HomeMy WebLinkAboutWARD LT 9Ward
Lot 9
011-122
-88
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 0sP101286 PID Number: 011-122-88
Name:
The Dittrich Company Wastewater System: [] New [] Upgrade
Address:
P.O. Box 90411 Anchorage, AK 99509 ABSORPTION FIELD
Phone: Number of Bedrooms:
632-8790 4 [] Deep Trench ~ Shallow Trench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION Sol, Rating: Total Depth from original grade:
1.0 GPD/Ft2 9 Ft.
Block: Lot: l~ Subdivision:Ward Depth to pipe bottom from5 original grade: Gravel depth beneath4pipe:
~ Ft. Ft.
Township: Range: Section: Fill added above odginal grade: Gravel Length:
0-1 Pt. 61 Ft.
Well: [] New [] Upgrade Gravelwidth: Number of lines: Distance between lines:
5 Ft. I - Ft,
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
AWWU Ft. Ft. 610 Ft2 ASTM D3034 PVC
Driller: Date Drilled: StaticWater Level: Installer: Date Installed:
Ft. Glacier Masonry 5/21/2011
Yield: GPM Pump Set at: Ft. Casing Height Above Greund:Ft'
TAN
K
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
T~ To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity:
From~
Tank Field Station Tank Sewer Line Anchorage Tank 1,250 Gal,
Material: Number of Compartments:
we, N/A N/A N/A N/A N/A Steel Two
SudaceWater >100' >100' N/A N/A % / LIFT STATION
Size: Manufacturer:
Lot Line >5' >10' N/A N/A Gal,
"Pump on" level at: "Pump off" level at: in. High water alarm at:
Foundation >5' >10' N/A N/A in, in.
Pump Make & Model Electrical Inspections performed by:
Curtain Drain None Noted
Remarks:
BENCH MARK
Location and Description:
Back Deck Northeast Corner.
Assumed Elevation:
100.0 Ft.
Inspections performed by: A. Harala Dates: 1st 5/21/2011
2nd 5/21/2011
Development Services Department Approval
Conditional Approval Date:
Permit Number: OSP101286
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
Page 2 of 3
PID No. 011-122-88
LLI
LLI
50'
PENNY ROSE CIRCLE
DRIVE
Four Bedroom Home
S1~
S2
S1 25A.7' 27B.7'
32 1 34'3'1 33.9'
C5 123.2' 126.2'
C6 129-1'1119.7'
M1 131,1 119.0'
0
0
0
0
Z
LEGEND
TH - Test Hole
M1 - Monitor Tube
C5 - Cleon Out
FCO - Foundotion Cleon Out
WARD SUBDIVISION
LOT 9
40,155 S.F.
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655.- 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP101286
Page 3 of 3
PID No. 011-122-88
/--- 96.6 o4 ~o
I /' ExJstinql [1~ ~
II Gr°und I~ ~1
1,250 Gallon ]~
Septic Tank ] ~.~
85.0
fgU.Z
Existing and Finished
Grade
Geotextile Fabric
Drainfield Rock
8~.0-/
I 61' (Trench Length)
,~ 72.0
No Groundwater
85.0
PROFILE AS-BUILT
No Scale
On-Site WaStewater Disposal System
OSP101286
01112288000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
Tax Code Number:
Work Type: Initial
Permit Effective Dates: December 20, 2010 to
Design Engineer: ANDERSON ENGINEERING
Subdivision: WARD
December 20, 2011
Permit
Site Legal Address: WARD LT 9 G:2222
Owner/Address:' WELLS FARGO BANK NATIONAL
ASSOCIATION K3213-013 PO BOX 196127 ANCHORAGE AK 995196127
Site Mailing Address:
Lot Size in Sq Ft: 40155
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: ?
Date:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www. muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-122-88
Property owner(s). The Dittrich Company
Mailing address P.O. Box 90411 Anchorage, AK
Site address Penny Rose Circle Anchorage, AK
Legal description (Sub'd., Block & Lot) Lot 9, Ward Subdivision
Legal description (Township, Range & Section)
Lot Size 40,155 Sq. Ft.
