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HomeMy WebLinkAboutGLENN VIEW ESTATES WEST PH 1 BLK 1 LT 4Glenn View Estates West #1 Block 1 Lot 4 #051-793-04 Municipality of Anchorage'^ `T Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.sk.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO10252 PID Number. 051.793.04 "•'a•' iroy Alderman __ Wastewater System: ® New ❑ Upgrade 71e°'Box 670045. Chuglak. AK 99567 ABSORPTION FIELD FTuw: Npdwera eaerpa . -3403 4 Do" D.r .M ow ®snsora aM D Sae D MOwM o om.r LEGAL DESCRIPTION Re" T�ow.1 e 5.466 0.6 GPoIFl FI. em La tAmd"mort: Depte to p9• eaten rra- WxM" Wad• Cr d" eer"ete p9• 1 4 Glenn View West Estates 1.46 Ft. 4 FL 7a 9: R•r•C•. Saaton: Fe added Flpva ON" Wade: Cara Lapp: 1+ Ft. 77 Ft. Well: ❑ New ❑ Upgrade Cn l"mn: 5 Nude's was: 5a0[aeat.«" wws. 1 NA Ft. FL Claaad aO (P Ovate. A B. C): TOW Depm, Gasd b TOW aeaupewt Free P"MaterW Public Ft. FL 770+ Fr I D3034 & F810 pater Date paled Slaw Wata Lavat: tr"Wtr. Dale e"tatted FL South Fork Const. 1012412001 Pset aL La" Hoot move Gt,„atd. TANK GPMtarp FL FL SEPARATION DISTANCES ® septic ❑ Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lift Station Holding Tank PublWPrivat Sewer Line ewaw Anchorage Tank " 125AG.1. w« 200+ ' 200'+ 200' + NA 25+ ' Malenal. Steel Nuaea a ca pv mnxa: 2 StalaO. waW 1004 100'+ 100'+ NA LIFT STATION LAX Lk" 5'+ 10'+ 10'+ NA 500 Gal Anchorage Tank /Orenco Fa• ^•^•^ 10'+ NA .. at. 39" ;0renco. Pump OR Mwei FL 37" 44 ti h in. NA 'S0'+ NA NA ak.16 Mdaa EWCOval Vdpecttona padomtM W. CwWa pan 30 GPM Allied Alaska Electric Inc. none *none known ' BENCH MARK Insulation over tanks & field Lento' Patio doorsill . iil va 100 FL Engineer's Stamp ••. Inspections performed by: KND Engineering, Inc. Dates: 1't 1012312001st AW g ,.• �' TH % *0/ 2,0/24,200, .... �.� �. I...i Development Services Department Approval 3' oil �; �• J �� p. � Ksnnath AL tier W-o..� Date: 2 . 26 -02 ,� N•e Cf 7II6 Reviewed and approved by: 4 f� .• an.two) t,�%%OFESS10 � ©0% AS—BUILT SYSTEM DETAILS/SITE PLAN Permit SWO10252 GLENN VIEW WEST ESTATES, LOT 4, BLOCK 1 PID#051-793-04 Lot 4 Water 1250 CAL SEPTIC T Etbl1SE"" 4 SDR" E Lot VACAN' Public Water 50' OF AL\ ..........:.. ' ESS100 AV n• PREPARED FOR: LEROY ALDERMAN P.O. BOX 670045 HU AK, AK. 99567 (907) 688-3403 FIELD BOOKS cowulm °01M f" FLEMING DRAW Sl o FLEMING acac0: KMO A" T• FLEMING O"W° 2/19/0 DWr. rtc: Gro: NW1459 Am nc, 01062.OWG '0B " : 01062 SCALE, NTS 86.7 0. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ------------- -all 8.89 8.7 > A -D=49.7' B -D=14.7' W I I I NYg $ A -E=56.2' ZI nY 00.5 FINAL GRADE 99,7 B -E=20.2' B-F=25.2'rt.rttr, ` K rea.ro C -F=54.2' 1IGAL500 ..��v11�r--Kt GA A -G=92.0' LIFT1.25- PVC B -G=72.6' TATIO SEWER ROCK95.8 93.2 93.2 OF AL\ ..........:.. ' ESS100 AV n• PREPARED FOR: LEROY ALDERMAN P.O. BOX 670045 HU AK, AK. 99567 (907) 688-3403 FIELD BOOKS cowulm °01M f" FLEMING DRAW Sl o FLEMING acac0: KMO A" T• FLEMING O"W° 2/19/0 DWr. rtc: Gro: NW1459 Am nc, 01062.OWG '0B " : 01062 SCALE, NTS 86.7 0. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ------------- -all KINID ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 February 22, 2002 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SW010252— Glenn View Estates West, Lot 4, Block 1 Gentlemen: The foundation and subsequent wastewater stubout elevations were set below the proposed design elevation. To address this elevation problem, a 500 -gallon lift station add-on from Anchorage Tank / Orenco was installed. The pressurized distribution system hole spacing design was as follows: 1. Residual head = 5'. 2. Hole size = 3/16" =1.00 gallon per hole @ 30 psi. 3. 30 gallons (pump delivery)/1.00 gallon/hole = 30 holes. 4. 