Loading...
HomeMy WebLinkAboutHALVERSON LT 16AHalverson Lot 16A #051-133-44 Municipality of Anchorage Department of Health and Human Services 1 Division of Environmental Services Onsite Services Section 8251' Street Roan 502 P.O. Boot 196650 Anchorage, AK 9951M50Page of www.dandrorage.ak.us (907) 3434744 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWDOOy PIDNumber. 'RET6 9A1.Vr=r Son1 Wastewater System: ®New ❑ Upgrade AdOrau: l &26,ATG.ttle OP. e14U 4AK AK 99667 ABSORPTION FIELD � Ph�: kP&r d a.soome: yO DMp Tr.w gawo. Tr.wr o as Q Maatl , o onn: LEGAL DESCRIPTION /50 VIM?Ea1Rai` TOW DeMftm "°""0"°` sz a laC //OA s 1 -VE 0 owF uFa. 3. / 5.ft 92Fl. O*WW 3.-3e2/ Fl Fl. Fl. Well: ®New Upgrade c.al.me 5 N.b.I Whnp betwom sr c ehveoem t�, E0. c : TOW Depll:/0 O Cane Yx �� Fl. TOW arvpem s..: GOD ^ Ft FVe Mash: 1303 �( Fr io Dom: Dna Deed: abee wale leer: SULLIVAN or 2r oo Ywaer, 6C NST ome Yens¢ , pS 18 Zoon vwis ^aro sa a: `'r,° rwyue°�" ceow: /OnpM unfek6cil, TANK Fl. ZFe. SEPARATION DISTANCES 0 Septic 0 Hotdkq Q S-TT—P. O Otl*r: To From Sepac Tank Uft Stagon ►{DtdNlg Tank Sawarthe _ /%GH0:2A:s� I�A.tK- 1260 ca. was 10D`4' 7FI,Ol!d ST£EL NnMrawewan.n I Z &,b. WA. Ioe4. t- — — LIFT STATION tduee I0'4- I01- — — cal Faatleem I� Io {- — �, nip ai Mva a: w Vdr Nye..rer dam aC n I ,. C~ omh / o D'+ I oD`+- — -. o Mau t exarw Yawaeaa pabmed W. P"raft 'I' Ube lGnavr. BENCH MARK � s w DeeO4Yoc otfo� o� SJdiy I Atfrrrd EW eft% /DD ►L � i..... ....Z4 Gj; 9 � Inspections performed by: Kel1D �N(ihC(fih{ Dates: 1" OMMo na 9 T * _` �i� 2n4 OS / D -D Y. n / Department of Health and Human Services a rov I CE -7116 ,1 Reviewed and approved by: (�/ o�00 II� Date: R -,7-1 - 01 ! 1 T4s SSto�-do" AS -BUILT .SYSTEM DETAILS/SITE PLAN Pernit# SWOO( G HALVERSON S/D, LOT 16A PIDH 051-133-44 4KND99-Lf':`.tel` ' P SCALE, 1' 50' - 9.01 9, y A -C=63.7' t 2 c B -C=64.9' A -D=71.1' q•4 EINAL GRADE 01.1 B -D=72.1' A -E=89.2' nrn r I vrn A -F=83.3, 1250GAL L B -F-77 9' AN SEVER ROCK aw 5.3 5.291.8 91.89 rte.\\ � se• I�P.OF• 4 ` PREPARED FOR qkX SCALE NTS �!S•,.%' %r + CHUCK IIOVRER CLC CONSTRUCTION . 9 * + 2401 CHILLIGAN DR ................"._....._................,q =......... ANCHORAGE. AK 99517 \ KEN p ___---� FlELD 80OKS p waa END ENGINEERING CE -711 �01lOMT, _ pure IT. _ oco� KMD 20441 PTARMIGAN BLVD. `"""' """" w Amaen _ oAm EAGLE RIVER, AK 99577-8730 essTDi+n` .� T o 0 \\\_�— ova rar. aQNYYI BD:.:.;.::;::;.:-::�:.::;;:;:;:: Am "zj 99073.DWG 99073 907 898-8111 FAX 007 808-8111 LOT 16A w 4KND99-Lf':`.tel` ' P SCALE, 1' 50' - 9.01 9, y A -C=63.7' t 2 c B -C=64.9' A -D=71.1' q•4 EINAL GRADE 01.1 B -D=72.1' A -E=89.2' nrn r I vrn A -F=83.3, 1250GAL L B -F-77 9' AN SEVER ROCK aw 5.3 5.291.8 91.89 rte.\\ � se• I�P.OF• 4 ` PREPARED FOR qkX SCALE NTS �!S•,.%' %r + CHUCK IIOVRER CLC CONSTRUCTION . 9 * + 2401 CHILLIGAN DR ................"._....._................,q =......... ANCHORAGE. AK 99517 \ KEN p ___---� FlELD 80OKS p waa END ENGINEERING CE -711 �01lOMT, _ pure IT. _ oco� KMD 20441 PTARMIGAN BLVD. `"""' """" w Amaen _ oAm EAGLE RIVER, AK 99577-8730 essTDi+n` .� T o 0 \\\_�— ova rar. aQNYYI BD:.:.;.::;::;.:-::�:.::;;:;:;:: Am "zj 99073.DWG 99073 907 898-8111 FAX 007 808-8111 ICE ex#tfYp'b'BxtXX-lit by Doc co. aba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND Y/= T tic IYA[ <1 C,Cfo,J BORE HOLE DATA ADDRESS S K 13 D LEGAL DESCRIPTION jYA4 IC<SJn-t AoT PERMIT NUMBER ggO3(.3 Date of IssueQQ TAX INDENTIFICATION NUMBER A I -L I_ I_ - 'q I_ Is well located at approved permit locati es Q No Method of Drilling: it rotary Q cable tool Depth of well: /00 Casing Type ST tc[ Wait Thickness • or, Inches Diameter 6 /1 Inches, depth_afeet Liner Type: /0 6 ej t Casing Stickup Above Ground: c>2 }eel Static Water Level (from ground level): feet Pumping level:—feet after hrs. pumping wpm Recover Rale: 113 gpm Method of Testing: /91 A. WeDIntake Opening Type: Q Open End [J Open Hole Greened; Start feet Stopped feet rforatfons Start�f//e{{ss,Stopped _feet , GroutType: Volume /S o,413l Depth: from feet, to feel Pump Intake Depth: teel Pump Size hp Brand Name C/4S 6 J7 JC -4J p D J)LnC Lrj146s't S1� r Y SA�d Cvl.