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HomeMy WebLinkAboutVALLEY EDGE LT 4Volley Edge Lot 4 #060-331-14 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water 8 Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.sk.us (907) 343-7904 Page 1 of 3 Onsite Wastewater Disposal System and/or Well Inspection Report SW060076 PID Number. 060-331-- I %f Permit Number. Nome: Wastewater System: ■ New ❑ Upgrade LEROY ALDERMAN Address: ABSORPTION FIELD P.O. BOX 670045 ' CHUGIAK, AK 99567 Phone: No. of Bedrooms: 4 O Deep Trench ■ shallow Trench O Bed O sound 0Other (907) 223-8100 LEGAL DESCRIPTION Sea Rig: tad Oep4 horn anprcl area•: 1.2 M/54. n. 8.5 MAX. n Block: Lot: Subdivision: depth b pips touter from aWza W.": G." depth beneath pipe: 3.09 4 VALLEY EDGE SEE DWG. R R Township: Range: Section: — rm eda.d eaa.e wWlna grade: Ga.d w gU: 60 n. — — SEE DWG. R rra.w .idle: Nwnaer of drew: oietanw W~ free: WELL: ■ New ❑ Upgrade 5 FL 1 In. Cbeeirwalion P te. Ae.c): TOW Depot: ooeW To: Told obeorp6m vee: rip. wwt"d01: 517 so. n D 3034/ F-810/ SCH 40 PVC PRIVATE 180 rL61 n Orieen 004 &r i Stalio wotw Lowe: 0wt~ adte FORK CONST. 7 17-18/2006 SULLIVAN WATER WELLSd5/18/nr' 65 RSOUTH ^rd° perp s .Coe+W Ne qM "°°" G caw: TANK 10 cpm UNKNOWN n 2+ n SEPARATION DISTANCES aseptic 0Holding ■S.T.E.P. OOther io Septic Absorption Lilt Holding k/Aisle mawrock•w• ANCHORAGE TANK eopoMY ins°Y0" 1500 From rook Feld Station rook sewer un.. Noncar w aompenmen4: Well too'+ 100'+ 100'+ — 25'+ STEEL 2 Surface water too'+ too'+ 100'+ - - LIFT STATION Lot Line 5'+ 10'+ 5'+ — — site to gya,s; 1500 Nerwraalurr: ANCHORAGE TANK 11 wro an le.w a: of l eL Nigh soler alwm OL Foundation 5'+ 10'+ 5'+ — — 42" 42" 46" Pwrq meas s woad: aw kel lnepeabne Warned b/ Curtain Drain NONE KNOWN 020 OSI 05 HHF RISING SON BENCH MARK Remarks: Loca4on are o..aiptioa: BOTTOM OF SIDING ® FCO Ae«•.ma O..al,an. 100.00 it ENGINEERS SEAL Inspections performed by: GEG, Ltd. Dates: 1St 7/17/2006 000 p o OFF ��4 2nd 7/18/2006 gs400 3rd 7/18/2006op�P.• 0, Development Services Department Approval 0 y ........ �............. 0 Reviewed and approved by: Date: Q'f e A. Gar es s. 0 ; . .o E-79 ; FG �fs� •'••.43,.1 �•� c°'v 04od proressla^°o`er lvI Reviewed and approved by: ate -2-a-2,_07 �00000��a (Re.. 4/06) EPA PERMIT NUMBER: SWO60076 Mph fOpM AS—BUILT DRAWING PARCEL 1D NUMBER: 060-331-02 NEW 1 A B C I 1 WELL 1 I 1 ST' 31.6 23.6 48.4 I I NEW DRAINFIELD ... ....�" 1 39.6 24.4 47.2 1 11 414 24.8 51.7 \88.4 53.5 51.7 109.9 70.9 48.9 61 C -11-V pfpR Mph fOpM / % NEW DRAINFIELD ... ....�" THIe ---�? NEW 1500 GALLON S.T.E.P. TANK BERNARD DRIVE GAR -NESS ENGINEERING GROUP, Ltd. CONSULTANTS i GENERAL CONTRACTORS ]A3 C TI0011 MM. !JA[ 101. MDC^W m M!M • NY[ Cwy) 1 m • M (W7036 -U" • � —4-- ..M�Y.^^ PREPARED FOR: PHONE NUMBER: PAGE NUMBER: LEROY ALDERMAN 223-8100 2 OF 3 LEGAL DESCRIPTION: ORAwN BY: LOT 4, BLOCK 2, VALLEY EDGE SUBDIVISION: C.J.G. DATE: TYPE OF WORK: 8/14/2C AS—BUILT DRAWING OF NEW SEPTIC SYSTEM (Rev. 01105) ALTERNATE SITE '••Je fr A. Corn ss: C 95 ' F: PERMIT NUMBER: AS -BUILT DRAWING P331UO2 SW060076 TOP OF MANHOLE crt / FINAL 5T2GRADE MH f c 87.32 87.06-87.25 rTi f TOP OF TANK AT INLET - 82.97 - TOP OF TANK AT OUTLET - 82.95 I I NEW 1500 GALLON INVERT OF BUNG S.T.E.P. TANK AT INLET - 82.34 FILTER FABRIC TH/1 FINAL GRADE - 97.95-98.88 ORIGINAL GRADE 99.58 O HIGH POINT THE DISTRIBUTION UNE IS 1.25 INCH PVC WITH 1/4- HOLES SPACED 2 FEET ON CENTER. (30 HOLES TOTAL) LLQ_ RELATIVE ELEVATION OF BOTTOM OF TEST HOLE - 84.58 (TEST HOLE DRY) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 6 GENERAL CONTRACTORS M, c (oonw- m • r.