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Home My WebLink AboutGLENN VIEW ESTATES NORTH BLK 1 LT 3Glenn View Estates North Block 1 Lot 3 #051-821-16 ake --o a propof.;ed Ae±ac\ ea swage_ a ;elect! alternot±c £;+e_ has been okssy d, Advantex Treatment System with 40' Long x 3' Wide x 8' Effective Depth Trench. Application Rate 1 GPD/SF. GLENN VIEW ESTATES NORTH BLOCK 1, LOT 3 Page 1 of 1 Poet, Jeff W. From: Chuck Leet [chuck@alaskarim.com] Sent: Monday, March 17, 2014 11:36 AM To: Poet, Jeff W. Cc: KLiebne@bobservices.com Subject: Glenn View North, Block 1, Lot 3 Jeff, Per on conversation, this confirms that the swing ties on the above referenced septic system were based on the as constructed home. Please feel free to insert this email into online file. Charles A. Leet, P.E. Alaska Rim Engineering, Inc. 907.745.0222 907.355.3848 3/17/2014 Trict A w Lot 2 15' TELECOM. 8 ELECT. EASEMENT c4 Nc Rr FOODS Ng N .13 g 1 Lot 4 HOUSE DETAJL SCALE 1' • 30' m b• TWO STORY WOOD FRAME RESIDENCE "So. COVERED PORCH &Pi i sa5•E 119.29' Tract E /2 N 2.0' CANT PLOT PLAN ASBUILT SCALE I' ' 90' GRID NW 1560 Project Na 03-230 Lang & Associates, inc. 11500 Daryl Avenue. Anchorage, Alaska 99515 907 522-6476 Phone Registered Land Surveyors (907) 522-4625 Fax the foliowI described property: .... _ - T 2003=42) Improvements situated thereon are within the properly lines and do not encroach onto the properly adlacent thereto, that no Improvements on the property lying acquaint thereto encroach on the surveyed premises and that then are noaye, transmlalon lines or other visible easements on said properly except as I�aated hereon. th Dated this the. Day of M0.9 -[.k4 'looat Anchorage, Alaska R 1s the nsponsibillty of the owner to determine the existence of any -easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 0 Municipality Anchorage `- t' of •'`'° i 1 Development Services Department ,,�� `� Building Safety Division ��'ir On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: sw-030395 PID Number: 051-821-16 t�L,,�.r : l• ' of Name: Thomas & Company, Mike Thomas Wastewater System: 0 New ❑ Upgrade Address: HCO5 Box 6909, Palmer, AK 99645 ABSORPTION FIELD Phone: Number of Bedrooms: 746-0682 4 0 Deep Trench ❑Shallow Trench • Bed • Mound ■ Other. LEGAL DESCRIPTION Soil Rating: 0.45 GPD/Ftz Total Depth from original grade: 12 Ft. Block: Lot: Subdivision: 1 3 Glenn View Est. North Depth to pipe bottom from original grade: 2-4 Ft. Gravel depth beneath pipe: 8 Ft. Township: Range: Section: Fill added above original grade: 1-2 Ft. Gravel Length: 85 Ft. Well: ■ New ❑ Upgra• - Gravel width: 3 Ft. Number of lines: 1 Distance between lines: Ft. Classification (Private, A B, C): Total Depth: Ft. Cased to: Ft. Total absorption area: 1360 F� Pipe Material: D3034/F-810 Driller. S. t- Dale Drilled: Static Water Level: Ft. Installer. Bailey's Backhoe Date Installed: 10/20-21/03 Yield: GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TAN K SEPARATION DISTANCES o Septic ■ Holding ■ S.T.E.P. ■ Other: To From Septic Tank Absorption Field Lift Station Holding Tank 5ublicJPrivate Sewer Line Manufacturer Anchorage Tank Capacity: 1250 Gal, Well 200+ 200+ ------ ----- 25+ Material Steel Number of Compartments: 2 Surface Water 100+ 100+ ------ LIFT STATION Lot Line 5+ 5+ --- Size: Gal. Manufacturer: tel! -F Foundation 5+ 10+ 'Pump on' level et: - ,17i. in. High water alarm at: in. ----- Curtain Drain Pump Make & . . . - Electrical Inspections performed by. Remarks: BENCH MARK Location and Description: Foundation Anchor Bolt Assumed Eievauon: Ft. 100 °°41.1... ! .:' �•pF. A.gsfitl `.' 49T I�• / V •.•• •I II" Charles A. Leet �,..'• ��• *,,V,‘,....... i PERMIT NUMBER 030395 VACANT 6 LOT 2 LOT 3 TH5 N3 YT C05 4 RECORD DRAWING PID NUMBER 051-821-16 0' f. 0 0 „„ a CO 1250 CALLON a . ova. eat"' 4 1H4 CO3 �I ! 