HomeMy WebLinkAboutSKYHILLS PH 1 BLK 1 LT 8Skyhills # 1
Lot 8
Block 1,
#011-122-19
Municipality of Anchorage Page l_~___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: SW990299 P[DNumber: 011-122-19
'~ame: Wastewater System: ~ New [] Upgrade
Crown Pointe~: Inc.
P.O. Box 112313 Anchorage, AK 99511 ABSORPTION F~ELD
INc. of ~edrooms:
Phone: 3 4 5-- 6 2 7 7 F1ve ~ Deep Trench [] Shallow Trench E) Bed [] Mound 63 Other
LEGAL DESCRIPTION so, eating: Total Depth from original grade:
· 8 GPD/Sq. Ft, 1 2 '
Lot: ~lock: Subdi~,ksion: Depth to pipe bosom from original grade: Gravel d~oth beneath pipe
8 1 SkyHills No. 1 Ft. Ft.
Township; I Range: I Section: Fill added above original grade: Gravel length:
I
I
2 Ft. 5 3,5 Ft.
Gravel width: Number of lines: ID]stance behveen lines:
WELL:
New
Upgrade
3 Ft. 1I N/A Ft.
'~assification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe material:
City Water System Ft. Ft. 963 SD. Ft. ASTM D3034 PVC
~'riller: Date Drilled: StaticWater Level: Installer: Date installed:
Pt., LH Construction 10/4-22/~p
Yield; I Pump Set at: Casing Height Above Ground: TAN K
_ GPMI Ft. Ft,
SEPARATION DISTANCES ~ septic E3 Holding ~ S.T.E.P.
TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank SewerLines Anchorage Tank 1 , 500
Well- N/A N/A N/A N/A N/A Material: Steel NumberofCompar~ments:
TWO
Surface N/A
Water > 100 >100 N/A N/A N/A LIFT STATION
Lot > 5 ' > 1 0 ' N/A N/A N/A Size in gallons: Manufacturer:
Line
5 ' > 1 0 ' N / A N / A N / A "Pump on" level at: I "Pump off" level at: High water alarm at:
Foundation
CurtainDrain None NOted on Lot Pump Make&Model Electrica[Inspections pedoTmed by:
Remarks: BENCH MARK
Location and Description: ]~ack Door Stoop
Assumed Elevation:1 0 0 . 0
ENGINEER'S SEAL
Department of Health and Human Services approval
72-O13 (Rev. 9/91 ) MOA 25 '~,
Permit Number SW990299
PID No. 011-122-19
S1 31 .5'
S2 15.5 32.4'
C3 32.5 41 .9'
10' U~..'-- ESU[.
M1 2 70.6'
C5 6 55.8'
.[ ' /.. Bedroom ~ '
-/ /
' /.' C~ .'.. .' .. ·
.
'' '.- YC¥ ~
~?~ ¥;A¢" ,,x~:~ .~,~, HILLs n~,,_
Page 2 of 3
I
-/ o~?
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 SW990299
PID No. 011-122-19
100.2
51'
13.5' 4'
25.8'
78.5
6.5'
92.3
/-
Geotextile Fabric
Drainfield Rock
\ 87
.6
81 .0
47'
IPROFILE AS-BUILT
No Scale
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 198650, Anchorage, AK 99519-6850
(9O7) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Aug 24, 1999
Expiration Date: Aug 23, 2000
Permit Number: SW990299
Legal Description: SKYHILLS PH 1 BLK 1 LT
Design Engineer: 0014 Anderson Engineering
Owner Name: Crown Pointe, Inc.
Owner Address: PO Box 112313
Anchorage, AK 99511-2313
Parcel ID: 011-122-19
Site Address:
Lot Size: 61687 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
I~ 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 ( 18AA072 ) and Drinking Water Regulations ( 18AA080 ).
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 (lay.
B. Covered, sealed, and heated to prevent freezing.
Received By: "~~~' ~ ~-.~Z~
Date:
RECEIVED
Mailing Address:
Legal Description:
Lot Size:
Number of Bedrooms:
AUG 1 0 1999 MUNICIPALITY OF ANCHORAGE
Department of Hea th & Human Services ~, ,-- ~;
Municipatity of Anch~or~.site Sewer/Well Permit Application _~ L\ ~,,~ ~. '~
Dept. Health & Human uerwces SINGLE FAMILY DWELLING Parcel Identification Number
Property Owner Name: Cro~wn~Pointe Inc. _Day Phone: 3~45-6277
P.O. Box 1 '~ 2_3! 3 Anchorage_, AK 99511__-23~1~3
_Lot 8,~Bo~k 1, Sk~v H__il!s Subdivision ~L'"*.,/~. -'--~,~
Inspections will be conducted by:
%1 61,6_8_7 Square Feet
Fi~ve__(5_)
X Approved Engineerin9 Firm
~.__)'~'[ '~(~t.,,(t"'_.4,¢~~'\,.z.~ ',~ { '""' ~' -~) -~' ___ Municipality (permit fee included)
Does your house contain any of the following: Hot Tub, ~wimming Pool, Therapy Pool, Jacuzzi,
Or Water Softener Unit? N~o If yes, which one?
