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HomeMy WebLinkAboutHERITAGE HILLS BLK 4 LT 5LL LL LL y LL C y LL L�y m c� (D �4 • L : tl °� m d = :0 m a ° v m v m� O x 0 • • 13 C), :V ���. •ate :N 3 m 2o L •ZLu-El Z c O O o c ICU0. .� -chc Ze L •`� •O 0 N v W oU S Z U W C O•• t _ ••-•\\�1�. LL LL O m o Z o co O M U Z a Q a, v M N E w o D 12 m z' z d. 2 N N aZ a N ti u� o LL LL❑ ca W J Q ¢ a=C C _O O Z N c ' c y a = ❑ z Y .1 m o U cn H CL _- a� a `s z Q V H = FW. F- u O 0 d 3 o a a o �a �w H m Q = a CL .. V) z O ;, Q- 'O O O Y Z W .c Q Ns •> a W V= .O ci. Q m �' 0 3 D a Q cn CL o ii m3 C7 �IL °- ia- O J a d z m a 0 zz 0 3 0 w' + co UX ` c�3 j E LO Z n m"aW Q c 2= `W c C A E]m J F �? a' = o cn T- Q Im 4) Y VO W C _ H Z CQ Z c7 m 76 c o N 3 O UJ W Q v, O z El U= ' Z Z Q 0 O ao 00(D Q F- O O N Q m o T- W a (n �' U) �' O C N E J Q ❑ Z d Z z O .v .yo LL W W w F- a a �' O -' a D O N Q - n FQ- N Y LL O N y. _M m (n i .F + f < Q W > V Q d' v J z �W O .- O �- T-- T- Z Z r �, ~ cn a N a� w w p Y Y Z O E :3 0N wr C V Q F N C = O C C C G 0 �j ° C (n Q) Z m Q$ Oca J wH a _ _ yy45 y a) co V o f, XX � y� 4 C Q d a) CL 3 J z< N fn O d J d W (!J S 3 fn 7 U- 4: y C - C C U Q Z FO- LL L MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241088 Work Type: SepticTank Upgrade Tax Code Number: 01522131000 Site Legal Address: HERITAGE HILLS BLK 4 LT 5 G:2737 Site Mailing Address: 12301 TRACY RD, Anchorage Owner: ALEXANDER MARSHALL Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ij yI1,11- I ) e 1) a I - t 111 e I I rI)epartment 5/29/2024 5/29/2025 15414 ❑ 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 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing ;' Special Provisions: • The edge of the crib is to be located to ensure that the required separation is met. Issued By: (�(/ Date: Date: 3 MUNICIPALITY CH Development Services Department p p `^� Phone: 907-343-7904 On -Site Water & Wastewater Section '— Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 015-221-31 Property owner(s) MARSHALL Mailing address 12301 TRACY RD ANCH Site address SAME Legal description (Sub'd., Block & Lot) HERITAGE HILLS Legal description (Township, Range & Section) Lot Size 15,414 Sq. Ft. Number of Bedrooms 3 Day phone BLK 4 LT 5 APPLICATION IS FOR: (N all that apply) Absorption Field ❑ Septic Tank El Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade 0 Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) El (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. (Signature of property owner or authorized agent) Permit/Rush Fees: 3 �--o Waiver Fees: Date of Payment: s--Zg Date of Payment: Receipt Number: d/144ZO Receipt Number: Permit No. © f 2 Yl OV` Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc MAY 13, 2024 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: HERITAGE HILLS BLK 4 LT 5 To whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241088, Deb Wockenfuss, 05/29/24 L 1"=50' OLD TANK TO BE REMOVED EXISTING HOUSE INSTALL NEW 1,000 GALLON PLASTIC SEPTIC TANK W/ 20" RISER, DOUBLE CO EACH SIDE. DECOM. OLD TANK PER UPC, MAINTAIN 5' FROM FIELD AND 10' FROM BLDG. SCALE: DJRDRAWN: DATE: HERITAGE HILLS BLK 4 LT 5 Anchorage, Alaska MARSHALL 5/13/2024 EXISTING CONCRETE SEEPAGE PIT WELL WELL WELL TR A C Y R D WELL WELL 150 & 100' COMM. WELL RADIUS FROM LOT 8A HERITAGE HILLS BLK 4, LOT 6 COMM WATER SERVICE FROM LOT 8A WELL WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241088, Deb Wockenfuss, 05/29/24 M 0 131st AVE 1"=30' 0 n 00 N89°59'00"w 130.00' I moo. 0 Uij i • SEPTIC PIPES (tyP) O 0 F-- 2g FUEL OIL (n 0 �' PIPES w Q 00 x � a LOT 5 B LK 4 Q Iz 0 61.1 17L o o, z Z GRAVEL D/W 7. x � WELL in X x 59 Q�_'xU��____�iQ:- �-'--x x x--- __X �X x 30' I 30' LOT 6 BLK 4 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HERITAGE HILLS LOT 5 BLOCK 4 PLAT 63-41 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoulc any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE. E-MAIL MAY 2, 2024 1 "=30' schullerakOgmail.com 24-034 DRAW BY: CHECKED BY GRID NUMBEM Baas AGE: JLS SW2737 240144 OF 'kNU&V �� ., L A / .....,A � SAL 'YD 1' 40� 0 �v/'/� , • • � ,yam �:1P�. 