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