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863 Lakewood Hills Rd - Sewage System As-built INDIVIDl1AL SEWAGE SYSTEM AS-BUItT Date Installed��I�"�Y Permit No.��7 Owner: ;r�;�1�� � Project Address ��� --�a�c�o�D3fr��� ,�gaK �'11� House Type: II III Property ID No.(PIN)_ _ - _ _ _ _ _ - _ _ _ -_ _(Dak Co Tax Info 651-438-4576,or www.co.dakota.mn:us) C� wp Installed for�Bdrms or al/day Commercial Use?Y N� ❑New[�fieplace�Repair Addition Property Transfer U grade?�/P� � Bsmt Lift P p?Y N�uture� �N ' Jacuzzi?Y(N�Garb Disp?Y,�N� r� i /(( Soil Survey Map Uni Soil Compact�i?Y� �/ 1�2,g Fill Soil? Y�} a���nC � � 0' Circle Soi�euture: � Ss (Faster than 0.1 mpi) G����S Coarse Sand Medium Sand Loamy Sand 0.83 / FI�iFE S�1NL? t.G� L•� >-���, �,G�. Sandy Loam'1.27 �'� + W oam 1.67 ti Silt Loam, Silt 2.00 Sandy Clay Loam 2.2 Silty Clay Loam I Clay Loam ,� Silty Clay, Clay 4.2 �* ; �u�� (Slower than 120 mpi) t Soil dry enou for ��"`��� � � � construction�N 5'°� � SETBACKS: Prop.Lin�es 10'�C?f � �' Bldgs 10'to Tank�&20'to Drnfld�Z� o 00 Well(s) setback��-�( )not installed yet "� - " Well Depth ,r0 ()Orig.Well Record( )Measured 1 ��- t� I ��������5 Distance to Lake�Creek�/�Wetland� ��� Buried Water Pressure Lines 10'to Ta Drnfld?� �i�r Line drawn from Tan o Pump Truck Aceess 100" Y�1 System located by Photos?Y�GPS?Y� RESERVE AREA. Y/ Fenced Off? Y N SEPTIC/HOLDING TANK(S) �New ❑ Exi �ng Owner informed to reserve Reserve Area? Y Liquid Capacity O-- 1 compartment Owner given Septic System Owner Guide? Y� Made by �o�.c� i _ Watertight? Y N �BED OR GRAVELLESS DRAINFIELD: Baffle Type: Plastic Fiberglass Sanitary-T Conc�� Dro oxes evel? Y�1 Type — conerete/plastic No. of Inspection ipes -_-�"/6"diam. Tank Level? Y N Trench Depth �� �� Width /�c� �� No./Diam. Manhole Access_s�lnlet/Outlet/Center Number of Trenches � Trench Bottom Level Y/N No. & Height of Manhole Risers — ' Trench Lengths � Spacing — New Tanks 4 ft or less below Final Grade N Rock Clean.�1 2"over Pipe? N GeoTextile Cover N Pipes into Tank Sealed? with l�n�� e Depth Below Pipe?_�" Soil Backfill Depth " Riser into Tank Base S led?with o K .� Y N Gravelless Pipe Size? Made by Outlet Effluer�t F�Iter? Y�Type Cha�rs�er�ize? Made by • ���re�� Absorption Area: Sq Ft��� Lineal Ft /a J�9'S' Percent Slope_�% Scari ication ethod: � � � Trench Bottom to mottling/bedrock? inches Dike Width Up Down Side pUMP TANK Made by l60�"�`�,v6fd �Capaci I� Clean Rock�Depth Below Pipe � inches No. & Height of Risers �--- � `` Sealed? N Clean Sand? Y/N Depth Upslope----" Downslop�---" Pump Manufacturer � Model# ��_ Inches to Mottlin�,�Pipe Size/Spacing � tr Horsepower CZGPM �3 _Feet of Head�� Perf Size/Spacing�Final Cover Depth /� " Cycles Per Day�Gallons Per Cycle �r Rock Bed Size /���� Supplier: Size of Discharge Line 1.5" Sand Base Size Supplier: Type of Electrical Hookup ost&box b tar� Upslope needing drain e/diversion? Y N rovided jY N q�arm Loca ' garage basement Grading done:Rough Fina1 Alarm• ank Alert Level Alarm/Other j�Seeding OSod to e done by: C cle o n er. Y%N Water Meter? Y/N I hereby certify,as installer,that this individual sewage treatment system Designated RegisteredG�� ��. was installed according to the approved design,and as applicable,this Professional Onsite� Municipality's Sewage Treatment System Ordinar,ce,&accurately locates � p y �� � � alI system com onents for ter rel cation. PCA Lic.No Com an Name� � � Instal q j c� ��� � Si n Date: !�/�"��/ P � Address �1^� , Insp tor � �� /� Sign Date: pproved: / es Yes with Conditions: White copy: Yellow:Owner Pin<:lnstaller - o:\emgmt\forms\ Im\ists\as-built-form.doc