Day phone 632-8790
Zip Code 99509
Zip Code 99516
Number of Bedrooms Four (4)
THIS APPLICATION IS FOR ([~ all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
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 Dwelling and is in accordance with applicable Municipal Codes.
1//
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P.O, BOX 240773
ANCHORAGE, AK 99524
522-7773 677~7766 (FAX)
December 16, 2010
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 9, Ward Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 9, Ward 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 accommodate the home. The subdivision is served by the AWWU
water system. The attached Site Plan and backup documentation identify the location
and configuration of the proposed septic system along with the alternate site. No
existing wells are closer than 100' from the proposed septic system. Drainage arrows
are shown on the site plan showing the grade and direction of flow on the lot. The
drainage pattern will not be changed as a result of this project.
The test holes placed on the tract in the area of the absorption trench and alternate site
indicated clean sand (SM/SP/SW) material with some silt. The percolation rate of the
soil was determined to be less than 1 minute per inch. More than 50% of the soil
particles pass the No. 4 sieve and a sand liner is not required. No groundwater was
found during the placement of the test holes and none was noted during the monitoring
period. An application rate of 1.0 gallons per day per square foot was used in the
design of the absorption system. We are proposing to place a new 1,250-gallon septic
tank and a 60' long by 5' wide by 4' effective depth absorption trench to treat and
dispose of the effluent generated in the house. The elevation of the distribution line in
the absorption trench will be 5' below the surface and the total depth will be 9'. A
minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the absorption
trench and 4' over the septic tank.
The ground surface on the lot in the area of the absorption trench slopes from the north
to the south at a grade of 2% to 5%. The new trench will be constructed parallel with
the slope as much as possible in conformance with Municipal requirements. The new
Lot 9, Ward Subdivision
December 16, 2010
Page Two
septic system will be constructed a minimum of 100' from all wells and any surface
water and 10' from the proposed and existing water services in the area.
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.
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.
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.
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
t
50'
Hanks Subdivision
N89*51'06"E 119,8~'
0
Lot 1
O~
r4 40,168
~ sq.ft.
SOO' 15'56"E
Lot 2
r4
40,262
sq.ft.
114.01' 134.00'
S89'51'10"W 329.76'
249.69'
134.00'
Gas Esmt
VACANT
PENNY
-- ROSE
CIRCLE
....... 15.3.99 .....
VACANT
\
'"" 10' T&E Esmt
........ 134.00 .........223.06 ..... -) - --~.~.f - -
~t~.ff. S~d.v.~.on ~:;."
I
I ~ ..... ..~....~..;.:~. _..~......,.,...~ ..... ............ ~ ...... ~ ....
ARE P
SCALE
ura~nage__.~.~ \ \
VACANT
42,1 34
~xx Lot 6
sq.ft.
sq.ft.
Lot 4
VACANT
WARD
SUBDIVISION
LOT 9
4-0,155 S.F.
I,I
I,I
-r-
0
03
.,-
0
PENNY ROSE CIRCLE
) ' N 89'51'10"E 113.95'
,, .~' _ ·
~15' GAS ESMT.
W
Four Bedroom Home
FCO
x ~
..30'
S1 r~ 1.250 Gollon
S2 ,_] Septic Tonk
IC0(2)
60' Lonq x 5' Wide
x 4' Effective Depth
Absorption Trench
c0f
Altemote Site
10' T. & E. ESMT.
