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Home My WebLink AboutT15N R1W SEC 8 LT 187.4111111 Municipality of Anchorage Community Development Department NOV ` of 3 .12 Z0iPage On-Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191414 PID Number: 051-154-30 ❑ New ■ Upgrade Name: BYRON MATLOCK ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ound Address: 19744 SUNSET BLVD., CHUGIAK, AK 99567 ❑ Other Phone: No. of Bedrooms: Soil Rating: Total Depth from origina de: 863-0210 4 GPD/Sq. Ft. FL LEGAL DESCRIPTION Depth to pipe invert from original grade: Ft, Grave epth beneath pipe: Fl. Subdivision: Block: Lot:Fill added above original grade: Gravel length: - - 187 G FL Fl. Township: 15N Range: 1WSection: 8 Gravel width: ��t r Ft. Beds Number of lines: Distance between lines: Fl. SEPARATIONDISTANCES Total absorp' area: Number of trenches: Dist. between trenches: To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank sewer Lines so. FL FL Well 100'+ _ 25'+ TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑ Other Manufacturer Capacity: Surface Water 100'+ - GREER TANK *1500 Gal. Lot Line 5'+ - - N/A Material: Number of compartments: HDPE PLASTIC 2 LIFT STATION Foundation 10'+ - - - Curtain Drain NONE KNOWN Manufacturer. Ca I y: Gal. Remarks: *LARGER TANK THAN NEEDED INSTALLED "Pumpon"Ievelat Highwateralarmab PER THE REQUEST OF THE OWNER. Pump Make & Model Electrical Inspections performed by: PIPE MATERIAL D3034 D3034 House to tank (FOR NEW) Tank to (FOR NEW) drainfield Installer D3034 ARM SEPTIC SERVICES, LLC Drainfield EXISTING CO/MT (FOR NEW) Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft I- Inspection Location and Description: Dates: 1st 11/4/2019 2nd 3rd - 4th - BOTTOM OF SIDING NEAR FCO ENGINEER'S SEAL Community Development Department Approval 44 �F �P•••••••.... ..:9S 4 Conditional approval: Date:AV 4 LH_ ............. . .. ... ...... .............. ........... . ........................... 0 . Garn ss ,.=�: �' CE-7953 = Z AV ♦ Approved: Date: t2 —� • LICENSE1%"1 FECJ'S;`�• #AECC884 Inspection Report _1-1-12.doc PERMIT NUMBER: OSP191414 RECORD DRAWING GAS EASEMENT - - 1"=30' PARCEL ID NUMBER: 051-154-30 d •; A EXISTING • WELL •-- ate'=--• - t -� ��,^l�,•l� ---------------- �-moi- -- ---_ --------- ---------- I RESERVE d..'. j. WELL SITE I . gig; ! �:a•'• �e..�•y,:_" �'• '•:� I d- ••,• ., d' . 7. 1 OFWp a' ••DRIVEWAY. `\ t' ,e •4�� :d+' I '} O id 1 CL 4 d.t NOTE: OLD SEPTIC TANK TO BE DECOMMISSIONED PER UPC n KEN DUFFUS, P.E. TEST HOLE # TH 16-1 I I II I I II 4 -BEDROOM I I RESERVE DRAINFIELD 1 I II II II Ij Li NEW GREER 1500 GALLON HDPE PLASTIC SEPTIC TANK INSTALLED DOUBLE CLEANOUTS (DBL1 & DBL2) k�w --------- jlU 1 / p z POSSIBLE 50' RIGHT-OF-WAY EASEMENT. I UNCLEARIF THIS EXISTS 1"=30' PARCEL ID NUMBER: 051-154-30 d •; A EXISTING • WELL •-- ate'=--• - t -� ��,^l�,•l� ---------------- �-moi- -- ---_ --------- ---------- I RESERVE d..'. j. WELL SITE I . gig; ! �:a•'• �e..�•y,:_" �'• '•:� I d- ••,• ., d' . 7. 1 OFWp a' ••DRIVEWAY. `\ t' ,e •4�� :d+' I '} O id 1 CL 4 d.t NOTE: OLD SEPTIC TANK TO BE DECOMMISSIONED PER UPC n KEN DUFFUS, P.E. TEST HOLE # TH 16-1 I I II I I II 4 -BEDROOM I I RESERVE DRAINFIELD 1 I II II II Ij Li NEW GREER 1500 GALLON HDPE PLASTIC SEPTIC TANK INSTALLED DOUBLE CLEANOUTS (DBL1 & DBL2) GARNESS ENGINEERING GROUP, Ltd - - = CIVIL & ENVIRONMENTAL ENGINEERS =- 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 • FAX (907) 336.3246 • WEBSITE: www.gamessongineedng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: BYRON MATLOCK 863-0210 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: Tl 5N, R1 W, SECTION 8; LOT 187 J.L.M. TYPE OF WORK: DATE: �. DESIGN OF SEPTIC TANK UPGRADE AND RESERVE SITE 11/11/2019 OF „1,1 �?' 