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HomeMy WebLinkAboutSKYHILLS PH 1 BLK 1 LT 6kyhllolls #i Block 1 Lot 6 #011-122-17 Municipality of Anchorage Page 1 of 3 _ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW990032 PID Number: 011-122-17 Name: Crown Pointe, Inc. Wastewater System 1;1 New O Upgrade Address: P.O. Box 112313 Anch. , AK 99511 FIELD__ Phone: 223-8075 No. of Bedrooms: Four _ABSORPTION ❑Deep Trench K7 Shallow Trench ❑Bed ❑Mound ❑Other _- LEGAL DESCRIPTION Soil Rating: 1 ? Total Depthl frrorip original grade: —GPD/Sq. . Ft. _ Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 6 1 Sky Hills Phase I 6' FI 4' Ft. Township Range: Section: Fill added above original grade: 1 — 211 Gravel length: 501 Ft. ��� — WELL: O New ❑ U Upgrade 1 Ft. Gravel width: 51 Number of lines: Distance betwn lines: --1 -eeFt. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Muni. Water Ft, I FL 500 SD. Ft. ASTM D3034 PVC Driller: — Date Drilled: Static Water Level: Installer: Date insta)led` Fc LH Constructi —• _4/13/99 Yield: _ Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. — -- SEPARATION DISTANCES _ XXSeptic O Holding ❑ S.T.E.P. -- To Septic Absorption Lift Holding Public/Private Manufacturer: —_ Capacity in gallons: From Tank Field Station Tank Sewerunea Anchoraae_Tank 1.250 WelF >100 >100 N/A N/A N/A Ma`Steel Number of Companments: Two Surface >100 >100 N/A N/A N/A LIFT STATION - N/A Water — Lot >51 >10' N/A N/A N/A Size in gallons: --- Manufacturer: 11_ Line > 5 ' > 1 0 ' N / A N / A "Pump on" level at: "Pump off' level at: �� High water alarm at: Foundation __ Curtain None Noted a/A Pump Make&Model Electrical Inspections performed by: Draiin� BENCH MARK_ Remarks: Location and Description: Concrete Step .At Front — Entrance Assumed Elevation: 100.0 ENGINRER'S SEAL Inspections performed by: MEA -- Dates: 1st 4 / 1 3 / 99 F� 2nd 4/13/99 C ,y FAffYL1t��-.i6i'r� Department of Health and Human Services approval Reviewed and approved by: Date:�0=`l9�irr�� --�r 72-013 (Rev. 9/91) MOA 25 Municipality of Anchorage Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW990032 PID No. 011-122-17 0' T_& E. ESW. --- r- O ��`�� -4 is:z °' S1 18.8 10.0 S2 18.0 16.7 C4 27.5 43.7 C5 39. 26.2 M1 41.4 26.4 S - Septic Vent C - Cleanout M - Monitor Tube Four Bedroom .Home /i C1 T1q C5 C_=1 1,L�\te n 0 rt � r` �'tt t �� 61A'3i lu(7ia ,qq PLAN AS-BUIL1" SCALE 1" = 40' Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW990032 U) , U £ N NM v m 98.9 `a vu 1,250 Gal 90.6 X Sep. Tank N x Q •7 r E PID No. 011-122-17 <r U - Fw .. , ,.-- 45'1_ PROFILE AS -BUILT. HORIZONTAL SCALE 1" := 10' NO VERTICAL SCALE 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 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial 11 C) �0' (Jan Date Issued: Mar 15, 1999 Expiration Date: Mar 14, 2000 Permit Number: SW990032 Parcel ID: 011-122-17 Legal Description: SKYHILLS PH 1 BLK 1 LT 6 Design Engineer: 0014 Anderson Engineering Site Address: 008232 SKYHILLS DR Owner Name: Crown Pointe, Inc. Lot Size: 47668 SQ. FT. Owner Address: PO Box 112313 Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 99511-2313 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 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: Date: j14�9� Issued By: GLrw'� Date: S �5 March 8, 1999 Municipality of Anchorage Department of Health and Human Services 82.5 "L" Street Anchorage, AK 99502-0650 Subject: Lot 6, Block 1, Skyhills Subdivision Septic System Design Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 6, Block 1, Skyhills Subdivision intends to construct a four bedroom home on the lot. We are therefore requesting a permit to construct a septic system on the lot to serve the house. The subdivision is served by the Municipal water system so a well permit is unnecessary. The attached site plan and backup documentation describe the proposed system and show the location of the new system. The testholes placed on