HomeMy WebLinkAboutCINERAMA TERRACE BLK 1 LT 4Onsite File
Municipality of Anchorage
On -Site Water and Wastewater Program - (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191158 1 PID Number: 020-521-03
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
RANDALL & DIXIE CORK
ABSORPTION FIELD - IDSF
El Deep Trench El Shallow Trench ®Bed ❑ Mound
Address
8755 CINERAMA CIRCLE, ANCH., AK 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
2 GPD/SF
4 , Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
CINERAMA-TERRACE 1 4 -
Fill added above original grade -
VARIES 0 - 0.3+ Ft.
Gravel length
30 Ft.
Township Range Section
Gravel width
12 Ft.
Beds: Number of Lines
4
Distance between lines
2 Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
360 Ft'
Ft.
Well
--
100'+
NA
NA
NA
TANK ® Septic ® S.T.E.P. I] Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1250 Gal.
Surface water
--
100'+
NA
NA
Material
Number of compartments
2
Lot Line
--
10'+
NA
NASTEEL
NA
Foundation
--
10'+
NA
NA
LIFT STATION
Manufacturer
ANCHORAGE TANK
Capacity
1250 Gal.
Curtain Drain
NA
*NA
NA
NA
Remarks Existing STEP tank removed and new
Pump on level at
44 in.
Pump off level at
42 in.
High water alarm at
48 in.
STEP installed in same location.
New air compressor added for IDSF.
Pump make and model
Franklin 2445040117 — 1/2HP
Electrical Inspections performed by
MOA
PIPE MATERIAL House to tank 3034 Tank to 3034
Installer A+
drainfield
Drainfield 3034 co/MT 3034
Inspector FWCS / MNA
BENCH MARK (Assumed elevation) 100 ft
Inspection�:, 9/25/19 9/26/2019
Location and description
dates: 2nd
3`d 9/27/19 4" 10/24/19
BOTTOM OF SIDING
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional
OF��
Ar
Approval: Date
4.9 M *
Jp • MICHAEL N. ANDERSON -
No. CE 9469
10/2$/.19-- e
App o ed Date
sst°��' AW
inspection KeporL!J-1-1z.c1oc
CINERAMA TERRACE B1, L4
Q.
I
G 50
RADIUS
P�
G�
G�
O 100'
RADIUS
p \ NEW
1250 -GAL
STEP
\_\G
® \
REBUILT IDSF
PID: 020-521-03
PERMIT: OSP191158
SCALE: V = 30'
A — C =1 1 , 3 FLUSHING
1 1 VALVE
B -C=30.4' FCO 0 CO MH MT MT
A - D = 2 2.4' 103.8 CO 104.4 FINAL GRADE 104.7
104.4
B - D = 3 6.3' ORIGINAL GRADE
95.5
A - E = 3 5.0' FILER FABRIC do INSUL 100.9
B - E = 2 4.0' 94.9 NEW 6" PEA GRAVEL
A -F-27,8' iSEEL SEP.250 N 100.4 2' FILER SAND 100.4
B - F =11.5' AIRLINE
NO CRNO
98.4 NO ED
A -G=38.0'
/
B -G=17.4' NOTES: INSULATED NORTHERN PORTION BOH 13
A -H-45.3' OF BED ALONG GARAGE & REPLACED SEPTIC SECTION GRNO WTR. 91'4 EA
NON—FUNCTIONING AIR COMPRESSOR. NOTED
B—H=22.1' 94.5 ® ST
INSTALL SCALE: NTS
PREPARED FOR: SUPPORTOSERVICES:
RANDALL & DIXIE CORK ��� OF ALAS
I
CINERAMA TERRACE 81, L4 ®.. C.
6
8755 CINERAMA CIR., ANCH., AK 99516 * 49TH 9*
Michael N. Anderson, P.E. DATE: 10/25/2019 MICHAEL N. ANDERSON
�+ No. CE 9469 "�
4661 Natrona Ave. �`'' 2�'
DRAWN: FWCS 10/25/19 v
AV
Anchorage, Alaska 99516 '�o ti�
(907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' `%PESSIO'O
MUNICIPALITY OF ANCHORAGE
Onsite Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 C..
http:llw .muni.org/onsite N
I. eparnncnt
On -Site Wastewater Disposal System Permit
Permit Number: OSP191158 Effective Date: 5/20/2019
Work Type: Septic Upgrade Expiration Date: 5/19/2020
Tax Code Number: 02052103000
Site Legal Address: 0-19F-KKIKA -(SSV ACE 2,LK j LT `4
Site Mailing Address: '055 1111ASKI\Mf} QKCLEt "ri{k
Owner: CORK RANDALL & DIXIE Lot Size in Sq Ft:
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
a Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 (2417).
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: Date: '51201m
Issued By: Date: Jr ZO �9
MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 020-521-03
ANCHORAGE
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s) RANDALL & DIXIE CORK Day phone 9074404195
Mailinq address 8755 CINERAMA CIRCLE, ANCHORAGE, AK 99516
Site address 8755 CINERAMA CIRCLE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) CINERAMA TERRACE B1, L4
Legal description (Township, Range & Section)
Lot Size 119188 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
(® all that apply)
Absorption Field
®
Initial ❑
Septic Tank
®
Upgrade
Holding Tank
❑
Renewal ❑
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
Distance:
I certify that the above information is correct. I further certify that this is; in accordance with
applicable Municipal Codes.
FWCS - Brent Western
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5gs- Waiver Fees:
Date of Payment: L-11360 Date of Payment:
Receipt Number: QL]053�) Receipt Number:
Permit No. 05Pq L `62 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTerrnit Application.doc
Michael N. Anderson, P.E. Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345 -3377 / Fax 345 -1391
Support Services
Brent M. Western
907-440-4601
April 30, 2019
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: CINERAMA TERRACE BLOCK 1, LOT 4
The septic field has failed and on behalf of the owner we request a septic permit to
upgrade the system on the above referenced lot. It appears that the bottomless sand filter
(IDSF) absorption field has developed a biomat in the top 3-4 of the sand and pea gravel
and is not operating properly, which may have occurred by air compressor not
functioning properly, maintainance or just over time the last 20 years.