1 '••` .......... :.;... _ ...... .....:. J. effr I,y A. Ga`es :: #��J,,•� .� /GE=7953 ��: F '••. •'444PROFESS\StPi�� LICENSE �4slk"`*** #AECC884 / k�w \w \ C B EXISTING DRAINAGE SWALE QF B o SHOWN ON AS -BUILT SURVEY. -� DITCHLINE HEAVILY VEGETATED. w DITCHLINE DRY ON 8/13/19, 8123119,8/29/19, & 9/3119. DRAINAGE SWALE NOT SHOWN Col a ON MOA WETLANDS MAP. � MN CO2 '° B NOTE: REQUEST THE \ CO3 FCO 26.1 22.2 POST -CONSTRUCTION MTI MH 29.3 39.4 SURVEY BE WAIVED SINCE / STI 33.1 42.5 THE NEW TANK LOCATION DBL1 34.5 43.0 IS NOT CLOSE TO ANY / DBL2 35.252.5 PROPERTY LINE AND THE EXISTING DEEP C01 36. 0 OWNER IS NOT SELLING 30.0 / TRENCH DRAINFIELD CO2 55.4 THE HOME AT THIS TIME 49.6 CO3 73.8 45.7 / { TH#2T MTI 72.7 45.9 GARNESS ENGINEERING GROUP, Ltd - - = CIVIL & ENVIRONMENTAL ENGINEERS =- 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 • FAX (907) 336.3246 • WEBSITE: www.gamessongineedng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: BYRON MATLOCK 863-0210 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: Tl 5N, R1 W, SECTION 8; LOT 187 J.L.M. TYPE OF WORK: DATE: �. DESIGN OF SEPTIC TANK UPGRADE AND RESERVE SITE 11/11/2019 OF „1,1 �?' 1 '••` .......... :.;... _ ...... .....:. J. effr I,y A. Ga`es :: #��J,,•� .� /GE=7953 ��: F '••. •'444PROFESS\StPi�� LICENSE �4slk"`*** #AECC884 / PERMIT NUMBER: PARCEL ID NUMBER: OSP191414 RECORD DRAWING 051-155-43 TOP OF MH ^� �� GARNESS ENGINEERING GROUP, Ltd ENGINEERING => SALES s CONSULTING 3701 E. TUDOR ROAD, SUITE 101' ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 33&3246' WEBSITE: w .gamessengineering.mm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: BYRON MATLOCK 863-0210 3 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: T15N, R1W, SECTION 8; LOT 187 J.L.M. TYPE OF WORK: DATE: �. RECORD DRAWING OF SEPTIC TANK UPGRADE 11/5/2019 .•'�E OF 44, * • . 49 * 0 ..............., i .... ................. ♦ �'. e . Ga Hess Qj i Al ice. :•SA. i Ar• FQ•• .......... �. 1 LICENSE �11rrL'Im* � #AECC884 0 ,"°""'Y MUNICIPALITY OF ANCHORAGE ,,, On-Site Water&Wastewater Program en s�� r, ! PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 \ d�f http://www.muni.org/onsite " - rpartment 44"c off Ac,E On-Site Wastewater Disposal System Permit Permit Number: OSP191414 Effective Date: 9/24/2019 Work Type: Septic Upgrade Expiration Date: 9/23/2020 Tax Code Number: 05115430000 Site Legal Address: T15N R1W SEC 8 LT 187 G:1257 Site Mailing Address: 19744 SUNSET BLVD, Chugiak Owner: MATLOCK BYRON L &ANNA M Lot Size in Sq Ft: 108900 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4 This permit is for the construction of: I Disposal Field El Septic Tank ❑ Holding Tank 0 Privy 0 Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing C� t Received By: �- �. Date: 1 / • Issued By: ltJE6'- / Date: �� MUNICIPALITY OF ANCHO R-i' a 0 " • fry Development Services Department -hone: 907 343-7904 On-Site Water & Wastewater Section — � Fax: 907-343-7997 c 0" 01 6 2 L9 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-154-30 Property owner(s) BYRON MATLOCK Day phone 863-0210 Mailing address P.O. BOX 670862, CHUGIAK, AK 99567 Site address 19744 SUNSET BLVD., CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) 187 Legal description (Township, Range & Section) T15N, R1 W, SECTION 8 Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field U Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank ❑ Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: sq6- Waiver Fees:_ Date of Payment: q//91/4 Date