1 ! .1 . / 10' BUILDING SETBACK LIN NORTHWOODS TI ' T & E ASEMENT CIR. LOT 4 VACANT 'A' CO1 33' 33' T1 34.7" 33'5' 12 42' 35'5' CO2 48'6' 37'8" CO3 51' 37'8" C04 51' 32'5' C05 70' 37'10" MT 69.r 35'6' Z15' T & E INATE-j EASEMENT KEY, TYP. 1 sr \\i\ 1\a\ \1 25' BUILDIN '‘ SETBACK LINE LOT 5 15� BLOCK 1 VACANT — _L 1" = 60' EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITIES CONNECTIONS, AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ,,,0000Dtt e Sw 49TH �' w•,.9d�� Charles A. Leet •; f 0 CE 10480 .,•• ��d f(� g, QQz,iPROFESSaktkvs , �OO�oo SITE PLAN ENG W.O. 0300976 P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 DATE: 3/2/04 1 SCALE: 1" = 60' FILE: 0300976 LOT 3, BLOCK 1, GLENN VIEW ESTATES NORTH, PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. SHEET 1 OF 1 PERMIT NUMBER 030395 perforated 4' PVC see Note 1 3/4' to 3' sewer rock solid 4' *B3. DIP. or PVC Bch. 40 RECORD DRAWING Install monitor tube at end of trench Install cleanout at end of drain pipe 1—foot •1116 mss. PID NUMBER 051-821-16 2' ± { Note 1: Install all perforated PVC level (within 0.01 foot of same elevation) 85' ± WIDE DRAINFIELD PLAN VIEW perforated PVC hole orientation (holes down) SECTION X—X N permeable geotextie ound surfaoe Insulation. If used see Note 2 ELEV. 97.0. Insulation, if used ELEV. 93.0' 8' effective depth ELEV. 85.0 TRENCH DETAIL Note 2: Place a minimum of 4—feet of earth cover (or equivalent) over absorption trench. One Inch of Western 'insultoam II (or eq.) may be substituted for one foot of earth cover up to a maximum of two Inches of Insulation. Note 3: Maximum excavation shalt be no more 12 feet. Note 4: Not used P P*X49 H i\ %• D �Ie),/ 0 Q c, Charles A. Leet :. d 00 • CE 10480 : v��`� Q4, , PROFEssake�' dam' dd000000d' undisturbed earth T7 seasonal high groundwater 4 ELEV. 79.0 , TRENCH SECTION SITE PLAN ENG W.O. 0300976 DATE: 3/2/04 MONITOR TUBE DETAIL P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 SCALE: nts removeabl• cap non—perforated PVC above sewer rock coupling 4' PVC perforated • 6' in In sewer rook FILE: 0300976 LOT 3, BLOCK 1, GLENN VIEW ESTATES NORTH, PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. SHEET 2 OF 3 • PERMIT NUMBER 030395 1" = 60' RECORD DRAWING a\ n 4.7 PID NUMBER 051-821-16 12.ap o LOT 3 TH3 MT C05 0 CO 1250 GALLON 13' CO TH5 STEEL SEPTIC TANK N GRp,DE BREpK 0 N SEPTIC SYSTEM PLOT PLAN / Datum Els►. 100.00' (Assumed) T. O. 98.3 =flout cleanout 4��000pp�� a �E .Pr. ..q.ADO c P .•• . • 49TH .%*d�� p PQ �; •••, Charles A. Leet ? f • CE 10480 septic tank Inlet Slay. 93.7 Oulet Eley. 93.5 soil absorption system (see Design Sheet 2) / SEPTIC SYSTEM PROFILE SITE PLAN ENG P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 W.O. 0300976 DATE: 3/2/04 SCALE: 1" = 60' FILE: 0300976 LOT 3, BLOCK 1, GLENN VIEW ESTATES NORTH, PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. SHEET 3 OF 3 Tract A. Lot 2 15' TELECOM. 8 ELECT. EASEMENT co 8 ' 4°Rr 1W0 ops Nett Lot 4 3.91,£1.00 S cal HOUSE DETAIL SCALE 1' • 30' S 84 11155°E 119.29' Tract E PLOT PLAN ASBUILT ._. SCALE I. • I GRID NW 1560 Project Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska —6476 Registered Land Surveyors (907) 522-4625 Fax I hereby certify that I have surveyed the following described properly: LOT 3, BLOCK 1, GLENN VIEW ESTATES NORTH (PLAT 2003-42) Anchorage Recording District, Aiaska,.and that the Improvements situated thereon are within the property lines and do not encroach onto the properly adjacent. thereto, that no improvements on the property Lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the - Day of Mt'. -Ztr .2004-, at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. No.. 03-230 99515 SOF 6.9 Tract A. Lot 2 15' TELECOM. 8 ELECT. EASEMENT 8 koRriiivoops Netti -....