+ (WY) 32w • roslc ...e.•...�w...ys• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: LEROY ALDERMAN 223-8100 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: LOT 4. BLOCK 2. VALLEY EDGE SUBDIVISION; C.J.G. arE: TYPE OF WORK: 8/14/2C PROFILE AS -BUILT OF NEW SEPTIC SYSTEM IRev. 0L05) ..... .`'ttI.` ...... etf A.�GD[ntss� 3 79q •..� �14Dai_ a Feb 08 07 01:03p Jim Sullivan 907 p•1 Development Services Department Building Safety Division ., it on -Site Water & Wastewater Program r" `o 4700 Bragow Street = ' • � " P.O. Box 196650 Z" C.. Mark elep dr Anchorage, AK 99519-6650 wun. Mnizry/onsite Mayor (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW4�wz6 Date of Issue: Parcel Identification Number. -331-I 1 Legal Description Property Owner Name & Address: 7�11f}•j8,t 676'arr Pump Installation nate: I/—. - pump i—• -Pump Intake Depth Below Top of Wcll Casing: /37 feet Pump manufacturer's Name: Pump Model: M6,3 7-5-52- Pump S SZPump Size 3A hp Pittess Adapter Burial Depth: /Q feet Pilless Adapter Manufacturer's Namc: PiticssAdapter Installer. Well Disinfected Upon Completion? [R Yes ❑ No Method of Disinfection: Comments: Pump Installer Name: �" `r4701Z"'S tem '*l Attention: The pump installer sliall provide a pump installation log to tile DSDi3days of pump installation. (LL Certitieb �rftttng log by DOC CO. d" SULLIVAN KWATER P.o. BOX 07OZ72, CHUGIA, ALASKA 99567DWELLS -2759 `G BO �0 y �_� RE HOLE DATA OWNER OF LAND: r.-- DEPTH ADDRESS: LEGALDESCRIPTION: 09ILLCY E - Lo -r DATE_ �// 0( PERMIT NUMBER: D 6" 76 Date of 13sue,45- - p6 TAX IDENTIFICATION NUMBER: 0 6b ' 3.7/ " Is well located at approved permit location? Method of Drilling: it rotary Depth of well. Casing Type_Sjj247Z- Wait Thickness d�-'+ inches Diameter /Inches. depth n feet UnerType: A)k)( Casing Stickup Above Ground: d feet Static Water Level: < feel Recover Rate: gpm Method of Testing:SPO Well Intake Opening type: (2 'Op end O open hole O Screened: Stopped fee 0Perforations Start ,ice etC441opped f� Grout Type:/�Volumes Depth: from 20feet. to � fec Well Disinfected Upon Completion? la�s O No Method of Disinfection: e.# /' 0 (A/, 5nIiM Driller's Name �. J�LgJ.t p6n1 6�4j"C; - co9/3,L � o 6A.4 T3Ey,ca�c /3�,...Sa /3A 9r:- J /off P14 {?erwa ATTENTION: It Is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu eoroug'. Department of Environmental Conservation. TO/T0 39Vd NVAI-F-M 6GZZ889 SE:80 900Z/91/80 MMFeb 12 2007 12:47PM Rising Son Electric, Inc. 622-6777 ■• \ Pj5ing bon Uecl:ric. Inc. 11916 \VoodLand Drive � r r z EagLe River, AIC. 99577 `ko (907) 622-6777 February 12, 2007 Gamess Engineering Group Attn: Jody 3701 E. Tudor Road, Ste. #101 Anchorage, AK 99507 Re: Lot 4 Valley Edge Subdivision P.1 Dear]ody: The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely, Kevin S. Hombuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 cc: file M2C1 P.O. Box 670045 Chugiak, AK 99567 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 //-Ii•o6 � /2:G ONSITE WASTEWATER DISPOSAL SYSTEM 1 WATER SUPPLY PERMIT Initial Permit Number: SWO60076 Date Issued: May 03, 2006 Expiration Date: May 03, 2007 Parcel IDnut) -331-14 S Legal Description: VALLEY EDGE- - LOT 4 Design Engineer: 0855 Garness Engineering Group, LTD Site Address: NHN BERNARD ROAD Owner Name: LEROY ALDERMAN Lot Size: 837945 SO. Fr. Owner Address: PO BOX 670045 Total Bedrooms: 4 Permit Bedrooms: 4 CHUGIAK , AK 99567 - This permit is for the construction of: Q Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ 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. �7_o W 1 cc .