We propose to rebuild the IDSF as it currently exists by removing any contaminated sand
and all the pea gravel in the IDSF and then installing new sand and pea gravel to the same
existing elevations and layout of the IDSF. The existing components (STEP tank,
pressure line and air line, alarm, air compressor, flushing valves, ) will continue to be
used unless deemed needing to be replaced.
The lot and area is served by private water and the design will not impact any of the
neighboring properties. Please contact Brent M. Western or me if you have any questions.
Sincerely,
Michael N. Anderson, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191158, Rebecca Carroll, 05/20/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191158, Rebecca Carroll, 05/20/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191158, Rebecca Carroll, 05/20/19
Municipality of Anchorage Page 1 3
of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW9901 28 PID Number: 020-033-07
Name:
Mark & Janice Rednall
Wastewater System: n New ❑ Upgrade
Address:
3560 Kachemak Circle
ABSORPTION FIELD
Phone:
No. of Bedrooms:
Three ( 3)
O Deep Trench ❑ Shallow Trench Need ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:q2F
Total Depth from original grade:
Lot: 4 Block: 1 - Subdivision :
Cinerama Terrace
Depth to pipe bottoGravel
t. 4
depth beneath pipe
Township: Range: Section:
Fill added above
t. 6" Pea Gravel ft.
Gravel length:
. 30Ft.
WELL: ® New ❑ Upgrade
Gravel width:Number
oflines: Disfancebetweenlines:.
Classification (Private, A,B,C): Total Depth: Cased To:
Private
Total absorption area:
4 2. S ft.
Pipe material:
167 Ft. 51 Ft.
Driller:
360
So. Ft.
Orenco Kit
Al D,Ate gdflgd99 Statics Dater Level:
Alpine VY
Installer:
Date installed:
Ft.
Acreage Syste
s 8/18,19/99
Yield: 4 Pump Set at: Casing Height Above Ground:
GPM Ft. 2+ Ft.
TANK
SEPARATION
DISTANCES
O Septic ❑ Holding N S.T.E.P.
To
From
Septic
Tank
Absorption
Lift
Holding
Public/Private
Manufacturer.
Ca aci
p ty in gallons:
Feld
station
Tank
SewerLmes
Anchorage Tank
1,250 STEP<::.
Well-
100'
>100t
>100'
N/A
>25'
Material: Steel
Number
Number of Compartments:
Watre
>100'
>100'
>100'
N/A
N/A
- LIFT STATION -
LO[
Line
>5
>10
>10
N/A
-
N/A
Size in gallons:
250
Manufacturer.
Anchorage Tank/Orenco
Foundation
r
)'S
,
>10
>10
N/A
N/A
"Pump on" level at:
"Pump off' level at:
High water alarm at:
42"
42"
44"
Curtain
Drain
>�r�t
>50'
>50,
N/A
N/A
Pump Make &Model
Electrical Inspections performed by:
OSI
Aurora Electric
Remarks: Tank, Field and Line From
BENCH MARK
House are Covered With 2" Direct
Location and Description:
Garage Slab
Bury Insulation.
Air Gauge is Located With the
Assumed Elevation:
In
Compressor in the Garage:
f
y'At.'SA�.4
Inspections performed by: MFA Dates: lSt 8 / 18 / 99�bf
-AA
2nd 8/19/99
Department of Health and Human Services approval
o-Y£9
Reviewed /O/
and approved by: Date: 4g O o
0L/
'pJ11� /Rnv R/Oi\ •\nn ne
Municipality of Anchorage Page 2 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SW990128 PID No. 020-033-07
ERpMP l��pc
g/
c�N /
I\\
Y A� 9• a £y
11tY gas / �
Site
�HS 3 12'
S
M4
S1
C1 m
Sea�oo
\ 2rzeeK°me
� l�
We Ll
30' ottomless
Fil er
it Comp ss
Located fia
PLAN AS -BUILT
SCALE 1" = 40'
and Gauge
age
S2
19.4
39.8
�
o
38.6
w
12.9
1
30.0
1
N
37.1
22.4
M4
31.1
10.8
Well
N
Ct
u
m
1
� l�
We Ll
30' ottomless
Fil er
it Comp ss
Located fia
PLAN AS -BUILT
SCALE 1" = 40'
and Gauge
age
S2
19.4
39.8
MH
19.0
38.6
M1
12.9
1
30.0
1
M3
37.1
22.4
M4
31.1
10.8
Municipality of Anchorage Page 3 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SW990128 PID No. 020-033-07
Valve
4
�1
GeotXtile Fabric/Isul tion
101.3 2' Fil er Sand 6" of 3/8" Pea
Gravel
99:3 Airline
30'
90.0
NOTE: 12' X 30' Bottomless Sand Filter Kit
From Anchorage Tank.
1/2" HDPE Air Line Insulated.With 1/2"
Soa�m Pipe Wrap Inside a"Schedule 40 PVC "
ket and Buried a Minimum of 3'
�.
Ar
PROFILE AS -BUILT
`+ ' ?"R HORIZONTAL SCALE 1" = 10'
F t H
�> NO VERTICAL SCALE
N x
2" Insulation
2" Ins
1.
Under Driveway
GAL
1.25" HDPE -
95.53
STEP
Tank
95.33
To Bed
E+
'n
-
I
Flushin cr
105.3�
Valve
4
�1
GeotXtile Fabric/Isul tion
101.3 2' Fil er Sand 6" of 3/8" Pea
Gravel
99:3 Airline
30'
90.0
NOTE: 12' X 30' Bottomless Sand Filter Kit
From Anchorage Tank.
1/2" HDPE Air Line Insulated.With 1/2"
Soa�m Pipe Wrap Inside a"Schedule 40 PVC "
ket and Buried a Minimum of 3'
�.