75 LF lateral / 30 holes = 2.5' spacing per hole. 5. All holes shall have caps installed per manufacture specs. 6. Holes at end of lateral shall be constructed w/o caps and placed down. 7. Contractor shall use 11/4" PVC from tank to field and in field. We do not expect there to be any adverse effect on adjacent lots by the operation of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, MD Engineering , q'enneth M. Duffus, P.E. Attachments: HAA On -Site Inspection Report As -Built System Details/Site Plan �PIX't ALLIED ALASKA E'_ECTRIC FA'S N7. : 907373385.-4 Feb. 25 2002 09:33GiM PI February 24, 2002 M2CI, Inc. (Builder/Seller) ELEIC TR/CA L CONTRACT/NG I Chugink, AK (907) 688-3403 fax RE. Gregory A. and Kathleen L. Voge (Buyer:.) Glenn View West — Lot 4, Block I (Property) 21441 Linda Jo Circle To whom it may concern: The lift station at lot 4, block 1 — Glenn View West subdivision was inspected and tested by a licensed electrician and meets all requirements of the national electric code. Please reference the following license numbers: Electrical License number for Martin D. Brown: 19991557 — State of Alaska Contractor's License number. 27843 — State of Alaska I certify this information to be true and correct. Sincerely, ALLIED ALASKA ELECTRIC, LLC r� • P.O.8" 876310, Was+7k Alaska 99687 offlK (907) 37MS93/ CeU 232-8687/Fax 373-3894 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 18, 2001 Expiration Date: Jul 18, 2002 Permit Number: SWO10252 Parcel ID: 051-793-04 Legal Description: Glenn View Estates West Block 1 Lot 4 Design Engineer: 0070 KND Engineering Site Address: NHN Linda Jo Circle Owner Name: Leroy Alderman Lot Size: 41095 SO. FT. Owner Address: PO Box 670045 Total Bedrooms: 4 Permit Bedrooms: 4 Chugiak , AK 99567 - This permit is for the construction of: I i Disposal Field E✓ Septic Tank Holding Tank E] 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. Received By: Issued By: Date: 7—/S— 6)/ Date: ti -O 4 Lo I MUNICIPALITY OF ANCHORAGE �jj/2iJ IJP 31 PM �7 Development Services Department / 7 On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 18, 2001 Expiration Date: Jul 18, 2002 Permit Number: SWO10252 Parcel ID: 051-793-04 Legal Description: Glenn View Estates West Block 1 Lot 4 Design Engineer: 0070 KND Engineering Site Address: NHN Linda Jo Circle Owner Name: Leroy Alderman Lot Size: 41095 SO. FT. Owner Address: PO Box 670045 Total Bedrooms: 4 Permit Bedrooms: 4 Chugiak , AK 99567 - This permit is for the construction of: I i Disposal Field E✓ Septic Tank Holding Tank E] 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. Received By: Issued By: Date: 7—/S— 6)/ Date: ti -O 4 Lo I 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.cl.anchorage.ak.us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 051 - Parcel I.D. -2W793-04 Permit Number SW Property owner(s) Leroy Alderman Mailing address (1) P.O. BOX 670045 Chugiak. AK Day phone 688.3403 S!T>: Meiling address (2) A4 11/4 441DA ZTe C P Zip Code 99567 Ev(t cs w4Z Legal description (Lot, Block & Sub'd.) Glenn View Weelfst. Block 1. Lot 4 Legal description (Section, Township & Range) Lot Size 41.095 sq.ft. Acres/Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR: Sewer Only ® Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. (Signature of property owneFor authorized agent) Date of Payment: Date of Payment: Receipt Number: jasy Receipt Number: (Rev. 1200) K D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER. AK 99577-8736 (907)696-6111/FAX (907)696-8111 July 5, 2001 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: New sewer permit — Glenn View West Estates, Lot 4, Block 1 Gentlemen: The owner has requested we proceed forward to obtain a septic permit on the subject lot. On June 27, 2001 we dug two testholes for the proposed system. The results of these tests are attached. The general slope of this lot is flat. We have designed our system utilizing the testholes we excavated for the 4 -bedroom house, which is proposed for this lot. The lot will be served by public water. We propose to install two 5' wide shallow trenches. Water was not encountered during the excavation or monitoring. 