98' ~J
EL.'= 254.¢
2.5'
Cleanout O 50'
N 89'52'00"E 155.99'
SITF PLh
0
0
Z
SCALE 1' = 40'
TH - Test Hole
MT - Monitor Tube
CO - Cleon Out
FCO - Foundotion Cleon Out
LOT 9, WARD SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home 5' Wide Trench System
Perc. Rate: <1 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.0 GPD/SF '~ 4' Drainfield Rock
4 Bedrooms X 150 GPD/1.0 GPD/SF (Application Rate) = 600 SF Absorption Area
600 SF/5 SF/LF*.5 (Red. Factor) = 60 LF Trench Length
THEREFORE: Construct a 60' Long x 5' Wide x 4' Effective Depth Aborption Trench at the
Location Shown. Flow Line Elevation in Trench to be 51 Below Odginal Ground Surface. Total Depth
to be 9' Below Existing Ground. Provide 3' of Cover Over Trench and 4' Over Tank or Provide
2" of Insulation and 2' of Cover. Maintain 10' Separation From Water Services in the Area.
1611
11
1011
Backfill
Ge°textile
Fabric
4" Perforated
PVC (Holes Down)
-- Drainfield Rock
TYPICAL DEEP TRENCH SECTION-;---','-",--.,
NOTE: Grade Area Over Trench to Drain Away. ~ ~/ 49th ~ %~ ~
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Private Wells in the Area.
Minimum 100' Separation From Su~ace Water or Streams.
Minimum 10' Separation From Water Se~ice Line.
3
L~
5
6
7
8
9
PROJECT #:
PERFORMED FOR:
LEGAL DESCRIPTION:
06
0G/OL
SM
Otive
Sand with Sitf
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM
L. 700 SOUTH BRAGAW ANCHORAGE, AK 99519
SOILS LOG - PERCOLATION'TEST
LanTech Inc.
Lof 9, Johnston Subdivision
DATE PERFORMED:
TEST HOLE #
2/18105
WAS GROUNDWATER
ENCOUNTERED?
'18 SLOPE
SITE PLAN
See Sire Plan
IF YES, WHAT DEPTH.'?
DEPTH OF WATER
SP AFTER MONITORING:
Less Sitf DATE:
NO S
L
O
P
None E
2/28/200S
See Sire Plan
18
COMMENTS:
B0H 18'
GROSS NET DEPTH To 'NET
READING DATE
TIME TIME WATER DROP
Start 2/18 15:4-0 6.38"
1 15:50 10 Dry
Recharge 1551 6.38"
2 16.'01 10 Dry >10'
Recharge 16:02 6.38"
3 16:12 10 Dry >10'
PERC RATE: >1 MI~q./INCH PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN 5.0 FT. AND 6,0 FT.
Test Hole Pre SoaRed Prior fo Percolation Test.
TEST PERFORMED BY: AH
I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN' ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2/28/2005
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 9, WARD 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 60' long by 5' wide by 4' effective depth
absorption trench also at the location shown on the plan. The distribution line
in the trench will be placed at 5.0' below the existing ground surface. Total
depth of the trench will be 9.0' below the existing ground surface. The new
absorption trench must be placed a minimum of 100' from all wells in the area
and 100' from any surface water in the area. The septic system must also
be a minimum of 10' from the water service line on the lot. A minimum of 3'
of cover is required over the absorption trench and 4' of cover over the septic
tank.
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. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
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 Building Safety On-Site Water and Wastewater
Program for system installations. Owners installing their own systems must
receive prior approval from the On-Site Water and Wastewater Program
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 include two 4" cleanouts for pumping access.
Lot 9, Ward Subdivision
December 16, 2010
Page 2 of 3
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.
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 the distribution line 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.
7. Grade area surrounding the absorption trench to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for
absorption trenches. All pockets of unacceptable materials must be removed
and replaced.
Lot 9, Ward Subdivision
December 16, 2010
Page 3 of 3
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).
