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HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 4 LT 9 Municipality of Anchorage Page 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: *-S~,~-./O~Lto .'~a,'~(%' PID Number: N~: C~ ~ ~ ~O~ Wastewater System: D New ~Upgrade Address: J ~ ~E~ %~L~ ABSORPTION FIELD Total Depth fron~ ~riginal grade: LEGAL DESCRIPTION .~q~ Soi,,~,,n~: ~ ~w~..,.: Is o,io.: Fill added above origil)a~rade: Ft, Gravel length: ~ '~ Ft. Number of lines: J Distance belween lines: WELL: D New ~ Upgrade Gr~ve~ ~i~th: ~ Ft. ~I " Fb Classilication (Private. A,B,C): Total Depth: Cased TO: Total absorption ares: Pipe material: Ft. Ft., J '~ SQ. Ft. Driller: DateOrilled: SlaticWaterLevel: Inst Iler: D i t I GPMI FtI .~. TAN K SEPARATION DISTANCES ~s~¢ic u ,o~ing ~ S.T.E.P. TO Septic Absorption Lift Holding Public/Pdvat~ Manufactur r~ Cspacity in gallons: From Tank Field Stsdon Tank Sewer Lines ~- . Surface W~te, ~ 0 ,) ~ LIFT STATION I CurtainDrain ~0 ~ ~ump Make & Model I Electrical Inspections pedormed by: Remarks: BENCH MARK ' ~ ~[~ ~ ~¢¢ ~ Location and Des ription: 0 Inspections performed by: ls Department of Health urea es approval ,. Reviewed and approved by: / ate' 72-013 (Rev. 9/91) MOA 25 ~5 0 25 50 75 100 125 150 / ~. . ££ALE,' I" = 5OF?. / ,',' .:.:%:. : ,'1, ~t ~ // / S~iNGT~E~:~ / / / ! / ! / / / / i / I I~l AC 8 FT / ~//~ BO 11 FT AD 14 FT BO 19 FT \ \ GE 8! FT OF 75 FT  AE 109 FT AF 82 FT ? TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 (907') 279-2;~ l~ LOT 9 BLOCK 4 VALLI VUE ESTATE 6222 GREENTREE CIRCLE DAN COKER J J SEPTIC SYS[EM ASBUILT DATE: Jl..fNL: 30, 1995 SHEET: 2/.~' GRID: 2538 Standard Trez~ch: 56 F/ Total Length 11 F/ Tota/ Depth 9 Ft. Effective Rock Depth Monl%o~ 4' ?opso/I 3 ft. of cover 8s 80.0 Mira Pi 140 .71L 9 £~ o£ Septic ~ock SCALE 85 Diversion Valve 91.01 ~ooL septic, i. onk REVISED;' 9/30/94 TOBBEN SPURKLAND P.E. 203 Wl5th Ave Anchora Ak 99501 9 BLOCK 4 VALLI VUE ESTJT£ 6222 GREEN TREE CIRCLE DAN COKER .]:SEPtiC SYSTSM ASBUILT DATE: JUNE 30, 1995 SHEET: G£1D: 25,58 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT NUMBER:SW940386 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:COKER DONALD A & TAEK0 W OWNER ADDRESS:6222 GREEN TREE CIR ANCHORAGE, ALASKA 99516 PAGE 1 OF 1 DATE ISSUED: 10/06/94 EXPIATION DAT~:10/06/95 PARCEL ID:01534152 LEGAL DESCRIPTION: VALLI VUE ESTATES #2 BLK T 9 4 L LOT SIZE: 21719 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 343-4744 (24 HOURS) 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. 2031W 15th. Avenue, Suite 203 Anchorage, Alaska 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 9 BLOCK 4 VALLI VUE ESTATE DAN COKER No Ground Water or Impervious Layer to 17 ft. Use Standard Trench Soil Rating. From test 9/28/94 17 min/in - .6 gal/sq, ft. No. of Bedrooms 4 Required Area per Bedroom: 150/.6 - 250 sq.ft.. Total area required: 250 x 4 = 1000 sq. ft. Ground slopes ~ 20% between existing tank and proposed trench Testhole Total Depth 17 Ft Less 6 feet 11 Ft Less 3 feet Cover 8 Ft Rock Depth 9 Ft. Add one foot of fill for cover Length of Trench 1000 / 18 = 55.5[FT.] SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 56 FT. TOTAL WIDTH 2 FT. TOTAL DEPTH 11 FT. ROCK DEPTH 9 FT. COVER 3 FT. SEPTIC TANK ' 1250 GAL. CHECK INTEGRITY INSTALL DIVERSION VALVE TO EXISTING TRENCH BULL-RUN The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Design LOt 9 Block 4 Valli Vue Estate N TOBBEN SPURKLAND P.E. 203 W 15TH, AVENUE ANCH, AK. 99.501 f907~ 279--3916 LOT 9 BLOCK 4 VALLI VUE ESTATE 6222 GREENTNEE C1£6L£ DAN COKE£ SEPTIC SYSTEM DESIGN DATE: AUGUST 20, I£94 SHEET: I/$ GRID: 2558 N 2~ ~ 75 $£ALD 1" = 50 FT, 125 X / I1~ // / ~ ~ / / I I / / / ~%1 / ! / / TOBBEN SPURKLAND P.E. 20:5 W 15TH. AVENUE ANCH. AK. 99501 (907~ 279--3916 LOT 9 BLOCK 4 VALLI VUE ESTATE 6222 GR££NI'RE£ CIRCLE DAN COl(ER J J SEPTIC SYSTEM DESIGN DATE: SEPT, 7,1994 SHEET: 2/3 gRID: 2558 I© Standard Treaeh: 56 Ft Total Length 11 ?t [oiol Depth 9 Ft. Effective Rock Depth Clmonouts Noni~om 4~ TopsoH 5 ft. of cover Diversion Valve 9 Pt o£ Septic Rock NB ~CALE 1~50 go(, septic tank Ex/sling, Check Integrity REVISED; 9/50/94 TOBBEN SPURKLAND P.E. 203 W15th Ave Ak 9950i LOT 9 BLOCK 4 VALLI VUE ESTATE 6222 GREEN TREE CIRCLE DAN COKER SEPHC SYSTEM DESIGN DATE: SEPT. 7, 7994 SHEET: GRID; 2558 Munic~pahty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 L Street, Anchorage, Alaska 99502-0650 SO LS LOG -- PERCOLATION TEST LEGAL D~SCRIPTION: L~T ff j~ ~ ~1 ~; ~ Township, Range, Section: 4- 5- 6- 7 8 9 10 11 12 13 14 15 16 17 18 19 20- COMMENTS WAS GROUND WATER ~X~/ ENCOUNTERED? 1) IF YES, AT WHAT SL DEPTH? pO E Depth ~ Water Altc~ Reading Date Gross Net Depth to Net Time Time Water Drop Io° I'.~ ~l ~ IO° ~1~ 15 ~ PERCOLATION RATE ~ -~ (minutes/inch} PERC HOLE DIAMETER ~ :/ TEST RUN BETWEEN ~ FT AND ~ ?~-- FT 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~--~ LEGAL DESCRIPTION: LO"~-- 2 3 4 5 $ 7 8 10 11 12 14 17 2O COMMENTS (ENGINEER'S SEALJ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE / 7 (minutes/inch) PERC HOLE DIAMETER TEST RUN B TWEEN '~ FT AND ~ ~//Z--'FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: GREA ER ANCHORAGE AREA BORUUGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS ~k'~iq -l~(5~..~J L PHONE,~'~¢~--~/"~oO'''~.' LEGAL OESC RIPTION ~C~ ~Z~ (~ (~L~l~.~., SEPTIC TANK: DISTANCE (~,~ FROM W ELL "-~ ~v'f~'-- INSIDE LENGTH MANUFACTURER ~'~-j~ "~/~ ' MATE R I AL INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY__ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL~-~ FOUNDATION I, TOTAL LENGTH NEAREST LOT LINE OF LINES NUMBER OF LINES ~ DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF~H LINE ~ ~ ,.~./ DEPTH OF FILTER * L/"" DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH T!.~-E ~ I~'. ABOVE TILE IN. WELL: · TYPE ~--~:~"~',~'t~J..'~.. (~ CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION__ LOT LINE , SEWER LINE CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH SEPTIC SEEPAGE , TANK__ SYSTEMI DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAl-: LOT SLOPE: ~-- REMARKS: Form LQ-032 DEPRRTMENT OF HERLTH RND EN',,,'IRONHENTRL. PROTECTION 25'10 E. TUDOR RD.., RNCHORRGE., BK. 99507 276-222i RF'PL I CRNT LOCRT I ON LEGRL BOB LUTJE GREEN TREE CIF.:CLE L9 B4 ',/RLLI VUE '-- ' ' '-' ' ''] IS T~'F'E OF' _,OIL RBz, ORB'IILN SYSTEM : MF:t::.4IFIUM NUHE:ER OF BEDROOMS = 4 SRR BU.,-, _~t1.. LOT SIZE TRENCH SOIL RRTING ~t~0~ SQIJRRE FEET ,=,Q FT,."BR) = J..70 '['HE REQUIRED SIZE OF THE SOIL HB_.ORFIlON ='-r_TEM IS: [:.EF'TF~= :I.~L LEr-~G'FH= ¢;-]9 ,3F:R%-"EL [:.EPTH=: THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD. ]'HE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET:). THERE IS NO SET HID'TH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN THE OUTFRLL PIPE RND TNE BOTTOM OF THE EXCRVRTION (IN FEET). F"R~Z:~{RGE F"LI~-~T REQI_II F~E[:, Ell'HER R CLRSS I OR II NSF RPPROVED PLRNT MR¥ BE INSTRLLED. R CONTINUOUS MRINTENRNCE RGREEMENT IS REQUIRE~. IF R MRINTENRNCE RGREEMENT IS NOT KEPT CURRENT YOU MR9 BE REQUIRED TO ENLRRGE THE SOIL RBSORPTION SYSTEM RND?OR 90U MR9 BE SUBJECT TO PROSECUTION. IF R CL.R__ I S"r'STEM IS USED THE LENGTH IS 49. 0 FEEl". IF R CLRS':-'; It S'¢STEM I"'] USED THE LENG'rH I"--; E,3:. 