„............, ay y 3,91,£Ie00 S 84611'85'E 119.28. Tract E Lot 4 HOUSE DETAIL SCALE J • 30' PLOT PLAN ASBUILT X SCALE 1" ' 6°' GRID NW 1560 Project No. 03-230 Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515 —6476 Ph Registered Land Surveyors (9073 522-4625 Fax I hereby certify that I have surveyed the following described property: LOT 3, BLOCK 1, GLENN VIEW ESTATES NORTH (PLAT 2003-42) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the properly lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed promises and that there ars no roadways, transmission lines orother visible easements on said property except as indicated hereon. Dated this the _ Day of Mt,..12-4-44 .1-00 4; at Anchorage, Alaska It 1s the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 /D- 2 I 0,-22_ dz3 03 A1_G o/9 y ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW030395 Legal Description Glenn View Estates:,North._Bfock;1' LO Design Engineer: 0032 Alaska Rim Engineering Owner Name: Mike Thomas Owner Address: HCO5 Box 6909 Palmer , AK 99645 - Date Issued: Sep 24, 2003 Expiration Date: Sep 23, 2004 Parcel ID: 051-821-16 Site Address: Unknown " Lot Size: 48224 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: E✓ Disposal Field Q✓ Septic Tank ❑ Holding Tank ❑ Privy Private Well 0 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (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 day. B. Covered, sealed, and heated to prevent freezing. /0/20 3/0 3 5 EE ek6. Rio 05576,v Dirt p o cT /s; 03 4.rrnclysz SYS 7'gn l?oM iVc 771 -/P of 140145E to 7Nt Sou7g, Received By: Issued By: /19C -1-4-1A Date. Date: 7/2403 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 '_ ON-SITE SEWER/WELL PERMIT APPLICATION . FOR A SINGLE FAMILY DWELLING Parcel I.D. OC-; 1 -"c‘ Z_A —1U Property owner(s) Mailing address (1) 1\tkke, 714onias Permit Number swa30 3q.5 - Day phone ?% —a&,Sz- Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lor Legal description (Section, Township & Range) Lot Size 4 S f 22'-1 Acre THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub . :Swimming Pool Therapy Pool Number of Bedrooms 4 G\L.v - v\u-O Well Only Water Storage ❑ Jacuzzi ❑ Water Softening Unit 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 acc• lance with applicable Municipal Codes. (Sig e of property owner or authorized agent) Permit Fees: goo Waiver Fees: Date of Payment: 'l H03 Date of Payment: Receipt Number: (Rev. 12/00) SS -3 11, Receipt Number: oltPast2a Tull engtReektng, One. Phone (907) 745-0222 Fax (907) 746-0222 akrim@rogershsa.com October 15, 2003 Mr. Dan Roth Municipality of Anchorage Development Service Department Anchorage, AK 99519 RE: Lot 3, Block 1 Glenn View North Estates Parcel Id. 051-821-16 Permit No. 030395 Subject: Request for Change — Design Narrative Dear Mr. Roth: P.O. Box 2749 Palmer, Alaska 99645 In our permit request we indicated that we would conduct a deeper and more through soils evaluation of the subject property. This has been completed. As a result of this information we are requesting a change in our original design to take advantage of the new data as outlined below. Soils An additional soils investigation was conducted on October 6, 2003 by Alaska Rim Engineering, Inc. The approximate test hole locations are located on the attached site plan. The soils were classified as GM and SM see the attached soil log and perk data. Based on the percolation test an application rate of .45 gal/day/sft was the correct assumption. Groundwater was encountered at 16.5 feet. The ground water appears to be deeper as we move towards the edge of the bluff/hill. Trench Design The dwelling proposed is a four-bedroom, with an estimated daily wastewater flow rate of 600 gallons per day. The wastewater application rate from the perk test is 0.45 gal/day/sft. The required absorption area is 1,333 square feet. Proposed is a deep trench with an effective depth of 8 -feet and a length of 85 feet. By moving the absorption field toward the Engineers • Planners • Surveyors Lot 3, Block 1 Glenn View North Estates 10/15/2003 Request for Change — Design Narrative Page 2 of 2 back of the lot the vertical separation distance gets greater and the deep trenches can become deeper. Enclosed are drawings of the proposed system. Please call met 907.745.0222 