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Home My WebLink AboutGREEN PASTURES LT 1 Onsite File Green Pastures Lot 1 #051 - 283 - 32 Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181187 PID Number: 051-283-32 New ❑ ❑Upgrade Name: JEREMY & NICOLE RUESNIK ABSORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench EJ Bed El Mound Address 17911 ALMDALE AVE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 5 GPD/SF 4.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.0 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot GREEN PASTURES 1 Fill added above original grade 0.0 Ft Gravel length 2@30 Ft Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 3002 Ft` 10.9 Ft. Well 101.3 113.9 117.5 N/A 75.8 TANK ❑ Septic [D S.T.E.P. ❑ Holding ❑ Other Manufacturer ADVANTEX Capacity 2500G,1. Surface Water 100+ 100+ 100+ N/A Material Number of compartments Lot Line 65.7 44.0 65.1 N/A FIBERGLASS 2 NA Foundation 25.3 i 41.4 41.9 N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ 50+ N/A ORENCO 500 Gal. Remarks Pump on level at TIMED in. Pump off level at in. High water alarm at 45in. Pump make and model P2005 Electrical Inspections performed by 907 ELECTRIC Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield FISCHER BROTHERS Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 330.0ft Inspection:, dates: 10/10/18 2nd 10/11/18 Location and description 3°' 10/11/18 4" 11/6/18 SE BOTTOM TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date TH tteven loon .norae � 8149 Approve v� Date —1 ?D Otap `• 1 I RUPUI I_ 1- 1 - 1 L.000 PRIMARY DESIGN PARAMETERS Ct B FC 1 7.8 30.0 3 0 ��41.8 TI 26.7 I—A T2 NO. BEDROOM: 5(750 gpd) 12 52,2 44,7 56.4 ELS M "� E TANK SIZE: 25009 ADVANTEX CATIII :75�,9 M2 62.5 71.7 M3 PERC RATE: 7.83 MPI 570 M4 75.7 79.7 SOIL RATING: 5 GPD/SF AREA ROD: 150 SF REDUCTION FACTOR: 1.0 ADJUSTED ABSORPTION AREA: 150 SF WELL SYS. TYPE WIDE 0.5'ED MIN LENGTH: 30 LF 30.0LFx5.0'Wx0.5' E.D., 4.5' TD TOTAL AREA: 150 SF RESERVE DESIGN PARAMETERS R 'BR 101.3 NO. BEDROOM: 5(750 gpd) L SFJD i — A 1,8 '\ TIC i TANK SIZE: 25009 ADVANTEX CATIII 113.9 AREA PERC RATE: 7.83 MPI I SOIL RATING: 5 GPD/SF 0 AREA ROD: 150 SF \ INISTAL' ED 25 00' ADVANTEX REDUCTION FACTOR: 1.0 f r! TANK W/ 2 EA AX -20 POD ADJUSTED ABSORPTION AREA: 150 SF W1 AUX PUMP VAULT AND W1 SYS. TYPE: WIDE 0.5*ED T FC BEFORE TANK MIN LENGTH: 30 LF USED: 10.9 30.OLFx5.0'WxO.5' E.D- 4.5' TD INSTALLED PRIMARY ABSORPTION AREA TOTAL AREA: 150 SF DRIVEIIVI�Iiy 30LFx5.0'V1x0.5'E.D.,4.5".D. TH- 1.25"o PIPE W1 0.125 DRILLED HOLES Z Ct B FC 1 7.8 30.0 3 0 ��41.8 TI 26.7 I—A T2 39.9 12 52,2 44,7 56.4 ELS M "� E 48.1 :75�,9 M2 62.5 71.7 M3 63.9 570 M4 75.7 79.7 Z Ct 0 D < Z < C) CC. FC. 330.0 I—A AX20 I Aa2-0 2500g ADVANTEX TANK PROFILE SCALE; NTS as 18" O.C. W/ MTs AT ENDS OF FIELD 44�0 "INSTALLED RESERVE ABSORPTION AREA -30LFx5.O'Wx0.5'E.D.,4.5'T.D. 1. T, 5"0 PIPE W1 0.125" DRILLED LED HOLES 18" rl— _ 2 )20 R.O.�A/. A Util ReserO.C. W/ MTs AT ENDS OF FIELD AL\VDALE AVE r Ct Z D 2 10 0 D 10 z CONNECTED RA.,NMCK 0 Co. FG, r Ct CONNECTED RA.,NMCK TO L41DDLE: OFEACH FIELD 3i&5 'I-, - kN-- -- o.m NOTES: PANNONE ENG SVC, LLC Date RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 1/7/2019 PHONE (907) 272-8218 FAX (907) 272-8211 Scale *: 1 "=50' .... .. ..... P.I.D. NO GREEN PASTURES Ll -361, 283-321 DRAWN JEREMY & NICOLE RUESNIK PERMIT NO. CE 8149 OSPI81187 179111 ALMADALE AVEEAGI-E RIVER, AK ...... Sheet 2 OF 2 OWNER OFLAND: ADDRESS: LEGAL DESCRIPTION: DATE PERMIT NUM8ER:OahsOf|sSu8� TAY, IDENTIFICATION NUMBER: 051 - - k;well located sdapproved permit location? >,"�- []No Method of Drilling: e*oir notary i] cable tool Depth nfwell: Casing 7ypefI�e��_�WaUThickness —inches Diameter inches, depth feet Liner Type: Casing Stickup Above Ground: feet Static Water Level: feet Recover Rate: I ___gpnn Method of Testing: ` Well Intake Opening Type: .D open end *�,�open hole [lScreened; Start _______feet Stopped ______-feet 'i Perforations Start _____ feet Stopped _____feet Grout Type: Volume 105 Depth: from feet, to ha8t Well Disinfected Upon Completion? "d.Yeo JNo Method of Disinfection: " _ ATTENTION: It isthe responsibility of the property owner to submit acopy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Ma\Su Borough: Legal Description Green Pastures Lot I Pump Installation Date: II,I3'18 Pump Intake Depth Below Top ufWell Casing Pump manufacturer's Name: F&VV Pump Model: 4F07G1030I Pump Size: l PidessAdapter Burial Depth: 10 Pit|essAdapter Installer: Unknown Disinfected Upon Completion? 0 yes Method ofDisinfection: Chlorine 5OPPM Comments: Pit|essWlanufacturer Martinson Pump Installers Name: Sullivan Water Wells Property Owner Name &Address Jeremy & Nicole Ruesink Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump insta |of| 1/11D019.X:56AKx I, ) y < LO coo V) 00 D: I,- < 1-i C\j Z 0 z 0 LLJ 0 Ld < CD Lij LLJ Li- (D Z < V) oar Lij U) Z 0 Lu -i O� T w < Ir (3 0' < rs V) a_ 0 Ir CC Q� Ld z LLJ C) D 5- < 0 0 C) woo z LL- -i Z 0 D- Z < LLJ o 0 0� m Z U-) < < w G� In n < 0 r-) ::D < ::D (n CL :3: Li Cl� LLJ z 5 T LLJ W c) < LL > Lli U) < LLJ P- C) 0 LLJ D LLI 03 Z ff) W 0 a;,- Z: 0 0 V) < mea < F- -r 10-3 0 < LLJ 0 (D (A 0 tr) Q X t-- (f) Q) 0 C) D (n Lij F-) C� Lli Cr W 0 0 Z Lr) 00 0 0 1 0 0� Q� 0 (D LL Z 57 0 0 V) z U) > 0 LL- z o 04 a- D 0:� 0 x ui > 3.9 -,.* .ON (A Lli rr In Li cr 0 < LU a- LU 0- (.0 LLJ Lj m U < D Lli Ld Clq 0 0 0 M IN T D fr- -i Y) (10 Li FO4 LLJ EL W W m LLJ U < Z Lli C� LLJ 0 C) (,C - 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LLI Q� Lu CL C14 f �7 <9 d � LLI o M < z > r -r LLJ < L.LJ 0 z o I LLJ C) V -i F- Lj Q� >- C) V) 0� a z :?: LLJ 0_ LLJ < �: 00 < GD :3: 0 < LLJ < u - LZ r-1 0 6'SZ 0 0 1 - 0 Lli U) = 0 0 < bi U) z o (D 0 0 Ld a-0 0 < - .on cf) < z z U) L'i C) ci 0 V) 0 cn 0 (n z n (n ::D 0 LLJ LLJ 0 CD < G-' 0� > x (D N < I 6Tz Ld LLJ 0 LLJ 0 bi L'i LLJ (D -1 0 oo < cr z :z z 5 -j ko 0 ;-, C) --1 0 < u D: < < 0 OM F- Z< x 00Q Lij L, :D tc) I u co Co -4 AIL4(1 < 0 0 LLJ A 6T x z Li c Zo cJsz z LL 0 L'i 00 Lli .6' (L < = :3: (f) = co CL Z 0 LU M" 0- 0 cr 0:� Lli 6i cli: U) V) It Lj� 0 LLJ (n 1, j o cr-, < 01 le W fr LL- Q� ( < U < 0 D LLJ oc 9Z*66Z 3.29,9LON . —N U) 0 --- 0 5- 0 M Z n < W W I VA u o (n 0 (n n LJJ < < < doo C14< < > n 0 Sol— m (n ~ 0 a� 4v c (n n, bi X # cfj- 0 Lli (D > �;7 0 o ED L'i V) C) 7' LJ U) a- C) m a %ZC I LLJ 0 0 (D > 0 Q� () 0 �z 0 Uw(D <n�-,7 W(D z H -,=,LLj < Q� (-)z �7 oll 00'- M LLJ D-- < LLJ F- 0 0 Z U) < 0 Z IW Ld CO _j 'o xj� M < 0 m < --i "Zzs §: LLj F— m [-- Lli < LiJ Uj fy > C) LLJ cr- 0 0 x 0 0 0 's 57 <tt Q C-� LLJ :D Li 1: I rr.,, ‘ roe MUNICIPALITY OF ANCHORAGE sent On-Site Water&Wastewater Program N.0 ��, �.� PO Box 196650 4700 Elmore Road • Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,� r. http://www.muni.org/onsite 46y Dcpartmcnt On-Site Water & Wastewater System Permit Permit Number: OSP181187 Effective Date: 7/27/2018 Work Type: WellSeptic Initial Expiration Date: 7/27/2019 Tax Code Number: 05128332000 Site Legal Address: GREEN PASTURES LT 1 G:0753 Site Mailing Address: 17911 ALMDALE AVE, Eagle River Owner: RUESINK JEREMY & NICOLE Lot Size in Sq Ft: 49199 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 5 This permit is for the construction of: 21 Disposal Field Q Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing LSpecial Provisions: During the Land Use Permit review, it is likely that the Plot Plan will change quite a bit. This may trigger a change in the approved Onsite design. A change order may be required. ' tfth R 0 eceived By: i/� ,1�,_,Filp , �� Date: A `�i, Issued By: ,ll �4� Date: 7A Ir 9 MUNICIPALITY OF ANCHORAGE VS Community Development Department ?