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, MID Engineering Kenneth M. Duffus, P.E. Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE 1 GLENN VIEW WEST ESTATES, LOT 4, BLOCK 1 S LTIETWAI► i NO PUSLIC WELLS WITHIN !OC' Or PROPOSED SYSTEM NO P*IVATE WELLS WITHIN !W Or PROPOSED SYSTEM EXCEPT A$ Note& NO SEPTIC SYSTEMS WITHIN EW Or PROPOSCD WELL EXCEPT AS NOTED Ar �QE�� OF AL91 Of * 4 91U* 9 ce-vue a: JO 1 \ \P"SSloltlw' r DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/.8 GPD PER SO. FT. (6.67 MIN/IN.)= 750 SO. FT (750/5'(W)) X .5(RF) (4.0' GRAVEL) -75.0 FT. TRENCH USE I TRENCH - 75 (L) X 5' (W) X 4.0' (D) Total depth of system Is 5.5' from original grade. Total depth of gravel below distribution pipe Is 4.0' . PL NOTES: 1. USE 1250 GALLON SEPTIC TANK AND INSULATE IF ( 4. OF COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER. 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS 6 SEPTICS. PREPARED FOR: LEROY ALDERMAN P.O. BOX 670045 CHUGIAK, AK. 99567 (907) 688-3403 FIELD BOOKS CONFUTED 90"a" Y' FLEMINGORAWN' VSG STA FLEMING «000' KMO As"X" FLEMING DATE: 7/17 0NGrLE'. ORa NW14° ACRD raE: 01062.DWG J08 "` 01062 Scale: 1'= 100' PAGE 1 OF 2 LLMNI 01' ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ©IN WASTEWATER DISPOSAL SYSTEM DETAILS GLENN VIEW WEST ESTATES, LOT 4, BLOCK 1 25' TH#2001- -o MT 3� �O PROPOSED 1250 GAL SEPTIC TANK T 22' DECK —i F C O PROPOSED 4 BDRM HOUSE OF ALq �'' �* 4ATH-� *+ SS100, FA SLOPE 75/ PREPARED FOR: LEROY ALDERMAN P.O. BOX 670045 CHUGIAK, AK. 99567 (907) 688-3403 FIELD BOOKS COMPUTED, puoulr. MIN WAW: %T—"Q FLEMING CKcm'D' KMD •s"A* FLEMING Wa. 7/17 M sac: anu NW145 Am nc: 01062.DWC I '108 "" 01062 0 #2001-1 42/ = FLA Scale: 1'= 20' PAGE 2 OF 2 M1 1V 1W ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 �4 D � OF ��P; ••"~ dV� ENGINEERING Net Time 20441 PTARMIGAN BLVD. jolt f' L EAGLE RIVER, AK 99577-8736,x•,• 6/27/01 AI • Knn°�1• SOILS PERCOLATION TEST C27115 I, s� •.- Performed for. M2C1 Date Performed: 6/27/01 Project: GVW Bl, L4 TESf HOLE # 2001-1 Depth (Feet) 13- 14- 15- 16- 17- 18- 19- 20 - SEE ATTACHED SITE PLAN ORG- brown, moist FOR HOLE LOCATION GM/SM — med dense, brown w/ cobbles Density, silt increasing w/ depth B.O.11. Was Groundwater encountered? NO What depth? NA Depth to water after monitoring? NO Date? 7/5/01 Reading Date Gross Time Net Time Depth to Water Net Drop 1 6/27/01 1:00 103/16" - 2 1:10 10 min 77/16" 212/16" 3 1:20 10 min 58/16" 115/16" 4 1:30 10 min 37/16" 21/16" 5 ' 1:31 6" 6 1:41 10 min 315/16" 21/16" 7 • 1:42 - 6" - 8 1:52 10 min 315/16" 21/16" 9 10 11 12 ' Water Added Percolation Rate 4.85 (min/in) Pere Hole Diameter 6" Test Run Between 3 feet and 4 feet This test was performed by YkH2L !JODfAIE'/ 1, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. N D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST Performed for. M20 Date Performed: 6/27/01 Project: GVW Bl, L4 TEST HOLE # 2001-2 Depth SEE ATTACHED SITE PLAN ORG — brown, moist FOR HOLE LOCATION GM/SM — med dense, brown w/ cobbles Density, silt increasing w/ depth B.O.H. 13- 14- 15- 16- 17- 18- 19- 20 - This test was performed by 11ICTOIL 60A541 Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 7/5/01 Reading Date Gross Time Net Time Depth to Water Net Drop 1 6/27/01 2:00 8" - 2 2:10 10 min 4" 4" 3 2:20 10 min 112/16" 34/16" 4 • 2:21 5" - 5 2:31 10 min 