Press Alt + R to read the document text or Alt + P to download or print.

No preview available

The URL can be used to link to this page

Home My WebLink AboutMICHAELS RIDGE LT 2Mich I' Rid Lot 2 #017-113-16 - - Municipality of Anchorage Page '~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL'SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 843-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .~'t,~/0 ~ ~7~~' PID Number: ~ ~- I I~ - ~ "'~': ~ ;~ ~1~. ~ ~h~ Wastewater System: ~New D Upgrade ~'": ~ I~ ~'~ ABSORPTION FIELD ~ DeepT~ench ~ Shallow Trench ~Bed ~ Mound ~ Other SEPARATION DISTANCES ~s,~ti~ ~ Holding ~ S.T.E.P. Su,aCewater ~[O ~lO ¢1/O LIFT STATION Foundation ~ [ m ~ Remarks: BENCH MARK I Al~umed ENGINEER'S SEAL Inspections performed by; ~ ~ Dates: ,st * '~ -"~ "/ Department of Health and Human Se~ices approval ,. :~,~ :: ....... \ \. \ \ JlOBSEN SPURKLAND P.E. 203 PI 15TH. AVENUE ANCH. Al(. 99501 (907) ~79-39;6 PERMIt # SV000275 \ \ \ \g \ \ \ \ I I % M1CtlI~Z'S RIDGI:/ S/D LOT 2 SEC 32, TI2N RJW MICHELSOHN AND DAUGHTER \ \ . I "' \ \'.'.'.'.'.'.'....~-"~ i ? ~ ';~.'.'.'.',;~'?.%'.'.'.'.'.'.'.1 ~ ======================= \ ' ' \'' '1 \ -V-- PID # 017-I1~-13 I IO0. O0 FI' _. / -,- , --,--, O~rf: ocr. It, £ooo I SHEED 2/3 GRID: 3137 I I HICHRII£,DWG ~ 4-INCH INSULATION. 18 FT ~IRCO~PR[$SOR 103~ ~ u~rs ~ .,I I I ~ ~cnwrro swoar Rr~ ~ m t 49th I~ ~ ~ ~.v~..,--,...~= I. PRIMARY TREATMENT, SEPNC TANK eee.~S%~4 J. C~RIFICATION TANK ~m~*~*~ 4. DISCHARGE TANK 5. SOIL ABSORPTION [OBBEN SPUR~ND P.L ~0~ 2 ~[ICtlEL'S RIDGE S/fl sEPnc SYSTEW SCHEMATIC 203 P/151h Ave GOLDEN VIEP/ DRIVE DATE: OC~. II, 2000 Anchoroae Ak 99501 279-.~6 WICHELSOHN AND DAUGHTER SHEET: 3/~ GRID: ~137 PERMIT ~ SWOOO~75 PID ~ 017-I12-I3 MICHR[P.~DVG v v .v_ ":'- F~orn : ALPINE [~qILL 907 345 0202 ... ,.: .-, .':-~ Oct. 10. k:'~)O 04:15 ~ PO1 Municipality of Anchorage Department of Health and Human Services 825 'L' Street ' Rick Mysrrom P.O. Box 190650 Anchorage, Alaska 9{]519-6050 Meyer h~t p:#www.cl.e richer age ek tls t' 750 W Dimond Blvd. Anchorage, Ak 99515 Borchole Data: Depth (fl) Permit Number: #SW p00275 Date of issue: ?2.00 Parcel Identification Number: 017-112.13 ' Date Started: I0-5-00 Date Completed: 10-6-00 Is well I~atc,'l at approv~J permit location? []' Yes [] No Legal Description: ~fichaels R~ Prnp~rty Owner Name & Addr~s: Michelsohn & Daughter Const. Inc. Soil T~,pe. 31ficknms & Water Strata From To stick-up 0 2 silt fill 2 4 organics 4 6 silt 6 10 gravelly sill 10 42 cobbly gravelly sill 42 61 sandy silty gra vel 61 76 water sand & gravel 76 81 RECEIVED' OCT 12. 2000 D MunicipaJity Of Anchoreto ept. Health & Human 5orr/cee Method of Drilling [] ah' rotary Casing type: .s, teel Wall Thickness: ,025 inches Diameter: _6 inches Depth: _8/feet Liner Type: Diameter: ~. inches Depth: Casing sfickup above ground: ~ feet [] cable tool f~ Static water level (from ground level): 3/feet Pumping level: 81 feet after _2 hours pumping $0 + gpm Recovery Rate: .3,0 ? gpm Method of Testing: ,airlift Well Intake Opening Type: [~ Open End [] Open Hole [] Screened Start. feet Stopped [] I'erforations Start ~. fcct Stopped feet Grout Type: tlend.qni, te tl 8_ Volume: L~ Depth: Start_O feet Stopped_+ feet Pump: Intake Depth feet Pump siz~ lip Brand Name Well Disinfected Upon Completion? [] Yes [] No Method ofDislafccfiun: .Clorlne Tablets Com m Cn ts: Well Driller: Alpine Ddlling & Enterprises P 0 Box 110496 Anchorage AK 99511 , ,.. · ,. · _ p operty · .; :'.'[~,. "-, : ,'* c.DevelopmentSe~ces Depanment~...." .... · .~2~,; ' '.', ~Y// ...... ~ ,.. , Building Safe~ O vision.-,; .,: .... , .. - .~ ~ ' ,~'. - . : '* ' ~ On-S~teWaterandWastewater Pr~ram~'. / :.,.,' ,"<. ,, ,.: ~.,:;~,::~q.~ . . .., , - . .4700Sou* ra ,wSt.. . *, .... .. . :', , .: : ' ', ~ .*:.' .,", P.O. Box1966~'~chorage,:~;99~19-6650~,...*',:. ~, ...:: ..... ~.' ,"; , :; .:";' ".: ; · , * .,, ",'",,. · ~can~orageakus" ~- ,,..~ . , ,.;:.