should you have any question or need any clarification. Bailry Backhoe will be on site the latter part of the week backfilling the foundation and they would like to start the installing the septic there after. Sincerely, " Alaska Rim Engineering, Inc. Charles A. Leet, P.E. Project Engineer Encl: Soil Log — Percolation Test (3) Site Plan (3) Cc: Client AK Rim File # 03-00976 1 O*.1�:L A S�� li .'tik,•� ,_y •'. S7.1 0: • • VACANT \ \ \ N \ N N N N N LOT 2 YT*CO o ,To NORTHWOODS CIR. LOT 4 VACANT 15 T & E WATER EASEMENT KEY, TYP. .1 25 BUILDING, SETBACK UNE\\ LOT 5 BLOCK F' '143 15, 1 1"=60' VACANT EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITIES CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. P�E .PF •.AGq.. D P t / 49TH %.57 •%. * VD V 0o Charles A. Leet • CE 10480 • " ddd� 0% oo%d� SITE PLAN ENG P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 W.O. 0300976 DATE: 9/11 /03 SCALE: 1" = 60' FILE: 0300976 LOT 3, BLOCK 1, GLENN VIEW ESTATES NORTH, PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. SHEET 1 OF 3 1" = 30' ANT 0 0 0 SEPTIC SYSTEM PLOT PLAN 100 min 100 mm ospp.d dbl cl..nout 4—inoh ABS at uniform slope MIA. slop. 2 S (1/4' per ft.) max. slop. 8 X (1• per ft.) Install final 10 feet of 4' ABS prior to septic tank at a slop. of 2 percent (1/4• per foot (w/ 2 inches of rid&id insulation) . 9f. ....... •.si 49TH vi •:.57 %Charles A. Leet •CE 10480 '�ti d ti Ro�ssioto-d'" O000% w•t ooupl.rs on and Doth ti (w/ 2 of hsepse og itIllcd insulation) soil absorption system (see Design Sheet 2) 4—inoh ABS at uniform .lop. b.twsen septic tank and SAB min. slope 2 % (1/4 per ft.) SEPTIC SYSTEM PROFILE 44�0000Op� q k�9F,... 1 Conventional Single Family Residential PROPOSED SEPTIC SYSTEM DESIGN `e°a` LOT 3, BLOCK 1 GLENN VIEW NORTH ESTATES Descrlptbn ENG INC. Alaska Rim Engineering, Inc. Data 10/16/09 P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 Completed Dat. SHEET 2 OF 3 perforated 4• PVC see Nota 1 3/4• to 3• sewer rook Metall monitor tuba at and of trench Metall cleanout at end of drain pipe 1—foot // 4 4 solid 4• ABS. DIP, or PVC Soh. 40 Nota 1: Install all perforated PVC level (within 0.01 foot of same elevation) 85' ± `ot WIDE DRAINFIELD PLAN VIEW �\\ 2' ± perforated PVC hole orientation (holes down) SECTION X -X 8' sheens. depth TRENCH DETAIL Nota 2: Place a minimum of 4—f.et of earth sower (or equivalent) over absorption trema One inch of western •maulfoam 11 (or sq.) May b• substituted for one foot of earth ewer up to a maxim= of two inches of laaalattem Note 3: 1Laximum excavation shall be no more 13 het. Not. 4: Not used TRENCH SECTION 44�Oo000p�� .I7F........ 49TH �\ '• _ / ', 9* iQ c • Charles A. Leet ' 20 j f •• CE 10480 ... �ddd0 o Q•�da Conventional Single Family Residential PROPOSED SEPTIC SYSTEM DESIGN =pile. LOT 3, BLOCK 1 GLENN VIEW NORTH ESTATES ENG P.O. BOX 2749 PALMER, ALASKA 99645 INC. PHONE: (907)745-0222 FAX: (907)746-0222 Alaska Rim Engineering, Inc. Date 10/16/03 Completed omp Datt.. —SHEET 3 OF 3 Performed For. Legal Description: Depth (Feet) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoraoe.ak.us (907) 343-7904 Soils Log/��- Percolation Test 71% e- *,1 d. 0- n (V YN 'S A n4pain L6-r 33 t Gte.hr,t % Moext+ Slope 1-' rgoirLOrzc�+►a�c 2 - Si awdevo-- 3- l,/SAip !.N 4- tipza '/4-$M 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- .ra°l`iia3 COMMENTS F3o rTOMt op- TESr140LE WAS GROUND WATER ENCOUNTERED? No •‘ ' ' 1 �v• +rj pA'# •'of '• •' • .....'4"/ • r1eS a t c ttt1 4O PRQ4ES`1`4"� Date Performed: to! (Q (03 Township, Range, Section: IF YES, AT WHAT DEPTH? Yes Depth to Water After Monitoring? t ° Date: Ito g Site Plan a 0 Reading Date Gross Time Net Time Depth to Water Net Drop PIZE.'�at.