Ar
PROFILE AS -BUILT
`+ ' ?"R HORIZONTAL SCALE 1" = 10'
F t H
�> NO VERTICAL SCALE
Municipality of Anchorage
Department of Health and Human Services am
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650 cam
Rick Mystrom http:/Mhw✓.d.anchorage.ak.us
Mayor
Permit Number: #SW.99128 Date of Issue: 6-9-99 Parcel Identification Number: 020-033-07
Date Started: 10-2-99 Date Completed: 10-2-gg Is well located at approved permit location? M Yes ❑ No
Legal Descriptio4: Cinerama Terrace Blk 1 U4
Property Owner Name & Address: Mark & Janice Rednall
3560 Kachemak Circle
Anchorage, Ak 99515
Borehole Data:
Soil Type, Thielal s & Water Strata
stick-up
fill material
Depth (ft)
From To
0 2
2 11
Method of Drilling ®air rotary E] cable tool
Casing type: steel
Wall Thickness: .250 inches
Diameter: 6 inches Depth: 51 feet
organic & silt
11
19
Liner Type:
gravelly silt
water sand & gravel
19
33
33
37
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 50 feet
Pumping level: 167 feet after
2 hoursum in 4
P P g_gPm
silty gravel 37 51
bedrock 51 167
Recovery Rate: 4 gpm
Method of Testing: airlift
h2o
130
160
Well Intake Opening Type:
❑ Open End M Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: bentonite # 8 Volume: 1 baQ
Depth: Start 0 feet Stopped feet
RECEIVED
Pump: Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? M Yes ❑ No
Method of Disinfection: clorine tablets
APR 06 2000
Municipality of AnchorWge
Dept. Health & Human Services
Comments •
Well Driller: Alpine Drilling & Enterprises
P.O. Box 110496
Anchorage AK 99511
Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property
nax�nar
11 fhA au,A11 Arill, chap mm�iAP a umll Inrt fn the rlanf of Naalth R Anman Cnn�incc mifhin An Aavc of nmm�latinn
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: Mark and Jan R dnall Date Perforr
Legal Description: Lot 4 Block 1 Cinerarna Terrace Subdivision
SLOPE Sll
11 1 OG/OL
T THO E NO
4
5
6 GM
7 <20% Silt
8
1C
11
12
13
14
15
1
17
18
Some Was Groundwater
Gravel Encountered?
If Yet, What Depth?
Depth to Water
After Monitoring
Date:
Bedrock
No S
L
O
None P
8/20/99 E
Reading
. _'q' A I%I�
6
See Septic System As -Built
Perc. Rate: 13 Min./Inch Perc. Hole Diameter:
21 Test Run Between Ft. and Ft.
Comments: Same Material As Encountered in Testhole No. 2. Percolation Rate is Similar.
Performed By: Mike Anderson I, Michael E Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 3/31/00
PROPERTY OWNER AGREEMENT
® FOR THE MAINTENANCE OF AN
ON-SITi: WASTEWATER DISPOSAL
SYSTEM
This agreement, dated pg L
_, is made between the Municipality of
Anchorage Department of Health and Human Services (DHHS) and the property
owner(s) of- p
'J L-0" t ls/ ni crzA n +I� 1 if} c
This agreement is made for the purpose of maintaining an on-site wastewater disposal
system on the subject property.
The property owners agree to the following;
Submit to the Municipality of Anchorage, ou an annual basis, an inspection and
operation statement from a registered professional engineer. This inspection and
operation statement shall verify that the engineer has inspected all effluent and air
PUMP, timers, and alarms, and that any deficiencies have been repaired and that the
system is functioning as designed.
/A
(Signature)
(Signature)
(Printed Name)
(Printed Name)
------------------------------ Notarize Here-------------------------------------
_ __
State ofX/ik _ On this � %°��day of /
IL /�-
Q { 1 _ personally appeared before me,
who is personally known to me
_) whose identity I proved on the basis of ALD
whose identity I proved on the:oath/affirmation of
a credible witness
to be the signer of the above document, and he/she acknowledged that he/she sijur-d it.
Y(-�L .4�
Notary public
My commission expires 9--3—aeco .
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services 8 tg i� to �r•'
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT
Initial
Permit Number: SW990128
Legal Description: CINERAMA TERRACE BLK 1 LT 4
Design Engineer: 0014 Anderson Engineering
Owner Name: Mark & Janie Rednall
Owner Address: 3560 Kachemak Circle
Anchorage , AK 99515-
Date Issued: Jun 09, 1999
Expiration Date: Jun 08, 2000
ParcelID: 020-033-07
Site Address:
Lot Size: 119188 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑✓ 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
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
Issued By:
Date:
r
Date: !p—%'/C/
June 8, 1999
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 4, Block 1, Cinerama Terrace
Septic System Design
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owners of Lot 4, Block 1, Cinerama Terrace intend to construct a
three bedroom home on the lot at the location shown on the attached Site
Plan. They have recently constructed a french drain along the south and
east property lines to control the groundwater elevation and protect both
the new septic system and house foundation. The drain appears to be
working as only 2' of groundwater is now evident in Testhole No. 1 at this
time.
We are hereby requesting a permit to construct a well and septic system
on the lot at the locations shown. Testholes placed on the lot revealed fill
material at the southern end to a depth of 4' which was underlain by 2' of
organics and peat. This was underlain by silty gravel with poorly graded
sand which percolated at a rate of 6 minutes per inch. This layer extended
to bedrock which was found at 11.5' below the surface. No groundwater
was found during construction, but 2' was noted on May 26, which is
normally the high water period of the year.
The lot is plagued by surface water in many locations and has a history of
high ground water. The placement of the french drain should aid in control
of the groundwater, but due to the presence of the water and the limited
spaced for an absorption area we are proposing the construction of a
bottomless intermittent sand filter system constructed at 4' below the
present ground surface. A minimum of 2' of Lake Otis Sand or similar
Lot 4, Block 1, Cinerama Terrace
June 8, 1999
Page Two
material will then be imported and placed in accordance with the attached
details. The remaining portion of the filter will be constructed atop the
sand.
The surface of the lot slopes from the south to the north at varying
grades. The flattest portion of the lot is approximately 4% and this is the
area for the absorption bed. The slope then drops off at grades from 6% to
10% and eventually enters into a developable wetland. Control of
groundwater on this lot is essential for successful operation of the septic
system and construction of the house.
If the system is constructed as designed the following statements apply:
1. The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the future.
3. The system, if constructed as designed, will have no adverse
impact on reserved space, either surface or subsurface, on any lots
located in the area.
4. The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E. �� a �6 ,
Attachments
K SEPTI
SCALE 1" = 80'
ANDERSON ENGINEERING JOB
P.O. Box 240773 SHEET NO. OF
ANCHORAGE, AK 99524
(907) 563.7155 CALCULATEOBV DATE
(907) 337.8855 CHECKED BY DATE
LOT 4, BLOCK 1, CINERAMA TERRACE
DESIGN FACTORS:
3 Bedroom Home
Perc. Rate: 6 Min./inch
Application Rate: 2 GPD/SF
SYSTEM REQUIREMENTS:
Bottomless Inter. Sand Filter
1,250 Gallon STEP Tank
2' Lake Otis Sand Or Equal
Air Supply Line (Anch. Tank)
6" of 3/8" Pea Gravel
3 Bedrooms X 150 GPD = 450 Gallons Per Day
450 GPD/2 GPD/SF /10 LF (Width of Bed) = 22.5 LF Length of Bed
Therefore: Construct a Bottomless Intermittent Sand Filter System 1 0'
Wide X 30' Long. Distribution Piping to be Placed at 3.5' Below the
Original Ground Surface.
2 FEET MIN. OP FLIM 5XV--z I g
AIR UW 181,BEl Odl
PROFILE VIEW V
(NO SCALE)
NOTE: Grade Area to Drain Away.
"ojAr,�9
:46
: ��
E319ME. EMM
a. 4W -E
LOT 4, BLOCK 1, CINERAMA TERRACE
DESIGN FACTORS:
3 Bedroom Home
Pere. Rate: 6 Min.Anch
Application Rate: 2 GPD/SF
SYSTEM REQUIREMENTS:
Bottomless Inter. Sand Filter
1,250 Gallon STEP Tank
2' Lake Otis Sand Or Equal
Air Supply Line (Anch. Tank)
6" of 3/8" Pea Gravel
3 Bedrooms X 150 GPD = 450 Gallons Per Day
450 GPD/2 GPD/SF /10 LF (Width of Bed) = 22.5 LF Length of Bed
Therefore: Construct a Bottomless Intermittent Sand Filter System 1 0'
Wide X 30' Long. Distribution Piping to be Placed at 3.5' Below the
Original Ground Surface.
Uk COL FMf. O '. ED Ai
OX 2 Ft 7.O NCO 3/ 4" DIA 5CH. 40 PVC LAfFM5
(Hae5. 5W5, AN7 PLIJSiN6
`:YF.PM' f1PE OVIDEVALVESPEt:OfEWN 0 ESICd1)�
ML'J�i'7e0/� rPRar D
f "-4" Rk MONMOPM in AT EALH
11/ 4" DIA. 50140 PVC LOM I'MMATEP BEtIMEEN for PM000 BAER
uw of 5W Atv4J P15TgBIJfION PIPE
51EP WM MA�av NVW- (DRU. 1/ 4 INOi DIA HOLES), AROIISD EWE BED
PLACE CAP ON BOMOM Aft DELL
30
(M.) 1/ 4" HOES
PLAN VIEW
(NO SCALE)
NOTE: Grade Area to Drain Away.
TANK.
no
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 -L" Street, Anchorage, Alaska 49502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR-
M.
Tune
- ENCOUNTERED?
IV
DATE
s
IF YES, AT WHAT --"
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DEPT - -
' LEGAL DESCRIPTION;
-,
11
1 .-
GAN
MA Township, Range, Section:
1
2
3
4
S
6
8
9
10
11
12
13
14
75
16
17
18
19
20
-' `KAy'- r-,
WAS GROUND WATER
M.
Tune
- ENCOUNTERED?
IV
551
s
IF YES, AT WHAT --"
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DEPT - -
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E
Depth m
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q
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Reading Dam G-
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I Depth to
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Drop
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{
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I
{
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PERCOLATION RATE� L
f (mututevu.Ul PEAL HOLE DIAMETER
. .. TEST RUN BETWEEN "'�� � SAND 7 FT _ -
COMMENTS Perc: Cavity presoaked prior to testing.
PERFORMED BY./, 1 = � sa�rRY THAT TH�Z'TtPERFORMED )
. Michael E. Anderson � /
ACCORDANCE WITH ALL SATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DA7E
72-008 (Re ,4iP5) -
Municipality of Anchorage 7 ' wt
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street Anchorage. Alaska 49502-4650
t] Q
SOILS LOG —PERCOLATION TESTid-
PERFORMED FOR: - - �� o° , , °.•. -
DATE PERFOR I�p. •�^
LEGALDESCRIPTION:—Lr- 6-f f Gj� �-` TownSt ip. Range. Section:
1 �G
�..� SLOPE SITE PLAN(V<jY,SG &3td
Iii I I I IINi
2.
IAhF I
- Z I
12-
13-
14-
15-
16-
17-
18-
20
2131415161718
WAS GROUND WATER \/
ENCOUNTERED? r
IFYES.ATWHAT
DEPTH?
DIP m vtav Aav
Mao ? 6
20 I
JL_ jJ PERCOLATION RATE t3(rtv nncvmchl PERC HOLE DIAMETER 40 1,
_ TEST RUN BETWEEN FT AND s FT
COMMENTS Parc_ Cavity presoaked prior to testing. -
Reading DateI GfO#
Tune
I Net
rune
I Depth to
water
I Net
Drop
-LJL:4.8
30
/C',1oZ
I T,31
5 sl
I -a-s
I
! ! 621
- 30_
I Io•9
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PERFORMED BY_ � - 1 �S TMY THAI THISTESTWAS PERFORMED IN
Michael E. Anderson SZ7(%%
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE,
DA__
72-008 (Rev. 4/E5) - - .
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 4, BLOCK 1, CINERAMA TERRACE SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and
placement of a new 1,250 gallon combination septic tank/lift
station and pressure distribution system. Work also includes the
construction of a new 30' long x 10' wide Bottomless
Intermittent Sand Filter. All existing material must be
excavated to the GM/SP layer which is expected to be 6' below
the surface. A minimum of 2' of Lake Otis Sand or material
meeting the attached specification must then be imported and
placed in the filter area. The filter must then be constructed
atop the imported material.
2. Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground
utility locates and for the layout of the septic system.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from
soil settling. The property owner shall be responsible for
revegetation of affected areas unless specifically agreed
otherwise.
5. Contractors installing wastewater disposal systems must be
certified by the Municipal Department of Health and Human
Services for system installations. Owners installing their own
systems must receive prior approval from D.H.H.S. before
beginning system installation.
SEPTIC TANK/LIFT STATION INSTALLATION
1. The 1,250 gallon septic tank/lift station is to be constructed by
a certified tank manufacturer. Construction shall include an 18"
manhole for access to the lift station.