*.,r,. ,, -.,... .'~. '"'"' '" ": ' ON;~ITE sEWE~ELE'SUBMI~AE,~OM~ENT~SHEE~-:..:' -., '" ' To; TOBBEN : .....:~' "' ' '" ' ,'SPURK~ND .... ..:.~, .,., .... . .. , .,.,...: , .. .. . .... al description: LeI2 'MICHEL'SRIDGE ,, -,.:.,, ... " : L-., ' ' -": ~ lhe a~a~hed pape~ork has been reviewed and Is ~elng returned for the following reasons: : U ';T d ph'" ' .... ' ate ..... .: opog a ~cmfo~at~onmlssmgorinadequ ., ~.- ' . .. ,, - · .-- .. . · . ..... . : . ~..: ..... L ,., : ' .' -~ - ; . .... ~ In~mplete; lng MAINTENANCE ~GREEME~ FOR BIOCYCLE~ · ' .... . . miss .. ~ Additional adequacy test i~formation needed.,-, , ~- . }~...'"'~ . .. : '... '~ . ~',.. ~ Water sample unaccep~bl~. :' ~, ':' - '~ ",: ~ ' ~ :, Measured d]~t~n&s to~ew0rsMe,s,, ~fida~fi' dmin~'o~ ~trea~ within ~O ~2 0f ~y~tem missifi~. ~ Replacementdtsposal~tenot,hownand/ortested/ ,.'~ ~: . . [orations ol ~ll ~ods. porcolat~on and water momtong~ tests not ~hown .: ~roPo,ed ~Y~tem too deep ~ors6i~'~h~ati;~'~b~liiee ':';' ' ; :;..'~ ~'" - ' Well lo~ required. -. ' ~ · · Discre~an~ in number o[ bedrooms: ' :~ ': ' {: ' '/ ~ Other. "-", ': ~'.. " : Name of~eviewer: ' · . .... - ,~ . . .: -D~to:.: "' ' - ..... · ~looso supply tho nocosso~ tn~°r~ot{on'{n~ m-submtt ~our LEAVE THIS FORM A TTACHE~)';TO iTHE PAPERWORK. MUNICIPALITY OF ANCHORAGE Department of Heaith and Human Services On-Site Services Program 825 L Street. Room 502 P.O. Box 196650. Anchorage. AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Aug 02, 2000 Expiration Date: Aug 02, 2001 Permit Number: SW000275 Parcel I~: 01,7-112-13 Legal Description: T12N R3W SEC 34 NE4NE4SE4SE4 PTN PARCEL 4 Design Engineer. 0007 Tobben Spurkland, PE Site Address: Owner Name: Michelsohn & Daughter Construction, In Lot Size: 138750 SQ. FT. Owner Addrass: 750 W. Dimond Blvd. Total Bedrooms: 5 Anchorage, AK 99515- Permit Bedrooms: 5 This permit is for the construction of: [] Disposal Field [] Septic Tank [] 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. T.SPURKLAND P.E. 203 WEST Ifil'Il. AVENUE SUITE 203 ANCIIORAGE, ALASKA 99501 (90'0 279-3916 Fax (90-0-276-6013 Michelsohn & Daughter 750 W. Dimond Blvd. Suite 100 Anchorage, Alaska 9951 $ April 19, 2000 Subject: Soil Identification NE4,NF.4,NE4,SE4, SEC ~TI2N, R3W Dear Mr. Michelsohn Per your verbal request I witnessed the excavation of several holes on this property on April 17, 2000 The purpose of the testholes was to identify the sub surface soil conditions and evaluate the possibility to install a waste water disposal system on the lot. A track mounted backhoe was utilized to dig the testholes, which was located with your concurrence. Several of the testholas revealed soil conditions that were not suitable for standard septic systems. Groundwater was observed at less than four feet below ground surface, and very dense silty soil with very Iow percolation rates were found. At the locations indicated on the attached siteplan we observed the soil conditions shown on the aRached" SOIL LOG" I believe that these conditions can be found along the narrow ridge than runs in a southeast direction on the south poRion of the lot. I have located these tastholes with a rag tape and the locations are therefore somewhat inaccurate, but my measurements are close enough to determine that the locations are indeed on this lot. My recommendation is to install BioCycle systems on the two proposed lot. The cost of these systems are somewhat more than a standard septic system, but the operational benefits outweigh this additional cost. Yours 203 W ISth. Avenue, Suite 203 ANCtlORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 2 MICHELS RIDGE S/D MICHELSOHN AND DAUGIITER Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 July 25, 2000 We are submitting an application for the installation of a well and waste water disposal system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet I/3), the proposed improvements of the lot, of which only the well and waste disposal systems are subject to this permit application, (sheet 2/3), and a schematic of the waste disposal system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Ground Water or Impervious Layer to 12 ~ Percolation Rate < I rain/inch Sand Filter Required Use BioCycle Soil Application Rate 4 gal / sq ft No. of Bedrooms 5 Required Area per Bedroom: 150/4 = 37.5 sq.ft. Total area required: 37.5 x 5 ~ 187.5 sqft Use 10x20 bed Area 200 sq ft SYSTEM CONFIGURATION BIOCYCLE 1000 GAL SEPTIC TANK STANDARD BED TOTAL LENOTII 20 FT TOTAL WIDTtl 10 leT TOTAL DEPTtl 6 FT FILTER SAND 2 FT ROCK DEPTII 0.5 FT COVER 3 FT The installation of this well and waste water disposal system system will not prevent development of the adjacent lots. There are no developed or natural surface / sub surface drainage coorses 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 runoffwill not result from this installation. -1- LOT 4 im~m SP~R~ND P.E. 20~ ~ ~sm, ~VENUE ANCH. AK. 9950! PERMIt # SVDOYYY MI¢tlI:;L'$ R/I)OE S/I) LOT S££ $2, T~2N MICHELSOHN AND DAUGHTER P1D # YY SEPTIC SYSTE~ DESIGN DA TE: JUL Y 27, 2000 SHEET: I/$ GRID: 3137 HICHRI£I. DWG I \ t \ I \ I \ \ ~\ k \ \ \ \ \ \ \ \ \ I \ \ \ \ \ \ I I t I I I \ \ JloBEeiV SPURKLAND P.E. j j 203 W 15rH. AVENUE ,~NCH. AK. 99501 PE£MIr # SWOOYYY .,IIICtlI:,'L'$ RIDG'I:; aid LOI' Z \CC 32, rl2N MICHELSOHN AND DAUOHrER PID# YY SEPTIC SYSTEt, t DES/ON DARE: JULY 27, 2000 SHEEr: 2/3 GRID: 3137 MICHRIZ£.DWG ~ 4-INCH INSULATION 0 5 lO FT ~,~o.P~rSxo~ / 00000000( ,DO0000 v .. .. .... ~< ~.~ ............ ~,~ BIOCYCLE 6000 ~.....~ ................ ~.,....~ ~ ~ *e;~.: ..... .....'~4 I. PRIMARY TREATMENT, SEPTIC rANK ~ ~ ....... ~,~ ~* 2. AERATION TANK 'ii2~SS~i~~ J. C~RIFICATION TANK ~ 4. DISCHARGE TANK & SOIL ABSORPTION fOBBEN SPURK~ND 20~ Wlflth Ave LOT 2 JflCIIEL'S R/DOE S/fl SEPTIC SYSTEM SCHEMATIC Anchoraqe Ak 99501 GOLDEN VIEW DRIVE DATE: JULY 27, 2000 279-3916 WICHELSOHN AND DAUGHTER SHEET: 3/~ GRID: 3137 PERMIT ~ SWOOOXXX Plfl Munl '.~1: allty o! Anchorage DEPARTMENT O; '~EALTH & HUMAN SERVICES 825 "L" Street. Am:horage. Alaska 99502-0650 SOILS LOG - PERCOLATION TEST (ENGINEER'S SEAL) PERPORMED FOR: 2 3 4- 5- 6- 7 8 9 10 ti 12 13- 14- 15 16 17 19 20. SLOPE SITE PLAN DISCLAIMK~. Past and WAS GROUND WATER ENCOUNTEREO? PERCOLATION RATE ~ I Im,nule~mch) PEAL HOLE OIAMETER __ T~ST RUN SETWEEN /'/~ ,TA.D /0 FT ~nitndwatp~ rnndtttnn~ indicated aPR far thc dates ~hown only. future presence &nd/or depth of groundwater can not be predicted trom these oo,~T~,.,,~vactons. PERFORMED BY: - I o ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ' ACGOROANCEWITHALLSTATEANDMUNICIPALG!.,I;.F..LINESINEFFEC?O, THISDA'~E. OATE; ~-- 12~8 (Rev. 4185) Munl'.~Fallty of Anchorage DEPARTMENT O~ ~EALTH & HUMAN SERVICES 825 "L" Street, Af.:horage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST St. OPE SITE PLAN 4 7- 9- I"te I-,._ 10 WAS OROUNO WATER ENCOUNTERED? Y ,, 12 14- 15- 16- 17- 1~. 19 20 PERCOLATION RATE "~ I {m,nuleShf*~Ch) PERC HOLE DIAMETER __ Tt.$T RUN BETWEEN ~ FT AND ~ FT DISCLAIMER' ~rn,,n~w~ c~n~t~nn~ ~n~c~t~ ~ for the dates shown only. Past and future presence ~nd/or depth of gro[ndwa[er can not be predicted trom :nese oDse~a~,ons. W PERFORMED BY: . ---- I ~ . -- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOflDANCGWITHALLSTATGANOMUNIC~PA~Gtd[ELINESINEFFECTONIHISOA~. DATE: ~'~ ~ --~ PERFORMED FOR: LECAL DESCRIPTION: ~, ..='~.-~.-~'."f~ Y Y ~' '~; / ~, ~.' DEPARTMENT OF ~EALTH & HU~~,~ /~1~ ": ~'~ ~: ~ :t ' 825 "L" Street Ai,chorage. Alaska~65~ ,~'~ ,', g" ";~ "' .: - ...... :.. "' '~; g~g~S5~c-- / '~;"; "-"""" Township, Range. Section: ELOPE SITE PLAN 3 5 6 7 8 10 11 12 13- 14 15 16 17- 18 19 20. DISCLAIt4FR ' Arn.ndwnt~r Past and future presence trom these oDser~.~.lons. PERFORMED BY: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ' MonitorirLg? Cross Net Depth to Nit Date Time Time Wmte¢ Drop PERCOLATION RATE ~ ) immuleumch) PERC HOLE OIAMETER .~ TEST RUN eETWEEN ~ FTAND ~ FT condtt(nns indicated atp for the dates and/or depth of groundwater can not be shown only. predict=d T~' '~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUll ELINEE IN EFFECT ON THIS DATE. DATE: ~._....~<. [ 4~ 4~<..~ 72-008 {Re~. 4/8S) Municipality of Anchorage On -Site Water and Wastewater Program (907) 343=7904 s x F E T Y Certificate of On -Site Systems Approval Parcel I.D. 017-113-16 Expiration Date: 20,?o 1. GENERAL INFORMATION: Complete legal description MICHAELS RIDGE; LOT 2 Location (site address) 14830 Golden View Drive *Anchorage Current Property owner(s) Lawrence Stinson Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ q 1 Z 5 O (cov ( h ` Waiver Fee $ Date of Payment 7 r 2- 0 Receipt Number . Fj ► ► 3 E6 COSA # 61 S C `� 013 50 Date of Payment Receipt Number Waiver # rayti 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: a _ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and a000000 industry practices. The reported results describe the condition of the system/s on the date/s of the o F " evaluation. Separation distances were measured to readily identifiable features. Hidden defects or o encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions,co j groundwater levels (that may fluctuate during the year), quality of construction (materials and c✓1 .. TH �* workmanship), and the water usage of the family utilizing the systemis. These conditions can vary, and �' are outside the control of GEG. Satisfactory test results do not guarantee future performance of the G� system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of ........ f A. . s.. the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in OQ'1�' CE -7953• the future. The content of this report is for the sole benefit of the person/party that retained GEG to VQ s Pr �� ZcQG perform the evaluation. Reliance upon the information provided in this report by any other person or a o� o party (including subsequent property purchasers) is not authorized, nor will it confer any legal right �0rofessto^oo whatsoever. 44�0�0 #AECC884 6. DSD SIGNATURE System #1 Approved for 5 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the foll WITY or `<<«ttccrrrrr�� g ON-SITE J,�j o WATERAND m gtip st6y ,,gTE R AA. CI SERVIG��,�� ill)J)1))1 Original Certificate Date: 1__� 1_7 0 zo The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Othera/Kic A � zp 10 COSA Checklist Legal Description: MICHAELS RIDGE; LOT 2 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled ") 6/00 Total depth 81 ft Cased to 81 ft ❑ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7114120 Static water level at beginning of test 23.9 ft. Comments Parcel ID: 017-113-16 Structure served by this system 1 t�) -� Well production at time of test 7.3+ gom Water storage tank volume N/Ai7E gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑Coliform bacteria is Negative Nitrate 0.743 mg/L ❑ Nitrate less than MRL (ND Arsenic ug/L ® Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 7114120 B. TANK DATA Age of tank(s) 20 years Tank type/material SEVLG' Measured operating fluid level in septic tank 51" 0 Standpipes/foundation cleanout per record drawing Date of pumping 10/3/19 D. ABSORPTION FIELD DATA BED C. LIFT STATION ❑ Required maintenance completed Age of lift station 20 years Lift station material EERCLVS Comments: BIOCYCLE SEE ATTACHED MAINTENANCE LOGS Which system tested (date installed) 2000 Adequacy test date 2/4120 Al ALL standpipes present per record drawing Results QPass For 5 bedrooms Total measured depth from grade 3.58 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade ft (min) Water added 891 gal ❑ N/A —pressurized field 5 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 135 depth into effective Elapsed time min ❑ Code -required soil cover over field Final fluid depth 0 in ❑System presoaked Absorption rate 750+ god (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons if yes, enter date N/A Comments/Deficiencies: SEE ATTACHED EMAIL FROM OWNER REGARDING FREEZING COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q Yes if No Community Sewer Manhole/Cleanout > 100' M Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft PrivateSewer/Septic Line > 25' P71 Yes if No ft Absorption Field on Lot > 100' [Q Yes if No ft Holding Tank > 100' [D Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Fv� Yes if No ft Cj Yes if No ft ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' Z Yes Manure/Animal Excreta Storage > 100' ft Community Sewer Main > 75' Q Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Building Foundations > 10' ❑ Yes if Nod -4' ft Surface Water > 100' QQ Yes if No ft Property Line > 5' R71 Yes if No ft Wells on Adjacent Lots: Water Service Line > 10' Absorption Field > 5' Q Yes if No ft Private Wells > 100' M Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' Z Yes if'No ft if septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALLATION G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 www.muni.org/onsite Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 201350 Subdivision: Michaels Ridge Lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 20 years old. Typical replacement costs range from $8,000 to $11,000 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 20 year old steel tank MAY look like. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org MUNICIPALITY OF kNCRORAGE ADVANCED NNIAS'1'1,'N�'A'I'ER'rll,A'I'NII.'N'I'SYSI'F"NI MAINTEINANCE AND REPAIR AGREENMENt' TI IIS MAINTI-'NANCE AND RLPAIR AGREENIENT, herein the -AGREFAIE-NI•" made and entered into as ol'this Day of,, LV_ of 20v—. by and between Charies H Holden, JR herein the -OWNER," and the Municipality of Anchorage, herein the 'AMUNICIPALITY", in accordance with Anchorage INlunicipal Code (ANIC) 15.65.365. In consideration of the mutual covenants contained herein. the parties to this agree ree as 6611o\vs: C7 - Advanced Wastewater Treatment Systems. The Municipality grants permission to the Z" 0\vner to utilize and operate an Advanced Wastewater Treatment System (AWWTS). described as 14830 Golden View Dr, Anchorage, AK 99516 located at (legal description) z:I Bi0ext 2. 'Maintenance. Repairs and Alterations. (Owner is reqUired to read, understand and initial each section) Throughout the term of this Agreement. the Owner shall enter into a service toreement xvith an ANNWrs service and maintenance provider approved by the k1unicipality or the manufacturer's representative, The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated Septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the O\vner dllrillO the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). 0\\,Ilel- a-rees that 0111N, ilia intenance and repair personnel approved by the N'lunicipality Or the 111,1111117aCtUrer's representative \vill inspect and make any necessary maintenance, repairs or permitted alterations to the system. 0�vner acknowledges that regular maintenance of in AWWTS reduces the potential failure Ol'the SVSteill, Which could include se\vi,,e backup and costly repairs or drainfield replacement. (rev. 05,'18/2018) Page I of 3 _W- Omwr acknowIed-es that the NfimicipaIity may rcgtIest records of III aintenance all of repairs from the mantiracturcr`s representative or maintenance provider. CIA .. Ocaner acknowledges that the fisc for failing to a maintain in(] Gta repair an AWWTS rnay be assessed in aecordautce with ANTIC; 14,60.030. Owner agrees to grant the "Municipality reasonable access to test and inspect the AWWTS, The Municipality will give at least 24-11our notice. Owner agrees that any sale or transfer of° title ofthe property will not occur without a nein Certificate ofOn-Site Systems Approval. ;. Owner agrccs that the AWWTS installation and maintenance requirements as provided by the AWWTS vendorl`installer and approved by the NILIIIicipality are the governing guidelines for the eorrsu•trction, maintenance and repair ofthe Owner's AWW"i'S. Owner agrees to maintain remote monitoring ofthe AWWTS as required by the AWWTS approval. 3. Term. ']'he term or this Agreement shall begin on the date oratpproval by the Municipality to operatte the installed system, or upon transfer of title, and shall continue whole the .A%VWTS is operational or until title is transferred. 4. Nonwaiver. The failure ofthe Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity ofthe Agreement orally part hereof, or the right ofthe Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Iviunicipality. Any attempt to amend this agreement by either an unautltorired representative or unauthorized means shall be void. G. .Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws ofthe State ofAlaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions orthis Agreement decreed invalid by a court ofcompetent jurisdiction shalt not invalidate the remaining provisitans ofthe Agreement. {rev. 05/15!2018} Page 2 of 3 (sigliaturc) Dalc: _'2 a �)_, t J c ) STATI.' �}, � cc coup C' = ��•� i h ) ss. =f=1-tit�i� �tt7t'7tt'i-r�l-�l;i�f'f�tt`•1' ) rtr The ti�rcgoing insinstrument was acknow led�;c�l hclorc me this (Illy(Illyof -•l L i�-` 20 *70, by u-nd a CaY- NOTARY PUBLIC`�.��,\��\Q!�µE�qO+��''% My Commission expires; 3—Iq ^ AL{ x STATE OF :TENNESSEE t NOTARY _= PUBLIC ��iBY\\\`��ryb�a MUNICIPALITY: �ri��ss/ 111011110% ,9 By: hate: 7 0 (signature) (print na►ttc) Title: (rcv. 05/18/20 18) Page 3 or p§, " , 3705 Arctic Blvd 1-#313 Anchorage AK 99503 Email: crbioak@gmail.com (907) 274-0314 Homeowner Info Customer Name: Lawrence and Elizabeth Stinson Tank#: 89 Install Date: Aug. 2000 Address: 14830 Goldenview Area: Rabbit Creek-Goldenview Initial Inspection: Alarms Tested: Air P1 High Water 0 Battery Tested: Yes ❑ No ❑ N/A VI (Please make sure alarm is on "normal", not "mute") Does system have a septic tank ? No ❑ Yes 0 (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes Repaired ❑ Yes Repaired ❑ Strong ❑ Mild Z None ❑ System Inspection Inlet plumbing in working order? Solids pillow normal? Yes Replaced ❑ Yes Requires Pumping ❑ Aeration Chamber } _ rat iol Are all aerators functioning? Any buildup of solids? Yes FV1 Replaced ❑ Yes ❑ No FVJ 2- ....!,.-.,_�r>K.v_r „a:;... ,,...,..wz,$a, u ,�..:-.W.rxtU,.,u✓�'�::�.ads,:�r�.,,.�T.,:��.a.�.��..a,_1s�. G. .cts��-k'>...a"r�.�a,.�u.�r x.,..,�a^. y..c....f . .,r,� �,.� w�ns....a.,�:r�.... �..i.... Clarification return system operating? Any buildup of solids? Yes C✓] Adjusted ❑ Yes ❑ No V1 pH Reading: Dissolved Oxygen PPM Turbidity of discharge (in FTU) (pH of 6-8 is ideal) (2-5 is ideal) (Under 35 FTU is considered compliant.) 7.2 3.7 5.32 t{ k. �' ' < i r�.- `a.,S 7^l�-�z f. "`x` -'`'"� * 't"�""` �.� .J �r tike � � n'�� y �{'x5#� �a"-"--3'': e 4,� „� 'v,�.,«:''��*^i .c°""",Z "r'4 ay .3s �.' •`"'tib .r'��' g 3 �E�# 6�� x+ 'L. � ..�ry`t�f §i a$ e'+,1 i l r� � • .yam Pump float operating? Alarm float functioning? Any buildup of solids? Yes [1 Replaced ❑ Yes 171 Replaced ❑ Yes ❑ No C✓] Filter cleaned? Discharge line condition: Yes [71 N/A ❑ Good IZI Replaced ❑ Comments: .r Has emailing or mailing of form been requested? Inspected By: Chris Date: 05/12/20 (contact office to request...) Yes ❑ No C1) =v > -+�m rl DmS .. mcnM oo� u 1 0 u' � o m x 0 m0 r ;u O �m0 C7 0 m X m m or b Z 1: I r j a PARK, HILL 5UBD. � rt00°01'1TIE 180.03 10' Telecomm. & Elec. Easement I I I -t o i3 -� to C-) } OI S.� I OC) m I -' CD N m �I CD Z Co rnl cCO n I C w CD 31.0 M deck 12.0 p3 'c 0 -n N 13.0 CD ,7;;`.;'•` z=`'•ii: o 25.0 •�:i' T y 12.0- 42.2 10.0o co m O p t m m m > m O rn aa� O u:Amcr o— a) a�c�i -gym N _ Q =0 O �'((77 a O� fD O O N0 fMD �] m � � � r rJ N A O •Q .A J G O m O 0 O W s r y O O 3? 0 c a. iQ f�D O NQ V I0 MCC3 GOn -- c� mm C�i w ?3 " m m< Ga m O m -n a �x 'CUSoallCOD �w O w cu m m m o to CD t�aE3w y c3 W m CD Z e, rm a o m a fo wCD c7 CDA Q < v •O (n O O on In �j O y O �_ O N C7 0 `� o `� n rp S N m m C-) a �� > Ej- -I m _ D - m m CD w � Q to rp S. 7 NORTH 179.97 W o On cn C) O O GOLDEN VIEW DRIVE 84581 z co cn N U1 Cq w rn N w r - O Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 017- l/3-/ ~ I-P HA # Expiration Date: ~' '- 1, GENERAL INFORMATION Complete legal description 'LOW Location (site address or directions) Current Property owner(s) J,t g.,l~ Mailing address Day phone Lending agency Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. I'"' NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class .__ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [~ Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State cf Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) 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(are) In compliance with all applicabIe Municipal and State codes, ordinances, and regulations in effect at the time of installation. Address ..~P...O'~ ~/5 ~ H Engineefs P~nted Name ~ P ~ ~ 5. DSD SIGNATURE J,/' Approved for I~ Disapproved, Conditional approval for Phone Date ~-E.NGINEEB.:S.','-? .. ' ¢, :.'. ~ -",' "':-' ~ j · bedrooms. bedrooms, with the [ollowing stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www,ci.anchorage, ak.us ~07) HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: Lo'~ ~.- ~'¢[~ /'rS f A. WELL DATA '*' Wall type ~, Date completed '%/oo Total depth B I It. I/3 -/~ Parcel IO:~:)l 7 -~ Wall Log (Y/N) ~ W~res properly protected (Y/N) ~'/ Casing height (above ground) ~.t~ In. Date of test Static water level Well production FROM WELL LOG It. g.p.m. ATINSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform ._.~_~coloniesil00 mi, Data of sampta: "lfSIo, Nitrate ~ mgJL Collected by: Other bacteria ~ colonies/100 mi. B. SEPTIC/HOLDING TANK DATA TankTypeJMatertal Ak£Lt ' I~-~t k Tank size J~..~ gal. Number of Compartments Foundation cteanout (Y/N) ~ Date of pumping J~.~' ~'1~'~1~ C. ABSORPTION FIELD DATA Depression ove~ tank (Y/N) h?/ Pumper ~ o u.~ ~' Date installed ~ Cleanoute (Y/N) y High water alarm (Y/N) t S tem t e_ Gravel below pipe ~). __~ ff. Date installed ~'-,~,~-OO Soil rating (g.p.d./it~ or ~Fodrm) ~ Length I~ [~) fl. WM~ I D fl. To~Idepth ~ff. Eff. abs~n~O~ M~.oringtube~ Depmssion over field ~ Fluid dep~ in abso~fi~ field ~m t~t ~ ~. Wa~r edd~ / g~. N~ dep~/~n. E~ps~ Time: /~n. F~al fl~d dep~ ~ ~. ~so~t~ ra~ >= ~ g.p.d. ~y mjuvena~on ~a~t (past 12 mo.) (Y~ & ~e) / E y~, g~e date / D. uFr STATION . Data installed ~,~/c~ 'Pump on" level at _,~:~ in. Datum E. BEPARATION DISTANCES size in ga,ons //- 'Pump off' level at ~_~n. Cycles tested ManhotaiAccess High water alarm level at ~ in. Meets alarm & drcutt requirements? Septic tankJtiff station on lot Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL ON LOT TO: J L1/' ~.O~ On adjacent lots I ~'~ C) On adjacent lots //~ Public sewer manhole/ctaanout Sewer/septic service line [ ~ Q Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation Water main I~/,~ Water sen~ce line Wells on adjacent lots Building foundation '~ I {~ Water main SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / ~ Water Service line ~ 5 C~ Curtain drain H I C~ SurPace water ~'4.[ ~:) Driveway, parking/verade ~t~rage ~ Wells on adjacent lots ~ I O'C) F. COMMENTS G. ENGINEER'S CERTIFICATION .' : ~'." "--. '~? ':. ' ~n~anm ~ MOA ~ g~ellnes ~ e~e~ ~ m~s d~e. r, , , ............ Date ~ .:: · ..... . .. H**Fee $ 5aA Data of Payment Receipt Number (Rev. ~ 2,~0) Waiver Fee $ Date of Payment Receipt Number Nov-21-01 01:26P Bonnle Plehne~ & Associate (907)762-]aB8 , Municipality of Anchorage D~elapme"t Ssr~kff D~p*rtment (gO?) 343.~ PROPERTY OWNER AGRY~L~LII:,~FT FOR THE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This afreemcnt, dated October3I; 2 0,0i~ made betwec- ~e Municipality of'^nchoraie Development $crvice$~eepe/tment (DSD) and the prol~ny ov.'net(s) of: HJ. chae].'s P.J. dge Lot 2 eke 3.4830 Go].denv.i. ew Dr.i. ve Thi~ ag'recmcnt is made lot the purpose ofmzintalalag aa on.site wutewater d!sposal system on thc subject propc~'y, The propert~ owner~ aires fo the feilowb~g: Submit to the Municipality of Ax~chomge, on ~ ~ual b~is, ~ ln~pect[o~ ~d opc~tion s:stement from a re,island profeMlon~l ~8inc~. ~s inspcctmn ~d o~at on statement sha:l vcri~ that ~c engineer hu ins~ ~1 affiant ~d ~ p~p~, timers, ~d a~a~s, and that any ~cficic~ica hiv~~ ~d ~t ~e fy,tern b ~ct~o~n8 U de~i~ed. (Pdn~d N~e) (Printed Na~e) The Foreio~ IM~'ument was acknowledged before mc by ~~ ~, ~ onthls~yof 20 . Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St, ' P.O, Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ~/7-//~ - ~ 1 ~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Current Property owner(s)'""~¢.~ ~/ Mailing address : '7~0 Lending agency Expiration Date: .'7 - .J ,/- O [ Day phone ~-~,~ 7~ Day phone Mailing address Real Estate Agent Mailing Address Un/ess otherwise requested, HAA will be he/d by DSD for pickup. 2. NUMBER OF BEDROOMS: ~ Day phone, 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except beb,veen spouses) for propedies served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with ne,,,/water sample results less than 30 days eld. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality cf Anchorage is ncr responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investiga[ion, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and fype 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm - I~-~'' ~u~-J4.1~..~ '~..u~_. Address Engineer's Printed Name 5. DSD SIGNATURE J~. Approved for Disapproved. bedrooms. Conditional approval for Phone ~7"J- '5~'-/(:, . Date bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 12~C) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 99519-6650 w~v.ci.anchorage.ak.us (9O7) 343-79O4 Legal Description: A. WELL DATA Well type ~ Date completed Total depth Data of test Static water level Well production HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C provide PWSID # Sanitary seal (Y/N) Cased ) fl. FROM WELL LOG .2,1 ~ O g.p.m. · Well Log (Y/N) ~'/ Wires properly protected (Y/N) ,y' casing height (above ground) ,,~/-/ in. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform ._~colonies/100 mL Data of sample~ : ~- ~-~) / Nit~te t~.~;:~ mg./~. Collected by: Other bacteria ~ [:) colonies/100 mi. Be SEPTIC/HOLDING TANK DATA TankType/Material ~ 4~I~/I"~ ~ Tanksize f~.~ gal. NumberofCompartmants_4~_. Foundation cteanout (Y/N) ~ Depression over tank (Y/N) Date of puml~il~ "~/~- / Pumpa' Data installed ¢~ -,2~ -~-~ Cleanouts (Y/N) "// High water alarm (Y/N) ABSORPTION FIELD DATA Date installed g' Total depth Z~. ,'- Date of adequacy test fl. ~ I O fl. G~el bel~ pipe ~, ~ fl. Eft. ~so~fi~ ~ea ~ .~ M~g tube ~ Depression over field ~ Resul~ (Pas~Fail) ~/~ -- For ~ b~ms Fluid depth in absorption field before test /"//in Water added ~'"/gal. New depth /,~in. Elabsed Time: J min. Final fluid dep~ ~in. //.~bsorption rata >= Jg.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date SEPARATION DISTANCES FROM WELL ON LOT TO: Septic .,nldtilt station on lot Absorption field on lot ! Public sewer main Sewer/septic service line Manhole/Access ~/N) High water alarm level at Meets alarm & circuit requirements? y On adjacent lots On adjacent lots Public sewer manhole/cteanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation C~ . Property line ~,1 ~. Absorption field "1 CD Water main t4,,/~z~ Water sewice line '~ ~ Surface water Wells on adjacent lots · / ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line. Water Service line Curtain drain Building foundation Surface water Wells on adjacent lots main Driveway, pa~dng/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify thaf I have determined through field inspections and review of Municipal records that the above systems are/n conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name De., I fl - Waiver Fee $ Date of Payment Receipt Number