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Home My WebLink AboutSKYWAY PARK ESTATES BLK 3 LT 5 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: ~ ~k.)q z~O~.~' PID Number: 0/¢l'~ / ~/-~ "~": ~o~ ~, [PI Wastewate, System: D New ~ Upgrade Address: ~.~_~ ~/it T~ , ~","~ )~1 ~,'¢J: ~ ?¢~ABSORPTION FIELD Phone: ~/~--¢0~ I~°'°'"~d'°°m~:~ ~ Deep Trench ~ShallowTre~ch ~Bed ~Mou.d ~Other LEGAL DESCRIPTION SoilRating: 0, 6 GPD/Sq. Ft. Total Depth from original grade: ~,~ Lot: 3epth to pipe bottom from origins fade: Gravel depth beneath pipe ~. ~o~k: ~ S~b~iv~io~: . Township: ~ Range: Section: Fill added above original grade: ~ Gravel length: / Number of lines: Distance betwe ~ lines' WELL: D New D Upgrad er~velwidth: ~ ~t. ~ ~ Yt'. Classification (~rivate, &,B,C): Total Dept~ Cased TO: Total absorption area: Pipe~ateriah ~Driller:~ * ~ , SlaticWaterLevel: Installer: Date installed: ~EPARATION DISTANCES ~Septic ~ Holding D S.T.E.P. Me, lecture: ¢~ ~ /~ Capacity in gallons: I'~ TO Septic Absorption Lift Ho~ding Public/Privet( ~ ~ From Tank Field 81alion Tank Sewer Li~es ~ ¢ ¢ ~ Material: ~'~e / NumberofCompadments: ~ Well- ' -- Sudace Water ~00'~ (~+ 1 LIFT STATION Lot I;0' Cu~ai~Drain .~ ~/~, ~. ~ ~ ~ / ~[ I Electrical Inspections peflormed by: RF: O.F BENCH Assumed Elevation: ENG~AL , S & S ~NGINEE~'NG 17034 Eagle River Loop Road, NO, 204 ~W-~ ~'~ Inspections pedormed by~. ,~ ~,,~.. ~k,~ 9~5'~ Dates: 1st ~- ~- q~ ~;~'~,..,,,,.~,~ Department of Health and Human Se~ices approval ~,, z~'-,~,.~ Reviewed and approved b ~ ~ Date: ~' / ~ - ? ~ ! *~_"~,~.~h%,~" 72~013 (Rev. 9/91 ) MOA ?.5 PERMIT NO SW990226 PAGE 2 OF 3 Municip. cti-t: oF .A.n_c h.o ~ c 9.e' DEPARTMENT OF HEA(TH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 eAnchor(ige, AL(lsk(l 99519-6650 ® Telephome: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 5, SKYWAY PARK ESTATES P.I.D. NO. 019--141--25 NOTE: ~. PERFORATED PBLY HOSE INSTALLED 6" ABDVE THE BDTTE]M THE TRENEN IN THE SE~/ER ROCK FOR FUTURE AIR SPURG[NG IF NECESSARY. TI-Ii:ii · FS FLO~/ SPLITTER TH~B · C[]8 m MT2 x co~ MT1 CO 01 ~, 1250 GALLON SEPTIC TANK (INTEGRITY VERIFIE]]) DIVERTER VALVE & DBL 2 (DUI L EXISTING FC[] BEDROOM HOUSE GRAVEL DRIVE 100' ~/ELL RADIUS SCALE: 1 "=40' RUN) i LOT EASEMENT 8 I~OBERT C, COWAN CE - B801 PERMIT NO SW990226 PAGE 3 OF' 3 Municip, aEit oF ~nchoraee DEPARTMENT OF HEA{.THAND HUN[AN SERVICES ENVIRONIVlE!NTAL SERVICES DIVISION P,E], Box 196650 OAncho~age, A~aska 99519-66500TeLephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 3, SKYWAY PARK ESTATES P.LD. NO. 019--141--25 MT2 98.5' ~- ~__FINAL_ GRADE EXISTING ~ 1250 GAL 9 SEPTIC 94.0' TANK CO1 C02 MTgm n nMT1 [CO1 = 94.5' II H II/- C°2: 95.9, III "~t-g4Gm = 92.2', IC02 = 92.2 ~g.O'~' '~T~ - SS O' '~.$' WATER FOUND ~.0' B.o.~. A B FCO 34.0' 39.5' ST1 31.0' 45.5' ST2 32.0' 51.0' DEL1 32.5' 53,0' DEL2 33.0' 54.0r- FS -79,0' 88.5~- C01 98,0' 64.0' MT1 96.5' 65,5' C02 89.5' 130.0~ MT2 90,0' 128.0' OV 33.5' 54.5~- .Z g2/-,5/.-':2-~./! C 5 4- 5- 6- 7- 8- 9- 13- 14- 15- 16- 17- 18~ 19- 20- · .............. Municipality o! Anchorage ~~hrt DEPARTMENT OF HEALTH & HUMAN SERVICES ," * 825 "L".Street, Anchorage, Alaska 99502-0650 SOILS LOG --, PERCOLATION TEST ~ .~ ~oa~ c. COWA~ />"; ~_ [ ~C~-7~ DATE PERFORMED; "'~'~'~n'/''~' 7' ' - Township, Range, Section: ~_ SLOPE SITE PLAN S WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT /~.