Lot 4, Block 1, Cinerama Terrace Subdivision
May 26, 1999
Page 2
2. The septic tank/lift station shall be sufficiently bedded to
prevent settling or shifting of the tank.
3. All standpipes shall extend a minimum of 12 inches above final
grade.
4. Septic tank/lift stations installed without 4' of cover shall have
a minimum of 2" of direct burial insulation.
5. A foundation cleanout shall be installed one to four feet from the
building foundation. No cleanouts are required between the I i f t
station and the drainfield in a pressure distribution system.
6. Final grading over the septic tank/lift station shall be such that
a positive slope exists away from the septic tank.
ABSORPTION BED CONSTRUCTION:
1. The absorption beds shall be constructed to the dimensions
shown on the design. The bottom of the bed shall be within 2" of
level.
2. Distribution
piping must be placed
level with perforations
down
atop a level
bed of drainfield rock.
Rock should then be
placed
over the pipe
to provide a minimum
of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the
drainfield rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion in the drainfield rock
must be perforated.
5. Direct bury insulation must be placed over the distribution
system when less than 3' of backfill depth is available.
Finish grade over the bed must be mounded to prevent
settlement or depressions.
MATERIAL SPECIFICATIONS:
1. The lift station must be constructed by a Municipally approved
septic tank manufacturer. An Orenco 20 OSI 05 HHF - 5 is
recommended.
Lot 4, Block 1, Cinerama Terrace Subdivision
May 26, 1999
Page 3
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast iron (perforated and solid), ASTM D3034 or PVC (Perforated
and solid), ASTM F810 or HDPE (perforated, but not solid) and
ASTM D2662 or ABS (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight
couplings (Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be
installed between the final drain rock layer and the native soil
layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3%
passing the #200 sieve.
EQUIPMENT SPECIFICATIONS:
1. Air Supply Line Shall be a Wasteflow Emitterline, 1/2" Inside
Diameter from Anchorage Tank. Line shall be insulated with
1/2" foam pipe wrap inside a 2" Schedule 40 PVC Jacket buried a
minimum of 3' below the surface.
2. Air Compressor Shall be a Thomas Industries Model 5070 as
supplied by Anchorage Tank. Compressor shall be located in the
garage or crawl space.
3. Pressure Gauge from 0 to 10 PSI Shall be furnished and installed.
INSPECTIONS:
A minimum of two inspections are required by Municipal Ordinance.
These inspections must be conducted under the supervision of a
professional engineer registered in the State of Alaska. The first
inspection must be conducted after the excavation of trenches, beds
or pits and before the installation
of any gravel. A septic tank may be set in place, but may not be
backfilled.
Lot 4, Block 1, Cinerama Terrace Subdivision
May 26, 1999
Page 4
The second inspection must be conducted after the placement of
the geotextile fabric, gravel, distribution piping, standpipes,
cleanouts and insulation. No backfill should be in place at the time
of the second inspection.
The contractor is responsible during the layout of the system to
assure that all separation distances from adjacent wells in the
area are met.
Certificate of On -Site Systems Approval
Parcel I.D. 020-521-03 Expiration Date:
1. GENERAL INFORMATION
Complete legal description CINERAMA TERRACE BLOCK 1 LOT 4
Location (site address) 8755 CINERAMA CIRCLE ANCHORAGE AK 99516
Current property owner(s) RANDALL & DIXIE CORK Day phone
Mailing address
Real estate agent
8755 CINERAMA CIRCLE ANCHORAGE AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
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 myinvestigation 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
ame of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4661 NATRONA AVENUE ANCHORAGE AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON PE Date 10/3/2019
Comments: This investigation was completed in compliance with MOA guidelines, regulations, -
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by Ft5 and Anderson Construction & Engineering.
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
� ' off.aL s
IV
lirC'BtAfi. \. J�}:DEh"idX'
10/3/19,1
'��'SStO`t��•
Conditional approval for bedrooms, with the following stipulations:
"IM 111 i)MI11.
Original Certificate Date: 10
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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: CINERAMA TERRACE BLOCK 1 LOT 4 Parcel ID: 020-521-03
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA
® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons
-- Date drilled - 10/2/1999 - Well disinfected for coliform test? ❑ Yes ® No
Total depth 167 'ft ' `'Coliform bacteria is Negative
Cased to 51 ft Nitrate mg/L ❑ Nitrate less than MRL (ND)
® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND)
® Wires are properly protected
Casing height (above ground) 24+ in. Collected by
Date of flow test for COSA 4/28/2019
Static water level at beginning of test 79 ft. Date of Sample 9/25/2019
Well production at time of test 4 gpm
Comments
B. TANK DATA – 10/24/2019 - 1250 GAL STEP
Age of tank(s) NA - NEW years
Tank type/material STEP / STEEL
Measured operating fluid level in septic tank
® Standpipes/foundation cleanout per record drawing
Date of pumping
C. LIFT STATION
® Required maintenance completed
Age of lift station 0 years
Lift station material STEEL
Comments:
D. ABSORPTION FIELD DATA – 30'L x 12'W x 0.5'ED – 2 GPD/SF = 360 SF
Which system tested (date installed) NA - NEW
® ALL standpipes present per record drawing
Total measured depth from grade 6 ft (max)
Measured depth to pipe invert from grade 3.8+ 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 gallons
Com ments/Deficiencies:
COSA Checklist copy 2.docx
Adequacy test date
Results ❑ Pass For _ bedrooms
Fluid depth prior to test _ in
Water added _gal
New depth —in
Elapsed time —min
Final fluid depth _ in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
—0
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
® Yes
Septic Tank/Lift Station on Lot > 100'
ft
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
-
—
Animal Containment > 50' -® Yes
if No
®,Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From"Septic/Holding Tank on Lotto: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No
ft
ft
ft
ft
ft
ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100' ❑ Yes if No *99'+/- ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
r
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® 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'
® Yes
if No
ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*CAT III SYSTEM — Existing tank removed and new STEP installed in the same location / hole as original tank.