� Phone: 907-343-7904 Development Services Division �—� Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-283-32 Property owner(s) JEREMY& NICOLE RUESINK Day phone Mailing address 22633 JUDD CIRCLE, CHUGIAK, AK 99567 Site address 17911 ALMDALE AVE Legal description (Sub'd., Block & Lot) GREEN PASTURES L1 Legal description (Township, Range & Section) Lot Size 49,199 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field 0 Initial 0 Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade ❑ Holding Tank ❑ Renewal Duplex (D) ❑ ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well 0 Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. -VI (Signature of property owner or authorized agent) Permit/Rush Fees: 4'78 •VD Waiver Fees: Date of Payment: II ??l g Date of Payment: Receipt Number: Dot ( J 0 Receipt Number: Permit No. OS 08118-7 Waiver No. le Permit App_:-: ....,.c `f i[ J i Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181187, Deb Wockenfuss, 07/27/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181187, Deb Wockenfuss, 07/27/18 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT,herein the"AGREEMENT"made and entered\ into as of this d 5 Day of Ji (y of 20 13 , by and between ,3A.rny 4-Alleat— Z.,.. s,,,x. , ,herein the"OWNER,"and the Municipality of Anchorage, herein the"MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein,the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as 44C0 < located at(legal description) 1711! Al mdake-- Ate-, C 6. "tit 1 A%c.. SS 5.77 — — Gat I , 6,-rel aaS1un, 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement V/f-' with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. • It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs,and inspection costs. This includes an annual maintenance fee(typically$400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. i-Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system,which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 VAOwner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. vi, Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. "I' Owner agrees to grant the Municipality reasonable access to test and inspect the lotAWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. i___*Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction,maintenance and repair of the Owner's AWWTS. id'irt'Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system,or upon transfer of title,and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions,nor in any way affect the validity of the Agreement or any part hereof,or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev.05/18/2018) Page 2 of 3 OWNER: By:, a /qie.,,,,,,,,-,1,_ (signature) Date: 7/2(9()g SPE• *141..►-sta-tcf fllc..L.N e,,..-2,..,4print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoin i tr�ru�m�� e twas acknowledged before m this��day of 714,17/ , 20 ) ), by �it�G Al 1./tole �K l i NOW Y PUBLIC F R ALS /Q -✓NOTARY PUBLIC My Commission expires: 02, 05 O JEAN STOVER STATE OF ALASKA i ? COWSSION EXPIRES DECEMBai 03,201e MUNICIPALITY:4 By: ..