28/16" 28/16" 6 2:32 - 5" - 7 2:42 1 10 min 28/16" 28/16" 8 • 2:43 5" - 9 2:53 10 min 28/16" 28/16" 10 I1 12 • I Water I Added Percolation Rate4.0 (min/in) Perc Hole Diameter 6" Test Run Between 3 feet and 4 feet 1, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. -- Municipality of Anchorage Development Services Department 442". Building Safety DivisionOn-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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.793-04 HAA # 1-I lei O ,2 O O 6 D Expiration Date: �2 " � 6 — O 3 1. GENERAL INFORMATION Complete legal description ' Glenn View Estates West Block 1 Lot 4 Location (site address or directions) NHN - Linda Jo Circle, Chugiak, AK 99567 Current Property owner(s) M2C1 - Leroy Alderman Day phone 688-3403 Mailing address PO Box 670045. Chugiak, AK 99567 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: 4 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 ❑ 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 KND ENGINEERING, Inc. Phone (907) 696.6111 Address 20441 Ptarmigan Blvd., Eagle River, AK 99577 Engineer's Printed Name Kenneth M. Duffus Date 02/22/02 5. DSD SIGNATURE V Approved for —A— bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineers Report Other By:A&.,,---1(/ • Pc-� Original Certificate Date: C z (Rw. 01102) Municipality of Anchorage * Development Services Department Building Safety Division On-Ske Water 6 Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343-7904 A. WELL DATA Date completed Total depth ft. Date of test Static water level HEALTH AUTHORITY APPROVAL CHECKLIST I u"" 3 I^1rIP�Z11 •, F3t3kI' �� If A. B, or C provide PWSID # _ Sanitary seal (Y/N) Cased to R FROM WELL LOG Well production WATER SAMPLE RESULTS: Coliform colonies/100 mi. Arsenic: _ mg.A. B. SEPTICIHOLDING TANK DATA ft. _ 9 -p.m Nitrate mg.A. Date of sample:_ Tank Type/Material Anchorage Tank 1 Steel Date Installed 10123101 Wall Log (Y/N) Wires property protected (Y/N) Casing height (above ground) AT INSPECTION III 9 - p.m - Other bacteria colonies/100 ml. Tank size 1250 gal. Number of Compartments L Cieanouts (Y/N) Y Foundation cleanout (YIN) Y_pepression over tank (YM) (_High water alarm (VIM Y • 1500 not, LS.I Date of pumping NA - new tank Pumper C. ABSORPTION FIELD DATA Date Installed 1QR,101 Soil rating (9.p•d.11f or fe/bdrm) Q& System type Shallow Trench Length TY ft. Width 5 ft. Gravel below pipe A-- ft. Total depth fiJ ft. Eft. absorption area JMftr Monitoring tube.Y Depression over field y Date of adequacy test NA • new a0m Results (Pass/Fell) For _ bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ In. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. UFT STATION Date installed 10124101 Size In gallons ,'_Manhole/Access (V/N) Y 'Pump on" level at AL in. "Pump ofr level at M in.High water alar level atm in. Datum bottom of tank Cycles tested L Moab alarm b dreu0 requirements?-Ytj E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAl t station on lot On adjacent lots Absorption field on Public sewer main Sewer /septic service On adjacent Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property Une 'f+ Absorption field 51+ Water main 10'+ Water service line 10'+ Surface water 1001+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main _ 10'+ Water Service line 101+ Surface water 100'+ Driveway, parkinglveNcle storage 25'+ Curtain drain 50'+ Wells on adjacent lots '+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that f have determined through field inspectlons 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 _ Kenneth M. Durfus OF.q�R�� 1 • •MN .�. KCnntlill {.1, JJCy, ` r Date 02122102 HAA Fee $375.00 Date of Payment IL Receipt Number (Rev. 1?I01) Waiver Fee $ Date of Payment Receipt Number