(JcL u. t�1�r<aPR.� Cc#4'( ?4ee4JET AaOSc N4�01,4A Co,66<6r ►3�[�Oc2 � I I I �3rd2,cx I Well Disinfected Upon Completion? (g'res Q No Method of Disinfection: QM -u^0, ,JE ZM 60111 ' Comments: l A / Po3z Drillers Name ATTENTION: It is the responsibility tyof the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health 8 Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 34311744 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Renewal Date Issued: 28, 2000 i Expiration Date: Sep 28, 2001 Permit Number: SW000406 Parcel ID: 051-133-44 Legal Description: HALVERSON LT 16A Design Engineer: 0070 KND Engineering Site Address: 019968 UPPER GREATLAND DR Owner Name: Peter Halverson Lot Size: 54438 SO. FT. Owner Address: 20214 Upper Greatland Drive Total Bedrooms: 4 Permit Bedrooms: 4 Chugiak . AK 99567-6328 This permit is for the construction of: Disposal Field Q✓ Septic Tank Holding Tank ❑ Privy Private Well Water Storage All construction must be in accordance with: 1. 2. 3. 4. The attached approved design. 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 ). The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 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. Received By: Issued By: B. Covered, sealed, and heated to prevent freezing. Date: M –Z-Crzv Date:— 26 KINM ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11/FAX (907)696-8111 May 2, 2000 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Permit Extension SW990353— Halverson Lot 16A Gentlemen: The owner has requested we proceed forward to obtain an extension on the well and septic permit on the subject lot. The property had an existing well serving an adjacent property that was missed during the design. A water works easement was given and recorded for the existing well, as the attached plot plan shows.' The existing well does not impact the design for the subject lot. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, II�iYIP� Engineering /t " �W' 4 zz::'- = = � Brent M. Western attachments: On -Site Well and Sewer Extension Wastewater Absorption System Details/Site Plan Plot Plan r'' WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SIT HALVERS❑N S/D, LOT 16A aAl PS -T g- RE KEM \ TX r9B-1 M LOT 16A th r NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM, NO PRIVATE WELLS WITHIN 200' Or PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. A•4F...A' &, /* 9 9 f F KENNETH L. IIUMS.. / CE 7 � 'O 6 1 Ik . IWOFESS10111 � LOT 15 <413x- 46,936 1 1,900 PLA DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/1.2 GPD PER SO. FT. (1.1 MIN/IN.)= 500.0 SQ. FT (500/5'(W)) X 0.5(RF) (4.0 GRAVEL) = 50 FT. TRENCH USE 1 TRENCH - 50 (L) X 5' (W) X 4'(D) Total depth of system is 6.0' from original grade. Total depth of gravel below distribution pipe is 4.0' . NOTES: 1. USE 1250 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 1 3. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. I PREPARED FOR: CHUCK MOWRER CCC CONSTRUCTION 2401 CHILLIGAN DR Scale: 1'= 100' ANCHORAGE, AK 99517 PAGE OF 2 (907)243-1620 FIELD BOOKS COMPUTED. DDIINUAXM - DRA11N. ENGINEERING KM I STr""G - p1COtFD KMD 20441 PTARMIGAN BLVD. ASBUILT. _ DA . EAGLE RIVER, AK 99577-8736 D'Aa. ME: aaD: NW1260 I AM nE' 99073.DWG 'IDD N'1 99073 (907)696-6111/FAX (907)696-8111 WASTEWATER DISP❑SAL SYSTEM DETAILS HALVERSON S/D, LOT 16A C, KND99-1 PRIMq Y SY ZTEf TCS' F...Aq X91 KENNETH M. S CE -71 ; a w ��- �� -... 