of Payment: Receipt Number: ��yy 0i'U:/c6 Receipt Number: U Permit No. ccf/ /til C/ Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc . _ . Quanics GARNESS ENGINEERING GROUP, Ltd Advanced Treatment System ENGINEERING SALES^CONSULTING --- Oeai e a, /er September 6, 2019 Municipality of Anchorage Development Service Department On-Site Water& Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for T15N, R1 W, Section 8; Lot 187 To whom it may concern: The existing 3-bedroom house is served by a private well and private septic tank. The existing septic system consists of a 1250-gallon steel septic tank and a deep trench type drainfield. The existing septic tank is believed to be of poor integrity (due to the operating level in the tank) and must be upgraded. We are requesting a septic tank permit be granted for this property. On 10/22/2016, a 4-bedroom sewer permit (OSP161286) was issued based upon the Kenneth Duffus, P.E. design. A reissuance of the permit was granted on 7/26/2018 (OSP181214). The owner has recently hired us to see if his existing drainfield is adequately sized for 4-bedrooms and to see about upgrading his septic tank. Per the 1982 Inspection Report, the existing drainfield is 56 feet long by 3 feet wide with 6 feet of effective and should have a total effective absorption area of 672 sq.ft. Arm Septic Services, LLC recently installed a 2" monitoring tube and 4" cleanout on the east end of the drainfield. On 8/13/2019, we performed a septic adequacy test and found the absorption rate to be greater than 600 gpd, which meets the 4- bedroom absorption requirement. We also had two (2) test holes excavated on the property and performed percolation tests. Test hole #1 (TH#1) was excavated next to the existing drainfield and the percolation rate was found to be 1.08 minutes/inch. The 30-foot radius of TH#1 completely encompasses the existing drainfield. Based upon this percolation rate, a 1.2 application rate should be applicable for this drainfield. In short, a 4-bedroom drainfield would need to have 500 sq.ft. (600 gpd / 1.2 gpd/sq.ft.). Given there is 672 sq.ft. in the existing drainfield and that it has recently passed a septic adequacy test for 4-bedrroms, we request the existing drainfield be approved for 4-bedrooms. We have identified a reserve drainfield site on the design drawing at the same area as Mr. Duffus's design. 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. erI i Je ,- •. Garness, P.E., M.S. Pr:•ident 3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com I I \ ! \ APPROX.100' / I N \ WELL RADIUS / I - • \\\ /// JI `\G T15N,RIW,SECT.8; \�.---_.'/ m) �5�e��2 LOT 181 T15N,R1 W,SECT.8; j C-P.°, LOT 182 (n SERVED BY PRIVATE Z L 183 T15N, WSECT.8; LOT 183 WELL AND SEPTIC. DI NO RECORDS FOUND co, I J POTENTIAL WE�L�---%\ �I \� 1\\ RESERVE // RESERWELLSITEI \\ \ TENADAAVE. (UNDEVELOPED) / / - -- 1aNat Gas E \ ___ —. —_ — EXISTING WELL — \ EXIEIRQ_--- — — — — I - 3-BEDROOM I --- I IHOUSE I �, I - I / V KEN DUFFUS,P.E. // / a- TEST HOLE o.\ / /V // 1 N j // f ��i�(— T15N,R1W,SECT.8; -- —-- — , LOT 186 T15N,R1 W,SECT.8; PROPOSED SEPTIC ♦TH#1 LOT 188 TANK UPGRADE Q SERVED BY PRIVATE WELL AND (SEE DESIGN O SEPTIC.BOTH APPEAR TO BE ON EAST SIDE OF PROPERTY PAGE 2 OF 2) EXISTING / -I *TH#2 SEPTIC SYSTEM I d I C9 z I- ____ X / \\ I / i ^�� Lam_ '7 \ /� - - - - - ---------- I I / \ 1 I / \ � r 1 \ / I T15N,R1 W,SECT.8; \ -1-.. J I LOT 215 \\ // "� \ SERVED BY PRIVATE WELL- / i I. , \ WELL ON SOUTH SIDE OF / 'i r / PROPERTY.SEPTIC SYSTEM NN. — — \ LOCATION WAS PROPOSED. V T15N,R1 W,SECT.8; S N.N. N / LOT 213 — — SCALE T15N,R1 W,SECT.8; — — LOT 214 1"=100' 1 • • QBE..