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Home My WebLink AboutKNIK VIEW ESTATES BLK 4 LT 9 ~, Municipality of Anchorage Page __of___ 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 Permit Number: 5vqq~ooCj[~ PID Number: D~-l-Oq~-~/O ~-~,¥~ ~ ~l& ~ Wastewater System: ~New ~ Upgrade Address: ~ g ~o~ g?l o5 ~/~c~ flg~ ABSORPTION FIELD Pl~one: ~ ~ No. of ~edrooms: ' ~8-~~ C DeepTrench ~ShallowTrench ~Bed ~Mound U Other Lot: Bock: Subdiv~ion: Depth lo pipe botlom from original grade: Gravel depth beneath pipe Township: a : Section: Fill added above original or : Gravel length: Ft. ~7,~ Ft. WELL: New ~ D Upgrade Gravel width: ~ Ft. l ~A Ft. Classific~tion(%.A.B.~): / Total Depth: FL /C~¢dT°: Ft. Total absorption area: Dri[ler: /, / Dale Drilled: , Static Water Level: ,nst~ller:/ Ft. ~¢ ~ ~__0~5_¢~--(0~ Date installed:,. SEPARATION DISTANCES ~s~.tio u Ho~d~n~ ~ S.T.E.~. To Sepbc ~ Absorption Lift Holding ~ublic/Priwl~ Manufacturer: Capacity in gallons: Material: Number of Compadmenls: Sudace '[' wa,~, /oo'~ 1oo'+ / / / ~IFT STATION LotI J / + Size in gallon ufacturer: Foundation /o'~i /D % / / / Cu~ain " CMode, Eleclr~ Drain / ~ / / / / PumpM spections peflorm Remarks: ~/e~ /~¢~/~ ~¢ 7/~/Y~. BENCH MARK ~ J Location and Description: . V , Q ' Assumed Elevation: / ENGINEER'S SEAL Inspections perfo[med by: ~D ~,.~,~ Dates' 1st Departme,t of He and e~ces approv Reviewed and app~oved by: (~d> ~[~'0~ Date' 72-013 (Rev. 9t91) MOA 25 i![ ; q~ 3U~ T P AN ~ASTE~/ATER BISPBSAL SYSTEH LFIT 9, SLBCK 4, KNII< VIEW ESTATES P,I,D, 051-043-40 ri[ VACANT VACANT KNIK VISTA CBURT A-C-37.19+/- B C--t7,84+/ A-D=4a,56+/- B-D=22,41+/- A-E=48.99+/- B-E=4t,33+/- A-F-39,37+/- B-F-57,15+/- F G=aL40+/ PREPARED FBR: MOUNTAIN VALLEY BUILDERS DAVID NEUSCH\4ANDER P,B, Box 67i305 CHUGIAK, ALASKA 99567 KND ENGINEERING ~0441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 907-696-6111. ASBUiLT WASTEWATER DISPBSAL SYSTEM LOT s, SLOCK 4, ~,~,< W~V ES~ES -- CONNECT TB 4# SOLID FRO~ HOUSE ~ FINISHED GRA~E P,I,D, 051-043-40 lO00 G~L UNCLASSIFIED FILL(FROM TRENCH EX) jFILTER FABRIC SEWER ROCK BOTTOM OF TRENCH 9,0' AT TESTHBL ,E~ 37,5' CONNECT TO 4# SOLID FROM HOUSE ~] h ¢,0, ¢.~, BOTTOM OF TESTHOLE (]~ 37.5' INSTALLATION DETAILS ENTIRE SYSTEM COVERED WITH FABRIC. ALL PIPE IS D-3034 SYSTEM INSTALLED DEEPER DUE TO CHANGE IN HOUSE ELEVATION. SOIL FROM 7 12' RATED AT 1 MIN/INCH. PREPARED FOR: MOUNTAIN VALLEY BUILDERS DAVID NEUSCNWANDER P.O. Box 671305 CHUGIAK, ALASKA 99567 KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIYER, AK, 99577 907-696-6111 ~ MUNICIPALITY OF ANCHORAGE i DEPARTMENT OF HEALTH AND HUMAN SERVICES i!! P.O. BOX 196650, 825 "L" STREET, ROOM 502 :i ANCHORAGE, ALASKA 99519-6650 ] ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW'~50096 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:WALDE~ ENTERPRISES INC OWNER ADDRESS:62@8 STAEDEM DRIVE ANCHORAGE ALASKA 99504-1628 PARCEL ID:051043~0 LEGAL DESCRIPTION: KNIK VIEW ESTATES BLK 4 LT 9 LOT SIZE: 222111i (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 PAGE 1 OF 1 DATE ISSUED: 5/30/95 EXPIRATION DATE: 5/30/96 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /~EPTIC TANK SYSTEM ALL CONSTRUCTIONIMUST BE IN ACCORDANCE WITH: 1. THE ATTACHEDiAPPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 151165 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS I18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE ENGINEERiiMUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EAC~ INSPECTION. PROVIDE NOTIFICATION BY CALLING 343M4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER:ii5 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION S~STEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUSTiBE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, ~EALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWIN~ SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY ' ~f'/~ ISSUED BY: ~~.~[_/ DATE: DATE: BNGINBBRING 20441 PTAI~ [GAN BLVD. EAGLE RIVE AK 99577-8736 (907)696-6111/F kX (907)696-8111 May 22, 1995 On-Site Servicel DHHS 825 L Street Anchorage, AI< 99501 Dear Sirs: REF: Lot 9, Blo!k 4, Knlk View Estates - Request for Permit Attached is ourirequest for an on-site sewer permit for the above lot. The subdivision is served by public wateriand no on-site well will be provided. As shown on the site plan, there are no conflicts with proposed water lines, sewer systems or with potential ieserve areas. In addition, there are no class "A" public wells within 200' of the I property, and sufficient distance ( 10 + ) is provided for all area water lines. This lot is generally flat and comprised of mixed birch with a slope of approximately running southeast to northwest. There is adequate area directly south and east of the test hole location on the ilot to install both an original and a replacement system. The natural slope will prowde posmVe drainage away from the proposed ~nstallatton rote as well as ex~shng or wellsI There is no surface water within 200 feet of any portion of the potential proposed installation. We performed i one soils test within in the proposed absorption area, and conducted one percolation testlon this property. The area soils as shown on the soils log and identified from the road constr~ction is excellent and is comprised of sandy gravel's with little to no silt. The design we are ~ubmitting is based on a proposed three bedroom house and a percolation rate of approximat~iy (1 min./inch). In addition, no water was encountered during the excavation ~ '1 to 15.5 and nm~.e was found after water monitoring. Thank you for ~our consideration of this request. If there are any questions, please call me at 696-6111. Sincerely, I ~dfine~M. Du~fus, P.E. ~DEngineerf~g Attachments: On-Site Well and Sewer Application Wastewater Absorption System Details Site Plan Soils Log/Percolation Test WASTEWATER LOT 9, BLOCK 4, KNIK VIEW ESTATES P AN D~SPBSAL SYSTEM P,I,D, 051-043-40 %111 IOOD q~l. ~a n,'[( Area. ~ NOTES: 1. Total lot area House footprint Total area avail. 22,211sf 1,320sf 20,891sf for absorption area Area served by community water. Adjacent land vacant. PREPARED FOR: MOUNTAIN VALLEY BUILDERS DAVID NEUSCHWANDER P.O. Box 671305 CHUGIAK, ALASKA 99567 KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 907-696-6111 i ]]F-SIGN DFTAILS i WASTEWAT£R DISPOSAL SYSTEM LO]' 9, BLOCK 4, KNIK VIEW ESTATES i --CONNECT TO 4' SOLID FROM HOUSE I d d ~.._----ORIGINAL & FINISHED GRADE /P'IN,ULATIONFI]R<3' CDVER///FILT£RFABRiC Illl] Il : BOTTOM OF BED 6,5 7'~--~j,., i 37,5 ; BOTTOM OF TEST HOLE 15,5' CONNECT TO 4' SOLID FROM HOUSE NO WATER OBSERVED 37,5' M,T, i DESIGN DETAILS · ,~l,,."~l,. I 3 BEDROOM DWELLING WITH DAILY FLOW OF 150 GPD = 450 GPD 450 GPO / 1,8 GPD/SF TM 375 SF TOTAL ABSORPTION USE 37.5'L x 4.0'D x 5'W TRENCH.-(375/5~0,5)=37.5' ENTIRE SYSTEM WILL BE COVERED WITH FABRIC, INSULATION AS REQUIRED, ( <3' OF COVER ) ALL PIPE MUST MEET M,O.A, SPECIFICATIONS, PREPARED FOR~ MOUNTAIN VALLEY BUILDERS DAVID NEUSCHWANDER P,O, Box 671305 CHUGIAK, ALASKA 99567 P,I,D, 051-043-40 KND ENGINEERING ?_0441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 907-696-6111 GM/$P SP Cleo, n No Sll- DATE, 5-18-95 NOT TO SCALE DRAWING 95-58- OA PERFORMEO FOR:~ B LEGAL DESCRIPTIOn: L O t Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Neuschwander 9 Blk4 Knik View Organic 1 erc test P/GM Course sand 2obbles to 8/10" loose, Clean silt 9 10 11 12 13 14 15 Sand ean, no COMMENTS ltO~ e presoaked PERFORt Township, Range, S~ction: Estates SLOPE SiTE PLAN WAS GROUND WATER ENCOUNTERED;' S IF YES, AT WHAT . O DEPTH? N / A p E Depth to Water After MoniLorinD? N / A Date: 5 / 1 6 Gross Net Depth to Net Reading Date Time Time Water Drop 1 5/5 10:25 0 2.75" 0 2 10:26 lmin 3.75" 1" 3 10:27 lmin 4.75" 1" 4 10:28 1 rain 5.5" .75" 5 * Add 'water ~ 3.0" 6 ~0:29 lmin 4.0" l" 7 10:30 lmin 5.0" l" 8 10;31 lmin 6.0" 1,I 9 * Add water 4,5" _ l0 10:32 lmin 5.5" l" ll ] 0:33 lmin 6.5" l" PERCOLATION RATE ' (minutes/tach) PERC HOLE DIAMETER 6 II TEST RUN BETWEEN 3 __ FT AND ~ F'T prior to test. Maintained 6" head.~ PERFORMEDBY.i~ 0 I Ken Duffus CERTIFY IHAT THIS TEST WAS PERFORMED IN ACCORDANCE WITHj~LL STATE AND MUNICIPAL GUIDELINES IN EFFECI ON THIS DATE DATE _ 5 / 5 / C~ 72-008 (~tev 4/85) Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-043-40-000 Expiration Date: 10/24/2023 Legal description KNIK VIEW ESTATES BLK 4 LT 9 Site address 22641 KNIK VISTA ST Chugiak AK 99567 Current property owner(s) CRYDER JACOB M & JENNIFER C X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 7/24/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory x Arsenic Advisory COSA Approvd June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department X r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 05104340000 Complete legal description KNIK VIEW ESTATESBLK 4 LT 9 Location (site address) 22641 KNIK VISTA ST Current property owner(s) CRYDER JACOB M & JENNIFER C Day phone 952-2340 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units 9 Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: Al Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 28 yrs - See advisory if steel older than 20 years 6. ABSORPTION FIELD: 0 AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 1 5D Waiver Fee $ Date of Payment ZZ/_Z/z22' Date of Payment COSA # D S 2 f 2 3J Waiver # COSA Application—June 2022 COSA Checklist Legal Description: KNIK VIEW ESTATESBLK 4 LT 9 Parcel ID: 05104340000 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Total depth ft Water storage tank volume gallons Cased to ft Well disinfected for coliform test? ❑ Yes ❑■ No ❑ Sanitary seal is functioning correctly ❑ Coliform bacteria is Negative ❑ Wires are properly protected Nitrate mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) in. Arsenic ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COSA Collected by Static water level at beginning of test ft. Date Comments PUBLIC WATER SYSTEM SERVES THIS PROPERTY B. TANK DATA Measured operating fluid level in septic tank 49.5 Date of pumping 6/13/23 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/12/95 ❑■ ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficienci COSA Checklist June 2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/30/23 Results g Pass Fluid depth prior to test 8 in Water added 450 gal New fluid depth 10 in Elapsed time 30 min Final fluid depth 8 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 Effective depth used 8 in Effective depth remaining 40 in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic TanklLift Station on Lot > 100' ■❑ Yes Community Sewer Manhole[Cleanout > 100' J] Yes if No It ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private SewerlSeptic Line > 5' ❑ Yes if No ! ft Absorption Field on Lot > 100' ❑ Yes if No It Holding Tank > 100' ❑ Yes if No ! ft Neighboring Absorption Fields > 100' ❑■ Yes if No = ft Water Main > 10' Animal Containment> 50' ❑Yes if No ft ❑ Yes if No ft Yes if No ft Water Service Line > 10' ❑■ Yes if No Manure/Animal Excreta Storage > 100' If tank or field is under driveway comment below Community Sewer Main > 75' ❑Yes if filo ft n Yes if No ft ❑■ NIA — Served by Community Well (not on lot) or Public Water Frorn Septi011-1old in9 Tank and Absorption Field{s} on Lot to: (Please enter distances ff less than required) Building Foundations > 10' ■❑ Yes if No tt Surface Water > 100' ❑■ Yes if No ft Tank to Property Line > 5' ❑■ Yes if No It Wells on Adjacent Lots: Field to Property Line > 10' Q Yes if No = ft Private Wells > 100' ❑■ Yes if No = ft Water Main > 10' Q Yes if No = ft Community Wells > 200'■❑ Yes if No ft Water Service Line > 10' ❑■ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS C. CFRTIFICATION & 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, Lased on procedures outlined in the Certificate of Cn-Site Systems Approval Guidelines, indicates that the on-site water supply and}or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm NorthRim Engineering phone Engineer's Printed INamc Steve Eng Date _ COA Checklist Ju ne 2022 694-7028 9120122 ENGINEER'S OF 714 i* ;49D *' �` c^c Steve Eng M U H COUPIAUTYOoF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231239 Subdivision: Knik View Estates Block:4, Lot: 9 907-343-7904 Fax: 343-7997 The septic tank for this property is 28 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. 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 Parcel I.D. # ~'/- 1, GENERAL INFORMATION Completeilegal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (Site address or directions) Property owner Mailing address Lending agency i I Mailing address Agent Address i Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF NATER SUPPLY: Individual well Community well Public water NOTE: Ii community well system, provide written confirmation from State ADEC attest- igg to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer community wastewater system, provide written confirmation from State AD£C a:ttesting to the legality and status of system. 72q)25(Rev. 1/91) Fron MOA #21 By~ 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 of this Health Authority Approval application shows that the on-site water supply and/or~astewater disposal system is safe, functional and adequate for the number of bedrooms andtypelofstructureindicated 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 a~d/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 cfi Firm Addressl Engineer's, signature : DHHS SIGNATURE ~pproved for ! pisapproved. 20441 Ptarmigan Blvd. Phone /-¢?~-~,/// Date bedrooms. ,Conditional approval for Additiol al Comments bedrooms, with the following stipulations: Date 72'025 (Rev. 1/91) Ba~ MOA #21 i The Municipai;ty of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Cert!ficates based only upon the representations given in paragraph 5 above by an independent professional e¢gineer registered in the State of Alaska. The DHHS does this 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 ana yze data before a certificate is issued. The Municipality of Anchorage is not responsible fo? errors or omissions in the professional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"[." Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LcgalPcscriptiOi~: Z.o~'9 .~}/(tJ /{rfikVt'¢tD ~5-~w~-c$ ParcelI.P.: Off/- 0'43 Well t~e }[: If A, B, or C, attach ~EC letter. ADEC water ~stem number Log present (Y~) Date c ed Cased to Total depth Sanitary seal (~/N/ I ./ FROM WELL LOG Stattc water le!el / Well productio? cWo~oEr~ S AMPLE RE/~TS: Date of sampld: B. SEPTIC/HOLDING TANK DATA Dato ,,,stanea I Foundation cl6anout Date of Pump?g A"~- C. ABSORPTION FIELD DATA Date installecf[ Length ...,q ~, ~ t Width Nitrat/~/// / Collected by: AT INSPECTION tcria g,p.m. ~- Cleanouts (Y/N) ~/ size / O OO . Number of Compartments __ Depression (Y/N) /q Purnper ,tt,//~ ~ 2 Soil rating (g.p.d./£t" or~) Gravel thickness below pipe High water alarm (Y/N) 1, 2- System type Effective absorption area 37~¢4, Monitoring Tube present(Y/N) y [ ~ate of adeq?cy test A/',~ Results (Pass/FaiJg'( For / bedsores Fluid depth it~ absorpt¢l before test (in.); _~minediately after ~ater added (it~ Fluid depth ~(ins.) Minutes later: /Absorption rate ~ ~.d. eroxidetreat~ne~pastl2months)(Y~) / lfyes g~ate c] ~ Total depth Depression over field (Y/N) D. LIFT STATION Manho,e/^ccc? (V~) ~Z.. High water alarm levey Cycles tested [ ~ E. SEPARATIO~q DISTANCES ,, $i~allons "Pulllp on"/~ at* _ tlllll - vel at* On adjacent lots On adjace¢_ Public sexve~}~nhole/cleanout Liea~ton SEPARATION DISTANCES FROM WELL ON LOT TO: [ ii , Sewer/septic Setrx icc,~me SEPARA~ON[DISTANCES FROM SE~C~OLDING TANK ON LOT TO: Building foond~tion __ /O t 'f Property line /D ~ ~ Absoetion field iO~-f Water mainJse~ice linc / 0 ~ 4: Surface water/dt:ainage/DO '4 Wells on adjacent lots SUVA~A~OU[nlSZA~CU ~OU AUSO~mO~ Fm[n O~ [O* ~O: [ Building foundation /D t ~ Water maitffse~ice line / ~ ~ + Surface water ~: /~ t + Driveway, parkin~vehicle storage area / i Cu~ain drain ~ M ~ Wells on adjacent lots F. ENGI~ER~$ CERTIFICATION 1 certify that ~7~ave determiaed thrufiehl inspections and review of Municipal record<~~{tems are in conJbnnan~ with MOA //.4A guidelines in effect on this date, Engineer s Name ~ ~ ~. ~/ ...................... ~i .................................................................................. :~,~':0~"~? ......... HAA Fee $ ~ ~ Waiver Fee $ Rev. 8~95 eSS: h~aa.~vk.doc I Date of Payment Receipt Nmnber