the property revealed poorly graded sands which percolated at rates from less than 1 to 3 minutes per inch. The vast majority of the material passes the No. 4 sieve so a sand filter will not be required. Groundwater was not encountered during the excavation nor was any noted during the monitoring period. We have therefore designed a 5' wide absorption trench with 4' of gravel beneath the distribution pipe. The trench will be 50' long with a total depth from original grade of 8'. The ground surface of the lot slopes to the east from the proposed house location at a rate approximating 5%. This is the area of placement for the absorption trench. The trench will be constructed perpendicular to th The lot also slopes to the west from the house location at much steeper grades, but this area will not be utilized for the septic system. No conflicts exist with other lots in the area where septic systems will be constructed. All segments of the new system will be constructed a minimum of 10' from the water service line. If the system is constructed in accordance with our design the following statements apply: The system, if constricted as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The subdivision is currently served by a community water system. 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. Lot 6, Block 1, Skyhills Subdivision March 8, 1999 Page Two 3. The system, if constructed as designed, will have no adverse impact on reserved 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 Skyf-fills Subdivision �A j �•� H I Fns 4C j KINCAID ACRES HANKSSUBD. I KINCAID HEIGHI'G --______—___� I2I.___—_—____.-.� 4D n1AC, A I I I zC j 1 Ir I I I I -------------L-------------'------- EVANSON COURT _ nl-foe° Y >1 10 t 9 TH-93 '\ 111695 711646 Vacant 711-2 1 4 p° Tl -4s v-3 Vacant 9 17, I nb4 Vacant , \I 3 mACT A �" �• /a, p 2 711-43 TH -44 � p "4Ns1DN SURD. , S Vacant 1H-94 9 10 Y, = 2D p �I� � � I n164o nou 7 711-e2 I 711649 I __ - ,H -m -z, Wp39 �`B I ------------ 83 O ! 711-50 1 1 0 19 O 6 711-54 p _� %22 n 711-104 O / nI ml T 7 -35 711-90 p iH-101 -. _ 12 711693 Ola 6 IH -35 Vacant "THIS PROJECT I I ° UNSUBOMDEO I S .... n16z5— I o,H-99 93 17 VdCant ni-96 �`\i© o O p nl-loo � IG�e` e�lgg iH-p Z7 Ao��( ®�°) 1 S 14 7H-98 Q mpg 19 41 Vacant h .. o�...... ° ac n%"' \` p 711-84 qui E, IV `1::;, p 4 ,H-°70 1 Tit-" � ; ARE:A MAP \.1 '. :"wl4V r DIV nl-es 1 I ° 711-75 SCALE 1" = 200' I I I - 111081 ° 2 m-73 DI -74 I I II p p I UNSIIBOMDED N 00012'59"W 165.65' --_ -- __ 10'T-&E_ESAAT.__ ____- al vl Four Bedroom M Home n vCD x'1,250 41 Gallon �! Sep. Ta° 0 T112 5p, �Alte.rna e C tY, g' Eff X 5 lid Site ct • e c o yon Mn, pth SKYHlLCS �R� � ,0 a Co M 2>4 0 z N b rn rn a (f) z co W N z r n rr 0 { U) CC' �--r'� O W �_ V � m 00Ln <. W _n O ; C7 O SITIE PLAN SCALE 1" = 40' z C, m r O a O nl n n a � A G z � DD o A Z v 7i v al vl Four Bedroom M Home n vCD x'1,250 41 Gallon �! Sep. Ta° 0 T112 5p, �Alte.rna e C tY, g' Eff X 5 lid Site ct • e c o yon Mn, pth SKYHlLCS �R� � ,0 a Co M 2>4 0 z N b rn rn a (f) z co W N z r n rr 0 { U) CC' �--r'� O W �_ V � m 00Ln <. W _n O ; C7 O SITIE PLAN SCALE 1" = 40' C, O nl n n a � A G z � DD o A al vl Four Bedroom M Home n vCD x'1,250 41 Gallon �! Sep. Ta° 0 T112 5p, �Alte.rna e C tY, g' Eff X 5 lid Site ct • e c o yon Mn, pth SKYHlLCS �R� � ,0 a Co M 2>4 0 z N b rn rn a (f) z co W N z r n rr 0 { U) CC' �--r'� O W �_ V � m 00Ln <. W _n O ; C7 O SITIE PLAN SCALE 1" = 40' LOX C, BLOCK 1, SKYFIILLS DESIGN FACTORS: Four Bedroom Home Perc. Rate: 2.5 Min.Anch Application Rate: 1.2 GPD/SF SYSTEM REQUIREMENTS: 5" Wide Trench System 1,250 Gallon Septic 'rank 4' Drainfield Rock 4 Bedrooms X 150 GPD / 1.2 GPD/SF = 500 SF of Absorption Area 500 SF/5 LF X .5 (Red. Factor) = 50 LF Trench Length Therefore: Construct a 5' Wide Absorption Trench System With One Lateral 50' in Length with 4' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed at 4' Below the Original Ground Surface. 5' TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 3' of Cover over Septic System. Maintain 10' Separation From Lot Line. )wn ) 0o°w e e ao...n.. A}+... ':i ..:, M10WEANDEASON Jl' ,;, MunicipalityofAnchorage DEPARTMENT OF HEALTH & HUMAN SERVICESD� °khe N��ANL1f�ME 825 "L" Street, Anchorage, Alaska 99502-0650SOILS LOG — PERCOLATION TESTo. `f L H Construction PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION:_ LT&ILK I, Sky Hills Subdivision �� `j/• SLOPE SITE PLAN — 2 X 5HA1� 3 4 TESTHOLE NO. 2 5 • 6 �f 7 8 9- 10- 11 1011 12 13 14 — yI�I 15 ��//1 1 16 17 18 19 20 COMMENTS Pere Cavity was WAS GROUND WATER 11. an�rm uaTcocro fJ — S IF YES, AT WHAT L DEPTH? _ p_ E S o kpffim lUler � Datt �� mutronng? 9 � Reading Date Gross Net Depth to Time Time Water Net Drop — .a � hi•31— V,1 _ ;a �ZAr � ,a _ t 1210 I 13•Zh L,7 — t13 Zl Ne r q q PERCOLATION RATE `�& (mmutesrmce) PERC MOLE DIAMETER L TEST RUN BETWEEN 5 �v FT AND S�/� FT resoaked PERFORMED BY: �' ' {/ _ ' ✓ �"""T'��gTl Y THAT THIS T ST WAS PERFORMED IN Michael Anderson ��— 9 ACCORDANCE WITH All. STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: U Municipality of Anchorage UWE- DEPART MEN7 OF HEALTH & HUMAN Si:R\nCrs M "L' Street, Anchorage. Alaska 93502-DESD SOILS LOG -- PERCOLATION TEST A. 4+3014' ..w < V r`rz.oe., PERFORMED FOR:_ L H COnsI ru Ctign DATE PERFORMED: =w�T Lot 6, Block 1, Sky Hills Subdivision_ LEGAL DESCRIPTION: — -- ----- SLOPE SITE PLAN 17 18 19 OG/OL SM/ML TESTHOLE NO. 1 SP WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? DIA ID W= Abv 0 Reading I Dare I Grow l Nef Time I N.I Nv D m Net I Delff I I 13 -rte I S I No �I s= 02�" 20 o PERCOLATION RATE _2�/ lrtunlnrvutdtl PERC HOLE DIAMc fER � TEST RUN BETWEEN __L� FT AND --I—FT COMMENTS __ Perc. Cavitypresoaked prior too testing. PERFORMED BY: I _,A Y 711A7 THI TEST WAS PERFORMED IN Michael E. Anderson ACCORDANCE WITH ALL SATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DA i—= ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 6, BLOCK 1, SKYHILLS SUBDIVISION GENERAL: 1. The scope of this project includes the procurement and placement of a 1,250 gallon septic tank. It also includes the construction of a new 50' long X 5' wide X 4' effective depth absorption trench at the location shown on the site plan. 2. 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. 3. 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. 5. 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 on the Site Plan. Lot 6, Block 1, Skyhills March 8, 1999 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 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. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 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. 2. 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 fabric 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. L.ot 6, Block 1, Skyhills March 8, 1999 Page Three 5. 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. 6. 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 trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior 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, Fernco, or equal). Lot 6, Block 1, Skyhills March 8, 1999 Page Four 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. INS13ECTIONS: A minimum of two inspections are required by Municipal Ordinance. 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. L, s0 Municipality of Anchorage Development Services Department ''��` Building Safety Division On -Site Water and Wastewater Program g 4700 Elmore 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 pp nn�� 11 Parcel l.D. _ ('I��-�o'��"fit COSA# Expiration Date: 1. GENERAL INFORMATION Complete legal description SkvH "AAs ?"'I 31k 1 Loi (o Location (site address) '8137 Sky 9-1II5 Dr%ve Current Property owners) Alor woof Fgxe (Ind_ Day phone Zy3- 4649 Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: q 