✓�t S.� r �� '�fv �✓ aj, 7 0 / LC / 4c, Ins -4w/( n% 0. �./ l` f t�lv(tin �i>rv�t V$, • 9✓ �i Received By1��(�IIL14° nil Date: 3 O Issued By. Date: z&& Municipality of Anchorage -tel Development Services Department _' 4 Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw Sl. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.a nchorag e.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. bl DD" �r!- I q Property owner(s) LEROY ALDERMAN Day phone 23-8100 Mailing address p,0- BOX 670045 • CH G18K AK Site address Zip Code 99567 Legal description (Sub'd, Block & Lot) VALLEY EDGE SUBONISION LOT 4 Legal description (Township, Section & Range) N/A Lot Size U91 9949 Acre Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR ( ®all that apply): Absorption Field Septic Tank i] Holding Tank ❑ Privy Private Well O Water Storage THIS APPLICATION IS AN: Initial Upgrade i] Renewal ❑ 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 accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP Ltd. A agent) Permit/Rush Fees: %0•!L - /Ny v`a Date of Payment: 4 Pb !d Receipt Number: 3i GO (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS April 24, 2006 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Well and Septic System for Valley Edge S/D; Lot 4, Block 2, To whom it may concern: The proposed 4 bedroom house is to be served by a private well and septic system. A test hole was excavated on the property. We are proposing that a 1250 gallon septic tank and 5 -wide trench type drainfield be installed. The drainfield will be designed around the 30 foot radius of this test hole. The proposed well is to be drilled in the area shown on the attached site plan and design drawing. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 1.2 gallons/day/ft2 should be used and that the insitu sandy soils will act as a sand filter. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached topography site plan and design drawings, the average slope in the area is approximately 10 to 15 percent nrnning approximately south to north. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. M.S. N0"ached is a site plan drawing, a design drawing, one soil log, which are all pan of the design package for this septic system. (Contact G.B.G. Ltd. for 7page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246 • Website: gamessengineering.com (Rw. 0115) NUMBER OF BEDROOMS: 4 GALLONS PER DAY (GPD): 600 PERCOLATION RATES: S PROPOSED APPLICATION RATE: 1.2 MINIMUM DRAINFIELD SO.FT.: 500 MAXIMUM DEPTH: 9 FEET WIDTH: 5 FEET LENGTH: 60 FEET M.OA. APPROVED SAND FILTER: N/A EFFECTIVE: 3 FEET REDUCTION FACTOR: 0.56 ACTUAL SOST.: 517 TO OBTAIN A COPY OF THE LLIItH :ONTACT GEG. BY PROCEEDING FORWA WITH THIS INSTALLATION, THE ENGINEE WELL DRILLER. CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AN AGREE TO ACCEPT THE TERMS AND i I/ .^ J 1' - STATION OR A GRINDER I \� ' ROPOSED WELL I I PROPOSED 100' WELL RADIUS / INSTALL DOUBLE MAHOUTS/ PROPOSED 7 / / 1250 GALLON / SEPTIC TANK PROPOSED •i �/� .. 4 BEDROOM NOOSE /'• �C'` "I" ` f,0• MY >ROPOSEo — T — •-� 50TEMPORARY CUL-DE-SACS Irr�a•>�.s se�ml.n GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS E GENERAL CONTRACTORS IMI L TIPDII IIOM. U11E 101 • MGIMIIS M ErJDi .AOS (EDT})./?