This Application is For: Sewer On y XXX Sewer and Well _. Sewer Upgrade
I certify that the above information is correct, I further certify that this application is being made for a
Single Family Dwelling and in accordance with applicable Municipal Codes.
Engineer
Fees: ~)gAL ),
ANDEI :ENGINEERIN
~ ~ N C H O I~,A G
522 i7773;
August10,1999
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 8, Block 1, Sky Hills Subdivision
Septic System Design Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owners of Lot 8, Block 1, Sky Hills Subdivision intend to build a five bedroom home
on the lot. We are therefore applying for a permit to construct a septic system to serve
the house. The Site Plan shows the location of the new system along with the alternate
system. It also shows the location of the proposed water service line. 'l'he lot is
currently served by the Municipal water system.
The testholes placed on the lot revealed silty sands which percolated at rates ranging
from 2 to 8 minutes per inch. No groundwater was encountered nor was any noted
during the monitoring period. We have therefore designed a deep absorption trench
system with an 9' effective depth and 53' in length. The distribution pipe will be placed
at 3' below the surface and the total depth of the system will be 12'. A minimum of 3' of
cover will be provided over the trench.
The ground surface on the lot slopes in all directions from the home site as shown on
the Site Plan. At the back of the lot the slope is approximately 10% in the area of the
new absorption trench. The trench will be constructed parallel to the slope in
accordance with Municipal requirements. Since the subdivision is served by the
Municipal water system no conflicts will exist between the septic system and other
wells in the area. Similarly, the septic system will not conflict with other septic systems
on adjacent lots.
If the system is constructed in accordance with our design the following statements
apply:
]. 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. ']'he system, if constructed as designed, will have no adverse impact on reserved
space, either surface or subsurface, on any lots located in the area.
Lot 8, Block 1, Sky Hills Subdivision
August 10, 1999
Page Two
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
SkyHills S u bdi visi on ~-~
TC
2C
10
Vacant
Vacant
Vacant
7
Vacant
OG 4
Vacant
Vacant
TH7~ 0
TH7'
9
8
:.;' Vacant
]H-go
S PROjEcT
Vacant
4
3
KINCAID AC.~S
TH~95
3
2O
17
SCALE 1" = 200'
UNSUBDIV]DED
10' UTP_- I~MT.
?,500 Gallo]
Septic
_ve
-Bedroom
Home
NOTE:
Maintain Minimum 10'
Separation Between
Absorption Trench and
Water Line.
SKYHILLs DRIVE
SITE PLAIN
SCALE 1" = 40' '~'
LOT 8, BLOCK 1, SKY HILLS
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Five Bedroom System
Perc. Rate: 8 Min./Inch
Application Rate: .8 GPr)/SF
5 Bedrooms X 150 GPD / .8 GPD/SF
938 SF/18 SF/ LF of Trench = 52.1
Deep Trench System
1,500 Gal, Septic Tank
9' Drainfield Rock
= 938 SF of Absorption Area
LF Trnch Length
Therefore: Construct a Deep Absorption Trench System With One Lateral
53' in Length with 9' of Drainfield Rock Beneath the Lateral.
Distribution Pipe in Trench Placed at 3' Below the Original Ground
Surface, Total Depth to be 12' From Original Ground Surface. Mound
Over Trench to Provide 3' of Cover or 2" of Direct Burial Insulation and
2' of Cover,
Natural
2' -6" Backfill
Geotextile
Fabric
4" Perforated
PVC (Slots Down)
Dralnfield
Rock
No"rE:
TYPICAL DE_EP TRENCH
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 4' From Groundwater,
Maintain 10' Separation From Lot Line,
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: nr
1
2
3
4
5
7
8
L H Construction
BLK 1
! Sky Hills Subdivision
DATE PERFORM[
SLOPE
SITE PLAN
10
11
12
13
14-
15-
16-
17-
18-
19-
20-
COMMENTS .
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT O
DEPTH? p
E
Dcp~ to Water Alter ~.~l:~' ,~ ~ ~
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~ tmmutes/,nch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~,~1'* FT
Pete cavity was presoaked
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES tN EFFECT ON THIS DATE. DATE:
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
L H Construction
LT ~,BLK~,Sky Hills Subdivision
DATE PERFORN
1
2
3
4
5
6
7
8
9-
10-
11
12
13
14
15
16
17
18
19
20-
COMMENTS
Perc cavity was
SLOPE SITE PLAN
-
~--"' -:' :d?;-d'~~ ' }"I X ~ ~>'
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH? ~
~eDlh 10 Waler Nt~r ~.~.
Moflit0rin~? "~' Date:
Reading Date Time Time Water Drop
presoaked
(minutes/tach) PERC HOLE DIAMETER
Michael E Anderson
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
L H Construction
LT ~ BLK ~-, Sky Hills Subdivision
DATE PERFORMED:
1
2
3
4
5
6
7
8
9-
10-
11~
12
13
14
15
16
17-
18-
19-
20-
COMMENTS Perc cavity was
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
IF YES, AT WHAT
DEPTH?