~ / DEPTH? Be,th to Waler Alter /~, Monitor(]1§? (]ale: Gross Net Depth to Net Reading Date Time Time Water Drop COMMENTS PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) PERCOLATION RATE '~) (rnmutes/~nch) PERC HOLE DIAMETER S & S ENGINEERIN~ 17034 Eagle River Loop Road No, 2~ E~glo ~tvoT, Alaska 99577 _I~L("',d-/(.,~.,-~-~ I ~l ~ / ~. CERTIFY THAT THIS TEST WAS PERFORMED IN PE.EDRMED POR: C.~p. ¢~-' ¢'-( ( ~ Ce-fL- 7 8 9 10 12 13 14 15 16 17 18 19- 20- (ENGI~.ELEAL) Municipality of Anchorage ,~"/ ~ '~ '" .... - ' DEPARTMENT OF HEALTH & HUMAN SERVICES r~-~ ~ ,~"- ~' ,~,,~-7 ,,,,., 825 "L" Street, Anchorage, Alaska 99502-0650 ,, ........................ , ~ ROBERT C. COWAN ~,., · CE ,; 0801~ ... ~.¥ . ,.!,:-,'!> Township, Range, Section: ~"'~'y[/t,I ,/lcv';~'~'~k~.~,4 SLOPE SITE PLAN DEPTH? pO E geplh to Waler After / ,....- Monitoring? Dole: Gross Net Depth to Net Reading Date Time Time Water Drop ~ o ~-~o r"l Fq ~ ~/4-" ~ " PERCOLATION RATE ~-'~. ',~*,~ (rn,nutes/mch} PERC HOL~ DIAMETER S & S ENGINEERIN~ 17034 Eagle River Loop Road No 72-008 (Rev. 4;85) MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box '~96650, Anchorage, AK 995'19-6650 (907) 343-4744 ON-SITE WAS'rEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 28, 1999 Expiration Date: Jul 27, 2000 Permit Number: 8W990226 Legal Description: SKYWAY PARK ESTATES BLK 3 LT 5 Design Engineer: 0003 S & S Fngineering Owner Name: Joe Miller Owner Address: 2550 Denali Towers, Suite 1401 ANCHORAGE , AK 99503-0000 Parcel ID: 019-141-25 Site Address: 011900 TOY DR Lot Size: 82612 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 'This permit is for the construction of: [] Disposal Field [] Septic'rank ~ 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 By: ' - '"'"'~ Date: Date: ENGINEERINGSTUDIE$ AND REPORT8 WELL INSPECTION & FLOWTEST PERCOLATION TEST ROBERT C. COWAN, P.E. July 23, 1999 CIVIL ENGINEERS (907) 694-2079 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, Al<. 99519 REFERENCE: Lot 5, Block 3, Skyway Park Estates S/D Request yon issue a permit to install a septic system to serve the existing fonr bedroom dwelling on the referenced property. One test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation, 11.-23-92, no water was found. After seven days of ground water monitoring, water was not found. On 6-12-94, water was fonnd at 11.5 feet. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional infmTnation, please contact us. Sincerely, RCC/bjj Enclosure 17084 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RIVER, ALASKA 99577 m ~ ~ I ~1 I 0 oo ~ C J ----~ o ~ ~ ~ ~0' UTiLiTY E~SENE~T ~ ~ II ~ ~ ~ ~ m m -- ~ I1~I1~ I I <~ ~ [ ~1 I ~' ~ ~ ~1 ~0 __.~ o~ TOY D:RIVE "~' "~ ~' I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: g~.(iC ~ //~O ~C~ ~-J LEGAL DESCR,PTION:Z--OT ~ ~ ~....K'~/ .~/~//~ownship, Range, Section: sFp SLOPE 1 2 3~ 4- 5- 6- 7 ~2 13 ~4 ~7 2O SITE PLAN WAS GROUND WATER ENCOUNTERED? IL JO IF YES, AT WHAT ~ O DEPTH? p Baplh t(] Water ADer¢. Gross Net Depth to Net Reading Date Time Time Water Drop :qo lO 5V~" i~/~,, :~ /o ~ '/q" ~'/z " / :0,% /o %V¢' I Yz" :)~ /o %Yq" I'A" _ PERCOLATION RATE '~' (m~nutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~FTAND ~ ET COMMENTS PERFORMED BY: $ & S ENGINEERING i ~ ACCORDANCE WITI~:~¢:~E;~¢:~I~td~¢~;~LO~?UlI~)OE~-I~NE:~ IN EFFECT ON 'DHIS DATE. 72-008 (Rev, 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN BAT E: \~'~ ~;~..~ ~C~ ~ ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 5, Block 3, Skyway Park Estates July 23, 1999 GENERAL: The scope of this project includes the verification of the 1250 gallon septic tank and leachfield trench for the existing four bedroom house located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underbn'ound utility locates. Unless specifically a~,n'eed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts fbr pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page 2 Lot 5, Block 3, Skyway Pm:k Estates July 23, 1999 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 fr. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt battier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tribe extending through the gravel shall be perforated fi'om the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 5, Block 3, Skyway Park Estates July 23, 1999 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: T~vpe of Pipe_ Perforated ,Solid Cast h'on Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A pem~eable nontoxic silt ban'ier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gn'adation specifications must confotrn to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 5, Block 3, Skyway Park Estates July 23, 1999 The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before tbe placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of constraction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons perfo~rning work on this project or the failure of the comractor to can'y out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/iNSTALLER Municipality of Anchorage Page i _of. z DEPARTMENT OF HEALTH AN[) HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Wel~ Inspection Report Permit Number: ,5'~1~'102,°~' PID Number: KJIC/I~'12~5- -- ~u~ ~. ~ Zo~/ ~ ~so~ Wastewater System: ~New D Upgrade Address: ABSORPTION FIELD - ~C~' ~ q~/6-I ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other_ LEGAL DESCRIPTION s°" Rating: ~ '~ GPD/Sq.,~., Total Depth from? ,original grade: ~ot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range', Section: Fill added above original grade: Gravel length: ' .~ --7 Ft, ~ Ft, WELL: ~ New ~ Upgrade Gravelwidth; ~ Ft. Numberer lines:/ O]stancebeiweenlines:~/,~ F~ Classification (Private, A,B,C); Total Depth: Cased To: Total absorption area: Pipe material: ~ ~/~ ~ Driller; Date Drilled: StaticWater Level: Instager: Date installed: Yield: ~',~ GPM Pump Set at: Ft. Casing HeigM Above/tGr0und:F~ TANK SEPARATION DISTANCES ~s,pt~c ~ Ho~d~n~ = S.T.~.,. Sudace Wator M/a ~/a M~T 8T~TIO~ Lot /~ , Size in gall°ns; I Manufacturer: ~ Line IQ lO +~ ~ __ / / "Pump on" level at: ~" level at: High water alarm Foundation Remarks: BENCH MARK ~8.SEAL Department of Heal ices approval ~,~"., .,,. . .. ..., '%~ ~ ~' Reviewed and approved by: ~~ Date: )]~, 72-013 (Rev. 9/91)MOA 25 Permit No.Sw940205 Page 2 of 2 Municipality 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 andk)r Well Inspection Report Legal Descri 94,~ N.T.S~ CO1; otio~:KYWAY PARK ESTATES; BLOCK 3, LOT 5 PIDNo.: 01914125 FINAL CO3& (CO3& C04) 89 6 ,~d85 5' WA?ER FOUND 6/12/94 A B 34.1 39,9 31.4 45.5 32,3 50.6 46,2. ..10,8,4 65.3 34.0 56,8 28.7 C02 CO3 co4 ._MT C01 C62 $CAL~ t' = 40' N ~ BDRM ...HdUSE ............................. ....... NEW.....[... t250 GAL :. C, COWAN CE - 8801 NEW C04 NEW 1250 GAL. iSEPTiC 72-013 A (1/93) ' PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940205 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:VERGASON BRUCE M & E LORI OWNER ADDRESS:il900 TOY DR ANCHORAGE, ALASKA 99515 DATE ISSUED: 6/27/94 EXPIRATION DATE: 6/27/95 PARCEL ID:01914125 LEGAL DESCRIPTION: SKYWAY PARK ESTATES BLK 3 LT 5 LOT SIZE: 82612 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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 (iSAACS0). 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 SYSTEMUNDER 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: RECEIVED BY: 2~'/. ROBERT SHAFER, P.E. ROGER SHAFER, P.E. June 11, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-'i211 HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD OESIGN SOILTEST STRUCTURAL& MECHANICAL INSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Skyway Park Estates Subdivision: Lot 5; Block 3 Request you re-issue Permit ~SW920405 to drill a well and install a septic syste~ to serve the protm~ed four bedroom hot~e on the referenced property and approve an owner installation of the septic system. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test hole was checked on June 12, 1994 and groundwater was found at 11.5'. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review~.~s~ contact us. inc ely,f / A~/LSU/j k ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 .0£ =.,I ON-SITE WASTEWAT~ DISPOSAL SYSTEM CX)NS~RU~ION PRACTICES and MAT~IAL SPECIFIC~%TI(ANS REf'ERENCE: Skyway Park Estates Subdivision: Lot 5; Block 3 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tank and a five foot wide drainfield to serve the proposed four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and 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 any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1o A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. Page ~;o Sk~ay Park Estates Subdivision; Lot 5; Block 3 June 11, 1994 A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRA/NFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed-up) before gravel (sewer rock) placement. 2o Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire grave]. surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM 1. MATERIAL SP~C]~ICATIONS: Any septic tank proposed for installation must be Municipally approved septic tank manufacturer. constructed by a Page Three Skyway Park Estates Subdivision~ Lot 5; Block 3 June ll, 1994 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: a Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM FSlO (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSP~C~£IONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. Page Four Skyway Park Estates Subdivision~ Lot 5; Block 3 June 11, 1994 3o The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit° There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Augusl; 2/1, ]99/I ~Jdlnes Czos$ P.F,. PEog~am Maltage~ Ou SJbe Services 825 "l," S1 . Suite, 502 AmTho~:~ge, AK 99501 Rog: Owne~ buil. de~ i~stal[ed sepLJc sysLems I ~ll~l lequesting you~ author~zaLion to owner install a septSc sysLem under Lhe supel?vision of S & S Enginee~Sng, Jn South /\lu'hoFage, The roi lowing is my pasL expei:Jence: ] 9~10 /32 Aapl-e Co., Jl~sLal laLJon of existing Equipmenh opeFato~ ~epaJr and sephic systems. Residential Owner bui Ider JnsLalled system, South Auchor,-~qe. 19~5 U6 Owner/operako[ (6~0 case) back hoe mesJdeuLJal excavabiol~ oct. I[' you have any quesLions, please :Eeo] Ih'ce Lo 248-5000 ext. 27. BO.S[. reg./ contact me ab Date Drilled: 4-19-94 Static Water Level .. 