— — Ft LL, 4 2 1017/ 8'bo 361nth. 0 3. R(16 —4,0,,,c,t . IPA . l 1610 3).1ii 4V A. (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN S FT AND Cot, FT 6 PERFORMED BY: N.all (1,P r ,r yAs I ` 'Xa-e.r `� 1._� CERTIFY THAT THIS TE T W S PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10 I 0 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoraue.ak.us (907) 343-7904 Soils Log - Percolation Test Performed For: }� . "AA.1 mmcL:- net fictli Legal Description: L8 -r 3)B x._1 'Moan} Slope 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - Depth (Feet) ToP 'tL VF.4-4DVG5 COMMENTS 51 t_ -t -e Gtr eALI ktb Tau, 1 -BATT -X) pt4 5 ) 1� rTo ►x e F" -res-r 9oL' WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Depth to Water After Monitoring? Date: Township, Range, Section: No s L 0 P E 11 •9 ori ••:• •� ••�!. 0 •••• 'we e.Chailey A. Leet i �,, ' ; E;; , CE 10480 , •,..'' i OftSS Date Performed:to ( 1 t Rn-" Site Plan L Ptip Reading Date Gross Time Net Time Depth to Water Net Drop TILL- L - ----iae Sc A- r. 7 is tout, I03 4 37 507sontik 74 1.0 537 3..w;,, • ca 'Vs 7/e (b? 3:),„N., q ft !e, (mfr itesrrcrh) PERC HOLE DIAMETER TEST RUN BETWEEN 5. FT AND i , FT D PERFORMED BY: 1\,-��- s" v25 tedCERTIFY THAT THIS TE W PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: t J Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoraoe.ak.us (907) 343-7904 Soils Log - Percolation Test Performed For: �� -��, nmu�� xt,rt., fan Legal Description: Lis"' 3)3i r l G�ea,n�i. bloc --t+ Siope 1- 2- 3- 4- 5 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - Depth (Feet) s;1 \G 1.v.v ck�1 s� TSN , sR cs COMMENTS aFr-, T ►-►«-t S Tibt.''-/c�Q WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Date: Township, Range, Section: 116 s L 0 P E i•- ; . * i 4`• /*.49L— ,•.•.••rip/•mss'•• Charles A. Leet ..� t,000 t`^c'• CE 10480....°4:1 Date Performed:lAt.144_1)(' -lel,.\1/4,V-4:r Site Plan • T1, 5t 79- G Reading Date Gross Time Net Time Depth to Water Net Drop 1-10--. E Sot_ S i l01?l63 8410 Gl 1 c C 30 2- A 9`fo -V/42 • 2 tic,. foto `7 g -Eb t. TR, PERCOLATION RATE (mvMes/nrh) TEST RUN BETWEEN 5 FT AND PERC HOLE DIAMETER C.,- FT PERFORMED BY: X ,tmcums 1 0.+4'e ►.. L PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: lo' 15-10 CERTIFY THAT THIS TEST WAS Aasl2a Tim 2ngineening, One. Phone (907) 745-0222 Fax (907) 746-0222 akrim @ rogershsa.com September 11, 2003 Mr. Dan Roth Municipality of Anchorage Development Service Department Anchorage, AK 99519 RE: Lot 3, Block 1 Glenn View North Estates Subject: Permit Request — Design Narrative Dear Mr. Roth: P.O. Box 2749 Palmer, Alaska 99645 The owner of the above referenced lot is proposing a four-bedroom singly family residence. We are requesting a plan review and a permit to install a septic system to serve the proposed development. Soils The developers engineer performed a soils investigation on January 28, 2002. The approximate location of the test hole is located on the attached site plan. The soils were classified as silt (ML). The percolation test, with a perk rate of 5 min/inch, indicates the use of an application rate of 1.2 gal/day/sft. No groundwater was encountered at 12 feet. We plan to dig an additional test hole to confirm the developer's engineer's soil log and percolation test. We also plan to monitor for ground water for seven days. Should a change be required we will contact MOA Onsite Personnel as to the next step. Trench Design - The dwelling proposed is a four-bedroom, with an estimated daily wastewater flow rate of 600 gallons per day. The wastewater application rate from the perk test is 1.2 gal/day/sft. I have used 0.45 gal/day/sft, as my experience in the area indicates a more conservative approach is justified. The required absorption area is 1,333 square feet. Proposed is two 5 - foot wide beds with an effective depth of 48 -inches and a length of 70 feet. The flow will be split with a zable flow splitter. Enclosed are drawings of the proposed system. Engineers • Planners • Surveyors .t Lot 3, Block 1 Glenn View North Estates 9/9/2003 Permit Request — Design Narrative Page 2 of 2 Surface Waters There is no surface water within 100 feet of the proposed upgrades. Topography There is