•••..•.•. ..,44. �A♦ ✓' 1f. . ..0 V.. o .. •••• ' GARNESS ENGINEERING GROUP, Ltd ; *` :We 9� •'1* 1,10.3,t..`7 ,. -^ ENGINEERING,SALES'CONSULTING • 3701 E.TUDOR ROAD SUITE 101•ANCHORAGE.AK 99507•PHOPE(907)337.6179•FAX(907)338.3246•WEBSITE:www.gamessengineering.00m •• • '-. •• •••", PREPARED FOR: PHONE NUMBER: PAGE NUMBER: /0 •; - !' A. - = -• it BYRON MATLOCK 907-863-0210 1 OF 2 •0c / CE-/95/ ° a PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦♦�� i••• r ♦ T15N, R1 W, SECTION 8, LOT 187 J.L.M. ♦♦♦'CO.'• O ,,��\P\,� • TYPE OF WORK: DATE: '4 P ESS ,, ♦ SEPTIC SYSTEM DESIGN UPGRADE 9/6/2019 LICENSE 11 �� 1 s GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER / / \ THAT PERTAINS TO THIS DESIGN.BY PROCEEDING / �� FORWARD WITH THIS INSTALLATION,THE �"S� ENGINEER,WELL DRILLER,CONTRACTOR AND _ — — — — — r --Le PROPERTY OWNER AGREE THAT THEY HAVE _• READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. • • ,. • •' ' • • * . 1• •• 10'GAS EASEMENT . .1.• ** : ', • •• . ;• :. i EXISTING tWELL a POSSIBLE 50' ;•.. :. 2 RIGHT-OF-WAY I ti EASEMENT. a •' UNCLEAR IF .:la" i GREENHOUSE . ' THIS EXISTS 1.—_ I - .•1: 74•' RESERVE •..'• I •':. 'i WELL SITE y- .a•; ..•..• 1 . A.• :4. • //, 1 ea • \ OD zp� ' : :•DRIVEWAY• .4 ..•• •: •. •.. I cr Lu IY} • 4 ., • 20I �' a' / ).-e,lea \ tuO.4N a EXISTING STEEL SEPTIC TANK TO \ r t7 O \ BE DECOMMISSIONED PER UPC Y \\ \\ / n \ w \ \ / KEN DUFFUS, , 3 \ EXISTING DRAINAGE SWALE P.E.TEST HOLE I I e $ SHOItU: ' LT SU /JZ DITCHVEGEIH DITN 8/14EDROMI IF 88 9/3/ESERVI 1 p DRAINOT SHOWN / •• t— — a ON MOA WETLANDS MAP. DRAINFIELD 1 I CO /� / (SEE DESIG � jllj/j ,/ 1 CRITERIA) 11 �MH 1 I V I I CO •H#1 DESIGN CRITERIA:(RESERVE SITE) , j I NUMBER OF BEDROOMS:3,BUT SIZED FOR 4 U ti CO GALLONS PER DAY(GPD):600 1 CO PERCOLATION RATEIS: '9 MIN./INCH 1 NSTALL MT PROPOSED APP.RATE: 0.8 GPD/SQ.FT. / DOUBLE MINIMUM DRAINFIELD SOFT.: 750 CLEANOUTS EXISTING DEEP TRENCH PER KEN DUFFUS,P.E.TEST HOLE#TH 16-1 /, DRAINFIELD THAT IS 56'LONG BY 3' )1( PROPOSED IM-1530 FOOT WIDE WITH 6'OF EFFECTIVE. RESERVE DRAINFIELD DESIGN: / P1 INFILTATOR TANK OR PASSED ADEQUACY TEST FOR 1250 POLYETHYLENE 4-BEDROOMS ON 8/13/2019. MAXIMUM DEPTH: 11 FEET GREER SEPTIC TANK DRAINFIELD SHOULD HAVE 672 WIDTH: 2.5 FEET / SOFT.DRAINFIELD SHOULD BE LENGTH: 54 FEET SCALE: ADEQUATELY SIZED FOR EFFECTIVE: 7 FEET 1 TH#2 4-BEDROOMS BASED UPON GEG ACTUAL SOFT.: 756 1•=30' TH#1 PERCOLATION TEST. ♦4� , lJl ., I. • Y�� 1• GARNESS ENGINEERING GROUP, Ltd ; ; .4e ': � L‘� * �. • ...of •Games. . BYRON MATLOCK 863-0210 2 OF 2 • 0 '..�.. E 79'� :° 14../ PROJECT/LEGAL DESCRIPTION: DRAWN BY: •�♦ •' •• opt io. ��•••�— T15N, R1 W, SECTION 8; LOT 187 J.L.M. FO"p•'p''llt�� •••• �, TYPE OF WORK: DATE: LICENSE, 1A"S`� ,4 DESIGN OF SEPTIC TANK UPGRADE AND RESERVE SITE 9/5/2019 #AEcc6ea •1V; cF., . . ERI GROUP, Ltd ( s ) '.*GARNESS ENGINE NG G OU491'• - ENGINEERING SALES CONSULTING --Rv--=«=� -_-- - •• 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AX 99507•PHONE(907)337-8179•FAX(907)338.3248•WEBSITE:MMw.ownM efl Rl.Y1}OO fl • 4141110 • : SOIL LOG - PERCOLATION TEST • 0 t CE 79 3 •�� LEGAL DESCRIPTION: T15N,R1 W,SECTION 8;LOT 187 v../PF.••••.• • 1 •'��:. PERFORMED FOR: BYRON MATLOCK DATE: 8/23/2019 .1� pR ESS\tT .4• LICENSE 1�1it"`,�.4 DEPTH ORGANICS #AECC884 (feet) "�"" TEST HOLE #1 Z•;.#•;i LOAM (SM) r. ' �. r SOIL CLASSIFICATIONS SITE PLAN 2—•,..:1:r53. :s r ;`d,'' :o GW �.. ORG 3 '',. .-r• GP IML :-r..- r ,�' GM 11�� CL ,,; 4 —•rsa' r GC OL �' : :;_ r aoo:F.• SW j .i MH Q ...s_ r 1 SP J CH .<Ci 5� .; • • • •� G,\ .' ' r / SM / OH O :.•;.