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RAVEN WOODS BLK 3 LT 1
Raven Woods Block 3 Lot 1 #015-232-04 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water System Permit Permit Number: OSP221279 Work Type: Well Upgrade Tax Code Number: 01523204000 Site Legal Address: RAVEN WOODS BLK 3 LT 1 G:2738 Site Mailing Address: 5900 TRAPPERS TRAIL RD, Anchorage Owner: BLISS STEVEN D & KRISTINA L Design Engineer: ANCHORAGE WELL & PUMP SERVICE This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: IVA C _ri C S' Depar tment 7/26/2022 7/26/2023 83200 ❑ Private Well Q Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: • Water tanks and installation are to meet all AMC 15.55 Water Storage Tank requirements. Received By: Issued By: Date: Date: _712 3 Development Services Department' Phone: 907-343-7904 On -Site Water & Wastewater Section t Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-232-04000 Property owner(s) BLISS STEVEN D & KRISTINA L Day phone 907-575-8077 Mailing address 5900 TRAPPERS TRAIL RD, ANCHORAGE, AK 99516 Site address 5900 TRAPPERS TRAIL RD, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) RAVEN WOODS, BLK 3 LT 1 Legal description (Township, Range & Section) Lot Size 83,200 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage M APPLICATION IS AN: Initial 0 Upgrade ❑ Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) 0 (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above i ation is correct. I further certify that this is in accordance with apocable Munici odes f (Signa ure of property owner or authorized agent) � � !-/� �J . ,,&A /.1 Permit/Rush Fees: A 1 ( o Waiver Fees: Date of Payment: -- n� Date of Payment: Receipt Number: U 5 al`1 Receipt Number: Permit No. 6 S 1PA a i Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\FormsUient FormsTermit Application.doc ANCHORAGE* WELL & PUMPS SERVICE - 7640 KING STREET ANCHORAGE, AK 99518 907-243-0740 J 0 8 - -5 TX -0 6 67 U -C 5 SHEET NO.. 7700 'MALOM,�C TIZA�IL — CALCULATED BY CHECKED BY OF - DATE_ 7/ 1 q T - DATE 11-0 = W=3% MM 91411. Tr .. ......... T t. ..... 4- _F -T Co 7A A— (fs, - fill IFT 11-0 = W=3% MM 91411. I- .. '' - . ri5 a,Ri'"'sa6'iiia f 19 Municipality of Anchorage, i On -Site Water and Wastewater Section • (907) 343-7904,1 ON-SITE DEC WASTEWATER INSPECTION REPORT Permit Number: OSP211349 PID Number: 015-232-04 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Steven Bliss ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5900 Trappers Trail Rd, Anchorage ❑ Other Phone Number of Bedrooms 907-575-8077 3 Soil Rating Total depth from original grade LEGAL DESCRIPTION GPD/SF Ft. Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Raven Woods 3 1 Ft. Ft. Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES To Septic Absorption Holding Sewer Lift Station Ft. Total absorption area Number of trenches Ft. Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ 25'+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator Capacity 1060 Gal. Surface water 100'+ Material Number of compartments Lot Line 51+ NA HDPE 2 Foundation 7,8'* LIFT STATION Manufacturer Capacity Remarks *Tank is not in the foundation soil Gal. bearing prism (see Record Drawing). Alarm location Electrical installed by Installer PIPE MATERIAL House to tank Tank to 3034 drainfield 3034 Isabelle Construction Drainfield CO/MT3034 Inspector Crewdson Engineering, LLC BENCH MARK (Assumed elevation) 100 ft Inspection vt 6-7-2022 2nd 6-8-2022 Location and description 3`" 6-9-2022 4'h Top of slab at "BM" on record drawing. ON-SITE WATER AND WASTEWATER SECTION APPROVAL � r OF A Conditional Approval: Date �°�!s' j 00, � I v �II Ja A. Crewdson,� � Septic System Approved Date 20 23 011527 .•�2�'W ow_ 1i'S'�c�' ...... • • �,'...,r Note: this l0\ pROFESSIONP-� approval does not include well permit requirements. Qo., nGinoia Q� r�rr.-�aa a� o� DWY a D SEPTIC T, \`. AORq/��7F % r <p �\ ecov- y i• IAW 5+\ C1* *OPPOSING CLEANOUTS (aka; DOUBLE CLEANOUTS) PLAN SCALE: 1"=20' 2ND STOIR, DECK o DECK SUPPORT (TYP) TREATMENT SYSTEM SWING TIES NOTES A B FC 2.0' 13.0' MH 12.0' 13.1'- C1 19.9' 20.6' C2 21.6' 27.3' M1 37.5' 42.7' TOP OF SLAB NOTES LEGEND ASSUMED ELEV 1. All components and construction completed IAW AMC (D) - decommissioned 100' ELEV 15.65, BioMicrobics, and Infiltrator requirements. (E) - existing EG 99.7' BL 2. (D) Septic Tank 2.1. Decommissioned in place by completely filling the BL - blower BR -BEDROOM FC FG 99.8' tank with concrete grout. C# - cleanout MH 3. Septic Tank with Septic Treatment System DC - double cleanout —7.8' 3.1. Infiltrator IM -1060 with BioMicrobics RetroFAST 0.375. DWY - driveway l Note: the 2nd tank chamber pumpout is inside the EG - existing ground IN OUT manhole riser per MOA approval. ELEV - elevation ST 3.2. The deck support that is less than five feet from the FG - finish grade new septic tank is founded on the fully concrete INV - invert grouted decommissioned septic tank, the bottom of M# - monitor tube which is deeper than the new septic tank. As such, the MH - 24"0 manhole SEPTIC TANK ELEV deck support load path does not impact the new septic RFB - RetroFAST blower TOT 95.7' tank. SFH - single family home INLET INV 95.1' ST - septic tank OUTLET INV 94.9' TOT - top of tank PROFILE SCALE: 1"=10' Box 671389 Chugiak AK 99567 . cellc.l @outic Celllrexl:907-280-9493 • Fax:907-688-2295 Raven Woods, Block 3, Lot 1 Septic System RECORD DRAWING Prepared for: Steven Bliss Date: 12-27-22 Permit: OSP211349 Page: 1 of 1 ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWDSON ENGINEERING. LLC AND SHALL NOT BE USED FOR ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING. LLC AM OF Ja . Crewdson c • C11527 ���TF9F�PROfESS10NP�'.� � ALLC #112279 Tract A i Lot 3 Lot 4 i � PLOT PLAN --- AS BUILT X_ SCALE 1" = 50 GRID SW 2738 Project No 21-496 �j 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & A s s o c i a t e s, inc. (907) 522-6476 Phone ken®langsurvey.com Professional Land Surveyors jonothan0langsurvey.com OF. �l trovis®longsurvey.com ,� �'� • ' ' ' /�(,q ' ' • is I hereby certify that I have surveyed the following described property: LOT 1, BLOCK 3, RAVEN WOODS SUBDIVISION (PLAT No. P-583) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the _ ZEA Day of _ �Icw�su.?��- w22 at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. KENNETH G. LANG ,• 00.5202 ' �k'®�OFESS IONN� �P�O State of Alaska AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211349 Work Type: SepticTank Upgrade Tax Code Number: 01523204000 Site Legal Address: RAVEN WOODS BLK 3 LT 1 G:2738 Site Mailing Address: 5900 TRAPPERS TRAIL RD, Anchorage Owner: BLISS STEVEN D & KRISTINA L Design Engineer: CREWDSON ENGINEERING, LLC This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: cnt , Departinent 9/29/2021 9/29/2022 83200 Disposal Field Q SepticTank Holding Tank Privy Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling ( 907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: (N t,D % coirro ( Date: (7Za 3 MUNICIPALITY OF ACH Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I. D. 015-232-04 Property owner(s) Steven Bliss Day phone 907-575-8077 Mailing address 5900 Trappers Trail Rd, Anchorage, AK 99516 Site address same Legal description (Sub'd., Block & Lot) Raven Woods, Block 3, Lot 1 Legal description (Township, Range & Section) Lot Size 83,200 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade Q Duplex (D) ElHolding Tank F-1Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 22 Date of Payment: g '�- 0 Receipt Number: 0 -3 `i 7 Permit No. 03PZ ( 13 9 Clk Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc James “Jay” Crewdson, P.E. Email: CELLC.1@outlook.com Cell/Text: (907) 280‐9493 Fax: (907) 688‐2295 PO Box 671389 ● 18368 Amonson Road ● Chugiak, Alaska 99567 September 8, 2021 Onsite Reviewer Municipality of Anchorage On‐site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99519‐6650 Reference: Raven Woods, Block 3, Lot 1 Septic Tank Upgrade Design Narrative Septic Tank Upgrade: The existing 35‐year‐old 1250‐gallon steel septic tank serving the subject property needs to be upgraded. Along with the septic tank upgrade, the owner also decided to install a BioMicrobics RetroFAST septic treatment system to heal and extend the life of the aging drainfield. The proposed design is detailed on the design drawing. The proposed septic tank upgrade, if constructed as designed; Will satisfy all code required separation distances, Will not cause any probable adverse impacts to adjacent properties, Will not negatively impact existing wells and septic systems on adjacent properties, Will not be adversely affected by potential drainage that could flow onto and off of the subject property. Please feel free to contact me if you have any questions. James “Jay” Crewdson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211349, Deb Wockenfuss, 09/29/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211349, Deb Wockenfuss, 09/29/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211349, Deb Wockenfuss, 09/29/21 TRAPPERS TRAIL ROAD \ ASPHA LTEME PAVEMENT 1i N 0'00'00"1� 241.40' Tract A SHOP CONCRETE GRAVEL .J SEPTIC PIPES PAVER BRICKS x 12.2' SHED Lot 3 6.1' a 16.1' \ X WOODSHED PORCH u.0+1 1 N 1�18 •I / I � i +/ � X12.0' K 12.2' GREENHOUSE WOOD & WIRE FENCE Lot 1 83,200 s.f. (MOA) Lot 4 0 PLOT PLAN AS BUILT X SCALE —!L= GRID --SW 2738 Project No. 21-496/A1 Lang & Associates,inc. (907) Daryl Avenue, Anchorage, Alaska99515-3049 (907) 522-6476 Phone Professional Land Surveyors ken*l592-46y5 Fax o p kenOlan curve com �F A,�,9pp4 jonothanOlangsurvey.com Z�1O A • ,.SLQn I hereby certify that I have surveyed the following described property:TH.�� LOT 1, BLOCK 3, RAVEN WOODS SUBDIVISION (Plat No. P-583) o 49— Anchorage Recording District, Alaska, and that the Improvements situated thereon are""""""" within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed (7o a ' KENNET.. G..L4N . premises and that there are no roadways, transmission lines or other visible ^� l easements on said property except as Indicated hereon. (< < O�� P LS -0Z y�oA6 Dated this the�1 Day of at Anchorage, Alaska 44p�ORCAFsaoNA&�o� It Is the responsibility of the owner to determine the existence of any easements, �40000c covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 M N Co a) N Lot 2 0 Tract A SHOP CONCRETE GRAVEL .J SEPTIC PIPES PAVER BRICKS x 12.2' SHED Lot 3 6.1' a 16.1' \ X WOODSHED PORCH u.0+1 1 N 1�18 •I / I � i +/ � X12.0' K 12.2' GREENHOUSE WOOD & WIRE FENCE Lot 1 83,200 s.f. (MOA) Lot 4 0 PLOT PLAN AS BUILT X SCALE —!L= GRID --SW 2738 Project No. 21-496/A1 Lang & Associates,inc. (907) Daryl Avenue, Anchorage, Alaska99515-3049 (907) 522-6476 Phone Professional Land Surveyors ken*l592-46y5 Fax o p kenOlan curve com �F A,�,9pp4 jonothanOlangsurvey.com Z�1O A • ,.SLQn I hereby certify that I have surveyed the following described property:TH.�� LOT 1, BLOCK 3, RAVEN WOODS SUBDIVISION (Plat No. P-583) o 49— Anchorage Recording District, Alaska, and that the Improvements situated thereon are""""""" within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed (7o a ' KENNET.. G..L4N . premises and that there are no roadways, transmission lines or other visible ^� l easements on said property except as Indicated hereon. (< < O�� P LS -0Z y�oA6 Dated this the�1 Day of at Anchorage, Alaska 44p�ORCAFsaoNA&�o� It Is the responsibility of the owner to determine the existence of any easements, �40000c covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE DII&TMENT OF HEALTH AND HUMAN SEF*ES Environmental Aealth Division r 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES FflOM TO SEPTIC TANK ABSORPTION WELL FIELD Address Phone(s). Permit No. No. pf Bedrooms fig 1 g(od CION WELL /, ° LOT LINE LEGAL DESCRIPTION Lot / Bloc Subdivision FOUNDATION • Iv J / �' ��o• Township, Range, Section AS-BUILT DIAGRAM d r i ay. water bodies, (Show location of well, septic system, property Imes, foundation, etcj ANKS SEPTIC ❑ HOLDING ±`�' " Lei Z Manufacturer •.�eP%@ # Capacity in gallons J-21*1 — — — — — — — i / Matenal. No. of CompartmA� O114.-S 2 4,4Z TYPE OF SYSTIf M ❑ TRENCH )?'*BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from onginal gratle FT Total depth from original grade FT / /r.. P Fill added above grigmat grade FT Gravel depth beneath pipe / FT Gravel length g/ FT Gravel width - FT Total absorption- area •�, SO FT Distance between lines / FT I ' (� (>' _-4 s 41, Is, it 6� r I �. _4 V-C- tisuaL LOA li-A MAI-fill Number of lines Soil rating SQ FT Pipe material dl N T �-�pVC Installer Bate-Installed. 21Aq 6a Lf Lin 1;5 164 4k&�2 WELLS PRIVATE ❑ OTHER (Identify) Classification tA,6,C). Total Depth ,Z3 V FT Cased to 2,3�Itpections Installer iziui�Pl, Date Installed: l0 glo REMARKS: -le: a • Pertor ed y: Date: g/ ! / O `���+► ^l t% O .AI I* /'`�' •,••-n��® Or ��49TH* /• •• , ss • • •• •. • • o • SCOT 7 S. KIBLER • A , S� CE - 7105 �a�,AV w,4ra '•.......... jg4i ,,\/d`� p^y►•� / Gaie7� /I bYIG UGY GTeLUCLitre certify that this inspection was performed according to all Municipal and Stale guidelines inLellact on Ihis daO+moi Health Department Approval: Datea`f/s%� 72-013 f3/85) 1-1 U m I c; A 1: 1-v F= dcw m c-- FR e=� C -:v OF- DEPARTMENT HEALTH AND ENVIRONMENTAJW-ZDTECTION ^ 82=�� STREET ANCHORAGE AK 9� 1 ^ . " ^- , , 9J0 264-4720 [ / C1 PA -- E3 I EK c_Ei E_-_ W FEE FR W FE I L_ F� EE FC M I -T- PERMIT NO: 860201 DATE ISSUED: 06/30/86 APPLICANT: KRISTEN M. KURTZ ADDRESS: 5900 TRAPPER'S TRAIL ANCHORAGE, AK 99516 CONTACT PHONE: 688-9313 LEGAL DESCRIP: OISI'Wir' RAVENWOMY'�*�� -GIECTION: 23 `TOWNSHfP: 12N RANGE:^ 3W LOT SIZE: 1.892A (GQ"FT" OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to system. Choose the option that best fits you in designing your septic Your site" - - - - - - - - - - - - - - - - - - - � AIL � �r 4 � «r^w' / \ ' all Nnt°~ +-2—+w~~6/0--41 -- - - - - - - - - ~ - - - - - ~ - - I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set ` forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2" I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of th�is permit" 3" T will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or, public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permitis valid for a maximum of 4 bedrooms and any enlargement will require an additional permit~ IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIRNEP rS,U7N APpLlCHNT: KR" KURT7 ISSUED BY u�. DATE: -�r-�^^-~--�----- DATE: 6 - so — aj�^ rig E_r 1.) DEPTH TO PIPE BOT TOM (FT") 4"0 GRAVEL DEPTH (FT") . 0^5 TOTAL DEPTH (Fr.) 4"5 GRAVEL WIDTH (FT") 20"0 GRAVEL LENGTH (FT") 38"0 GRAVEL VOLUME (CU"YDS") 28,2 TANK SIZE (GALS) 1,250.0 ** SOIL RATING (S(D"FT"/BR) ,~~�, 125 �'a'eva Azwrlwvej ** TANK MUST HAVE AT LEAST TWO COMPARTM you in designing your septic Your site" - - - - - - - - - - - - - - - - - - - � AIL � �r 4 � «r^w' / \ ' all Nnt°~ +-2—+w~~6/0--41 -- - - - - - - - - ~ - - - - - ~ - - I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set ` forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2" I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of th�is permit" 3" T will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or, public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permitis valid for a maximum of 4 bedrooms and any enlargement will require an additional permit~ IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIRNEP rS,U7N APpLlCHNT: KR" KURT7 ISSUED BY u�. DATE: -�r-�^^-~--�----- DATE: 6 - so — aj�^ ENGINEERING (T OGY 0 SOILS LOG Ow"A v'ting'and &rt*es, Arctic- ubarctic L/ P.O. Box 110186, Anchorage, Alaska 99511 PERCOLATION 1947) 349-4942 TEST SOILS LOG — PERCOLATION TEST �f FecProomS PERFORMED FOR: C ✓1_SAen /C cf!'�L DATE PERFORMED: _ A LEGAL DESCRIPTION: LoY / [5/n[_.0 jure UE �o�. a'/o 1? - ,f �n D L -MLT � o 10 //1/-GM2 • �.t .b G W - ■■■■■■■■1�■ 6n1 12 6 w 3 3 7 G .$' rave/ w So e 13 IL is13 ■■■ 151 ■■■■■■■■�■�]]■ G50>1 b o.° GrovE l / soave S• wey 1>o,••'O Tia c.e 6 • b�ia' oo� 8 Date - Gross Time �o�. a'/o ,a ,f �n 10 0`,�! 11 M�t�� G W - ■■■■■■■■1�■ 6n1 12 oe�=mac 13 IL is13 ■■■ 151 ■■■■■■■■�■�]]■ SLOPE /0.s' vcr>l WAS GROUND WATER t 516u ENCOUNTERED? .t!,:! 1 _see 1. 6IZ3IS6 11. O. IF VES, AT WHAT DEPTH? *-6/14)it, 0. 16 40'Qi s ;• 17 i* •�9Tw 18 /.•.• •n ....t,is 19SCOTT S. KIBLER 20 `et ••�• CE - 7105 C 14, 20 .O n -V PLAN ■■■■■■■■■■ Date - Gross Time Net Time ,a woman ��■Eel MENIMENN SRI! ■■■R■ ■►T�■■ s' ■■■■■■■■1�■ IL ■■■ ■■■■■■■■�■�]]■ 09 Reading Date - Gross Time Net Time Depth to Water Net Drop s' PERCOLATION RATE ''C V,s'—L"/ (minuteshnch) TEST RUN BETWEEN 4t. S FT AND aJ..u7_. FT NRIVWWIWI.1�1 CERTIFIED BY: 1 ENGINEERING GIOLOGY ';CO6�$Uting' and Services, Arctic -Subarctic P.O. Box 110186, Anchorage, Alaska 99511 a (907) 149-4942 49TH SCOTT S. KIBLER / Z./- 1 d)"dx 5.a CE -71655 L.. 'sk' �iwJn6r/�.S'�e %an - ;PliIiCSSIU ��� T/2 �F_ 1 .ec 1�/ `. _ s� ' m z 3 _S.Ir't r Ne, f h 6--TiaroPus ,Tia i/ �c( --�• ` weal ed;us o P• TPS fGepnsrise /,a •� s,�� rsq sq.sA / aLhzorv<// E s�/,<syrir J'0' Barrier Frer.+ n� Orwi na.9e R''� Sir.om I"fie 3'W; t Leca}ad In �L ai rie. E./e Mrn 1 '1 t.. Direc><iax Of A/frert. ,s/aPe 0 Foundation Investigations 0 Site Exploration a Inspections • Percolation Teets a Soil Reports • Drilling Supervision � • i i F - pri c� V / Y o: a N: -W r (n Q M �i a 4 m J: Q- w O O O F .<. O o, o o o O F' F a+i w• u .�. H �`6H FWIQ1 ltf W [sv -. N; Rt FAL-*OTEC`I03 o ° , •'.' EVI06ME1 w Ci 2 1987 A w cedUt� a `F 3 A t# a 94 w' 94 :4 O4 cG c4: OC PG'< a x `3 r V rA AjCd ,A i^p rn .0 N N H H i+ q O: A �6 X - y d }toW mt'o Aa+ W - .L bi.l a dd EI: 4+ -ro •o vq -a:e�Da[(tD M: Uq 0: , � OId y epi, '� md t ,OpNp : ca V V uj •'in M.4 �7 M. it O% N iJ - O O c0. EE GC 1, N b: �eP N M iry R O O •+ N N .-f .-Ip N Nf N N N M N q v O W •-r.) oD 'O W qi D O O O O Ni..._C4 pq- M: t 7t M m W N; N \Af N N• N M tnCli w N 4' O O O O O O O O Z p c7 44 a w w 4. a w x ce x x x w a� '" q a z w w w w w w m w 2 A pp w Ew d Ew d WWW N tw,t/� Municipality of Anchorage Development Services Department Building Safety Division , On -Site Water and Wastewater Program �m 4700 South Bragaw St. s A £ Y Y 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. O t,S - 2 3 2 - 0 y HAA # 14A 6 / ©iZ ::?