11. �FESSIONp— 1250 I MT GAL--,S.T 2VE EM S, 7 o(>g- PREPARED FOR: CHUCK MOWRER CCC CONSTRUCTION 2401 CHILLIGAN DR ANCHORAGE, AK 99517 (907)243-1628 FlEU) BOOKS cwwau: B01nDMV.. - Damn: M $TWNG: _ OECK : KMD A�T: _ DAN , D"O. nom: °"0. NW126 Ac' ^'L`99073.DWG "a" 99073 i m Scalei 1'= 20' PAGE I2 OF 3 M1 10 ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-6736 NOTES: 1. A!L IAT CORNERS RECOVERED WITH 5/8 REBAR 2. ELEVATION IS ASSUMED 95' AT SW CORNER WATER FOR LS SK 490 PLOT PLAN * " ' 0 1 HEREBY CERTIFY TH>ATHAVE f SURVEYED THE FOIlASCRIBED f� PROPERTY: IAT I6A.R SUBDMSION;o� THAT THE PROPOSED EME NO DRAINAGE PATTERNS ASHOWN HLL LOT CORNERS HAVE BEEN FOUND AND ALL DIMENSIONS HAVE BEEN MEASURED TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND ABILITIES. EXCLUSION IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRADE AND UTIL.TIIES CONNECTIONS. AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS. OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PUT. ALASKA BUSH SURVEYING 21435 GINGER LEE DRIVE u CHUGIAK, ALASKA 99567 SCALE 907-688-2316 1' = 60 PIAT PUN OF LOT 16A HALVERSON SUBD. )CATED WITHIN MOA GRID NW 1260 DATE PREPARED FOR PETER HALVERSON 4/15/00 CHUGIAK, ALASKA MKID ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST Performed for. Pete Halverson Date Performed: 7/1/991 Project. Lot 16A Halverson TEST HOLE tl 99-1 Depth SEE ATTACHED SITE PLANT IftOrg—rootmat, soft/med dense FOR HOLE LOCATION 1- brown, mixed sand SM —r eddish smearin 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- g, Sand/silt GW- gray, med. dense, Boulders to 12" B.O.H. HOLE PRESOAKED PRIOR TO PERC. TEST Was Groundwater encountered? Yes What depth? 14' 1 Depth to water after monitoring? 14' Date? 7/8/99 Reading Date Gross Time Net Time Depth to Water Net Drop 1 7/8/99 4:00 - I 12" - 2 4:10 10 min I 115/16" 101/16" 3 4:11 - I 12" - 4 4:21 10 min 114/16" 102/16" 5 • 4:22 I 12" - 6 432 10 min 1 115/16" 101/16" 7 ' 4:33 - I 12" - 8 4:43 10min I 114/16" 102/16" 9 • 4:44 - I 12" - 10 4:54 10 min 115/16" 101/16" 11 4:55 1 12" - 12 10 min 115)16" 10 1/16" • Water Added Percolation Rate 1.1 (min/in) Perc Hole Diameter 6" Test Run Between 4.5 feet and 5.5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. I MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 s11 tpho P, qa"'� ,5/ISlb, b P Ilan, ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Permit Number: SW990353 Legal Description: HALVERSON LT 16A Design Engineer. 0070 KND Engineering Owner Name: Peter Halverson Owner Address: 20214 Upper Greatland Drive Chugiak . AK 99567-6328 Initial Date Issued: Sep 23, 1999 Expiration Date: Sep 22, 2000 Parcel ID: 051-133-44 Site Address: Lot Size: 54438 SO. FT. Total Bedrooms: 4 This permit Is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be In accordance with: 1. The attached approved design. 2. 3. 4. Permit Bedrooms: 4 ❑� Private Well ❑ Water Storage All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of i Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80 ). The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only). 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. 5. The following special provisions. Verify GW depth at time of construction. Received By: Issued By: Date: Date:�G.�' / / 'ICN J ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 FAX (907)696-8111 September 16, 1999 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: New sewer/well permit — Halverson S/D, Lot 16A Gentlemen: On July 1, 1999, we excavated one testhole for the subject property. The result test and water monitoring are attached. this We propose to install a 5' wide shallow trench. The depth to water is approximately 14' therefore we have designed the system in the upper six feet of the gravel layer. Additional fill will be placed over the system to provide a minimum of 3' of cover when complete. This