38~L.._ feet Draw Down N/A feet Bruce Vergason To~ Drive Gallons Per Minute ' 9 _~ lotal Feet of Casing' 51' ' _ Material Drilled: 0 feet to 1 ft. Overburden 1 ft, to 22 ft. Dirty Gravel 22 [~ ....... to 36 ft. Clay 36 ft. to 40 ft. sandy grave], 40 ft, tO 51 ft. ~_r.a~ve~_~ to to to HE~7 DRILLING 8540 AKULA DRIVE ANGtlORAG£, AK 99516 (907) 345-0593 RECEIVED OCT 2 4 19,94 Dept. I'/eal~ ~y °f ~nChora h & Human Se.!-.q.e Tom Fink, Mayor Municipality o3 Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 December 7, 1993 Bruce M. & Eo Lori Vergason 3341 Starboard Lane Anchorage, Alaska 99516 Subject: Lot 5 Block 3 Skyway Park Estates Subdivision Permit #SW920405, PID It019-141-25 The subject permit, issued December 7, ].992 by this office single family well and/or on-site wastewater system, has expired as of December 7, 1993. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well this office for documentation of the close the permit. log must be sent to installation and to If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, Sincerely,# / ~rogra~h Manager On-site Services please call this office at enc: Copy of Permit cc: S & S Engineering for a 343-4744. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920405 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:VERGASON BRUCE M & E LORI OWNER ADDRESS:3341 STARBOARD LANE ANCHORAGE, ALASKA 99516 DATE ISSUED:12/07/92 EXPIRATION DATE:12/07/93 PARCEL ID:01914125 LEGAL DESCRIPTION: SKYWAY PARK ESTATES BLK 5 3 LT LOT SIZE: 82612 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPOR~S WELL INSPECTION & FLOW TEST ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ROBERTSHAFER, PE ROGERSHAFER PE December 2, 1992 CIVIL ENGINEERS (9071694 2979 FAX 694 1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Skyway Park Subdivision, Block 3, Lot 5 We request you issue a septic system to serve referenced property. permit to drill a well and install a the proposed 4 bedroom house on the A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. This property has enough area for a septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincerely, Roger J. Shafer, P.E. RJS/JPW/lsu ON SITE WASTE WATER DISPOSAL SYSTEM OES~GN 17034 EAGLE R~VER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 L~ (3o -j <%. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'rEST PERFORMED FOR: LEGAL D ESCR I PTI O N: L.O--[_~_~ 4- 5- 6- 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- l/~--~.~'/~-~O ~ [)ATE PERFORMED: C-'-'-'-~K ~'~'.,~ownship, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 0epth I0 Water After~ Gross Net Depth to Net Reading Date Time Time Water Drop :~o /o ~/~" I%" PERCOLATION RATE ~- (minutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~,~ _ FT AND ~ FT COMMENTS PERFORMED BY: $ & $ ENGINEtiRING 11034 Ea~le RiYer ACCORDANCE 72-008 (Rev. 4/85) '~"~ CERTIFY '[HAT THIS TEST WAS PERFORMED IN IN EFFECT ON THIS DATE. DATE: 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FQR A SINGLE FAMILY DWELLING 019-141-25 HAA # GENERAL INFORMATION Complete legal description Lot !5, Block 3, Skyway Park Estates S/D Location (site address or directions) 11900 Toy Drive '' Anchoraqe, AK Property owne?°J~e Miller D~vnhone 244-8094 Anc56~age, Aq~'99503 · Mailing address % Pacific Tower Properties, 2550 Denali Towers, Suite 1401 Lending agency_Coun~_rywide/Jeanne Rogers Day phone 279-2405 Mailing address 3120 Denali, Suite 6, Anchorage, AK 99503 Agent. Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3, TYPE OF WATER SUPPLY: NOTE: 4 Individual well xxx Comrnunity well Public water 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: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) 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-~ite water supply and/or wastewater disposal system is in compliance with all Municipai and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 17034 Eagle River Loop Road No. 204 Address Engineer's signature Phone Date -~//6 /fl ~ DHHS SIGNATURE L~ Approved for /c"¢ 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 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. 1/91) Back MOA~'~I MuniciPality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES AUG u ~ 1099 Environmental Services Division MUNiCiPALiTY OF ANCHO 825 L Street, Room 502 · Anchorage, Alaska g9501 · (9~/]I~8~I~EJ~IJJERVICES Health AuthOrity Approval Checklist LegalDescription:l-07 ,5- Pj~-Oc~ ~ ~4y~4¥ /~4!,~/~ E, ~'. Parcell.I).: (]1 ~- )~1-~$- A. WELL DATA Well type Log present li~N Total depth If A, B, or C. attach ADEC letter. ADEC water systsm number Date completed 1.¢ /I ¢( / ~ */ Cased to ~' ~ Casing height (above ground) Sanitary seal ~N) ~' ~' J' Wires properly protected~Y)N) 'Y ~: J' Date of test Static water level We productien WATER SAMPLE RESULTS: FROM WELL LOG _ g.p.m. AT iNSPECTION g.p.m. Coliform O Nitrate Date of sample: _ B, SEPTIC/HOLDING TANK DATA Date installed Io/~! ~ ~ _Tank size Foundation cleanout Date of PUmping '7 / o~ ~ Pumper I 5/~ ~ c_ j- Collected by: . .. Other bacteria S & S ENGINEERING 170;~4 E=~cle-E-k~J~:~p~a(i No. Eagle Rlveh Alaska 99577 ] 3- S-o Number of Compartments "~ Cleanouts t~N) 7,¢-~£ Deoression (Y/,~ N C] _ High water alarm (Y/4~ ,'~ o C. ABSORPTION FIELD DATA Date in~talled ~'/"// Length_ ) 0',)- Width Effective absorption area t Date of adequacy test/,2/A - Soil rating ~or ft2/bdrm) O. 6 System type 'r,~,,, c~ Gravel thickness below p~pe ~- ~ Total deoth ~ Monitoring Tube present ~/N) Y~.( Depression over field (Y~ ~ 0 Results (Pass/Fail) _ =or ~ bedrooms Fluid depth in absorption field before test (in.); I_~ia't~y after gal. water added (in,): Fluid depth (ins) Minutes_lCerr Ab,mrption rate = g.p.d. Peroxide~~¢o l~months) (Y/N) If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cyc es test.~..~ Size in gallons E. SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / o Absorption field on lot ? o o Public sewer main /v /,4- Sewer/septic service line ~ .~ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ! 5- Property line ) ~.-o Absorption field Water main/service line )0 H-- Surface water/drainage j 0 0 4- Wells on adjacent lots J O ~l .4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ..~'c;) Building foundation G t Water main/service line Surface water / O 0 '¢- Driveway, parking/vehicle storage area Curtain drain P ~v£ /~ Ho w ~J Wells on adjacent lots ,f'O + HAA Fee $_ Date of Payment Receipt Number ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal record~s~~ms are in conformance with MOA HA.A gu_idelin~s in effect on this date, ' '" Signature ~ ~ ~ f~ Engineer's Name ~. Ce-~ Z ~, ~ o u~ ~.~. ~ Date ..... ~/6 /~ ~ , Waivar Faa ~)&---06'~ ¢9 Dateof Payment ~.~ ~ 7~ ~/) Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES~ Division of Environmental Services On-Site Services Section .. P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 , 01914125 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# ~-~ C} ~J~ 0 %~/~ Lot 5,= Block~.$?'~k~way' Par~'Estat6s Location (site address or directions) Toy Drive Anchorag6, AK Property owner Mailing address Lending agency Mailing address B~uc6 V~rgason 11900 Toy Drive Anchorage~ Day phone $45-5105 AK 99515 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: Individual well Community well Public water 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: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, I/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER: r~. 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 ail Municipal and State codes, ordinances, and regulationa in effect on the date of this inspection. Name of Firm S & S ENGINL~'~IHNG Phone DHHS SIGNATURE ~ Approved for ~ Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date // -/ 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 this as a courtesy to purchasers of homes and their lending institutions in order to satlsfycertaln 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 far errors or ornissions in the professional engineer's work, Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~LOc~3 ~'~'yl¢fi¢/o~,4~//Jl~arceli. D' Ol~JzC/"C..3'-- Legal Description: ).-o'r' ;~,, / A. Well Data Well type /o,,~ Log present (,~/N) Total depth Sanitary seal ON) ! Cased to If A, B, or C, attach ADEC letter. ADEC water system number Dateoompleted ~ /1~ /r4~/ Driller H'£FT"/ ~/ / . Casing height Wires properly protected (~t/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION 3~',$- / zoo ' d:~ g.p.m. ,.,C, ~ ~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/he~Cb~-tank on lot ) ~' ) / Absorption field on lot Public sewer main Sewer service line Z ; On adjacent lots ; On adjacent lots ! o (J Public sewer manhde/cleanout Petroleum tank N ,/~ /O O / '¢-- ~ WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/~TANK DATA Date installed I0 /~ /¢1 Cleanouts (~}N) High water alarm (Y~) Date of pumping ~ ~ ~ "1tank size 1 '.3- ..~-O¢'4'L'~ompartments Foundation cleanout ~N) .Depression (Y,~ Alarm tested (Y/N) T'~,,, ~ Pumper SEPARATION DISTANCES FROM SEPTIC/, ,..,,_D4NG TANK TO: Well(s) on lot On adjacent lots /0 0 To property line ) 0 Surface water/drainage Foundation Water main/service line /6 / 72-026 (3/93)* Front CONTINUED ON BACK PAGE C, LIFT S'rATION Date installed Manufacturer Size in gallons _ ~ (Y/N) __ Vent (Y/N) "Pump on" level at ./' "Pump off" Level at High water alarm level / Cycles tested __ Meets MOA electrical codes (Y/ / SEPARATION~ LIFT STATION TO: Well ono~~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed / ~¢ / ~ / q // Soil rating (GPD/Ft2) O, ~' System type Length ¢¢ '~ / Width "~ / '¢~ Gravel thickness ~., '¢- / Total depth Total absorption area '7 ~ (¢' ~r"LCleanout present Date of adequacy test ~'~ ~ ~' y,r~.-~,~ Results (pass/fail) "7. -~" /~'~- Depression over field (Y~ for Bedrooms Water level in absorption field before test Peroxide treatment (past 12 months) (Y/~t After test If yes, give date SFPARATION DISTANCE FROM ABSORP'rlON FIELD TO: Well on lot ! ')' ! To building foundation On adjacent lots ~- O 2./_ On adjacent lots ) o ~ Property line ;)' ~ / To existing or abandoned system on Pot "¢- Cutbank__ ,ID /,4 Water main/service line Surface water 1v lA Curtain drain Jv/ Driveway, parking/vehicle storage area ,~' / 7L E. ENGINI"ER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of thigr~i~spection. HAA Fee $ ,_.~O0. Date of Payment 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number ROBERT C, COWAN CE-8801