G. ENGINEER'S CERTIFICATION
I certify that 1 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 copy 2.docx
i��t:�lLl�-=1 r:'�`{�rit.iti=_i�t�[ iEi:: p 1, tlClI[11t173t1' l_I�_'iC�{9�;tllilI1C 11C>(]E:1`Cff1�`lid'°''.rJ.0J•�7�4�e�'1tCTiL�t�,.�.1_54'3CCt �'n3',a`_��Ifi'ai.
fill I4 . J W7-3 1 74�? - P,O, Bo.,,z '96 .SII Ail :ti.horagel, ':K W51'1-665 (I - h0p-rhJF'I w. Inal1LOng,
Intermittent DLx,;ing Sand filter
Ovirne3 +` p I A_ ,, r r t Ad'clresS
Legal Desc. RID
'-'cptic `dank:
_ _ 1
-Sfudge level inches --
sumping: r tquir '+d tel no -Pumping car ple-teCi (V no
Abs+arptio.n Field. X7 e_'Pk
-Liquid level__ 3 lnches -Flushing valves per approved design no
- ll flushin( valves opened, distr tauEion lines flushed, and flushing valves closed no
Uft station -
•Pump gasket ciew.ed Cy25� n4-Biotube effluent filter cleaned no
Timer flet ��attir�linches-High level _loyl setEaE)g—irkchFs yReferonoe
laQir�t
-Pump on () seound-s -Bump, ofF;�� � minute!,
-cumulative lifetim-
ycfes . -Cumulative rain tirrteM,L: liouft.
-Operation satisfactory OS)
n:�
Air Syrste€t't:
-Air perp fitter cleaned -fir pressure _PSL
-Date of latest install or rebs rt :' lc Air sy tcm operation risf�c_ _tont riots tisfactou
Alarm system:
-Dedicat l etectri .,a.l circuit -Audible and vicua.l ala rrn inside dwelling
Float settin{,
2ti --AI_arrn ystcm aneratioq ati fac- 4 �o s�tesfa tory
Comments:
Maintenance Provider-
Technician
rovider-T cl nirian 5 ; Date of ma intenancL-t .
company )� ti �_�4U �'cj Or
r� �
SigncLure i -- Date's t . a�
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR_ AGREEMENT, hereinthe "AGREEMENT" mad
entered into as of this _ 6 Day of QCTo6 97 of 20" 1 , by and between
�_.. I_� C ! Dt r. S ;1herein the `•OWNER,, and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code--
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as 8755 CIN PA �r cc 14NcHfln-�ri� 1� �}S/6
located at (legal description)
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shalt be maintained in a satisfactory
condition capable of performing as designed and producing treated septi c effluent in
accordance with the equipment's approval for operation in the Municipality.
c� It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
_QAC! Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfreld
replacement.
(rev. 05/18/2018) Page 1 of 3
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030,
Owner agrees to grant the Municipality, reasonable_ access to.test .and inspect the -
AWWTS. The Municipality will give at least 24-hour notice.
L Owner agrees that any sale or transfer of title of the property will not occur without a new
/
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwraiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: /_______(signature)
Date:
2., M(print name)
STATE OF ALASKA
ss.
TBM JUDICIAL DISTRICT
The foregoing-instrument was acknowledged before me this day of ,
20, by L
OR
EY-"C
NOTAR PUI C ALASKA
o��1
My Commission expires: C7 Lj j a
$ �O�At � '; %
r ,- a
.� _p_ N
a
s'�,r A�16L�G er N
;��
���•� OF
..A
.,,��sfon'Expj16
MHTNICIPALM:
try (signature)
Date:1.0
4--1 �C _(print name)
Title:
(rev. 05/18/2018) Page 3 of 3
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage. AK 9951916650
www.muni.org/onsfe
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Fta... e �� Dear
Parcell.D. M521.03 COSA#_
— C — O S
1. GENERAL INFORMATION Expiration Date:
Complete legal description Lot 4, Block 1, Cinerana Tice subdivision
Location (site address) 8755 cinerama Cirde Anchorage. AK 99516
Current Property owner(s) Mark and Janice riednall Day phone 230-6343
Mailing address 8755 Cinereme circle anchorage, AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Three (3)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Q
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 Onsite 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 Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with varid 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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation,
based on procedures outlined In the Certificate of Onsite Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name
Michael E. Anderson, P.E.
5. DSD SIGNATURE
—AZ Approved for 3 bedrooms.
Date 1M2/2007
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(R« SIM)
Original Certificate Date:/ I ` 6 —!2,7
Municipality of Anchorage
DevelopmentBuilding
SafetyoevisionDepartment `
Onsite Water & Wastewater Program
4700 Bregaw, Street
P.O. Box 196650
Anchorage, AK 99519 -SM
www.nruni.orglonsfte
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Oeauiptlon: Loc s, Back 1. CMwwm Twrm= sl6dMWM Parcel ID:o2od21-03
A. WELL DATA
We" hype Pmam NA, B, or C provide PWSID Weft Log (YIN) Y
Date completed j9R9r99 Sanitary seal (YIN) Y VWW Properly Protected (YIN) Y
Total depth tar fl. Cased to gt ft. Casing height (above grand) >24 in.
.. FROM WELL LOG AT INSPECTION
Date of test 1er29n999 1111=07
Static water level 50 It. 67.1 R
WON production 4 g.p.m. g
9 -
p.m -WATER SAMPLE RESULTS:
Coliform o colonieal100 ML Nitrate An m92 Other bacteria 9 colonies/100 mL
Arseni: . b u mg/I Date of sample: 10RBIW Collected by: F. LeDaw
B. SEPnCIHOLDING TANK DATA
Tank TypelMaterlal aTEPIftel Date dim wisn999
Tank size 1= gay. Number of Compartments Throe Cleanouts (Y/N) Y
Foundatlon deanocd (YRO Y Depression over tank (Y" N High water alarm (YIN) N
Date of pumping Sntl29or Pumper A P1w Homs awvion
C. ABSORPTION FIELD DATA
Date installed anam999 Soo rating (g.p.dA? or fl=Ibdrm) 2 aPD1SF System 4" Swka Fpw sae
La gth 90 R Width 12 R. Gravel below pipe •g ft
Total depth e fL Elfabsorption area m tt= Monko ft tube Y Depression over. field N
Date of adequacy test t 1nr2w Results (Pass/F" Pan For 3 bedrooms
Fluid depth in absorption field before test 2>s in. Water added Bao gal. New depth 10• in.