491H ................ i� �n ..... . .. .� .... r`. • ...� ••.J�6HN L. SCHULLER.• Q / s ��.. Ls 1040s ,.•• ..�...x, �°� ' • . , • , •' J� / 1831 Talkeetna street k�'°r • • • • 4� Anchorage, Alaska 99508 o fession a1 �- •.. (907) 227--1455 office ... ��\►`I\'�►:r►''�''�'` (907) 274-4992 fax 1 30' 30 ) 131st AVE N89*59'00"W 130.10' 0 CS < co LLJ 0 z 30' LOT 6 BLK 4 0 r1r) ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HERITAGE HILLS LOT 5 BLOCK 4 PLAT 63-41 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no cnchroachments exist other than noted. Under no circumstance shout( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE- SCALE:E—MAIL:JUNE 5., 2024 1 sp =30schullerak*gmail.com 24-034-2 DRAWN BY. ICHECKED BY: GRID NUMBER: B60KTPAGE- JLS SW2737 240212 .%411 SLJ)? t loop atmosAMF OF A%,� 00, C-:� 49TIl ? ?......... ...... ... . ....... A 0 0 It JOHN L. SCHULLER LS --10408 elf z 1831 Talkeetna Street AW ov Anchorage, Alaska 99508 Ar ®`\'d�\ MW ofessionlo\ 1~ (907) 227-1455 office (907) 274-4992 fax ~ ,~,.' HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N°. 142 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: LEGAL DESCRIPTION DISTANCE FROM WELL. Yf / LIQUID CAPACITY .,//~_~ ~.2 ~;) GALLONS. NUMBER OF MATERIAL L.5' 2~'-'''¢~'~-'~ COMPARTMENTS / ~-- ~- LIQUID INSIDE LENGTH ',,¢¢'"'~INSIDE WIDTH~DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: ~ , LENGTH .,.~3 . DEPTH .~' . NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH ,~:~/ / / /' LININO MATERIAL ~_~-~G2,/JL,/c:~..,~r~7~.~---./<'<'<~/'~/~4':-/. DISTANCE FROM WELL /'~C)/' / , BUILDING FOUNDATION .,;.~/ NEAREST LOT LINE..,,~'~-~' .~'~ .K'7 ~' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,.~..~.D~ SQ. FT, TILE DRAIN FIELD: (.~-~oo TOTAL LENGTH · IN, T~O AL EFFECTIVE IN. ABOVE TILE DISTANCE FROM .,~-'-'/ WATER WELL: TYPE ~,-'~//~' , DEPTH , BUILDING FOUNDATION, SAMPLE_ , NEAREST LOT LINE ./~ /;Tz.... NEAREST /.../ SEPTIC .~ / SEEPAGE / , SEWER LINE , TANK , SYSTEM //~)/ , CESSPOOl , SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE ~ /'.~'~ APPROVED .- HEALTH AUTHORITY GAAB-HD-2 ~' HEALTH DEPARTMENT ~: 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT CaseNo. (f ' ~ NAME OF APPLICANT ~5~./~/;~Y RESIDENCE ADDRESS ../y~./'.~.~,.,:C",,,_./2/y,r,z~' LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESU MAILING ADDRESS,-;9~D.-'2~/¢~2///-¢:/z~'oPHONE NO .2/// LO CAT I 0 N 0 F I N STA L LATI 0 N /'.,-d:~/~/~-~'~ ./:j//~z~__f ~'z~ ~SEEPAGE PiT ~DRAIN FIELD ,OTHER A~TI~IPATED DATE OF ~O~PL~TIO~'~:~:~:~ . BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS .//:/~ '~'~ z/..- 2/</~/~, , PERMIT TO INSTALL A ,~~ AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED ~ SEPTIC TANK SIZE /~s~ TYPE ~-~ SEEPAGE AREA DIAGRAM 0F SYSTEM HEALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. Depth /~' Location Sketch Was Ground Water Encountered?~ .... If Yes, At What Depth .... Besd[ng gate Gross i'ime Time Depth To '.q20 Nat Drop Star Rotate A Aucborage, Alaska 99502 jml~ 14th,73 weil~ /oN ~ f/Je~ $~.~ ~ ~ ~1~ ao~. ~ cost for ~~i~ of ~ . 'is ~ ~-f~t. ~ set at ~ f~t at a cost of No ~ge for ~ of ~p,t~ ~ptng, ~sc~~ of wat~ 1t~, taking omt pitle~s zdaptsr ~ inst~!l~ng the same. No charge fo~ additio~l ~lree~_dd~,~g a section to the water line, ooupl~ngs and ~tors a~ w~lding . as. wel~ as crmtting the hole in casing for pitless adapter. Also pressure gaug.e. D~: Bernie ~us of ~Pmmp~rt Drilling W~rks I'V06- 06106 ~ ~ 3 Said well producing 15 GPM, in a stable formation of fine and course gr~_.vel. Static recowery of 25 feet of wrater off bottom, original wate~ formatio~ may have i~een, ruptured by the h~gh pressure rotary drille~ well drtl!tnz +-bromgh the water formation 200 feet away. ~s ~ '" ,C~NTAL PR I0~" te~J~ FIRST FEDERAL SAVINGS AND LOAN ASSOCIATION 305 FIFTH AVENUE * ANCHORAGE, ALASKA 99501 * PHONE 272-6401 October 3, 1972 Greater Anchorage Area Borough Department of Environmental Control 3500 Tudor Road Anchorage, Alaska 99500 LOT 5, BLOCK 4, HERITAGE HILLS SUBDIVISION Gentlemen: This is to advise you that we are aware of and concur with Mr. Jerry Bruton's request to place a sepage pit closer than twenty feet from the lot line of Lot 5, Block 4, Heritage Hills Subdivision. First Federal Savings & Loan Association is entitle on this property cur- rently. We will advise future purchasers that this concession has been made. Thank you. Your~ truly ~ ~ ,..,' /' . ' '/ ~ ii3$y Star Route A .AWAM alllLING WMS W —7714 Anchorage, Alaska 7)502 July Oth,73 and drLd' ent to 2P8_fest, '�" C`ij of or').,,vj One sis inch caned water w)1 deepenedwell 5 $50().0() 5 .00 min3ss= on drilling cost. gy cost for installation of P=P [Eli III lit It zx+; foot .t . oo:c or s177.60 Ho oharge for pulling Of purip,test Pmaping, disconnecting of water line, taking nit pit, adapter _Md inatallln6 the saws. No charge for addon itial wirs,adding a erotica to the water line,couplings and connectors and welding as wall as cutting the hole in casing for pitless adaptor. Also pressure gauge. II ...iy vm w�,„ h Y Driller, gcrnis Cl .nt of Y�rpPs t milling Forks c , 12 ry, R 3 w rvi Drilling Site, Lt. S 31L. Lf Subdivisions Ne r, t^ SH s NCE - c 6 06 36 3 T2s- 9'r6-5.7 Clmeri tax,,.l Jensen Ph. }VI -.0160 Sdd well p>roduaing 15 GP!( in far=t tUn Of fires MA &7W',9.0 VrA7e1. Statio recovery of 25 fent of water off boElam. This wile original water formation may have been ruptured by the high pressure rotes drilled well drLUaag through the water formation 200 feet away. 'thir. .i has happcad.many Liars In the Past. ueoete check payahle to Rampart Drilling }forks for the sum of $677. I:...�:: All -i o� AN p•„E�E�VVol �Q pq T104 or^ gerale Claus of Rampart Drilling Works n•vK c•, t ' d, rg CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID CT&E Environmental Services Inc. 991334001 S & S Engineering Lot 5 Blk 4 Heritage Hills Lot 5 Blk 4 Heritage Hills Drinking Water Parameter Results Total Coliform-, Nitrate -N 01 Client PO# Printed Date/Time 04/07/99 14:04 Collected Date/Time 03/31/99 18:00 Received Date/Time 04/01/99 09:15 Technical Director: Stephen C. Ede Released By POL Units Method 0 col/100mL SM18 9222B 1.99 0.500 mg/L EPA 300.0 ALlouable Prep Analysis Limits Date Date Init 04/01/99 KAP 10 max 04/01/99 04/01/99 SCL C) V/ m CD r- r- cy')m I? M ti r 0 0 0') CD 0- 0 o > u) a) c M w L O 0 0 M i N N u / CD r U d co LO rn rn LO v J Q Y � J O m U J Q J Q W U U Q Q _H LU C) cY) c N O Q U) U U) L J in LU Ral 0 O a) M x 0 0 0 - OL m C O c 0 O A 'a L O N 4-1C E 0 f N 0 c a a U) O U %I.