a high bluff with slopes greater than 25% in the back third of the lot. We do not anticipate any adverse effects on the neighboring, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. This subdivision is server by a community water system. Sincerely, Alaska Rim Engineering, Inc. Charles A. Leet, P.E. Project Engineer Encl: Permit Application Permit fees Soil Log — Percolation Test (1) Site Plan (3) Cc: Client AK Rim File # 03-00976 VACANT \ \\ \ \ \N\ N N LOT 2 VACANT NORTHWOODS \ CIR. LOT 4 VACANT 15' T & E WATER EASEMENT KEY, TYP. "f:5‘ 25' BUILDING\ SETBACK LINE \\‘ LOT 5 BLOCK 1 1" = 60' EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITIES CONNECTIONS, AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. �.,0000pp% ' 49TH . Charles A. Leet CE 10480 . • dPROFEsslawd�' OOO000 FL SITE PLAN ASK ` RIM ENG EE INC. P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 1.€U 1 W.O. 0300976 DATE: 9/11/03 SCALE: 1 " • = 60' FILE: 0300976 LOT 3, BLOCK 1, GLENN VIEW ESTATES NORTH, PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. SHEET 1 OF 3 \ \ \ N N\\ N N LOT 2 tall!coi,k- 0' NORTHWOODS \ F do FLOW S 00 8 8 s e... 11.30 1250 ON STEEL SEPTIC TANK tgi VACANT T do E ASEMENT CI R. LOT 4 VACANT f WATER EASEMENT KEY, TYP. i i i i i \\\i\ 25'BUILDING SETBACK LINE \\� LOT 5 BLOCK 1 0- 1" = 60' EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITIES CONNECTIONS, AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ��000ODp� Pc�,v r l '•.'F 49TH • Charles A. Leet .�� d QQ�r ••• CE 10480 ••• cti a,1QOFESSIIZO'„ ' Oho SITE PLAN ASK RIM ENG! EE , INC. P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 W.O. 0300976 DATE: 9/11 /03 SCALE: 1" = 60' FILE: 0300976 LOT 3, BLOCK 1, GLENN VIEW ESTATES NORTH, PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. SHEET 1 OF 3 ti •' T & E ASEMENT LOT 4 VACANT F FLOW S r")), 12.0 1250 ALLON STEEL SEPTIC TANK LOT 3 W n1 SEPTIC SYSTEM PLOT PLAN i 10' min capped ean ut 10' min capped capped yen dbl cleanout 4—inch ABS at uniform slope .__/ min slope 2 X (1/4� per ft) max. slope 8 X (1 per ft) install find 10 feet of 4' ABS prior to septic tank at a dope of 2 percent (1/4' per foot) (w/ 2 inches of ridgid insulation) septic tank watertight couplers. on inlet and outlet of tto tank (w/ 2 inchaepes of ridgid insulation) soil absorption system (see Devlin Sheet 2) 4—inch ABS at uniform dope between septic tank and SAS. min. slope 2 X (1/4 per ft.) SEPTIC SYSTEM PROFILE 4�.„oODp��t pS;•egkk„��% ..9Nd ".19TH A *&D .. O Charles A. • Leet ' CE 10480...\.-47g i2;;;;) .P' d40ooOd Conventional Single Family Residential PROPOSED SEPTIC SYSTEM DESIGN Le°a` LOT 3, BLOCK 1 GLENN VIEW NORTH ESTATES Dvscriptloro ENG P.O. BOX 2749 PALMER, ALASKA 99645 INC. PHONE: (907)745-0222 FAX: (907)746-0222 Alaska Rim Engineering. Inc. n . 4I25/3, Completed Date SHEET 2 OF 3 perforated 4• PVC see Note 1 8/4• to 9• sewer rock install monitor tube at end of trench install cleanout at end of drain pipe 1 -foot IMAM. // solid 4• ABS. DIP, -01 or PVC Sch. 40 //, Note 1: Install all perforated PVC level (within 0.01 foot of same elevation) 70' ± WIDE DRAINFIELD PLAN VIEW 5' ± n perforated PVC hole orientation (holes down) SECTION X -X permeable geotextile insulation. U used see Note 2 ELEV. 100.0' insulation. if used Z ELEV. 98.0' .e 4• PVC drain pipe. w/ holes down 4' effective depth ELEV. 94.0' TRENCH DETAIL Note 2: Plane a minimum of 4 -feet of earth cover (or equivalent) over absorption trench. One inch of Western Insulfoam 11• (or eq.) may be substituted for one foot of earth cover up to a maximum of two inches of insulation. Note 9: Maximum excavation shall be no more 6 feet. Note 4: Not used undisturbed earth o seasonal high groundwater Im•ermeable layer t ELEV. 88.0 BOTTOM OF TH TRENCH SECTION MONITOR TUBE DETAIL removeable cap non -perforated PVC above sewer rook coupling 4• PVC pp rforated • d• mteervaIu In sewer rock .,,000Dpp% ......... 