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.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.org/onsite
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FoR A SINGLE FAMILY DWELLING
Parcel I.D. 011-122-88
GENERAL INFORMATION
Complete legal description
Location (site addres~°~7 ~' Penny Rose Circle
COSA # (~) ~¢.~ / \ \ ~(¢ .~
Expiration Date:
Lot 9, Ward Subdivision
Ancl~orage, AK 99502
Current Property owner(s) The Dittrich Company
Mailing address P.O. Box 90411 Anchorage, AK 99509
Day phone 632-8732
Lending agency
Day phone
Mailing address
Real Estate Agent
. Mailing Address
'Unless othem'ise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Four (4)
Day phone
TYPE OF WATER SUPPLY:
IndiVidual Well []
Individual Water Storage []
Community Class ~ Well []
Public Water System []
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 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 oft)edrooms and type of structure indicated herein. I further verify that based on the information
obtained f/om"~th,e r~'bnicipality of Anchorage files and from my investigation ar~Linspection, the on-site water
supply.ah~d)'O[v~stewater disPosal system is(are) in compliance with all applica~.' Ie Mdnicipal and State codes,
ordnances, ~nd regulations ~n effect at the hme of ~nstallabon. ~ ,~,,,
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
~"'/Approved for
Disapproved.
Conditional approval for
bedrooms.
Date 9/24/2011
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:~~e'~'~'~Original Certificate Date:
(Rev. 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type AWWU
Date completed..
Total depth ~
Lot 9, Ward Subdivision
IfA, B, or C provide PWSID # ~
Sanitary seal (Y/N) ~
Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate ~ mg/L
Arsenic: ugll Date of sample: ~
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 gal. Number of Compartments Two
Foundation cleanout (Y/N) Y Depression over tank (Y/N) ~
Date of pumping New Construction Pumper
C. ABSORPTION FIELD DATA
Parcel ID: 011-122-88
Well Log (Y/N)
Wires propedy protected (Y/N)
Casing height (above ground) ....
AT INSPECTION
Date installed 5/21/2011
Length 61 ft.
Total depth 9-10 ft.
g.p.m.
Other bacteria
Collected by:
in.
Soil rating (g.p.d./ft2 or ft2/bdrm) 1.0 GPD/.SF
Width 5 fi.'
Eft. absorption area 610 ftz Monitoring tube
Date of adequacy test New Const. Results (Pass/Fail) __
Fluid depth in absorption field before test in. Water added
Elapsed Time: ~ min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type 5' Wide Trench
Gravel below pipe 4 ff.
Y Depression over field N
For bedrooms
~ gal. New depth in.
in. Absorption rate >= g.p.d.
N If yes, give date
Date installed 5/21/2011
Cleanouts (Y/N) Y
N High water alarm. (Y/N) N
colonies/100 mL
LIFT STATION
Date installed
"Pump on" level at~
Datum
¸in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at~
Cycles tested
in.
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
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main N/A Water service line >10'
Wellson adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10'
Water Service line >10'
Curtain drain None Noted
Building foundation >1o'
surface water >100'
Wells on adjacent lots
F. COMMENTS: Property is Served by AWWU Water System.
Absorption field >5"
Surface water >1o0~
>100'
Water main >10'
Driveway, parking/vehicle storage >25'
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 COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 9/24/2011
COSAFee $ (~
Date of Payment,
I~P~t Number
(Rev. 11/05)
~" ~Waiver Fee $
Date of Payment
Receipt Number
'1-
0
PLAT NO. 2006-13
WARD SUBDIVISION
LOT 9
40,155 S.F.
PENNY ROSE CIRCLE
DRIVE
EXISTING BUILDING
SEPTIC SYSTEM
i2.6
10' T. & E. ESI~IT.
.89'52'oo"E ~3.9g' '
1"=40'
COVERED ENTRY
j~.",o.~. ~.1_____
24.0' i 0.0'
24.0'
8.0~
30,0'
14,5'
BUiLDiNG DETAIL
SCALE: 1"=20'
AS 'BU'iLT i',;,.~, ..............
CERTIFY THAT I HALVE SURVEYED THE
...... PROPERLY DEPICTED ABOVE AND THAT NO
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SURVEYING, LLC :iT IS THE IRESPONSIBILITY OF THE OWNER TO
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F.B. JOB NO.
NOTE: NO CORNERS SET THIS DATE,
11-03 WS9