- I" /M PREPARED FOR: PHONE NUMBER: PACE NUMBER: LEROY ALDERMAN 223-8100 2 OF 3 DRAWN BY: LEGAL DESCRIPTION: J.L.M. LOT 4, BLOCK 2; VALLEY EDGE SUBDIVISION DATE: TYPE OF WORK: 4/24/2C DESIGN FOR PROPOSED WELL AND SEPTIC SYSTEM IRw nl. IWN� •A -.J•.......:... Frey A. Gayness: Ls_ CF -7953 PAGE 3 OF 3 4 ALTERNATE SITE. WILL REQUIRE •.•�: �. •. UFT STATION / LLLiLL�L� � BERNARD DRIVE...... ................... ... .. ....... , ... . ...... ..................�....... -}-..-... :::. . -_=r"_-- 50TEMPORARY CUL-DE-SACS Irr�a•>�.s se�ml.n GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS E GENERAL CONTRACTORS IMI L TIPDII IIOM. U11E 101 • MGIMIIS M ErJDi .AOS (EDT})./?- I" /M PREPARED FOR: PHONE NUMBER: PACE NUMBER: LEROY ALDERMAN 223-8100 2 OF 3 DRAWN BY: LEGAL DESCRIPTION: J.L.M. LOT 4, BLOCK 2; VALLEY EDGE SUBDIVISION DATE: TYPE OF WORK: 4/24/2C DESIGN FOR PROPOSED WELL AND SEPTIC SYSTEM IRw nl. IWN� •A -.J•.......:... Frey A. Gayness: Ls_ CF -7953 — — — — — — — — — — — — — — — — — — — — — — — — — — F-0MT S' IDE I 0 MTO 01 ------------------ -----� I� 60 FEET LONG FILTER FABRIC GRADE ORIGINAL GRADE 9 FEET BEEP AT GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS —�� JAI L TOM AO.O. LIR IYs • NSDOWM M NlOt •ACK TIaJ)J%)-1�JI • Iu (NMJI'32" • KnM' wM^'• � PREPARED FOR: PHONE NUMBER: PAGE NUMBER: LEROY ALDERMAN 223-8100 3 OF 3 DRAWN BY: LEGAL OESCRIPnON: J.L.M LOT 4, BLOCK 2: VALLEY EDGE SUBDIVISION DATE: TYPE OF WORK: 4/24/2, DETAIL DRAWING OF PROPOSED SEPTIC SYSTEM 'R«, AIM ... .. .. ff ey G ness.: CE 795,3 •'a►4 \0� °tee..• • • 1 •Z µ/ � �,t� p� GARNESS ENGINEERING`GROUP, Ltd. ov,\Q. Off:' H�e CON3ULTANT3f GENERAL CONTRA- TORS��� . • AI L 1000e 101 • MOOR ML YflO) • f..0.i- 90) )-��>9 • fMl: W -.)TN • p➢If. baa. SOIL LOG — PERCOLATION TEST •• .....Jef ••• LEGAL DESCRIPTION: VALLEY EDGE SUBDIVISION: LOT3, BLOCK 2. —p *- . E 7es gg " WILDWOOD DEVELOPMENT DATE: 4/15/2004 Q����'e�' °�piv N PERFORMED FOR: ( eco P�ofess DEPTH lo�O\o (feet) TEST HOLE % ��OOOo��c ...c 7 k) ,oAHjIPH GM/SM 11• 12- 13. 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 4/15/2004 DRY SOIL CI ASSIFICATIONS 7:09 — 6. —_ ___= ORGANICS/ 7:39 30 0 6 3 7:39 — 6� — ___= FILL ,., GP 5 ML 6 —_ 3— 6 I GM CL TOOT GC OL 4— =_-_ -- °e C°o1 SW MH 5 TOOT ��• sM off SEE SITE PLAN .� SC 6 7 k) ,oAHjIPH GM/SM 11• 12- 13. 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 4/15/2004 DRY 4/22/200 7:09 — 6. —_ 2 DATE READING CLOCK (MINUTE) T DROP WATER READINGVEL (E CHES) 4/16/2004 1 7:09 — 6. —_ 2 7:39 30 0 6 3 7:39 — 6� — 4 8:09 30 0' 6� 5 8:09 — 6 —_ 6 8:39 30 0' 6 PERCOLATION RATE 5 (MIN./INCH) PERC. HULt VIA. o kllm.nua/ 19 TEST RUN BETWEEN 5.0 FT. AND 5.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: NICK HEITSTUMAN COMMENTS: PERFORMED BY CEG. Ltd. I. JEFFREY A. GARNESS. CERTIFY THAT THIS WA ZPE`FORMEO IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS i GENERAL CONTRACTORS w lot. p ? US • n: M -1tN • .vale ,.�...q�•�+a-^^� SOIL LOG• - PERCOLATION TEST LEGAL DESCRIPTION: VALLEY EDGE SUBDMSION: LOT 4, BLOCK 2. PERFORMED FOR: WILDWOOD DEVELOPMENT DATE: 6/19/2004 (� et) ORGANICS TEST HOLE #81 8- 9- 10- 11• 12- 13. 14 15 16 17 18 19 CM/SM SEE SITE PLAN DATE READING CLOCK (MINUTE) WATERREADING LEVEL DROP (IE CHES) CLASSIFICATION 1—_ OR r ISOIL r i 6 t 3 — — 6- 1G PglllllllML 6- 5- 6 — 3 0- GC • l SP CH • !SWIillllllMH t.�%� SC rGROUNDWATER' 8- 9- 10- 11• 12- 13. 