 1013 ~
Results (Pass/Fail),, NEW
Water added
in
Date installed 1111012000 Tank size.
Clean0uts Y Foundation cleanout Y
Date of pumping Pumper NEW TANK
C. ABSORPTION FIELD DATA
Date installed 1111012000 Soil rating (g,p.d./ft2 or ft=/bdrm) 0.6
Length 67,5 ft
Total depth 12 ft
Date of adequacy test ~
Fluid depth in absorption field before test ~ in
Elapsed Time: ~ min Final fluid depth
Any rejuvenation treatment (past 12 mo.) (YIN & type)
(Rev. I f/99)
System type DT
Gravel below pipe 7.5 ft
Monitoring tube_Y Depression over field N
For _4 bedrooms
gal. New depth in.
Absorption rate >= g,p.d.
If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons
in"Pump of/' level ~t
Cycles tested
in
Manhole/Access
High water alarm level at ~ in
Meets alarm & circuit requirements?.
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Building foundation
Water main 40
Drainage 100+
10
Property line ...85
Water service line 40
Wells on adjacent lots 200+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 32
Water Service line $0+
Curtain drain 100+
F. COMMENTS
Building foundation 10
Surface water 100+
Wells on adjacent lots 200+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Pdnted Name Steven R. Pannone, P.E.
Date 11-18-00
HAA Fee $
Date of Payment
Receipt Number
(Rev. 11/99)
Waiver Fee $
Absorption field 10
Surface water 100+
Water main 10o+
Driveway. parking/vehicle storage 30
Date of Payment
Receipt Number
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot
Public sewer main
Sewer/septic service line.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: