HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 3 LT 22Municipality of Anchorage ' Page 1 of. 3
U~?AH I MENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · AnchOrage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well InspeCtion Report
Permit Number: SW970144 PIDNumber: 05t 04324
Name:
Splne].l Homes Wastewater System: [lll~ew [] Upgrade
Acidress:
9210 Vanquard Drive_ ABSORPTION FIELD
Phone: Nc. of Becirooms: []'~eep Trench E] Shallow Trench i [] Bed [] Mound [] Other
344-5678
LEGAL. DESCRIPTION So,,a,,ng: .'"~f-~GPD/Sq. Ft. TotalDepthlromorigin~lgraae:
Lot: Block: Subdivieion: Dep~ to pi~ ~om lrom onginal gmoe: Gravel ~oplh ~neat~ pipe
22 ~ KNIK VIEW ESTS. /,~R. ~ ~.
Township: Range: S~ti~n: ~11 a~ above original gra~e; Gravel leng~:
WELL: ~ D New C Upgrade Gave, wiath: Nbmber of lines:
Cta~ificat[on {Private. A,B,C): Total
,,~, Dept.: C~e~ To: Total abso~tlon area: Pi~e mate.~: ~ ~. ~t.
Drille~ Date Drill~: S~t[c Water Level: Inslallen D~te '
installS: '
Yield: Pump Set at: ~ing Height A~v~ Ground:
1SEPARATION DISTANCES ~.~tic s Holding D S.T.~P.
To ~pac AD~U~ Li~ Ho~i~ ~P~t* Manufa~ren CapacJ~ in gallons:
Matedat: ,
~ Number of C~pa~ments:
Sudace
w~t.~ ~ ~ ~ ~ ~ LIFT STATION
~emarks: BENCH ~ARK
Lo.lion an~ D~cdption:
AS{umed Elevation: 100~
Inspections pe~0rmed by: H. A~e~so. Dates: 1st 11/9/2~ r',.~~~
2nd 11/10/97
Depadment of Health and Human ~e~ices approva~
Permit No SW970144 Page __2__ of 3
blunJcipality of Anchorage
DEPARTMENT OF HEAl.TH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well InspeCtion Report
Legal Description: LT 22, BLK 3, KNIK VIEW ESTS. SUBD.
PIDNo.: 051 04324
/
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JUDD ~21RC~E
1,250
Gal.
septic,-~
lO'T, &E, ESMT,
Cz~ M?I "~
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Alternate
PLAN AS-BLT
1" = 30'
LOT 22
Permit No.
~W~/U'I~ Page 3 ,~of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage,.Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well InspeCtion Report
Legal Description: .LT 22, BLK 3, KNIK VIEW ESTS. SUB]). PIDNO.:: 05104324
[,L'~ ~;,,'. ~ep~ic '. t ' ~'~. ~ock :' ' '/~' '
~> ~.:-~ ' ~ ~, ~ I~. ~, ..... ,i ~ "~ ........ ~-~1;
,: . ~ .... . .....~.. ,.,:.: ~ ,~,.~ ~ , . septic %~ ~L ' ' . rock
~. .' ~
~C;~' ," 9~ ?::r q, ',(~:?::t,,; EL~ATION AS ,BLT
SP1 Septic P~mp, compa[~ent 1 1" = 10"
SP2 2
C Clean Out
MT Monitor Tube
MEMORANDUM
DATE:
TO:
FROM:
SUBJECT:
June 30, 1998
Jeff Post
Mike Anderson, P.E.
RECEIVED
dUN 50 1998
Municipality of Anchorage
Dept. Health & Human Services
Lot 22, Block 3, Knik View Estates
Permit No. SW97014.4 :i:
Attached is a new Health Authority Checklist using the proper form for the septic system
recently constructed on Lot 5, Block 4, Knik View Estates Subdivision. We:have also
vertified the distance between the trenches is at least 14'. The scale used on the as-built
drawings makes it difficult to accurately depict the separation distance between the
trenches.
PAGE 1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUM~MN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
J~NCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970144
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NANE:SPINELL HOMES
OWNER ADDRESS:9210 VANGAURD DR.
ANCHORAGE, AK. 99507
PARCEL ID:05104324
LEGAL DESCRIPTION:
KNIK VIEW ESTATES BLK 3 LT 22
DATE ISSUED: 6/20/97
EXPIRATION DATE: 6/20/98
LOT SIZE: 21380 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORD~NCE 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 {18A3tC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1.) MAINTAIN A 14 FT. SEPARATION BETWEEN TRENCHES.
2.) ENSURE ALL CLEANOUTS ARE INSTALLED AS REQUIRED
AMC 15. 65
RECEIVED BY: i~t~ ~J~~/,,,""~ DATE:
ISSUED BY:
DATE:
MEMORANDUM
DATE: June 18, 1997
TO:
FROM:
Jim Williams, MOA- DHHS
Mike Anderson, P.E. ~{/V'] ~-
SUBJECT: LOt 22, BloCk 3, Knik View Estates
Septic System Construction Permit
An additional testhole was recently placed on Lot 22, Block 3, Knik View and a monitor
tube set in the m'ea of the alternate system. No groundwater was found during the
excavation and none has been noted to date. We will continue to monitor the water level
during the construction of the new system.
The total depth of the new system centered around Testhole No. 1 was raised 1' to
compensate for the rise in the groundwater to the 13' level noted during your site visit. The
bottom of the trench will have the necessary 4' clearance from groundwater. W'",~-~.;~0 ~,u- t,~
We again checked the percolation rate in Testhole No. 2. The percolation test shown on the
soils log is accurate. The accumulated water in the percolation cavity is probably caused by
siltation around the edges of the cavity. We are confident the soil will percolate at the rate
indicated.
All items mentioned during your site visit have now been addressed. We are hOpeful the
septic system permit for this lot can now be issued.
May 22, 1997
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
AnChorage, AK 99502-0650
Subject:
RECEIVED
N~Y 2 U 19~'~
Municipality:of Anchorage
Dept. Health & Human Servioe,,I
Lot 22, Block 3, Knik View Estates Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
We hereby apply for a permit to construct an onsite septic system on Lot
22, Block 3, Knik View Estates Subdivision. The attached site plan and
backup documentation identify the size and location of the new system to
serve to be constructed on the lot. 1-he subdivision s served by
community water and all required separation distances are easily met No
conflicts exist with other septic systems in the area.
Testholes performed on the property revealed silty gravels which
percolated between 30 and 60 minutes per inch. This material is overlain
by a layer of poorly graded gravel which percolates much faster. We have
designed the absorption trenches, however, to be primarily in the slower
percolating rnaterial. Total depth of the system will be 10' below the
surface. Insulation may be required to prevent frost penetrati°n into the
absorption trenches.
The surface of the lot slopes from southeast to northwest at grades
varying from 3% to 5%. The surface of the ground in the area of the
absorption trenches is fairly flat. The lot is of sufficient s~ze so that no
encroachments will exist between the septic system and any future
systems in the area. Property to the southwest is currently vacant .
if the system is constructed as designed the following statements can be
made:
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. The
subdivision is currently served by a community water system
Lot 22, Block 3, Knik View Estates Subdivision
May 22 1997
Page Two
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
The system, if constructed as designed wil have no adverse
impact on reserved space, either surface or subsurface, on any lots
located in the area.
The system, if constructed as designed, will have no adverse ~mpact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
AREA MAP
SCALE 1" = 100'
NSg'56'31"W 659.38
/
/
/2
/¢
179.92
/
/
/
/
/
SHEET NO.
CALCULATED BY
CHECKED BY
sc^~ /" =-/oc:;' !
OF
DATE
DATE
/9
/8
JUDD Circle
~ [As'r'' 180.00
175.00
205.~
/2
/J
?