- 0 0 -0 Q. L O 3 EL O L c �, U) a a% r- 0 ~ O E U L N a) O ❑ 0 O O a) c N (D Ni ca .5 70 O `� > U c N p -0 Q f!1 q 'N c N U c LL O U) ° o O °� L z Q O a) a .N U E �, N j C Q. -0O O m 0 cL Q. CL 0 - Or a o �_ E X Rf O N +' N LN cn m E -0 O Q 2:1 IL O O. ° > Q. 0 (D cn 0 — cn m '> °O> a) c. L -he o IL O Q O c �iz CD • � f w O cLc U (p Q I— O U O N O = N U a :E ;, a a c F- N 0 c a a U) O U o rn CA 0') CY)cy� I i` 00 (3) 0') (1) x LU c M r � oil n V O P� V z Lie O � U ®- a) /— E C/)V L Q � z ❑ W NU) U (13 ^>' W06 U E O � 0 c� U Q Q Q 0 L Q U -I.- C/) A C= O ^0 W U a) A Z O P: M CV � N 0 L LL •- Z C) J Q ❑ W Z U w C� a TMI J Y J = m z J Q J 0 LU Q w = o C'7 c CV o O L U) U N U N m -0 0) a) a) a) c 0 Q ca O U U 5i a) a) U- C J 1 ca o 3: c 0 69� E 0 cu LL 0 O m O U ❑ U U_ U w � •C "� N O O a) d a) a0) N a) O — N _ o a) O a) cn N U Q_. _>1 c L ■ O +- _ E a) �_ _ E � +' Q U ❑ 3 U U U a) >+ � ❑ a) ) N c O O C a) E > > �+ v :3 El CL a) O U to g N El 1:1m 2) _rZ c C O m ++ a) a ~ v cv > + M a) c c6 ❑ cn d C) 0) a) o ❑ a) C: a) N O C ) ❑ N a) — w 0) 0- 2 c c CL OL m O a) U J ❑ a ❑ 0. O > U O U N r o -O n m E CL m a) ¢ ❑ lJJ J❑ t 0 NE n- a) a) Fn Q.r ❑ W W r W ,F,^- 'a) VJ L a) ^�^,, N Rf U Q VJ Q Y Z o ` 0 Q > C% > ~a) n > `- M LU LL O LL O F- H U z cr _ vi a a O a) a) 21 F_ IL (1) cn a •— O H Q CO > N Q Q >� N M 14 ui CO > W m � a) a) U- C J 1 ca o 3: c 0 69� E 0 cu LL 0 O m O U ❑ U COSA Checklist Legal Description: HERITAGE HILLS BLK 4 LT 5 ParcellD: 015-221-31 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) Date drilled '7/14/73 Total depth 228 ft Cased to UN ft A Sanitary seal is functioning correctly ❑fi Wires are properly protected Casing height (above ground) 22 in. Date of flow test for COSA 5/24/24 Well production at time of test 3+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes No 9 Coliform bacteria is Negative Nitrate 0.519 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by MNA Static water level at beginning of test 177 ft. Date 6/3/24 Comments " NO LOG FROM ORIGINAL WELL. WELL DEEPEDED JULY 1973 B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWfS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 10/1/1970 0 ALL standpipes present per record drawing Total measured depth from grade 14.3 ft (max) Measured depth to pipe invert from grade 5.3 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 2000 gallons 5/5/24 date Any rejuvenation treatment (past 12 months) NO If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station _years Lift station material Comments: Adequacy test date 5/24/24 Results Q Pass Fluid depth prior to test 44 in Water added 500+ gal New fluid depth 62 in Elapsed time 1440 min Final fluid depth 44 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 108 in Effective depth used 44 in Effective depth remaining 64 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Fi Yes if No ft E Yes if No _ It Neighboring Tank > 100' 7a Yes if No _ It Absorption Field on Lot > 100' ❑� Yes if No _ ft Private Sewer/Septic Line > 25' 0 Yes if No _ It Holding Tank > 100' ❑ Yes if No _ It Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No _ It Qo Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No _ ft Q Yes if No _ It ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No _ ft Surface Water > 100' ❑E Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS [i Yes if No _ ft E Yes if No _ ft ❑� Yes if No _ It ❑� Yes if No _ ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' 2 Yes if No _ It g Yes if No _ It If tank or field is under driveway comment below G. CERTIFICATION & 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, 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 ___ /�/i! N ,�nc� cJ6L✓( Y. Engineer's Printed Name Glvrnc� COSA Checklist June 2022 Phone 6/14/24 Date Q Q 7 H %. I�CiIPY ei�R. . ,• ... • .... r. k, •1. .. • •Y II.I IYS{'' �• MICHAEL N. ANN R3P.N �•, CE -9