lot slopes from southeast to northwest at slopes less than 20% which is away from the proposed house and any surrounding wells. We propose to drill the well northwest of the house and septic area. There are no public or private wells within 100' of our proposed system location. There is neither surface water within 100' nor any known curtain drains within 50'. A low area, which indicates a seasonal drainage may flow in a swale, is within 50 feet' of the proposed site although there has not been and water observed in it. We do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, END Engineering Ke let . Duffus, P.E. attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PL HALVERSON S/D, LOT 16A LOT 16A �o lk NO PUBLIC WELLS WITHIN 200. OF PROPOSED SYSTEM NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200. OF PR DSED WELL EXCEPT AS NOTED. QF...ALgS 1 * r... * KERN CE U. D 04 �sslo��`' �► 1270 LOT 15 46,936 1 1,900 DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/1.2 GPD PER SO. FT. (1.1 MIN/IN.)= 500.0 SQ. FT (500/5'(W)) X 0.5(RF) (4.0 GRAVEL) = 50 FT. TRENCH USE 1 TRENCH - 50 (L) X 5' (W) X 4'(D) Total depth of system Is 6.0' from original grade. Total depth of gravel below distribution pipe Is 4.0' . NOTES: 1. USE 1250 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. I 3. CONTRACTOR WILL ENSURE MAXIMUM 27 SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. PREPARED FOR: CHUCK MOWRER CCC CONSTRUCTION 2401 CHILLIGAN DR Scale: 1'= 100' ANCHORAGE, AK 99517 PAGE' 1 OF 2 (907)243-1628 FIELD BOOKS COMPUTED: ' liLl dV 1iU ENGINEERING BOUNDARY: _ wAXN: M $TAX,Na — a4:aa:D: KMD 120441 PTARMIGAN (BLVD. ASBUY. _ DATE: Q/14/QQ I EAGLE RIVER, AK 99577-8736 DNa FKL: I aw. AM RF.99073.DWGI"" ` 99073 1(907)696-6111/FAR (907)696-8111` 99073 1(907)696-6111/FAX (907)696-6111 WASTEWATER DISPOSAL SYSTEM DETAILS HALVERSON S/D, LOT 16A KND99-1 PRIMA Air ... AZ4's�' 911 .......... .. .............. CE -711 p4 .. ..... ... Alf ssio"N' 'w PREPARED FOR; 2401 CHILLIGAN DR ANCHORAGE, AK 99517 (907)243-1628 FIELD BOOKS Comp0m. MAm: KMQ ocmm- KMD ASBMT. CAM 9/14 m. rLL. cmm NW126 "`"B 'tL99073.DWGI ""'° 99073 SccJ6: 1'= 20' PAGE 2 01 I KHD ENGINEERING 20441 PTARMIGANIBLVD. EAGLE RIVER, AK 99577-8736 ............. ....... .............. 111 December 29, 1978 $780759 f M.R. Crabtree Peter's Creek, Alaska l (o P- totexx V Subjects Lot 11�-Block-4-Crcatlarnl Estates Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions* please contact this office at 264-4720. Sincerely, Les 17. Buchholz, R.S. Senior Environmental Specialist 111B/1 j w enc: copy of permit Unable to mail - incomplete mailing a4dress. Filed only. 1= F=l r-4 I=. G• . <: A G = DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, At:. 95501 264-4720 WELL F-�EF;ZM I T PERMIT FJO. ( 780759 ) APPLICANT M R CRABTREE PETERS CPK ALASKA 6.-8 2505 LOCATION GREATLRND CIRCLE LOT SIZE 0 SQUARE FEET LEGAL L16 B4 GREATLRND EST I h1INlh1UM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOP. A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOG_ ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN _I 0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATION_ AND CONSTRUCTION DIAGRAM APE AVAILABLE TO IN=URE PROPER INSTALLATION. F'Ef= t•1 I T E: :F=I F�'E- GtiECErI(1EF�. �1. I CERTIFY THAT 1: I RM FAMILIAR. WITH THE PEQUIP.EMENTS FOR OH -SITE SEWERS AND FORTH BY THE PIUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED; .Less Et—_cst� v=---------,r-�=s-.. APPLICANT M R CRABTREE ISSUED BzCCc DATE- - ------------ WELLS RS SET V_. 