0 FEET. E, Hbk. FILLINt~ OF RNV _Y_TErl WITHOUT FINRL INSPECTION RND RF'F'RO',/RL B'¢ THIS [:,EF'RRTMENT WILL BE ..4.1BJECT TO PROSECLITION. · q- _. ,"',c ", IS MINIMLIM DI_IRNUE BETWEEN R HELL RND RN~r' ON-SITE SEHRGE DISPOSRL .=,¢.=,TEfl ±00 FEET FOR R PRIVRTE WELL OR 200 FEET FOR R FUBLI~ HELL SF'ECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROF'ER I Nc, TRLLRT I I CER'FIF9 THRT 1: IRM FRMILIBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORI'H BY THE MUNICIPALITY OF ~NCHOR~GE. 2: I HILL INST~L.I_ THE SgSTEM IN ~CCORD~NCE HITH THE CODES. ~: I UNDERSTAND THaT THE ON-SITE SE~ER SYSTEM M~Y REQUIRE ENLARGEMENT IF TWE RESIDENCE~EFE~pELE~TO/tl~CLUDE MORE TH~N 4 BEDROOMS. IS_qUED B'~-~-O~--c~r'~i-~-~.~ ..... ['RTE ................. Lot 9, Blk 4 D~epth in Feet From To 0.0 1.0 1 .0 6.0 6.0 15.5 TABLE A WO# 17667 SOIL DESCRIPTION Peat, Pt, with wood and roots. F-4, tan Sandy Silt (ML), with trace gravel, few cobbles, wet, soft. F-4, tan to olive G__raVellz ~and~ Silt, (ML to SM), occasional cobbles, damp, stiff to hard.· Bottom of Test Hole: Frost Line: Free Water Level: SA. De_mtn 1 5.0 10.0 3 15.0 15.5 ft. None observed None observed Type of Dry M% S__ample ~trength unified -- G '-- ML -- G -- ML/SM -- G -- .ML/SM ReI~arks: 1) 2) 3) 4) 6) Type of Sample, G=Grab, SP=Standard Penetration Dr~ Strength: N=None, L=Low, M=Medium, H=High Group refers to similar material this study only. General information, see Sheet 1 Frost & Textural Classification, see Sheet 2 unified Classification, see Sheet 3 4040 "B" STREET, ANCHORAGE, ALAS'KA 99503 PHONE: 907-279-2581 May 17, 1976 W.O. 17667 Grid 2538 Timberline Homes SRA Box 31-L Anchorage, AK Attention: Mr. Bob Lutje Subject: Subsurface Investigation Valli-Vue Estates - Lots 9 and 27~ Dlk 4 Dear Mr. Lutje: Transmitted herein in accordance with your instructions are the results of the above referenced investigation as performed by us on May 11 and 12, 1976. The scope of this project is investigation for suitability of on-site sewerage systems. Included ~n this transmittal are: Vicinity Map Test Hole Location Sketch Test Hole Log Explanatory Information Figure 1 Figure 2 Table A Sheets 1-3 The exploration was conducted using a Nodwell mounted Mobile Drill model B-50 drill rig with a continuous flight solid stem auger. The rig is owned and operated by Denali Drilling Inc. Drilling was supervised, the test holes logged, and the percolation test run by Mr. R. Mark Hansen, engineer with Alaska Testlab. The test holes were placed at the~app~oximate locations shown 'on Figure 2. Logs of these test holes are included as Table A of this report. In interpreting the logs it would be helpful to utilize-the explanatory information contained in sheets 1 to 3 of this report. When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the free water level. For the percolation test, the test hole was filled with water Timberline Homes May 17, 1976 Page 2 and left overnight to saturate. On returning, refilled with water and the drop in the water monitored over the next 60 minutes. the hole was level carefully This procedure is not a standardized percolation test, however, wE understand that the Anchorage Department of Environmental Quality prefers tests performed in this manner to evaluate a site for a proposed on-site sewerage system. Using the above test, the observed minim~u percolation rate for Lot 9 was 10 min. per inch, and for Lot 27 it was 12 min. per inch. No water table was observed during drilling, but it should be noted that the free water level normally fluctuates seasonally and with precipitation. We hope'this report meets your present needs. If we can be of further service, please feel free to contact us. Very truly yours, Approved: ALASKA TE S T LA B R. Mark ~ansen ~4elvln R. Nichols, -CE Laboratory Supervisor ~H:~n Attachments MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage.'Alaska 99519-6650 ,, ~43~47 ~4~ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~/.