14 15 16 17 18 19 CM/SM SEE SITE PLAN DATE READING CLOCK (MINUTE) WATERREADING LEVEL DROP (IE CHES) 8/20/2004 1—_ 2 — 3 O 6 3 — — 6- — 4 — 3 0- 6- 5- 6 — 3 0- 6 - PERCOLATION RATE 0<1 (MIN./INCH) PERC. HOLt VIA. o kl[A.ncai TEST RUN BETWEEN 4.0 FT. AND 4.5 FT. 20— 1 1 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ROB CAMBELL COMMENTS: 'THE INSITU SANDY SOILS WILL ACT AS A SAND FILTER. PERFORMED BY GEG. Ltd. I, JEFFREY A. GARNESS. CERTIFY THAT THIS WAS PER ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: (pi 7 0 • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 060-331-14 Expiration Date: 1. GENERAL INFORMATION: Complete legal description VALLEY EDGE; LOT 4 Location (site address) 19381 BERNARD DRIVE, EAGLE RIVER, AK 99577 Current Property owner(s) STEVE AND DOREEN HAMILTON Day phone 406-5512 Mailing address 19381 BERNARD DRIVE, EAGLE RIVER, AK 99577 Real Estate Agent DONNA ALDERMAN Day phone 360-0158 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ l 2..'y vfp Waiver Fee $ Date of Payment i 3 0/a 0.2 0 Date of Payment Receipt Number $ �S'O Receipt Number COSA # 0 J3 Cl 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE b, ZIL ...... ...... y �y ..ss • CF— 7953 tl�S C. � F,` o C� o #AECC884 System #1 Approved for bedrooms ��` •� OF A/1rC iii System #2 Approved for bedrooms Disapproved014. o Conditional approval for bedrooms, with the folloSiR§ stiWPa1iVs<:, �P1ER o1 PO _; �))FNT SEg `,�' Original Certificate Date: 6 3 ?-C) ZD 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 C Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10.10.12.doc � \ Legal Description: VALLEY EDGE; LOT 4 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5118106 Total depth 180 ft Cased to 61 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7113120 Static water level at beginning of test 65.1 ft. Comments B. TANK DATA Age of tank(s) 14 years Tank type/material STEEL Measured operating fluid level in septic tank 46°-47" ❑ Standpipes/foundation cleanout per record drawing Date of pumping 6/22/2020 i D. ABSORPTION FIELD DATA PRESSURIZED DEEP TRENCH0JT11MT2) Which system tested (date installed) 7117-18106 ❑ ALL standpipes present per record drawing Total measured depth from grade 7.0 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 060-331-14 Structure served by this system 1 Well production at time of test 5.9 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? ❑ Yes ❑ No ©/Coliform bacteria is Negative Nitrate (• `t' mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L RIArsenic less than MRL (ND) Collected by GEG,LTD. Date of Sample 7113120 C. LIFT STATION ❑ Required maintenance completed Age of lift station 14 years Lift station material STEEL Comments: Adequacy test date 7113120 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 27.25 in Water added 882 gal New depth 33.75 in Elapsed time 905 min Final fluid depth 26 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) NONE If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' M Yes if No Community Sewer Manhole/Cleanout > 100' Q Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' [✓ Yes if No ft Holding Tank > 100' 21 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ✓V Yes if No 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' ft ft ft ft ft 0 Yes if No ft Property Line > 5' M Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' El Yes if No. Water Main > 10' ✓V Yes if No ft Community Wells > 200' 0✓ Yes if No. Water Service Line > 10' Z✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Fv Yes if No ft If absorption field is under driveway comment below Property Line > 10'[]✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Water Service Line > 10' Yes if No ft Community Wells > 200' Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ft ft ❑✓ Yes if No ft Z Yes if No ft #AECC884 ...... ... .................... ........... . . �f rey G rness: �9. CE—� 4Pre �.79-5 R�"f ••.