-l�ds�l--tV-- - (signature) Date: J7�7i-/ nSS (print name) Title: (rev. 05/18/2018) Page 3 of 3 Parcel I.D. 051-283-32 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Green Pastures L1 Location (site addresso% 17911 Almdale Ave Expiration Date: q-11-1? Current Property owner(s) Jeremy & Nicole Ruesink Day phone Mailing address 22633 Judd Circle Chugiak, AK 99567 Real Estate Agent 2. TYPE OF DWELLING: FLI Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �J� , �/ p Waiver Fee $ Date of Payment ` 1 I ` r Date of Payment Receipt Number ff 0 9 l i7y Receipt Number COSA # 06C 9 16 (13 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 Address P.O. Box 1807 Palmer, AK 99645 Phone (907) 745-8200 Engineer's Printed Name Steven R Pannone ► Date 1g 123 OF !41„ '1r Tli 6. DSD SIGNATURE X_ System #1 Approved for bedrooms S�everi X f�tiriritirie CE -8149 System #2 Approved for bedrooms ��4'•. � Disapproved !!�N .8?OFE551d+'�" Conditional approval for bedrooms, with the following stipulations: C By: �-- Original Certificate Date: 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 sheeU .. c — If more than I septic system isonthe lot: COSACheck|iu1#Iof�__ Structure served bythis system 1____ Certificate of On -Site Systems Approval Checklist (�FB9D��@SfV[8SL1 Legal Description: A.WELL DATA Well type Private |fA.B.urCprovide PVVG!D# \/ Date completed _________ 9/11 /18 Sanitary seal (Y/N)___ Total depth 400ft. Cased to`84 ft. FROM WELL LOG Date 9/11/18 —� �� S�o�� Well production 1on WATER SAMPLE RESULTS: ft. Coliform NBg OOmL Nitrate ND mg/L ug/L Date 12/17/18 Arsenic e_________ B.SEPTIC/HOLDING TANK DATA TankType/k8e0oriu| AdV8Ot8X/Fib8[gl@SS Tanksiza2500 go|. Number ofCompo�nen(s2 Foundation cleanout (Y7N)Y Depression over tank (\YN)N Date ofpumping NewPumper Parcel ID: 051-283-32 �Y __- ��____ Wires properly protected (Y7N)Y Casing height (above ground) 24in. AT INSPECTION New Q1zm- SullivanCollected by: Water Wells 1��1��1� Da��a||od_______ C|eanouts(Y0J)Y Y High water alarm (Y/N) __ C.ABSORPTION FIELD DATA Date installed 10/11K19 Soil rating (g.p�.1ft2mK4bdnn) 5{�X}d System type Wide trench Length 30/30 5 �� Width '0 k. Gravel below pipe 0.�_____5 ft. Total depth 4.5 ft. Ef[absorption area 300 °c Monitoring tube \' Depression over field Kj Date ofadequacy test New Results (Poas/Fa||)For bedrooms Fluid depth inabsorption field before test in. Water added_______gal. New dop(h_____in. Elapsed Time: min. Final fluid depth in. Absorption rate >=g.p.d. Any rejuvenation treatment (past 12mo.)(YYN&type) Ifyes, give date ________ D. LIFT STATION Date inst10/11/18 a||ed Size ingallons 500 . Tinned --- "Pump on" at Timed ^Pumpo�' |eve| a�__. Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: 1��'f Sep��n��e�U�onk�____ Absorption field onlot 100'+ Public sewer main 75'f Sewer /septic service line 25+Animal containment areas 50'f SEPTIC/HOLDING TANK ONLOT TO: a Manhole/Access(YYN)Y 4� Meets alarm &circuit requirements? 100'+Onad�ma�|o� 0nadjacent lots 100'f Public sewer manhole/cleanout 100'+ Holding tank 100'f Manure/animal excrete storage areas 100'f Building foundation 10'f on Property line 10'f 25'+ 25'f Water main Water service |ina_____ Wells nnadjacent lots 100'+ ABSORPTION FIELD ONLOT TO: Property10'f |ine Building foundation 10'f ' Water Service line 25+ Surface water 100'f Curtain drain 50'+ Wells onadjacent lots 100'f F. COMMENTS G. ENGINEER'S CERTIFICATION /oertify that /havo determined through field inspections and review ofMunicipal records that the above systems are in conformance with MOA COSAguidelines /neffect onthis date. Engineer's Printed Name Steven Pannone cos«canary xheeLu-6-1s.do 1�'f Absorption field Surface water 100'f Water main 104 Ddvemmy, parking/vehicle osge101f in.