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 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 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 On -Site 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 Address Engineer's Printed Name LABS-spv2kl avJ 5. DSD SIGNATURE Approved for -4 --bedrooms. Disapproved. one Zu-39/6 Date 121 yLOA —I . OF At \11 :9 JTZ{.! I% �.. / 9,•,LAgSE.SPILM(tAh�_ j �6F"�1`�h Conditional approval for 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: 0 Original Certificate Date: 2 – O O (Rev. 11105) Municipality of Anchorage Development Services Department \ Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: 5k, Wks PN 1 Rlk 1 L T (c, Parcel ID: !:! J -I-Z-2 -/ 7 A. WELL DATA F%46J;. W,, Ee Z Well type= If A, B, or C provide PWSID # = Well Log (Y/N) Date completed — Sanitary seal (Y/N) = Total depth — ft. Cased to — ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: ft. g.p.m. Coliform colonies/100 mL Nitrate mg/L Arsenic: = ug/L date of sample: _ B. SEPTIC/HOLDINGTANKDATA TankTypetMaterial AnrlTornat �+nk I Peal Tank size 11450 gal. Number of Compartments 2 Wires properly protected (Y/N) '- Casing height (above ground) — in. AT INSPECTION ft. g.p.m. Other bacteria — colonies/100 mL Collected by: Date installed Cleanouts (Y/N) i Foundation cleanout (Y/N) _ L_ Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping o I o 6 Pumper A4 C. ABSORPTION FIELD DATA 1 Date installed 13 y9 Soil rating d.lf r ft2/bdrm) 1.2 System type 5kJ1bty Trenc h Length 50 ft. Width 5 ft. Gravel below pipe i ft. Total depth 113 ft. Eff. absorption area 520 ft' Monitoring tube i/ Depression over field /V Date of adequacy test II t oB Results (Pass/Fail) PcOS For 4 bedrooms Fluid depth in absorption field before test Z-7- in. Water added 840 gal. New depth in. Elapsed Time: 340 min. Final fluid depth 23 in. Absorption rate >= COO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) A444 kHo vn If yes, give date '-- D. LIFT STATION Date installed Size in gallons anhole/Access (Y/N) 'Pump on level _ in. 'Pump off" level at in. High water alarm ley Let in. Datum Cycles teste Meets ala circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas P46/,e- 4/,>ez On adjacent lots On adjacent lots Public sewer manhole/cleanout- Holding tank I Manure/animal excrete storage areas — SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5,4 Properly line 101+ Absorption field 5 r+ Water main to Water service line 1o14 Surface water N i Wells on adjacent lots 20o i - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line I014- Building foundation to + Water main to t t Water Service line to •- Surface water /V•O• Driveway, parking/vehicle storage S Curtain drain /V• O • Wells on adjacent lots *ZOO F. COMMENTS G. ENGINEER'S CERTIFICATION Or A4^�11)1 I certify that 1 have determined through field inspections andi c2 review of Municipal records that the above systems are in Q Q TH i conformance with MOA COSA guidelines in effect on this date. j ' A Engineer's Printed Name Att 5 Sp!1rVA cmac) /�� LA;; LA;; 12144 08 II�;JpfS'0`�� COSA Fee $ 14,3p Date of Payment 1914111 Receipt Number d$55A (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number, 31Ya SIH113S SM3NMOO ON 310N VHSVW '1.OIM1SIa ONIONO33S 30VMOHOW 'S3Nn 33N3-4 NO AWGNn08 ONIHSIl8V1S3 803 NO NOLLOnM1SNO3 210-4 a3Sn 38 N0383H Viva AMI (nnOHS S3owmmn3Ml3 ON 113ONn 'IKId NOISW08nS 03a8O338 3H1 NO MV3ddV ION Oa HOIHM SNOLLORiL43M NO S1NYN3AO3 'S1N3W3SV3 ANY 10 30N31SIX3 3H13NINHMa 01 83NN10 3H1 40 kLnIGISNOdS3U 3H1 SI 11 '031V310N1 SV 1d33M 1SIX3 S1N314HOY08ON3 ON Lwu oNV 3A08V a3131d3a A1M3d0Md 3H1 a3k-y%unS 3AVH 1 WAU MUM AS383H I t0-V=ll L ISISHS II -66 'oN eor 900Z/IZ/OI ZZZZ 31tla '8'd aiao 4449-94Z 3NOHd L0966 VNSVTY '30VMOHONY a unS ''aH ONnMoo 73 000z 'STM 'la-n1SVJ 'Y -433r all 'ONI.Muns ONYI KrTYI 1MJ .OZ=..l Gw3S IK30 Maine 'd'S 9994L4 L A0ol8 `9 10l L 3S`dHd `NOISIAIaBnS S11IHANS M-96 'ON 1VId .. 0 0 N N (O E-1