� g�..�i(JA�cpG ... • ' pro f es si006, t �� C #AECC884 ASBUILT HEPEBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO FNCROACHWENTS EXIST EXCEPT AS INDICATED. IT IS THE'RESPONSISILITY OF THE OWNER TO DETERMINE TK EXISTENCE OF ANY EASEMENTS, COVENANTS, OR REe;TRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SWLU ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SE -WARD & ASSOCIATES LAND SURVEYING 694-0829 SCALE: 0 A D.A TE: TH GRID: .. .... s Duane Mark Seward V Ls 69IB/ 4�ulg DRAW MUNICIPALITY OF ANCHORAGE Development Services Department j% Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Owners r ,n , ,,1n& 4o -n Street Address' 75ex- n v,' r Septic Tank: -Sludge level inches -Pumping- required yes tno -Pumping completed yes Lift station: -Pump basket cleaned ties no -Control floats cleaned �e� s. no -Operation satisfactory /-y-4 no K-,-7 AlarT System. -Effluent filter cleaned Q0 no -Proper float settings confirmed es no -Dedicated electrical alarm circuit 3 es no -Audible and visual alarm inside dwelling �esno -Alarm system operatio satisfacto not satisfactory .5 Manhole Riser -Ground water intrusion at riser to tank connection -Ground water intrusion around pipe penetrations es no Weep hole functional(ye no -Manhole lid: Functional e no Insulated es no Properly Secured es) no Other -All manufacturer required inspections and maintenance completed; yes,,, no Comments: Qualified Maintenance Provider: Technician Date of maintenance- Company53 Signature € Date ZZ r Parcel 1. D. 060-331-14 Municipality of Anchorage Y On -Site Water and Wastewater Program (907)343-7904 �. Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Valley Edge, Lot 4 Location (site address) Expiration Date: 2 �� 19381 Bernard Drive Eagle River, AK 99577 Current Property owner(s) James & Kenna Hefner Day phone 227-8489 Mailing address PMB 235 12110 Business Blvd. #6 Eagle River, AK 99577 Real Estate Agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duple' 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance request Received by: Four Day phone uRmITTAL AUG 2).-2914 TYPE OF WASTEWATER DISPOSAL: COSA to be releasekto the)ngineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number )( "q 4/5 G COSA# Date: G Waiver Fee $ _ Date of Payment Receipt Number Waiver # ❑ Holding Tank ❑ Community ❑ ❑ Public Sewer ❑ COSA to be releasekto the)ngineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number )( "q 4/5 G COSA# Date: G Waiver Fee $ _ Date of Payment Receipt Number 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. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE 522-7773 Date 8/9/14 _lx� System #1 Approved for bedrooms 0 O .MiaA pfd; AHMSorr:, r System #2 Approved for bedrooms I+ J f : CE -4381 Disapproved;41 yiD0 PROFESSV� 4`0 '?r2 Conditional approval for bedrooms, with the following stipulations. By: &�-,X o Original Certificate Date: g The Municipality of A, orage 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 sheet f ., c If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Valley Edge, Lot 4 A. WELL DATA Well type Private Date completed 5/18/16 Total depth 180 ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 61 ft. Parcel ID: 060-331-14 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. WATER