Elapsed Time: 162 min. Final fluid depth erg in. Abd rade >= 430 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN d type) N H
yea, give date
D. LIFT STATION
Data installed e2—SM
'Pump on' keel at 42 in.
pates Baran d Tank
E. SEPARATION DISTANCES
S@e in gallons zso
'Pump off level at42 in.
Cycles tested 4
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankfli t station on lot >iw
Absorption field on lot >1W
Public sewer main WA
Sewer hwptic aervrce line >25'
Manhole/Access (Y/N) Y
High water alarm level at 44 in.
Meals alarm 3 circuit mgtwanrerrls7 Y
On a4aoent lots >iw
On adjacent lots
>1W
Public sewer manholekleanout WA
Bldg tank WA
Animal containment areas N020 Manura/animel errata storage areas Nam
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >5 Property Ikre >9 Absorption field "s
Water main
WA Water cervica lim »o' Surface water >IW
Wells on e4soent lots >1W
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >1e' Building foundation »Q Wale main »o'
Water Service line »P Surface water »ar Dnvaway. pwbVNehide storage >�
Curtain drain
Nam NOW Wells on adjacent bb >1W
F. COMMENTS'
G. ENGINEER'S CERTIFICATION
I cer* that I have determined through field JOLVections and
review d Munkipal records that the above systems are in
ccrgbrmance we MOA COSA guldellnes in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
pate 7lr=07
COSA Fee S q3Q Waller Fee $ _
Date of Payment I / n, .- , Data of Payment
Receipt Number I g3$ PI'A"r Receipt Number
(Rev. 1 tr0e)
AIi
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
MEMORANDUM
DATE: November 6, 2007
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lot 4, Block 1, Cinerama Terrace Subdivision
Certificate of On Site System Approval
The Intermittent Dosing Sand Filter was installed on the subject lot by Acreage Systems
of Anchorage. Ed Sanderson typically placed a cap at the bottom of each monitor tube
to prevent infiltration of sand or gravel into the bottom of the pipe. This allows a buildup
of nearly 2" of water at the bottom of the monitor tube. The adequacy test performed
on the bed indicated more than 680 gallons of water was absorbed almost immediately
into the underlying strata.
We also inspected the air pump and noted slightly more than 5 pounds of pressure in
the line. The system is working as designed and meets all criteria for certification. In
addition, Mike Blakeslee of A Plus Home Services, the representative of Anchorage
Tank has stated his inspection revealed the septic system is in good working condition.
SGS Ref. #:
1075903
Client Name:
Anderson Engineering
Project Name:
Cinerama Terrace, L4, 61
Client Sample ID:
Cinerama Terrace, L4, B1
Matrix:
Drinking Water
PWSID
SGS Environmental Services Inc
200 W. Potter Drive
Anchorage, AK 99518
Tel: (907) 562-2343
Fax: (907) 561-5301
All dalestimes are Alaska Standard Time
Printed DateTme:
11/05/07 15:45
Collected DateMme:
11/01/07 15:30
Received Date/rime:
11/01/07 16;;o
Technical Director._
—e4ephen Ede
Allowable Prep Analysis
Parameter Results POL Units Method . Limits Date
Date Init
Coliform Bacteria 0.00 9222B 11/01/07 11/01/07 sdp
All
SGS Ret#
1075823001
Client Name
Anderson Engineering
Project Namc/N
Water Samples
Client Sample ID
CincramaTerracc L4, n 1
!Matrix
Drinking Water
PWSID 0
Sample Remarks:
A0 Dales/rimes are Alaska Standard Time
Printed DateMme 11/052007 9:30
Collected Date/time 10262007 13:12
Received Date/Time 10262007 15.50
Technical Director Stephen C. Ede
Parameter
Results
PQL
Units
Allowable
Method Container ID Limits
PMP
Da Asis
Dat
Init
Metals Department
Ilardness as CaCO3
93.9
5.00
mg/L
S%120 2340B
A
10/31/07 11/02/07
Mil
Waters Department
Total Nivatc/Nitritc.N
0.922
0.100
mg/L
SM204500NO3-F
A
1029/07
LCP
Private Individual Analysis
Aluminum
ND
20.0
ug/L
EP200.8
A
10/31/0711/01/07
MH
Antimony
ND
1.00
ug/L
EP200.8
A
(<6)
10/31/07 11/01/07
Mil
�...�P Arsenic
ND
5.00
ug/1.
EP200.8
A
(<10)
'10/31/07 11/01/07
Mll
Barium
21.2
3.00
ug/L
EP200.8
A
(0000)
10131/0711/01/07
Mll
Cadmium
ND
0.500
ug/L
EP200.8
A
(<5)
10/31/07 11/01/07
Mll
Calcium
29200
500
ug/L
EP200.8
C
10/31/0711/02/07
Mil
Chromium
ND
2.00
ug/L
EP200.8
A
(<I00)
10/31/0711/01/07
Mll
Copper
15.0
1.00
ug/L
EP200.8
A
(<1300)
10131/0711/01/07
MII
Iron
ND
250
ug/L
EP200.8
A
(<300)
10/31/0711/01/07
Mll
Lead
0.212
0.200
ug/L
EP200.8
A
(<15)
10/31/0711/01/07
MII
Magnesium
5120
50.0
ug/L
EP200.8
C
10/31/07 II/02/07
Mil
Manganese
1.23
1.00
ug/L
EP200.8
A
(<50)
10/31/0711/01/07
Mil
Phosphoms
ND
200
u9/1,
EP200.8
A
10/31/0711/01/07
MII
Potassium
ND
500
ug/L
EP200.8
A
10/31/07 11/01/07
Mll
Selenium
ND
5.00
u9/1.