-3?..;-:... r SC ziti,, ill '�^ r DEPTH TO Q� 7—;w., DATE 'ziii: r GROUNDWATER �e N .1:s': r 8 r• *= DRY 8/23/2019 :•��" r DRY 8/29/2019 SCALE: I 9 —...-4.:"= GP TO GM DRY 9/3/2019 r=too' '''> r WITH POCKETS ,�' r OF GP AND SILT .; r THROUGHOUT ' r DATE READING CLOCK NET TIME WATER LEVEL NET DROP 11 —�.='.,:>: • TIME (MINUTES) READING (INCHES)tea: , cr, r 8/23/20191 - - 6" 12 r ,..,: IS .;' r 2 - 6.5 0" 6" 13 `moi*: r 3 - - 6" - ;+= 4 - 6.5 0" 6" 14 ;t+•"� 1 5 - - 6" - - ,. ^• 6 - 6.5 0" 6" 15 • 7- , c+ r 8 - 6.5 0" 6" 16 Jc ' r 9 - - 6" :...z.,-..."2 1.,r. r 17 —1.•;=3= 10 6.5 0" 6" rz •r 11 - - 6" - '`'' " r 18 ` 12 - 6.5 0" 6" B.O.H. PERCOLATION RATE "1.08 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19 — TEST RUN BETWEEN 5.5 FT. AND 6.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: U YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: `PERK PERFORMED IN GP POCKET. PERFORMED BY GEG, Ltd. I,JEFFREY A.GARNESS, CERTIFY THAT THIS WAS PE FO MED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 5 6 / 9 . 4.•, F.-......— — ..4i.7„. GARNESS ENGINEERING GROUP, Ltd ff I • •• ENGINEERING SALES CONSULTING ,..--..,�,n ° - --.-_ 0 0 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 9957'PHONE(907)337-6179'FAX(907)33153246•WEBSITE:www.gunsennglmednoA0111 ( • • ......, •- • SOIL LOG - PERCOLATION TEST .j�i c7-7153e, � T15N,R1 W,SECTION 8;LOT 187 I (7-- •• •��• LEGAL DESCRIPTION: p •••. . I •J��:: PERFORMED FOR: BYRON MATLOCK DATE: 8/23/2019 v44 P2OFESS\U"4.4 LICENSE ,•1ims`iiikik DEPTH ,----_ - ORGANICS #AECC884 (feet) �� j^ TEST HOLE #2 1 :1LOAM (SM) S • • J` SOIL CLASSIFICATIONS SITE PLAN 2 J �a ".t: o' GW _ ORG 3 ''s ..f-_-_,:....,•:-*.,:: GP II ML J�V . • GM �11 CL h: !'' • 6 GC 1 OL �' 4 ,•.,.h� r 1 �r- • a°Qi.,FA SW lJ MH �Q 5 -..h. , SP CH \� moi: • ; •t •} SM ' ,//' / OH !Q +.: V ''' ' ¢ SC e ' P �.. DEPTH TO 7 J-'"h= DATE Q' :+:• • GROUNDWATER �(Ci N ... ,::: 8 -4.:-..h-: DRY 8/23/2019 :pis; • <• s"= DRY 8/29/2019 SCALE: ;7i • I 9 ..,: GP TO GM • DRY 9/3/2019 r=100' WITH POCKETS 10 : is OF GP AND SILT ;.,;. • THROUGHOUT '''�'' CLOCK NET TIME WATER LEVEL NET DROP a�; • DATE READING 11 ;:;" • TIME (MINUTES) READING (INCHES) ;.h ';z+ • 8/23/2019 1 5:29 - 6" - 12 —*,..:.:,h; z+'' • 2 5:39 10 2" 4" ==:h= 13 _ 3 5:39 6" ! 4 5:49 10 2-3/4" 3-1/4" 1s' I 14 5 5:49 - 6" - '3. • . • °" 6 5:59 10 2-3/4" 3-1/4" i • s . 15 :•-s• T • 7 5:59 - 6" - Z-.0.^.., • 8 6:09 10 3" 3" 16 �: ..,h� • ' • 9 6:09 - 6" - B.O'II. 17 — 10 6:19 10 3" 3" _ 11 6:19 - 6" - 18 — I 12 6:29 10 3" 3" PERCOLATION RATE 3.3 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19 — TEST RUN BETWEEN 5.0 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: I. YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I,JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERRFjORI�IED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: ci t-//r, MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program ,•S PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 A3 "' http://www.muni.org/onsite :;? ' lista 61 \, 1)(Tartrttent 4A;c;;;RAGE On-Site Wastewater Disposal System Permit Permit Number: OSP181214 Effective Date: 7/26/2018 Work Type: Septic Renewal Expiration Date: 7/26/2019 Tax Code Number: 05115430000 Site Legal Address: T15N R1W SEC 8 LT 187 G:1257 Site Mailing Address: 19744 SUNSET BLVD, Chugiak Owner: MATLOCK BYRON L & ANNA M Lot Size in Sq Ft: 108900 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 4 This permit is for the construction of: 0 Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: 71, "f".• •a/ Date: — ' ' ' ' Issued By: Qte..