SAMPLE RESULTS Coliform 0 colonies/100 mL Nitrate 1.19 mg/L Arsenic ND ug/L Date of sample: 7/29/14 Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/Steel Date installed 7/17-1812006 Tank size 1,500 gal. Number of Compartments 3 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) Y Date of pumping'^ ' '`� Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 7/17-18/06 Soil rating (g.p.d./ftZ or ftz/bdrm) 1.2 GPD/SF System type 5' Wide Length 60 ft. Width 5 ft. Gravel below pipe 3.09 ft. Total depth 6.9-8.5 ft. Eff. absorption area 517 ftZ Monitoring tube Y Depression over field N Date of adequacy test 7/31 /14 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 3 in. Water added 600 gal. New depth 7 in. Elapsed Time: 1,440 min. Final fluid depth 3 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date FROM WELL LOG AT INSPECTION 5118/06 7/31/14 Date of test 65 68.7 Static water level ft. ft. 10 4.0 Well production gpm P.P.M. WATER SAMPLE RESULTS Coliform 0 colonies/100 mL Nitrate 1.19 mg/L Arsenic ND ug/L Date of sample: 7/29/14 Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/Steel Date installed 7/17-1812006 Tank size 1,500 gal. Number of Compartments 3 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) Y Date of pumping'^ ' '`� Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 7/17-18/06 Soil rating (g.p.d./ftZ or ftz/bdrm) 1.2 GPD/SF System type 5' Wide Length 60 ft. Width 5 ft. Gravel below pipe 3.09 ft. Total depth 6.9-8.5 ft. Eff. absorption area 517 ftZ Monitoring tube Y Depression over field N Date of adequacy test 7/31 /14 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 3 in. Water added 600 gal. New depth 7 in. Elapsed Time: 1,440 min. Final fluid depth 3 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION No Add On Manhole - Gravity Flow to Absorption Trench. Date installed 7/18/06 Size in gallons 1,500 Manhole/Access (Y/N) Y "Pump on" level at 44 in. "Pump off' level at 38 in. High water alarm level at 46 Datum Bottom of Tank Cycles tested 3 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >1 00' Absorption field on lot >1 00' On adjacent lots >1 00' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: ' Building foundation >5' Property line > Water main >10' Water service line >10 Wells on adjacent lots >100' ABSORPTION FIELD ON LOTTO: Property line >10 Building foundation >10' Water Service line >10' Surfacewater >100' Curtain drain None Noted Wells on adjacent lots >100' 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 COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P. E. Date _ 8/9/14 COSA brown sheet -1 0-10-1 2.doc Absorption field >5' Surface water > 100' Water main N/A Driveway, parking/vehicle storage > 10, HAU E. ANDERSON Soo CE - 4381 i PROfE5510\ate � \ Municipality of Anchorage Development Services Department •. �i Building Safety Division • • •• / On -Site Water & Wastewater Program AA 4700 Bragaw Street 1 , 1 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. _11 -33 j COSH# 1. GENERAL INFORMATION Expiration Date: �— — O 7 Complete legal description VALLEY EDGE SUBDMSION LOT 4 Location (site address) :Llg� BERNARD DRIVE ' EAGLE RIVER AK 99577 Individual Well Current Property owners) LEROY ALDERMAN Day phone (907) 223-8100 ❑ Mailing address Lending agency Mailing address Real Estate Agent Mailing address P.O. BOX 670045 * CHUGIAK AK 99567 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank O Community Class Well 13 Community On-site ❑ Public Water System 171 