49TH / 41:�„D/� •a • ti Q . Charles A. Leet 0. • CE 10480 ; :47,-c9 d (10,2 % .... Qd�Pf�oopo oo�d�d Conventional Single Family Residential . PROPOSED SEPTIC SYSTEM DESIGN Descrlptbn Le°a` LOT 3, BLOCK 1 GLENN VIEW NORTH ESTATES ENG P.O. BOX 2749 PALMER, ALASKA 99645 PHONE: (907)745-0222 FAX: (907)746-0222 Alaska Rim Engineering, Inc. Design Date Completed Date SHEET 3 OF 3 ec ved ax • Au• 28 003 :06AH ax Stat on • HP LASERJET 3330 Aug 28 03 10:18a Jo Sonerholm Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519.6650 wwty, ci.anchoraae.ak.u$ (907)343-7904 Soils Log - Percolation Test ed Fcr: (L E'r.i \/lav(/ 1\101-i-1 Le i Description: 2-L, • 5- - 6- 6- 7- 7- 8- 8- 9- 0. 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 10- 11.12- 131G- 1516- 17- 18- 10- • ` , • Loi 3 914-1 T 2T 51 1---13 ►y L, 7) r �.AT • 5;14 P e ML, SM�SIP 20- 20- ao7►LM oh t-ko L1= C^,%• .NTS Slope WAS GROUND WATER ENCOUNTERED? (907) 352-1874 P.8 Date Perfo rned: Township. Range. Section: No s IF YES. AT WHAT DEPTH? Depto Water Aher v th Monitoring? �.a-__t E Date: 1/ZI{ to z - Site Plar. Reading Dale Gross Time Net Time Depth lo Water Nel Oroo FILL t'-'REsoAw... C° //,74) '7_. la.O-c. - p,--1 5Y-2.- :so 'bpi-tit.)al.r.j (af b r% ), o -e) 3 D el 1-1 1 L 373 -3 D d,. L {- PERCOLATION RATE 5-' IniwreiSno+) PERC HOLE DIA7 E iER �I IES: RUN BETWEEN 3 FT AND 1.4FT PERFOP:l_D BY: 1 _ . 2 1 1 ..S CERTIFYTHP.T THIS TES- WAS FERFGP:.t_O IN ACCORDANCE W1TH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /2. B /0 7. Performed For. Legal Description: 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - Depth (Feet) COMMENTS Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoraoe.ak.us (907) 343-7904 QLeui Soils Log - Percolation Test t 4-\ L0-1- 7., 81.a._ 1 Slope WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Date: q I�r R M h• • r 4;/i::'.•r :•,.•/ '•� / •'•• •or Ir •�e5,,1-e2t ` od •P • C.‘a 1003•• 4e" 1 f' . • ij,f'lf•f......•• ti‘ .. Date Performed: c ��E ~ Township, Range, Section: s L 0 P E Site Plan Reading PERGOlATION RATE .. Date Gross Time Net Time Depth to Water Net Drop -I' l LL �1Z.E t: 9 -24 -c.3 4 . 1-2Z-03 lois 30 5 � I. '14- lo: its' 36 II• Las - 3d �� lox (minutes/nem PERC HOLE DIAMETER •� t'a, TEST RUN BETWEEN 5 FT AND 4 FT PERFORMED BY: .30, au/LS I a1.0z dE iL'(� w{s CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: GI- ZZ --63 Performed For. Legal Description: 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - Depth (Feet) COMMENTS Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoraoe.ak.us (907) 343-7904 (2.1, Soils Log - Percolation Test 'tem 2 ev.s. a P-1-4-- 1 - 2 L Slope WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Depth to Water After Monitoring? Date: 4 •'.... IH ' Date Performed: Township, Range, Section: S L 0 P E .• ••• ?°^: Charles c - .......• .................. . cE 10480 • • — Site Plan 1 Reading Date Gross Time Net Tune Depth to Water Net Drop 4 I L L 'rz.E 50 lg. e__. el a, t -T , (e, 1-2x-03 10 28Vg -60t (� lo 56 30 7 %s. j ` rb It -- .1� 1 (minutes/nth) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND G FT 0 PERFORMED BY: (, t1(i.V1? 1 Is� V[�)eMetyltS CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage Development Services Departmen Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us ; (907) 343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT,SHEET To: CHARLES A. LEET Legal description:GLENN VIEW ESTATES NORTH'' BLOCK 1 LOT 13 The attached paperwork has been reviewed and is being returned for the following reasons: Original signature or stamp missing on Calculation error in design + _ Additional . soils information needed: NEED PERCOLATION TESTS AT ORIGINAL AND REPLACEMENT SITES' I 1 I t Water monitoring "results inadequate. P Y Discre anc in information n submitted. iii ;� � � I� Topographic information missing or inadequate. PLEASE "PUT NUMBER ON THE ARROWS ON THE SITE PLAN I' 1. i!'