Monitoring?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE ~,,~ I~ (mmulesJmch) PERC HOLE DIAMETER
TES~ RUN BETWEEN / ~ FT AND ~(¢ ET
pYesoaked
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
ON-SITE! WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 8, BLOCK 1, SKY HILLS SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,500 gallon septic tank. It also includes the construction of a
new 53' long x 3' wide x 9' effective depth absorption trench at the
location shown on the attached Site Plan. The total depth of the
trench will be 12' below existing ground. Mounding over the trench
may be required to provide a minimum of 3' of protective cover.
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.
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 INSTALL.ATION
1. The 1,500 gallon septic tank must be procured from an approved
source and installed at the location shown on the plans.
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 rninimum 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 8, Block 1, Sky Hills Subdivision
August 10, 1999
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:
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.
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.
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.
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.
Grade area surrounding the absorption trenches to drain away.
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.
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).
Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
Lot 8, Block 1, Sky Hills Subdivision
August 10, 1999
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:
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.
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 625 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-4744
Parcel I.D. 011 -122-19
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
/
Expiration Date:
Lot 8, Block 1, Skyhills Subdivision, Phase I
Location (site address or directions)
Current Property owner(s) crown Pointe, Inc, Day phone
Mailing address P.o. Bo× 112313 Anchorage, AZ( 99511
345-6277
Lending agency
Mailing address
[)ay phone
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOM,S: Five
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class Well[]
Public Water System []
(5)
TYPE OF WAS'TEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
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
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.
72-025 (Rev, 01/00)'
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 Health Authority Approval Guidelines for the Health Authority Approval
application show 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. 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 in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone
Address P.O. Box 240773 Anchorage, AK 99524
522-7773
Engineer's Printed Name Michael E. Andersonf P.E. Date 522-7773
DHHS SIGNATURE
P'/ Approved for ~ bedrooms.
Disapproved. -;
Conditional approval for bedrooms, with. the foil
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date: ~-/ /-/ ' 0 ~
Original Certificate Date:
Reissue Date:
75-025 (Rev. 01/00)'
Municipality of Anchorage
Departrnent of Health and Human Services
Divimon of Environmental Services
On-Site Services Section 825 "L' Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. cl.ancnorage.ak.us
(907) 343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
<tCEIVED
MUNICIPALI'I Y OF ANCI-~I,~
'VlP~NMENTA~ SERVICES DIVIm '
Legal Description:
A. WELL DATA
Well type __
Date completed
Tota depth
Lot 8,, Block ", Skyhi:Lls Subdivision
Municipal Water System
If A, B, or C provide PWSID #
Sanitary seal
ft Cased to ft
FROM WELL LOG
Date of test
Static water level fl
Wel oroduction g,p.rn
WATER SAMPLE RESULTS:
Coliform colonies/100 m
Date of sample:
B, SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Date installed ' 0/22/99 Tank size
Cleanouts Y Foundation cleanout_ Y
Date of Dumping New Construction
C. ABSORPTION FIELD DATA
Nitrate mg/I
Collected by:
Phase I Parcel l,D.:
011-122-19
Well Log
Wires properly protected
Ca,,~ng height (above ground)
AT INSPECTION
ft
g.p.m
Other bacteria
colonies/100 mi
500 gal Number of Compartments 2
Depression over tank N __ High water alarm N
Pumper N/~.
Date nstalled 10/4/99 Soil rating (g.p.d./ft2 or ft2/bdrm) · 8
Length 53.5 ft Width 3__fi Gravel below pipe 9
Total depth ' 4 fl Effective absorption are& 96~ft2 Monitoring tube
Date of adequacy test New const:. Resu ts (Pass/Fail)
Fluid aeoth in absorption field before test q Water added_
Elaosed Time: rain Final fluid demh in
Any rejuvenation treatment (past 12 mo.) (Y/N & type.) ~
in,
System type Deep Trench
ft
Y Depression over field N
For bedrooms
_ gal. New depth in.
Absorption rate >= ____ g.p.d.
If yes, give date N/A
72-026 (Rev. 01/00)*
D. LIFT STATION - N/A
Date installed
"Pump on" level at __
Datum
Size in gallons
in "Pump off" level at
Cycles tested
in
Manhole/Access
High water alarm level at in
Meets alarm & circuit requirements
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: No Well
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
on Lot
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Building foundation 5 ' Property line > 5 '
Water main > 10 ' Water service line > 10 '
Drainage > 100 ' Wells on adjacent lots > 100 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation > 10 '
Surface water > 100 '
Wells on adjacent lots > 100 '
Absorption field
Surface water
>10'
Water main
Property line > 10 '
Water Service line > 10 '
Curtain drain None Noted
F. COMMENTS
>5'
>100'
Driveway, parking/vehicle storage > 5
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 Printed Name Michael E. Anderson, P.E.
Date 6/12/00
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
'S
72-026 (Rev. 01/00)*