-Cd t/% Date: 7 MUNICIPALITY OF ANCHORAGE 9 , fC-,..rt\ Development Services Department \� F' ` Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051- -15`-f-30 Matlock, Byron &Anna Dayphone Property owner(s) Mailing address PO Box 670862, Chugiak, AK 99567 Site address 19744 Sunset Blvd, Chugiak Legal description (Sub'd., Block & Lot)_ Legal description (Township, Range & Section) T15N R1W SEC 8 LOT 187 108900 Lot Size Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field [ Initial ❑ Single Family (SF) n (w/wo ADU) Septic Tank [i Upgrade n Duplex (D) ❑ Holding Tank ❑ Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. A f/ r. 4 (Signature o property owr-ref authorized agent) Refrenit Rene-that ermit/Rush Fees: 12O Waiver Fees: eYle Date of Payment: -I1Ia1(2 Date of Payment: MJ Receipt Number: n 0(2—►'7,06 Receipt Number: Permit No. DSP I 1 Z)4- Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc L RAD a • ARC T ER RA ' V e3‘ CONSULTING, INC ' °9FSuLT I NG• ‘"`� 212 E.50 Ave,Anchorage,AK.99503 Office(907)868-3791,Fax(907)868-3793 July 18,2018 Municipality of Anchorage Development Services Department On-Site Water&Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: RENEWAL Request Sewer Permit— OSP161286 T15N R1W SEC 8 LOT 187 The owner has requested we request renewal of the septic upgrade permit that expired on October 22, 2017. No work was done on the permit and there have been no changes to the area of the permitted design. Work is anticipated to be complete this summer once the approved permit has been renewed. The property and adjacent lots are served by private water. 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 868- 3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting,Inc. /a '1 ' )Dea L. Duffus Project Manager 20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793 i Sias 1 N 89'56'19"E 330.31' 8.0' IV GAS ESMT O---o — W o +7.0' WELL 30.0' f"I 1p 0, x o� GRAVEL (7 1 ry o D/W 2 I Z a C-) e > = ■WX8.0' --L-----------/— m 1— m x o p Q D 48.0' cv 0 DECK W oO • 111111 0O N O C O • • (131N p O • N --.! N • - SEPTIC U! O rr VENTS • (tYP) m .P o LOT 187 —(1) S89'55'07"E 328.79' ------------A"---.....------441 I ANCHORAGE RECORDING DISTRICT ® =FVD REBAR AS BUILT OF: O =FND 1 1/2°COPPERWELD BLM LOT 187 T15N R1 W SEC8 S.M. , .,• D SUR L LAND SURVEY CERTIFICATION: I.John L. Schuller. have conducted a ��F ��` �� 0��' Sei�? physical survey of this property as shown on this drawing and that the �••�.•••• ••.Lq 1, w� improvements situated thereon are within the property lines and no • AI k O/•,_' •• , • l ,__,,,---76' � ✓�0 enchroachments exist other that noted. * 49TH % 1. �,, ,4 r EXCLUSION NOTES: It is the owners responsibility to determine the / / a existence of any easements, covenants,or restrictions which do not moi= / / C) appear on the recorded subdivision plat. Under no circumstance should II .JOHN L. SCHULLER:' ... / , any information on this drawing be used for construction of fences, re -.JOHN LS 10408 ;/� ,, . structures, improvements, or for establishing boundary lines. �;ea 2.:x.•16 a%,�� "'`' "`i°�~ A 1 1831 Talkeetna Street WORK ORDER NUMBER: DATE:FEB 20, 2016 ISCALE:?,, , E-MAIL \\�\t.��`�� Anchorage, Alaska 99508 16- 008 DRAWN BY: CHECKED BYGRID NUMBER: BOOK/PAGE: (907) 227-1455 office JLS 1 NW1257 160108 (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE If/~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT -- IPRONE [ ~]NEW iLEGAL DESCRIPTION LOCATION N~OF BEDROOMS~ U ~~ ~ ~ NO. of c~partme~ts a Well Foundation Nearest)otli e PERMITNO. ~ --~.. No. oflines~ Lengthofeach~~line Totallengt~]~fl~s/~., ~ Trench widths;inches Distanc~nlines ~~ ~ Total effeCtive absorption area ~ Top of tile to finish grade ~ I ~aterial beneath tile OTHER %¢0 - REMARKS 72-013 (Rev. 3/78) I I1:. OF' S;O]:L i::IIF.:'gOFi:F'T ]J ON ........... ,: Ihk:N .H htFt;:.:; ]; hlUH HUI 1L !...F.. "q:::' BEDI::~:OOM:!