2 Municipality of Anchorage • -- Development Services Department Building Safety Division On -Site Water and Wastewater Program ` 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA # D ef03G(-I Expiration Date: 3 Z 4 e 1. GENERAL INFORMATION Complete legal description A(,& Vgg:Sott z/6 LOT h<A Location (site address) I Z96tP tJPRf,Z VC -4477 -AM �2 Current Property owners) i ,a,i2A � Day phone 4 rt' —4PEo Mailing address Lending agency Mailing address Real Estate Agent Mailing Address L±2!2!N.,4,Kl Day phone Unless otherwise requested, COSA 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 Day phone TYPE OF WASTEWATER DISPOSAL: 93 Individual On-site 14 ❑ 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 fitie (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 Onsite 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. Name of Firm 1"61C&FF�� Phone e y41' 70?— Address 0ZAddress Z9 5 �Q 72y F—lICL� rTrttF_� Engineer's Printed Name ST�V'e F� r6' Date V. i", : Stwon w. Eng 5. DSD SIGNATURE v�`y�'•e, IE e2ss per.., •,. Approved for L_ bedrooms. ��i*" Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By. JZ:: Original Certificate Date: (Rev. 11005) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-66W www.muni.org/onske (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Well type Date completed 1%&0a Total depth /D( -ft. Date of test Static water level If A, B, or C provide PWSID # _ Well Log (YM) Sanitary seal (YM) Cased to _L/Oft. FROM WELL LOG 6F ft. Well production /(J g.p.m. WATER SAMPLE RESULTS: Wires properly protected (YM) Y Casing height (above ground) 2e-( In, AT INSPECTION 04 tl0 g.p.m. Coliform a colon' 100 mL Nitrate�_'m'gl,L lamer bacteria G colonies/1100 mL Arsenk (J. 2�4 % Date of sample: /�7�a� Collected by i.�s. E.c B. SEPTICIHOLDING TANK DATA 7 jl,ploc Tank Type/Material,!!t'11IPA(ilPQd 4`1255L Date installed.556YZZCA04 Tank size /2 5�0_ gal. Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) V Depression over tank (Y/N) High water alarm (Y/N) At Date of pumping ZU 0 Pumper C. ABSORPTION FIELD DATA Date installed *4' O o Soil rating ( or ft2/bdrm) System type [5w 1 r 4l Length Gft. Width S ft. Gravel below pipe X3 ft. Total depth / q ft. Eff. absorption area !gLoit2 Monitoring tube __�L Depression over field 6t` Date of adequacy test Results (Pass/Fad) Ifs S For 44 bedrooms Fluid depth in absorption field before test _6 in. Water add 00 gal. New depth o In. Elapsed Time: 30 min. Final fluid depth G in. Absorption rate >= t!d'O g.p.d. Any rejuvenation treatment (past 12 mo.) (YM 8 type) U4� e If yes, give date D. LIFT STATION Date installed 'Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off level _ In. Cycles test SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAip station on lot /00 r�- Absorption field on lot Zoo "'' Public sewer main N44 r Sewer /septic service line Z S 4 - Animal containment areas A1114 Manhole/ARcircualreouirements? 1' High waterI at Meets ala On adjacent lots I00 rr On adjacent lots rZOO �* Public sewer manhole/cleanout /V/A Holding tank A414 Manure/animal excrete storage areas _04/114 Ii SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 3 a f Property line Lf' Absorption field Water main Water service line Scl r f Surface water /0Q �f Wells on adjacent lots /OD "e - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �0 �f Building foundation,r0 rr Water main .V 1A Water Service line G r f Surface water / O u �� Driveway, parkkVIvehide storage :a ,f - Curtain drain6A/A'—' Wells on adjacent kris /0 /1- F. COMMENTS COSA Fee $ Waiver Fee $ _ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11/05) 1,, G. ENGINEER'S CERTIFICATION r`.: '' ` S•°) 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA in effect on this date. r . �i t • :� guidelines Engineer's Printed Name S71�t/f /5111J G F''�,'�' Date e` °;� r•J.. .� COSA Fee $ Waiver Fee $ _ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11/05) Analytica International, Inc. 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 ANALYTICA GROUP Northrim Eng Report Date: 1220/2006 Attn: Steve Eng Receipt Date: 12/72006 17237 Bear Paw Circle Sample Date: 12/72006 Eagle River, AK 99577 Sample Time: 10:30:OOAM 907-694-7028 Collected By: SE Fax: 907-694-7026 Client Sample ID: Halverson Sampling Location: LI 6A Client Project: Northrim Eng Sample Matrix: Aqueous COC #: 53805 PWS#: 1 12/72006 12/72006 PL Residual Chlorine: L Comments: Lab# A0612069 -02B Lab#: A0612069 -02A Flae Definitions: MRL = Method Reporting Limit MCL = Maximum Contaminant Limit B = Present also in Method Blank II = Exceeds Regulatory Limit M = Matrix Interference J = Estimated Value D = Lost to Dilution •• = RL higher than MCL; target not detected Analysis Method Prep s MRL MCL Method Prep Analysis Parameter Result Units Flags Dale Date Analyst 922313 -PA (Aqueous) - Coliforms in DW Test was conducted by. Analytica -Anchorage E. Coli <MRL PASS/FAI 1.0 1 12/72006 12/72006 PL L Total Coliform <MRL PASS/FAI 1.0 1 12/72006 12/72006 PL L Lab# A0612069 -02B 4500-NO3E(Aqucous)-Nitrate Test was conducted by: Analytica - Anchorage Nitrate as N 1.50 mg/L 0.50 10 12/82006 12/82006 AJ Reported by: Claire Toon, Page 2 of 2 Laboratory Project Manager Municipality of Anchorage Development Services Department Building Safety Division / On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OSI -133 i� COSA #. Expiration Date: i - 2 - D ro 1. GENERAL INFORMATION ''// Complete legal description &q L t/c�9 -50d SIO L 0 %— Location (site address) /99�-P (_,jP�i2 0p0' 114d,6 ))/Z - Current Property owner(s) /VI/Lr A f (?' 4AAC14 Y' Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address aza Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ I 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. I 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 Onsite 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. Nameo Address f Firm _Zkc I h l2 ivy _` ^g Phone /las? R642 P e,2eCE Engineer's Printed Name Sy,�5trts- F_AJC Date / 0,6e OF A C x 5. DSD SIGNATURE Approved for --I-- bedrooms. Disapproved. Steven W. Eng PE 6256 i Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System A Well Flow Advis( Nitrate Advisory X Arsenic Advisory Maintenance Agreements By. (Ft". 1IM5) WATER AND • n'= t—WAStWATE, PROGRAM Supplemental Engineer's Report Other Original Certificate Date: 9 - :L.—Oro Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage, AK 995198850 www.muni.orglonske (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Parcel ID: oS/'-: / 33 - 4iV Well type%U If A. B, or C provide PWSID # _ Well Log (Y/N) Date completed d/ tl/O 10 Sanitary seal (YM) Wires properly protected (YM) V_ Total depth 00 ft. Cased to._z•• Qft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test /,/2(100 4-P S o C Static water level 6 Q ft. .$ ft. Well production / 0 g.p.m. C4-_ g.p.m. WATER SAMPLE RESULTS: Cdiform_a—colonies/100 mL Nitrate X S mg1L Other bacteria colonies/100 mL Arsenic: Q• 26 7a�gA Date of sample: �qj� Collected by or B. SEPTIC/HOLDING TANK DATA Tank Type/Material &M f %RA^F 'TAM—'C - Date installed FI d -2t a o o Tank size 25 gal. Number of Compartments Z Cleanouts (YM) Foundation deanout (YIN) Depression over tank (YM) At High water alarm (Y/N) Date of pumping 20 0 6Pumper C. ABSORPTION FIELD DATA Date installed -SA-006 Soi rating ( 2 or fe/bdrm)/SiQ_ System type 774 l� Length 4 ft. Width _S ft. Gravel below pipe 2 Total depth fL Eff. absorption area0"fte Monitoring tube Depression over field Ai Date of adequacy test / C Results (Pass/Fail) ' S -f For _4( bedrooms Fluid depth In absorption field before test __0_ in. Water I added 410 gal. New depth d In. Elapsed Tkne:�0 min. Final flukl depth Q in. Absorption rate >= 0(S g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) LZ6((C If yes, give date D. UFT STATION Date installed in gallons Manhole/Access (Y 'Pump ori level at _ In. 