. ` € Incomplete; missing 1 11 I 1 Incomplete; missing Additional adequacy test information needed. Water sample unacceptable. °: 1; Measured/proposed distances/dimensions missing. MISSING Locations of all soils, percolation and water monitoring' ,tests not shown. Proposed system .too deep for soils information isubmitted.l' ;,; ii I. ! Well log required.:_ • Omission in narrative. ll Insufficient fill over tank or field. Other. li I .r I Name of reviewer: DAN iii j 1 3i '' Li, i I,. i, iii i. ' � : y, ; � 1 1- rre uest. 1 ssar information'and re submit ou Please supply the nece y � y, q . L'EAVETHIS FORM ATTACHED TO ;THE PAPERWORK i Date: 9/18/03 Municipality of Anchorage Development Services Department Building Safety Division - On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01 - S3z t — / I. 1. GENERAL INFORMATION Complete legal description 6 le NN U+Yw 6 +A -4E, HAA# p o`fobar Expiration Date: 3//i /o 5- No?L*6 ,S7/V BMoe* 1 1-0+-3 Location (site address or directions) Current Property owner(s) M; k E llo r4As Day phone 7-1/6- o C 84 Mailing address /IC c7f S 150x 6 P o ? Pit /•`se<,! • ftk 9 gb 45 - Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. 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 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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. (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 Health Authority 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. Name of Firm /f fmsivt Qi/s+ ,i47iNEEkpvt, Address P 0. &o( Z 7-44 Engineer's Printed Name Cl/va/c LEFT Date 3lti(oy Phone %}- (s --v zz. .,;,".„,(4,.,4-.Weg tt rJ • #0 114 5. DSD SIGNATURE .•��l .•''' • Approved for '( bedrooms. • 1 � Leet •: �� Disapproved. � '•c •' � f l IWO PROFESS\`'- Conditional approval for bedrooms, with the following stipON'tiVIs^-' By: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other (Rev. 01/02) Original Certificate Date: /u /o cf Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 3, Block 1, Glenn View Estates North Parcel ID:OS 1 SZl— l6 A. WELL DATA Well type If A, B, or C provide PWSID # Date completed • Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE LTS: Well Log (Y/N) Wires properly pro Casin d (Y/N) t (above ground) in. T INSPECTION ft. ft. g.p.m. g.p.m. Colifo • colonies/100 ml. Nitrate mg./I. Other bacteria colonies/100 ml. senic: mg./I. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material. Anchorage Tank Steel Tank size 1250 / gal. Number of Compartments 2 Foundation•cleaoout (Y/N) Y. Depression over tank (Y/N) N Date of pumping= New.. ' .. Pumper C. ABSORPTION. FIELD DATA,' Date installed. 10/20-21/03; :' Soil rating (g.p.d./ft2 or ft2/bdrm) .45 System type Deep Trench Length 85 ft. Width 2-3 ft. Gravel below pipe 8 ft. Total depth 12 ft. Eff. absorption area1360 ft2 Monitoring tube Y Depression over field N Date of adequacy test NA Results (Pass/Fail) NA For 4 bedrooms Date installed 10/20-21/03 Cleanouts (Y/N) Y High water alarm (Y/N) NA Fluid depth in absorption field before test NA in. Water added NA gal. Elapsed Time: NA min. New depth NA in. Final fluid depth NA ' in. Absorption rate >= NA Any rejuvenation treatment (past 12 mo.) (Y/N & type) NA If yes, give date g.p.d. D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tapk/liftstation on lot On adjacent lots Absorption field on lot — n adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Size in gallons vei at in High water alarm level at Cycles tested Meets alarm & circuit requirements? le/Ar ess Public sewer main eweJ r /septic service line Building foundation 5+ Property line 5+ Water main 10+ Water service line 40+ Wells on adjacent lots NA •., SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 80+ Wells on adjacent lots NA in. Absorption field 58+ Surface water 100+ Curtain drain NON KNOWN F. COMMENTS ' 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 Charles A. Leet, P.E. Date 3/10/04 HAA Fee $ 4 30 Date of Payment 3 ! it f OFf Receipt Number 111'1118 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number