~; .... ;E;0IL F.~:Fr'!'ING ,:Z:56! F'T/BR) ..... 2!L;: ::,]. J:. THE THE!; F',E(::dJ I ~'.ED ' ............ OF:' ~ 'T'HE: L. ENG'T'H D I P'IENS; :[ OP,I :1: '.L:; 'I"HE L. ENG']-H ( I N F'!::~ZE:'F ::, OF 'I"FIE I"REZNCH CiR DF?FI I NFI E:L..[>. THE: E:,E~F'"FH OF' I::t TF:E:NC:H OI:R F'ZT I:5 THE E:,Z:gTRNCE E:ET],.fE:EN THE ~51...I[[:F6¥:]:E f)F THE GR(:)I. Jf'~[) R~',IE:' q"HE BOT"f'OH OF' "f'HE E~':;CFI","F:ITION ':: IN FEEiT). 'T'HE:f~:E'. IS NO 5E:T HIDTH F'CID. TRENCHE:E:. THE (3RFWEL. DEF:'TH I~; THE H:[N:[P'ILJH DE;F'TH OF' GtRFI',,,'EL. BE'THIEEI'-,I THE CIUTF'FIL. I.... P:[F'IE FIN[) 'FHIE EJ[:)T"FCIPI CIF THE Ei:':',CFI',/I::IT :[ ON (IN FEET). !11~...., I:)EF:'FII:~:'FM[ii:NT DL.ff;Nt;NG I"HIE I:::'EFitM I T FI.::'F:'I .... F H'T' HFI% THE RE'}2 F' -" bEE ! [3 [ I. ] T"r' TEl ~ I",IFEIF?.h! "" ~ ' ': ]:H~;T'f::tL. L6r'r'[ ZE.,I I t'.,I'JSF'E:C:TICIJ'.,I:i5 OF: Fff-,l"r' I.,.tEL. LE; I:::tE:,J'FIC:E:NT 'T'O ~!'f..tZ~: F:'F;:CH::'EF?T"r' F:lf',l[::' THE: ,ILl 1...I ...... OF:r RE:i~; ]: [::,E!qCE:~; THF:Ff' THE: HEI....L. H ILI.. ::,E.r.E. BFtC:!.::]:::I!_..L!NG OF f::lN? :E;'./tiii;'T'E:h! !,.I:[THCII...tT F'i[NF:IL.. DEF::'F:fF~:THEI'.,r'f' I,!:[i...!... [3E 'Z, UB..:flEC:T TO PI:[NtHUi"! [)I:~.:,TFINCE: E:ETHEE~N FI HEL..L I:l!',IE:, Fli'.,F¢ ON-...E';Z[TE ::l..e[IZ~ F'E{ET F'OI-~: I:::I ,r'::'I:;~::[VFFt'E: HE:LL I::)1::~: ::[.5EI TO ;2EIE[ FEET F:'F;~:OM t..JF'()N TH[ii: "['"r*F'E I::ll:::' f::'t.E3L..IC: HEI._t~ .... h! .[ N :[ ]"lUJ'q D :[ ':":-;TFINC:E ,~:RCH"I I::1 F:'['? I 'v'FFFE HELL. 'TO f::l F't~' I TO I::I C:OHHtJNI'T";' :iJ;EHEI:~: L.:[NE I'Z':; 'TD F'EET. Cq"F'IE!:i~? RE:QU ]: REP'IE:NT:E; h!FI"r' F:F:'I::'L¥. :5PEX::: I F I:I',/F!]:L.F:IE~LIE TO IN:i:i;UF?.!E F'F:OF'EF~: F" E!iE F;i~ !h"1l ::IE "¥'- lEE: ,%::',: F" ::E IF;ii:: EE: :i'.E;; E::" EiE: EZ: I C:E:!;~:TIF:"r~ THFFI" :].: :[ I:::It~1 t:::FiH:[L.:[FtI:;: H:[TH THE RE(;!UIF.".E:ME:i',FF:~; F'OI:;?.TH 13'¢ THE: P1UHICIF'FIL..ITM O1:::' 2.: I H:[L.L. :INS;TI:ILL- 'T'I'"tE: ':_:';'.r'ri~;rE'.P! ].'N FIC:COF,'DF:Ii"~CE H:['T'H THE' CODES. }i:: I I...fNDE!:F;:fSTFti",E:, 'T'F!f::Ft' T'HE!: ON"'":!~,ITIE :~!;E:!.,JE;I;~: F,;:E:5I[;,ENCE ]:'~; ,gE:MODEL. ED TO INCLUDE HOF::E THFfN [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 3 5 6 R SLOPE SITE PLAN ,-----10 - 11 12 13 14 15 16- 17- 18- 19 20 Robert A. Sh No. 1457-E COMMENTS WAS GROUND WATER ~/~ pO E ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) TEST RUN BETWEEN q J/~- FTAND ~' I/Z- FT DATE: ,~ p~/~ ~ 72-008 (6/79) .er fie Drilliug og SULLIVAN WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS ~ O DATE - Sta~ed PERIRIT NUMBER DEPT. OF WELL -~ DRAW DOWN FT. Ended .~'~', GALS. PER HR KIND OF CASING KIND OF FORMATIOn, ~ , From t~ F ..~.TATIC' LEVEL OF_WATER FT. 7 F~om Ft. to Ft. From Ft. to Ft. rom · Ft. to Ft. From JO° Ft. to ~',~ Ft._ - , Ff01~ Ft. From Ft. Ux - ~ ' ;, Fj:b~~ · Ft. t~l'(~ c~ ~, , "'- ' ~.. ~'."~ ~-~..~ · Ft. tf~Ft,~ ~r ; From ] ~ Ft. to ~] Ft..~0{1¢ : ' ~'~' ' From ~3 Fi. to qC Ft. ~o-[g ~e.4~ ~tom; Ft.~Ft. From Ft. ,o Ft.,~ ~,. ~- .q~' F~' Et, ti ~m Or ~t. tot~O ~t. ~tn~t~ ~t~'~' ~ro~:' ~g Ft. to Ft. From~Ft. to ~' Ft. ~- ~. ~ ~q{' Ft~ Ft. to. Ft. From Ft. to .Ft. ' From Ft. to Ft. From Ft. to Ft.~~,~ . F{om Ft. to Ft. r~m vi. to . ~t.~:]'~'' 5..-' ; ~,om vt, to-. vt. From Ft. to Ft. ~ . ; .