~ - ',,5 NJ - ~,~ 1. GENERAL INFORMATION Complete legal description Location lsite address or directions) Property owner Mailing address Lending agency · Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup, 2. NUMBER OF BEDROOMS: z~. 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: lng to the legality and status of system. If community well system, provide written confirmation from State ADEC attest- TYPE OF WASTEWATER DISPOSAL: Individ~'al omsite Holding tank Community on-site ~ Public sewer .NOTE: If community wastewater system, provide.written confirmation from State ADEC attesting to the legality and status of system. ' - ti 72-025(Rev, I/91) Front MOA~21 , 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 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. NameofFirm '-~-ob[3¢~ ~:-:-~uv~V._~,~J ';;~- Phone ~?q-"&¢l/ l~ Address re.¢ % ~ /~,L.¢~ h' ¢d_¢ ~ Eng, neeCs signature .-~' ,L~.~_~'~ Date DHHS SIGNATURE Approved for Disapproved. ~ Conditional approval for I~ Additional Comments bedrooms. bedrooms, with the following stipulations: l~Z./~.¢~,O /¢,., ~.Scleop., 7'0 ,PEPLn(.E: Date ~.~ '-/J ?¢ : :~he Mur~i~ipality of A~chorage Department of Health and Human Services (DHHS) issues Health Authority i:t.!i~,'[~p, rovaI,C'brtificat6'~'based only upon the representations given in Paragraph 5 above, by an independent !': ~r~'e~eional en~)'in~er registered in the state 0f 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 analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work 72-025(Rev, I/91) BSCk MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type ~%,~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot AT INSPECTION MUNICl PALl I Y OF ANCHOk~.~I:: ENVIRONMENTAL SERVICES DIVISION 'g"P:~: 0 ,~ 1994 RECEIVED ; On adjacent lots ; On adjacent lots Public sewer main Sewer service line Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B, SEPTIC/HOLDING TANK DATA Date installed /q~ ~ . Cleanouts (Y/N) High water alarm (Y/N) Date of pumping ~.,?~.~ '~.~ ~_ ~ I .... ¢J~., Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage Tank size 12..3'D ~,e.~_v:% Compartments Foundation cleanout (Y/N) ~' Depression (Y/N) Alarm tested (Y/N) Foundation Water main/service line On adjacent lots Absorption field I'-q 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/:4 ~/' /~.-~ Soil rating (GPD/FF) / '7~') System type Length '~ ~') Width .:, ~ Gravel thickness f~ ~ Total depth / / Total absorption area .~ ¢~-0 Cleanout present (Y/N) "? Depression over field (Y/N) Date of adequacy test ¢'/// '~,'/ Results(pass/fail) '~"? for ~/ Water level in absorption field before test /o'~ ?*e/o,~ ./-ot, o{', ~; F~ After test ~.~ ~1 Peroxide treatment (past 12 months) (Y/N) I%I If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots ~ Surface water Curtain drain On adjacent lots h///,,_ Property line To existing or abandoned system on lot Cutbank ~'~l//'~ Water main/service line Driveway, parking/vehicle storage area ';, ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA gu/defines in effect On the date df this inspection. Signature )' ,*.4,~/¢-/~¢~'~''1/¢ Engineer's Name t ¢1o~¢, I -,~¢<~,~ d,,~ ~--- ~:" :':'~¢; ' HAA Fee $ ~,~o ~ ~ Date of Payment ~_~-~2. ~ -¢ ¢ Receipt Number ,,2.~' ~.~ 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number