- 2 Expiration Date: S - 2 ;z - 01 1. GENERAL INFORMATION Complete legal description Lot 2 f3/oe1c 3, Raven woody TYPE OF WASTEWATER DISPOSAL: Location (site address or directions) 5-9 0 a Tyr. h v or c Ti-ai I Individual On-site Current Property owner(s) Pa�1 R uo A on iem r' Day phone (6 r0) 2Zs �Y96 Mailing address F..0. fox t76yy Gr lv4, M- ❑ Lending agency Ct fy lYc r t4age Day phone 263 -0-/00 Mailing address t 21 w• Fi yew eecf l Gne J Anc%ararge f! -h 99503 Real Estate Agent lrlvr(ac SArrr hr Pruden %lu! ZA'/c Day phone 273 -7239 Mailing Address 'i211/ L?" sl. AAc4brczj2!e, Unless otherwise requested, HAA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: y 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well © Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 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 verify 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm F(�rt/r,4 Svc -r Phone 3yS-13 Address Al) c4U��Q2, 14-(' Engineer's Printed Name% hQacPom T )`rLcalfe Date Mw iS 2 00! 5. DSD SIGNATURE Approved for bedrooms. Disapproved. �iy�EfiIGINEER'S STAMP dao®oeeeaeseaeeeeaeawe•.. ,.. �� �a oenoee eeuesa•a.eae. e Y . e THECDCRE F. AACORE e ` CE - 3589 Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By:((J . Pte' Original Certificate Date: 2 d (Rev. 12/00) 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 (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: La f A. WELL DATA Well type lf i - Date completed 8/6/86 Total depth 23 Z ft. loo lc3 Rnries Wr C'cl� If A, B, or C provide PWSID # Sanitary seal (Y/N) __r Cased to 2 3 Z ft. FROM WELL LOG Date of test 8 /6 / c9er Static water level 2 /S ft. Well production 3. S _ g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate 0.955 mg./I. Date of sample: S/9 / 260 / Collected by: /or B. SEPTIC/HOLDING TANK DATA Parcel C7 /5`- 232 -ay Well Log (Y/N) r Wires properly protected (Y/N) 1' Casing height (above ground) 283 in. AT INSPECTION SI & / 2GG l g.p.m. Other bacteria 0_ colonies/100 ml. )ec6, 5ee,,'fP Tank Type/Material See f;c / Sf ee / Date installed S / /G 1,9 6' Tank size I ZSQ gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) P High water alarm (Y/N) N. ,f. Date of pumping 6 / lS/ GO Pumper C. ABSORPTION FIELD DATA Date installed 8/ l0/86 Soil rating (g.p.d./ft2 or ftzlbdrm) / Z,a C7;/6 -,,,',System type 5 ecx Length 319 ft. Width 12/ ft. Gravel below pipe 0.5— ft. Total depth 67_3 ft. Eff. absorption area -720 ftz Monitoring tube Y Depression over field Al Date of adequacy test 9'/6/?00/ Results(Pass/Fail) Parr For 9/ bedrooms Fluid depth in absorption field before test:L in. Water added B// gal. New depths in. Elapsed Time: 20 min. Final Fluid depth 3.6 in. Absorption rate >= X0 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) alone 6cn c c. If yes, give date -- D. LIFT STATION Floe l; Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump ofr level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 166 Absorption field on lot l 12 Public sewer main ti -A, Sewer /septic service line > 26' Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots > r a o ' On adjacent lots roa ' Public sewer manhole/cleanout N• A. Holding tank lam• A. SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 6 Property line Z5- ' Absorption field S Water main > 161, Water service line > ro' Surface water > 16o Wells on adjacent lots > 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > t o' Building foundation = 21' Water main > 1G ' Water Service line > I o ' Surface water > 1&0' Driveway, parking/vehicle storage /01 Curtain drain NcA@ Seel) Wells on adjacent lots > lcIr- F. COMMENTS ,tr G. ENGINEER'S CERTIFICATION a,d,,, o ,; ;,;.,,,,,;, I certify that t have determined through field inspections and1 THEODORE FORE review of Municipal records that the above systems are in f. conformance with MOA HAA guidelines in effect on this date. ENGjF9 q Engineer's Printed Name Theoofm✓e F• JKf&o L ° Date M &.x IS -0 2 Urj r HAA Fee $ Soo Waiver Fee $ Date of Payment S/ 16 y 2 c.G / Date of Payment Receipt Number Receipt Number (Rev. 12100) I>;w I 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# �ill,— -I -()LI HAA# WQ)SL100%'A 1. GENERAL INFORMATION Complete legal description Lot 1; Block 3;Raven Woods Subdivision , Location (site address or directions) 9900 Trappers Trail Rond Property owner Kris Abeag Day phone 762-3137 Mailing address c/o Jack White Co., 3201 "C" Street Ste. 100, Anchorage, AK 99503 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site x 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. 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-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. Name of Firm Address 17034 Eagle River Loop Road Engineers signature 6. DHHS SIGNATURE — Approved for 4— bedrooms. Disapproved. Conditional approval for Additional Comments Phone Si51i2979 bedrooms, with the following stipulations: By: JCiI f tJ yn iTN 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 orderto 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 engineers work. Date bedrooms, with the following stipulations: By: JCiI f tJ yn iTN 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 orderto 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 engineers work. ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1 &K 3 WVEN bJ45�i-D5 Parcel I.D. S CD A. Well Data Well type Pit -1 VA If A, B, or C, attach ADEC letter. ADEC water system number /U Log present &N) (E S Date completed Q Z G ! 96 Driller C)11 y' Wtu-1API S R2/LUNG G o, Total depth Cased to Z 3 Z Casing height Sanitary seal &1N) IIL Wires properly protected (9/N) Y61 FROM WELL LOG Date of test Static water level Z S Well flow MOT- 2EC0✓crX0 g.p.m. Pump levell ZZs RECOMMENCEb SEPARATION DISTANCES FROM WELL TO: / If - AT INSPECTION z ri Z g.p.m. UK Septi^ tank on lot __4cU -�- ; On adjacent lots Absorption field on lot 00,4- ; On adjacent lots Z Oct r� Public sewer main %S Public sewer manhole/cleanout Sewer service line ZS Petroleum tank /UO �iE KA 10c.1,�-_) WATER SAMPLE RESULTS: Coldorm ��lyU'"" ` Nitrate U Other bacteria Date of sample: Z� G/ 4 Collected by: B. SEPTIC/ TANK DATA Date installed�Tank size 12-Q �� L Compartments Z Cleanoutst�) i�� / F Foundation cleanout) TLS Depression ( �� High water alarm (YIN) illeD Alarm tested (Y/N) Date of pumping 2�0S y�L Pumper �f q"",� SEPARATION DISTANCES FROM SEPTIC/HOSMW TANK TO: r C Well(s) on lot Lo (�- On adjacent lots Foundation s �— r To property line Absorption field Water main/service line % 7L Surface water/drainage MJ ( 4- 72-026 (3W)' Fmt n-026(3W)'Fmt CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in Vent (Y/N) High water alarm level Meets MOA electrical codes "Pump on" level SEPARATION Q_WA_NCE FROM LIFT STATION TO: ABSORPTION FIELD DATA iss (YM) "Pump off" Level at Cycles tested adjacent lots Surface water Date installed >(��� pr9 Soil rating (GPD/Ft) %52 System type Length _ / Width Z-1 ( Gravel thickness U, S / Total depth D' Total absorption area / n g(y Cleanout presen6N) '�-S_Depression over field (Yot " Date of adequacy test ZLLZ 2 � Result fail) l"S for 4 F U2, Bedrooms Water level in absorption field before test ; /` After test Peroxide treatment (past 12 months) (Y/N) 1)6xE Kmoc,l If yes, give date NZA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Z4�� (74-- On adjacent lots /OLS r� Property line To building foundation /l) To existing or abandoned system on lot On adjacentlots S�!� � Cutbank AJD A)C I�CJ&L) Water main/service line w ��— Surtacewater � CSD /� Driveway, parking/vehicle storage areas Curtain drain li1t,I'J E. ENGINEERS CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the Signa Engin Date HAA Fee $ Jon ' e')O Date of Payment Receipt Number 25-K, 7 72-026 (3793)' Back Waiver Fee $ Date of Payment Receipt Number ate of this inspecldon. I -x< 0 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Ir- X0--07 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L�r t 'P?L'K 3 ?