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 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 samples. (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 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 riles 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 Finn CARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS. P.E. Date Z D Engineer's Comments: In conducting this evaluation, GEG, UD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSO Guidelines 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Idenlirlable features. The operational life of all wells and septic systems depend on the local sells condition, groundwater /avets 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 14 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: 11 OF ON-SITE , c WATER AND WASTEWATER PROGRAM n.. COSA Checklist (J Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other By. ° Original Certificate Date:. — 2 2 — 0_7 (R•v. 11,05) Municipality of Anchorage Development Services Department Building Safety Division , • •,• On -M water 6 wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onske (907)943.7904 CFRTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST Legal Description: YALI EY EDGE SUBDIVISION LOT 4 BLOCK 2 Parcel ID: D&iQ y A. WELL DATA Well type PRIVATE If A, B. or C provide PWSID# N/A Well Log (YIN)? 5-- 5 2006 Sanitary seal (YIN) YES Wires properly protected (YIN) YES 18 Date completed �— Casing height (above ground) 18+ in. Total depth 180 ft. Cased to 61 ft. FROM WELL LOG Date of test 5/1 BY2006 Static water level 65 ft. Well production 10 — 9 -p.m -WATER SAMPLE RESULTS: AT INSPECTION ft. g.p.m. Coliform i— colonies/100 ml. Nitrate 0•17- mg./L. Other bacteria O colonies/100 ml. Arsenic: 0-11ug•tL• Date of sample: 1 30 07 Collected by: GEG. Ltd. B. SEPTICIHOLDING TANK DATA Tank TypelMaterfal S.T.E.P. STEEL TANK Date installed 7/17-18/2006 Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation deanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) YES Date of pumping NEW Pumper c. ABSORPTION FIELD DATA Date installed 7LZ=-16/2a Soil rating (g.p.d.fleo<�jo 1_2 Length 60 ft. Width 5 ft. System type 5 -WIDE Gravel below pipe 3.09 ft. Total depth'a•a - e.5ft. Eff. absorption area 517 fe Monitoring tube YES Date of adequacy test NEW Results (Pass/Fall) PASS Fluid depth in absorption field before test = in. Elapsed Time: = min. Water added=gal. Final fluid depth =_ in. Depression over field NO For 4 bedrooms New depth =in. Absorption rate >= - g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date - I D. LIFT STATION Data installed7/17-18/2006 Size in gallons 1500 Manhole/Access (YIN)_ N/A "Pump on" level at 42 in. "Pump oft" level at 42 in. High water alarm level at 46 In. j Datum B.O.T. Cycles tested NEW Meets alarm 8 circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manureianimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water_ 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Parking/vehicle Driveway, rki g y pa storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined thro ugh held i nspedtons and * :' ¢ '•.� review of Municipal records that the above systems are in • • • • • • • • • • . • • conformance with MOA COSH guidelines in effect on this date. ....... ................... Engineer's Printed Name JEFFREY A. GARNESS'• r y ess. /I Aye CE -79 3 �` Date COSA Fee S S7, SO —y Date of Payment r � Q o Receipt Number— Ci i ,'� —7 (Rev. 11/%) Waiver Fee $ Date of Payment Receipt Number