/
R.50
/
/
/
./
2,~ L KNIK VIEW
. , LOT 22, BLOCK 3,
,
_Circle
VACANT ' . '
../'/ //'"
~/ ' O SERVED BY COMMUNITY WATER
LOT 22, BLOCK 3, KNIK VIEW SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home
Perc. Rate: 56 Min./Inch
Application Rate: .45 GPD/SF
Deep Trench System
1,250 Gallon Septic Tank
7' Drainfield Rock
4 Bedrooms X 150 GPD / .45 GPD/SF = 1,334 SF of Absorption Area
1,334 SF/14 SF (Sidewall Area) = 96 LF Length of Trench
Therefore: Construct a Deep Absorption Trench With Two Laterals Each
48' in Length. Distribution Pipe in Trench Placed at 2.0' Below the
Original Ground Surface. Mound Over Trench a Minimum of 1.5'.:
I '-.-&"
NOTE:
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Maintain 4' Vertical Separation From Ground Water:
Minimum 3' Cover Over Trench or Direct Bury Insulation.
Muni~tpality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG ~ PERCOLATION TEST
PERFORMED FOR: ~.~ p jhJ t.?/-. ~, /~O~ ~--~
DAT~ PERFORMED:
1
2
3
4
7
8
i.
20-
Township, Range, Section:
SLOPE SITE Pt.AN
III
IIII
WAS GROUND WATER LJ
ENCOUNTERED?
S
IF YES. AT WHAT ~ 0L
DEPTH? p
E
~:
Gro~ N~ I~ to Net
Reading DaTe Time Time Water Drol~
PERCOLATION RATE ~-~'' (mmutes~mch) PERC HOLE DIAMETER "~
TF~T RUN BETWEEN ~-~' Fi' AND ~.~. FT "
Muni~pality ef Ar;borage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Al,~ka 99502-0650
SOILS LOG -- PERCOLATION TEST
1
2
$
6-
7
8
9
10
11
12
13
14
15
COMMENTS
DATE PERFORMEDi
Township, Range,, Section:
~,~t,~* SLOPE
I,I
!
WAS GROUND WATER
ENCQUNTERED?
IF YE~, AT WNAT
DEFrH?
SITE PI.AN
Gro~, N~ ~ to N~
R#dlng ~ Time Tlm. Water
r
l'Eb"T RUN BB'V.~. EN = ~ FT A'D-- '~ I:'r ''
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 '%" Street, Anchorage, Alaska 99502-0§50
SOILS LOG -- PERCOLATION TEST
"ERPORMEO FOR:..~F~ d~L~ ~~
4
9
10
11
12
13
14
15
16
17
18'
19-
20-
DATI~ PERFORI{
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
Reading Date Gross Net Depth to
Time 'lima Wata~ D
PERCOLATION RATE
Immute~nch} PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND
[
FT z
PERFORMED BY: . I ~ ~-----~'~"'I~TIFY THAT THIS TEST WAS PERFORMED iN
·
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: __
72-00~ (Rev. 4/~) :
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS;
SUBJECT: LOT 22, BLOCK 3, KNIK VIEW EST. SUBDIVISION
GENERAL:
1. The scope of this project includes furnishing and installing
a new 1,250 gallon septic tank. Work also includes the
construction of a new deep absorption trench atotal of 84'
in length with 8' of drainfield rock beneath the distribution
piping. A flow divider must be placed between the two
laterals to provide even flow.
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 and verification of the location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected
specifically agreed otherwise.
areas unless
systems must
of Health and
5. Contractors installing wastewater disposal
be certified by the Municipal Department
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 INSTALLATION
1. A new 1,250 gallon septic tank must be procured from an
approved source and installed at the location shown on the
Site Plan.
Lot 22, Block 3, Knik View Estates Subdivision
May 22, 1997
Page Two
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts
for pumping access.
bedded to prevent
3. The septic tank shall be sufficiently
settling or shifting of the tank.
4. All standpipes on the septic tank shall extend a minirnum of
12 inches above final grade. ;
5. Tanks installed without 4' of cover shall have a minirrlum of
2" of direct burial insulation.
6. A foundation cleanout shall be installed one to fOur feet
from the building foundation. Two cleanouts are required
between the tank and the drainfield.
7. Final grading over the tank shall be such that a :ositive
slope exists away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown
on the design. The bottom of the trenches shall be within
2" of level.
2. Distribution piping must be placed level with perforations
down atop alevel 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 below: ground
must be perforated.
Lot 22, Block 3, Knik View Estates Subdivision
May 22, 1997
Page Three
5. Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any cort~munity
well.
6. Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to :prevent
settlement or depressions.
7. Grade area surrounding the absorption trenches to drain
away.
8. A minimum 2' of accepting soil is required below the
drainfield rock for a 5' wide trench. Contractor shall verify
this condition prior to placement of the rock. All pockets of
unacceptable materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
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 P.V.C.
(perforated and solid), ASTM F810 or H.D.P.F. (perforated,
but not solid) and ASTM D2662 or A.B.S. (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). ,
Lot 22, Block 3, Knik View Estates Subdivision
May 22, 1997
Page Four
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.
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 rnay not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution i piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
Contractor shall provide acopy of all field survey layout and
construction notes for use in preparing the certified as-built
of the completed system.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 051 04324
HAA #
1. GENERAL INFORMATION
Complete legal description
Lot 22, Block 3
View Estates
Location (site address or directions)
Property owner
Mailing address
I_ending agency
Mailing address
Spinell Homes
9210 Vanquard Drive
Day phone 3_~4-5670
Anchoracfe, AK 99507
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3, TYPE OF WATER SUPPLY:
NOTE:
'?nut (4)
Individual well
Community well
Public water
xx
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
×X
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Fton[ MOA~21
STATEMENT OF INSPECTION BY ENGINEER
/X,s cedified by my seal affixed hereto a~d a.s of the validation date shown below, I verify that my
investigation of this Health Authority Approval application 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 is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection·
Name of Firm Anderson Engineering Phone 522-7773
Address_ P.O. Box 240773 Anchorage, AK 99524
Engineer's signature ~--.~J.c~._,,(._.-~--~ Date 6/1 6/98
DHHS SIGNATURE
¢/ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does th is as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~)25 (Rev. 1/91) 8ack MOA #21
Legal Description:
A, WELL DATA
Well type A
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
Date of test
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
22, Block 3, Knik View . Parcel I.D.: 05104324
Estates
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to
Lot
2t8409
Casing height (above grounc
Wires properly protected (Y/N) ~
FROM WELL LOG AT INSPECTION
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of. sample:
B. SEPTIC/HOLDING TANK DATA
Date installed 1 1 / 9 / 9 7
Foundation cteanout (Y/N)
Date of Pumping New
C. ABSORPTION FIELD DATA
Nitrate
g,p,m.
Collected by:
_ Tank size 1 ,250
Y Depression (Y/N) Y
Pumper Construction
Date installed 1 1 / 1 0 / 9 7 Soil rating (g.p.d./fF or ft2/bdrm) .4 5 .
Length 9 6 ' Width 4 ' Gravel thickness below pipe
Effective absorption area ~ Monitoring Tube present (Y/N)
Date of adequacy test_ NRW Con.~-. Results (Pass/Fail) pa
Fluid depth in absorption field before test (in.);
Fluid depth (ins) Minutes later:.
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
Other bacteria '
g.p.m.
Number of ComPartments 2__ Clean0uts (Y/N) Y
High water alarm (Y/N) } ¥
System type ..~~.h
7 ' Total depth
_ Depression over field (Y/N)
For 4 bedrooms
Immediately after.~ gal. water added (in.): __
Absorption rate =
If yes, give date
.g.p.d.
D. LIFT STATION -
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
None on Lot
"Pump on" level at*
*Datum
"Pump off" level at*
SEPARATION DISTANCES FROMWELLON LOT TO: - No Well on Lot
Septic/holding tank on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5 ' Property line > 5 ' Absorption field > 5 '
Water main/service line > 10 ' Surface water/drainage > 100 ' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 10 ' Building foundation > 10 '
Surface water > 100 '
Water main/service line > 10 '
Driveway, parking/vehicle storage area > 10 '
Curtain drain Non~ ~n T,,~ Wells on adjacent lots
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
Signature 7'~x,~,_- ~~
Engineer's Name M~ ~.h~l ~: ~n~r~on, P.E.
Date 6/30/98
HAA Fee $.
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
>200'
Waiver Fee $
Date of Payment
Receipt Number
are