~ ~ ~.: Ft. to Ft. From Ft. to Ft. ':' .. F~om . ~ Ft. to' Ft MISCL. INFORMATION: DRILLER'S NAME V4,: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date .~/_~i¢' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Chugiak (b) Applicant NameB~-~-On Matlock Telephone: Home 688-9913___ Business562-22~-~- Applicant Address BOX 862. _C.h__ug±ak Al(. 92~567 (c) Applicant is (check one): Lending Institution []; Owner/builder'S]; Buyer []; Other [] (explain); ........ (d) Lending Institution Home Savings AND Loan Address l__O_01_.__E._._Be~nson_ Anc_hora_ge_ AK. (e) Reai Estate Company and Agent N~A Address Teleph one __2~2_~- ~. 4 ~1 ........ Telephone (f) Mail the HAA to the following address: P i c k_u_p~B_~ E~2g~_n~ e e_v_ TYPE OF RESIDENCE Single-Family:[~ Multi-Family [] Number of Bedreoms -3- Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4 SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding 'Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 72-025 (1 ~/84) Page 1 of 2 ENGINEERING FiRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th~s Health Authority Approval shows that the on~site water supply and/or wastewater disposal system is 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 ~s in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm --E~c~E~ EN6!NF..~.!NG SERVICES _ __ Telephone EAGLE RIVER, AK 99577 Address ~ Date ~ Engineer's Seal DHEP APP.OV X Approved for -~/¢''~,' ~- bedroo~ Approved _ u-""'~'~_. Disapproved -. Terms of 'Conditional Approval -- 'r ~' ~,--[~---- Date -- Con ti;onal CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspeclions or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional eng'neer s work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~.oY' /,~ ~ A. WELL DATA Welt Classification ~:~'t ,/~ ~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y Date Completed Z/'JA~. ';~ ~'- Yield , _ Total Depth / <j"e · Cased to ~';7 ~/~'~,~epth of Grouting Static Water Level ~'· Pump Set At ./~ · Casing Height Above Ground Electrical Wiring in Conduit (y/N) Separation Distances from Well: Sanitary Seal on Casing (Y/N) .Y Depression Around Wellhead (Y/N) ~ To Septic/Holding Tank on Lot /~;~0 Y- ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot' ./~',~ ~ "' ; On Adjoining Lots To Nearest Public Sewer Line "~'~'~'~-- To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results To Nearest Sewer Service Line on Lot -.~.b'- ~' Comments B. SEPTIC/HOLDING TANK DATA Date installed / ~' E' .~3 Size /~'~4;) No. of Compartments ,J/ Air-tight Caps (Y/N) .Y Foundation Cleanout (y/N) Standpipes (Y/N) · Depression over Tank (Y/N) /~) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) '~/"'~ ; for Holding Tank High-Water Alarm (Y/N) '~/',,'~ Separation Distances from Septic/Holding Tank: To Water-Supply Well . //~,P '/'' To Property Line To Water Main/Service Line Course Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~¢c;Z v' Width of Field 3~ ~' Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance f?om Absorption Field: To Water-Supply Well ? To Building Foundation Lot /~ ~ ~ ~.~,/~3 ~,,/~,~_ ~ Type of System Design Length of Field ~"~ Depth of Field /~ / Gravel Bed Thickness ~ / ~' ?..~. ~l(~"-v// Standpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line /~ c- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area. or Vehicle Storage Area To Property Line /¢ To Existing or Abandoned System on ; On Adjoining Lots -'~ '~ To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Agaiqst HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed y~.~i!~ Date Company .,~=',,~Z~.¢-. MOA No, Receipt NO. Date of Payment Amount: $ ~ Page 2 of 2 72-026 ( 11/84) Engineer;s Seal