'Pump off" level at _ in. High water alarm vel at in. Datum Cycles tested Meets alarm it requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /40 Absorption field on lot /OG rf Public sewer main 1914 Sewer /septic service line :�—It- Animal s r Animal containment areas 64�1 On adjacent lots On adjacent lots 40 o 14— Public sewer manhole/cleanout 11114 Holding tank /y/11 Manure/animal excrete storage areas r� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation rT' Property line /D r* Absorption field -5-4 Water main Water service line .SO � Surface water loo r f - Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /Q it Building foundation Q T` Water main Water Service line . r Surface water /ad f 4- Y, perking/vehicle storage (� `•f Curtain drain (1rce_ Wells on adjacent lots —/—ad r4 - F. COMMENTS G. ENGINEER'S CERTIFICATION ��CCr;�?•..�Zys��, I certify that I have determined through field inspections and R<wir.. review of Municipal records that the above systems are in r �. conformance with MOA COSH guidelines in effect on this date. j ..........................;... Engineer'spPrinted Name - STrt /F Erc/6' C� ��; s,.: �'w. Enp :4, rE 6456 •.� •�av�i Date � t+���PROFFSStONp+ COSA Fee $ q V Date of Payment FhziD, Receipt Number W,,Lq (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number �e .tee 1p tie 7ATZR FOR I6 Iu 490 u n NOTES: I 1. AIL IAT COMMS UCOV= WM 0/0 MMM 2. IDEVATION M ASSSUM 96' AT IW CORNER ,tom-. sm EXCLUSION IT IS TIS RSWONSMOM OP IS ToWMM TY1�1 0TEIC �Ci OF ANY XA.�IT9, COVCiANI2. NS WHICH DO NOT APPGR ON los RMCM0 SUDDITZ ON PLT. UNO>S NO CS(RIM1rANCIM RROIIID ANY D►TA 1SRtO 0 TMC[ IMM FOR CON3nR=ON OR FOR LTUB1Y40NG BOUNDARY ALASKA BUSH SURVEYING 21435 GINGER LEE DRIVE CHUGIAK. ALASKA 99567 907-688-2318 I 8Y81'O1 W. P1Ar PUN 01 IAT 16A HALVERSON SUM LOCATHD 1fMIIN MOA GRID NW 1200 SCALE DATE PREPARED FOR PETER MVERSON i' = 60' 11/1/00 CHUGIAK. ALASKA Analytica International, Inc. 5761 Silverado Way, Unit N Anchorage, AK 99518 Phone: 907-258-2155 Fax: 907-258-6634 ANALYT[CA GROUP Northrim Eng Report Date: 8/16/2006 Attn: Steve Eng Receipt Date: 8/9/2006 17237 Bear Paw Circle Sample Date: 8/8/2006 Sample Time: 12:30:OOPM Eagle River, AK 99577 Collected By: 907-694.7028 MCL Fax: 907-694-7026 Date Date Analyst 9223B -PA (Aqueous) - Coliforms in DW Flag, Definitions: N1RL = Method Reporting L mit Limit Client Sample ID: Halverson L16A MCL = Maximum Contaminant Sampling Location: B - Present also in Method Blank Client Project: Northrim Eng I1= Exceeds Regulatory Limit Sample Matrix: Aqueous M = Matrix Interference COC N: 54931 J = Estimated Value PWSN: D = Lost to Dilution Residual Chlorine: •• = RL higher than MCL; target not detected Comments: PASS/FAI Lab#: A0608116 -02A 1 Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 9223B -PA (Aqueous) - Coliforms in DW T est was conducted by: Analytica -Anchorage E. Coli <MRL PASS/FAI 1.0 1 8/9/2006 8/9/2006 PL L Total Coll iforn/OB <MRL PASS/FAI 1.0 1 8/9/2006 8/92006 PL L Lab#: A0608116 -02B Analysis Method Prep Prep Analysis Parameter Result Units Flags bIRL MCL Method Date Date Analyst 4500-NO3E (Aqueous) - Nitrate Test was conducted by: Analytica - Anchorage Nitrate as N 1.50 mg/L 0.50 10 9110200618/102006 AJ Lab#: A0608116 -02C Analysis Method Prep Prep Analysis I Parameter Result Units Flags MRL MCL 6lethod Date Date Analyst 200.8200.9(Aqueous)- Family Well Water • Test wasconductedby:Analytica- Thornton Arsenic 0.267 ug/L 0.15 10 200.8 8/152006 8/152006 KLS IX�AI?'1 Reported by: Claire Toon, Page I of 1 Laboratory Project Manager Municipality of Anchorage -• Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. ' " ITT P.O. Box 196650 Anchorage, AK 99519-6650 vnvw.ci.