�� weDz?r' Location (address or directions) (b) Applicant Name KFCi� 1 -0F -1-S Telephone: Home X?S^D471 Businesse���g-�'��'� Applicant Address Z5�-I00G1.1L !f-� 0'lL I��1 J. (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder(,f-; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution 4: /�4- 'S6 ✓IrSCs��Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: S & S ENGINEERING 1/034 hagie Ktver LOOP KUaJ 14.,. Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family j Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well E� Community ❑ Public ❑ Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite gr Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11 i84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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. Name of Firm S c& S -ENGINEERING Telephone — Address 17034 Eagle River Loop Road No. 204 Date Eagle River, Alaska 99577 /.nary.. ..x(w' 'a NO. 1457-f � a •°`vas 6. DHEP APPROVAL Approved for !�t bedrooms by Date fo Z / — ,?� 7 Approved x Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 • • 72-025 (11/84) • MUNICIPALITY OF ANCHORAGE (MOo AUTHORITY APPROVAL (HAA) MUN\O\pENtA�E���E OMW&KLIS FEBRUARY 1984 264-4720 E 0\1 a b 198I Legal Description: , ` ✓LI� `��✓� A. WELL DATA + �CC 1v 11 t�T V Well Classification K StL�- If A, B, C, D.E.C. Approved (Y/N) A Well Log Present&N) Date Completed 6 -L2' Sb Yield 21 rD &)A Total Depth 2212 Cased to 232 y Depth of Grouting Static Water Level Z t S r Pump Set At 2 ZS _ H Casing Height Above Ground Electrical Wiring in Conduit(fUN) Sanitary Seal on Casing (SIN) Depression Around Wellhead (Y/M Separation Distances from Well: To Septic/HefdRfg Tank on Lot On Adjoining Lots ( oto -J-- To J- To Nearest Edge of Absorption Field qn Lot Z On Adjoining Lots 1 EO 14- To Nearest Public Sewer Line r p To Nearest Public Sewer _ 1 Cleanout/Manhole / A p � To Nearest Sewer Service Line on Lot 2� { Water Sample Collected by 'L? Date LIP- k Water Sample Test Results Comments B. SEPTIC/U6M9fNG TANK DATA Date Installed 0 - \C:) -e& Size ,Z'5D No. of Compartments 2 Standpipe/N) Air -tight Caps<P/N) Foundation Cleanout CDN) Depression over Tank (Y/M . I /— Date Last Pumped I��W Pumping/Maintenance Contract on File (Y/N) ( JA Holding Tank High -Water Alarm (Y/N) N Separation Distances from SeptiTank: To Water -Supply Well t To Property Line i f To Water Main/Service Line ) O Course [J f) rJ Comments Page 1 of 2 72-026(11/84) for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage 0 C. ABSORPTION FIELD DATA 0 Soils Rating in Absorption Strata I' Type of System Design Fid Date Installed Length of Field _2��t Width of Field Zl 1 Depth of Field (�.S Square Feet of Absorption Area 1 - Depression over Field (Y/1 I� Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well f IZ To Building Foundation Lot /J Gravel Bed Thickness 8— Standpipes Present(%NI Date of Last Adequacy Test tiW To Water Main/Service Line (o'4 - To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons To Property Line ; On Adjoining Lots If To Existing or Abandoned System on .2� I -t - To Cutbank (if present) N0tJt Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " Check Permitted Bedroom Rating Against HAA Request "' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signet & S ENGINEERING pate CompaN)Q34 Eagle River Loop Road N6. M _ G Eagle ver, MOA No. k Receipt No. —�� D o Date of Payment Amount: $ e[ s. Se 4 �a f Page 2 of 2 72-026 (11/84)