EP200.8
A
(<50)
10/31/0711/01/07
Mil
Sodium
7140
500
ug/L
EP200.8
C
(<250000)
10/31/07 II/02/07
Mil
Silicon
4480
200
ug/L
EP200.8
A
10/31/0711/01/07
Mil
Silver
ND
1.00
ug/L
EP200.8
A
(<I00)
10/31/0711/01/07
MIF
Thallium
ND
1.00
ug(L
EP200.8
A
(Q)
10/31/0711/01/07
Mil
Zinc
ND
5.00
ug/L
EP200.8
A
(<5000)
10/31/0711/01/07
Mll
- PRELIAIINARY -
SCS ReLM
1075823003
Client Name
Andtxson Enginccring
Project Name/N
Walcr Samplcs
Client Sample ID
CincramaTcrracc L4, D I
Matrix
Drinking Watcr
PWSID 0
Samplc Remarks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 11/052007 9:30
Collected DatelTime 10292007 11.13
Received Date/Time 10292007 11:45
Technical Director Stephen C. Ede
Paancta
Results
POL
Unita
Method Container ID
Allowable PMp
Limits Date
Abate
Imt
Private Individual Analysis
Total Dissolved Solids
PH
Alkalinity
113
8.03
74.4
10.0
0.100
10.0
m8/L
pll units
mg/L
SM20 2540C A
SM20 4500-1113 D
SM20 2320B D
(<500)
(6.5-8.5)
10/30/07
1029/07
1029/07
3D11
CLS
1D11
- PRELIMINARY -
(83-547)
CINERAMA TERRACE SUBDIVISION
LOT 4, BLOCK 1
119,188 S.F.
N 89'43'42"E 358.24'
LOT 4
♦ aF At :W*
•moi; 491H t 9 00
Jeffery A. Gastoldl . o AN
Alf
�'p^ •.� LS-6091*00.000,000 '*'o 'offsslono% � J(a� •
a
halkas
weu
0
1
1
1 1$= 60'
\ y 10' T. & E.
\ ESMT.
00
Vo
A2«E o. R,5
Og'
/0\NERPMP
FINAL STRUCTURE AS -BUILT
AS -BUILT
GASTALDI LAND SURVEYING
JEFF A. GASTALDI, R.L.S.
4726 WEST 88TH AVENUE
ANCHORAGE, ALASKA 9950:
PHONE 248-5454
GRID
3241/3341
F.B.
99-13
DATE
10/26/99
�yl3i1
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENANTS OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE.
Nov. 1. 2001 9:24AM anderson engineering
NO.4DC4 r. i
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPALITY OF ANCHORAGE
AND,(,4Npq Lt. -+ 9ix tf: Cv4K
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
�Dayof"VemBFQ of20�,byandbetweenRA.ypAtt.rVlAjo- 1K
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
partics to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Westew@ter '$��M�S,
It
Treatment System (AWWTS), described as 54.i 0 it 9EC& located
at 14 *r 914 UL / Q ^t art,AN1A.Tr W g G, Anchorage, Alaska.
49— 97ss G•j dftA+AA G tCX4
2. Definitions.
A. Alteration. Any change to the design or fimction of an AW WTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AW WTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC)15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
Nov. 2, 2001 9:24AM anderson engineering
no. 4004 r. )
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AW WTS that were included in
the original design which would allow the AW WTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AW WTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of - Af ° iJ %C
(S 0 .00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
AW WTS.
Nov. 2. 200/ 9:24AM anderson engineering 110. 4004 F. 4
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AW WTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
S. Alterations, Installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AW WTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term bf this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustmcnt(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AW WTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AW WTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AW WTS
Operating Permit is:
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
Nov. 2. 2007 9:24AM anderson engineering no. 4004 r.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AW WTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AW WTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AW WTS.
7. Noavvitiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
8. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties arc:
Nov. 2. 2001 9:24AM anderson engineering No. 4004 r. o
Owner:
1?pNQA,c.A. t Grx10- C04 K
Anchorage: Purchasing Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law,. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
OWNER:
By:
Dace:
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
By:
Title:
Date:
The foregoing * strumentacknowledged before me this,5 day ofAL�
20� by XU �e ��l�t�.P
Commission expires:
92-025(Rev.1/91) Front MOA#2/
nrr.
„JLL VtU
Municipality of Anchorage APR 06 2000
DEPARTMENT OF HEALTH & HUMAN SERVICE&MCiPAurrOFANCH
Environmental Services Division ”"="rAL SERviCF4 "
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: Lot 4, Block 1 Cinerama Parcel I.D.: 020-033-07
A. WELL DATA Terrace
Well type Private If A, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N) Y
Total depth 167'
Sanitary seal (Y/N) Y
Date of test
Static water level
Date completed 10/29/99
Cased to 51 '
FROM WELL LOG
09
10 /z',-/ 9 9 9W
50'
Well production 4
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: 2/27/00
Casing height (above ground) >2'
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
Nitrate .961 mg/L
Collected by:
Other bacteria 0
MEA
►'1
g.p.m.
B. SEPTIC/HOLDING TANK DATA
Date installed 8 / 1 8 / &9 ��ank size 1,250 Number of Compartments 3 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression(Y/N) N High water alarm (Y/N)
Date of Pumping New
C. ABSORPTION FIELD DATA
Pumper Construction
Date installed 8 / 19 / 00 Soil rating (g.p.d./W orft2/bdrm) 7 System typeBottomlg Sand
Filter
Length —IOL—Width 1 2 ' Gravel thickness below pipe . 5 ' Total depth 6,
Effective absorption area 3 6 0 SF Monitoring Tube present (Y/N)--y - Depression over field (Y/N) y_
Date of adequacy test New Const. Results(Pass/Fail) For bedrooms
Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate = o.p,d,
Peroxide treatment (past 12 months) (YM) If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed 8/18/00 Size in gallons 250 (1,250 STEP)
Manhole/Access (Y/N) Y "Pump on" level at* 42 "Pump off" level at* 42"
High water alarm level at* 44" *Datum Bottom of Tank
Cycles tested New Construction
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septiclholding tank on lot 100, On adjacent lots >100'
Absorption field on lot >100' On adjacent lots >100'
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line >25' Lift station inn,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation >51 Property line > S ' Absorption field----L5-'-
Water
ield> 5'Water main/service line > 10 ' Surface water/drainage > 10 0 ' Wells on adjacent lots 10 n
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line > 10 ' Building foundation > 10 ' Water main/service line >10'
Surface water >100' Driveway, parking/vehicle storage area >10'
Curtain drain >50' Wells on adjacent lots >100,
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal recorYsof "W119ye systems are
in conformance with MOA H4A guidefin in effect on this date. l a ,�
Signature
Engineer's Name Mi chaal P. Andle n p R.
ams r,
Date 4/5/00 J, F `pi-5nam*�
HAA Fee $ 'i `` Waiver Fee $ _
Date of Payment 4/e, f Date of Payment
ReceiptNumber J� (�a�J / Receipt Number
72-026 (Rev. 3/96)*