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-133-44 Parcel I.D. - HAA # 11 P 3 Expiration Date: S - 3 1. GENERAL INFORMATION Complete legal description Lot 16A, Halverson Subdivision Loc ation (site address ordirections) NHN*Uyper Greatland Drive Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Peter Halverson Dayphone 268-1895 I.. 20214 Upper Greatland Drive, Chup,iak, AK 99567 Day phone 1. - 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 4 Day phone I TYPE OF WASTEWATER DISPOSAL © Individual On-site FKI Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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 less than 30 days old. (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 4MEWI 7PdWri O '-4 Ee9!e River LOOP Road NO -R0 - Name of Firm :-..(n River. Alaska 9957 Phone 6f y' `� 7 Address Engineer's Printed Name Robert C. Cowan. P. F. Date s -ho /o i OF 5. DSD SIGNATURE e� �,I ROBERT C. COWAN Disapproved. o bedrooms. ��+ }!iliCE-8801 ' Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other � By: CIJ. � Original Certificate Date: 3 p -O. (Rev. 12Ca( Municipality of Anchorage • �' Development Services Department Building Safety Division on-site water & wastewater Program 4700 South Bragaw St. P.O. Box 1966S0 Anchorage. AK 995IM650 www.ci.anchorege.ek.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.Of /le. �- �T�r-✓ � m 15 A. WELL DATA Wall type aV4'a- Date completed I Z/ ?Vvt Total depth./0-011- HEALTH epth/0 ft. If A, B. or C provide PWSID # = Sanitary seal&/N) A Cased to 2&fft. FROM WELL LOG Date of test Z/ Static water level Well production g p.m. WATER SAMPLE RESULTS: Coliform �:&—cokinies/100 mi. Date of sample: L ► 01 Nitrate Z. mg.A. Parcel ID: i%SS/ ^I / 33 - " i I Well Logo) Wires property protected&M) Casing height (above ground) i—In. AT INSPECTION ft. g.p.m. Other bacteria coloinies/100 ml. Collected by: 5�% 5 �/G Q-4 r t B. SEPTIC/HOLDING TANK DATA Tank Type/Material C Date installed S /(a Tank size nal• Number of Compartments CleanoulsoIN) Foundation cleanout (Y/N) 74i Date of pumping 'q ?,/ C. ABSORPTION FIELD DATA Date installed/ 2 0V Length (06 Depression over tank (YIN) A/D High water alarm (Y/N) I A/ Pumper dJW or ft'/bdrm) Z System type / �+1/GI+ s*✓ Soil rating (g.p• ' Width Total depth�ft. Eff. absorption area (W-ff ft. Gravel below pipe • 3 ft. Monitoring tube Depression over fieldy I Date of adequacy test __tA./ Results (Pass/Fail) For I bedrooms Fluid depth in absorption field befo�ftuid Water added_ gal. New Idepth_ in. Elapsed Time: _ mi Fepth _ in. Absorption rate >= I g-p•d• Any rejuvenation treatment (past 12 mo.) (Y/N & type) AI&AZf j&ONIAl If yes, give date I D. UFT STATION Date installed 4 P' Size in gallons `Pump on" level at m. `Pump ofi" level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot / VO r 4 - Absorption field on lot /00,+ - Public 00,t Public sewer main Al IA - Sewer /septic service line ZS r�- Manhole/Access (YM) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots /O o f - Public sewer manhole/cleanout _ / / Holding tank ^/ .* SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r � r Building foundation 64- Property line Absorption fiekl S rv'- Water main N f 1A Water service line / D �� Surface water / o p ,+ Wells on adjacent lots leen rt SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 4- Building foundation / O ^' Water main �1r Water Service line /Ory- Surface water /00 ' a' Driveway, parking/vehide storage / O 4- � Curtain drain Wells on adjacent kits 10"Z) r_ 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 effed on this date. Engineer's Printed Name _ ROQE.4T C. Cd wrlr Date S-A o/ o / HAA Fee Date of Payment 3 oo. <.. o bo/0 r Receipt Number 00 111 6 .i (Rev. 12!00) Waiver Fee $ Date of Payment Receipt Number . T: irorrrlAG[[� f, car:.... �!1• ROTMIApCOWAN I�Q. j+Giu, � CE - 8801 ••!`