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HomeMy WebLinkAboutT13N R3W SEC 22 LT 4 SW4TI 3N R3W tion 22 Lot $W4 of 4 #006-314-02 Municipality of Anchorage Page 1 Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box '196650 Anchorage, AK 99519-6650 w4vw.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW020223 PID Number:. 006-314-02 Wayne Lienhart Wastewater System: Deep Trench 2051 Glacier Street, Anchorage, AK 99508 ABSORPTION FIELD 646-2331 Five (5) Deep Trench LEGAL DESCRIPTION 1.2 c.o~e 10.5 SW ]~ of 4 3.5 F,. 7 13N 3W 22 ~,. 46 Well: Existing c~,,,..~,3 n. F,, ~, 644 ~e ASTM D3034 PVC ,. Acreage Systems 10/5-8/99 SEPARATION DISTANCES [] septic [] Holding [3 S.T.E.P. I-] Other; Tank Field Station Tank Se*e,U,~ Anchorage Tank 1,500 w., 65' >100' N/A N/A >25' Steel Two (2) s~.~w.,,, >100' >100' N/A N/A ~/ LIFT STATION - NONE ON LOT L,,~ >5' >10' N/A N/A ~° '~'°' ~,~, >5' >10' N/A N/A '~"~ ~' "'~" '~"~ '""'" I "~'""""~'" c,...~... None Noted ~ ,,~...a.o~. See Waiver for Well to Septic Tank Separation. BENCH MARK Tank was installed by owner in October of 1999. Garage Slab 100.0 Engineer's Stamp ...-C:.'..'2.:'..;.?,. Inspections performed by: J~_EA Dates: 1" 7/16/02 2'~ 7/17/02 $ '::~' ..... ~ ~ ~"?' ' "::;' Department ordeal? .a~ Human Services approval DEVELOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 99519-6650 - 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW020223 PID No. 041-021-47 Municipality of Anchorage Page 2 of 3 ~ ~asement.~u x.55'} 1~1/4 of SECTION LOT 4 ] Alternate szte TH2 TI~I ~ H1 C4 ~ Paved Parking Area Exi Well Swl/4 of SECTION LOT 4 L5~,I~UU'.X_3' Wide_. / ~ecczve uepcn sorptlon Trench Garage S2 S1 Five Bedroo[ Home Steep 70%± Steep 70%~ Steep 70%~ '1'0' Utility Easement Sl 8A. 3 B 41.7 S2 19.9 131.5 C4 ! I 64.0 M1 60.7 C5 40.3 C 93,8 92.1 87.3 PLAN AS-BUILT SCALE 1" = 40' Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK, 99519-6655 - 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number. SW020223 006-314-02 Page 3 of 3 No Exterior Foundation Cleanout Poved Surfoce 4' Insulot;on Under Povement CutOff At Orivewoy Povement Surfoce 96'1j 89.1 PROFILE AS-BUILT $cole: 1' = 10' MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTL~NATER DISPOSAL SYSTEM PERMIT Initial I Upgrade Date Issued: Jul 16. 2002 Expiration Date: Jul 16, 2003 Permtt Number: SW020223 ~ripfio-n?T'i3NR3W SEC 22 LT 4 SW4 Design Engineer: 0014 Anderson Engineering Owner Name: Wayne Ltenhart Owner Address: 2051 Glacier ST. Anchorage. AK 99508- Parcel ID: 006-314-02 Site Address: 002051 GLACIER ST Lot Size: 22500 SQ. FT. Total Bedrooms: 5 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. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Aiaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ), 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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: Issued By: 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 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 006-3t4-02 Permit Number SW Property owner(s) Wayne Llenhart Day phone 646-2331 Mailing address (1) 2051 Glacier Street Anchorage, AK 9908 Mailing address (2) Legal description (Lot, Block & Sub'd.) Lot 4~ Section 22, T13N~ R3W Zip Code Legal description (Section, Township & Range) Lot Size ~,~OE) Acre~. Number of Bedrooms Five (5) THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only Water Storage Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: (~,~o OO Date of Payment: Receipt Number: uj o Looql ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) July 15, 2002 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4, Section 22, T13N, R3W Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer:. The existing septic absorption crib on Lot 4, Section 22, T13N, R3W is located beneath the garage slab in conflict with the Uniform Plumbing Code. A new absorption trench must be constructed therefore in order to obtain a Certificate of Health Authority Approval on the property. We are therefore requesting a permit be issued for the construction of a new absorption trench to serve the proposed home. The attached Site Plan and backup documentation identify the location and configuration of the new septic system and the parameters used in the design. Also identified on the plans are the test hole locations and the locations of the well and septic tank on the lot. Drainage arrows are also shown and current drainage patterns will be maintained after construction. The absorption trench will be constructed on the lot immediately to the north of the subject property. The same owner has control of both lots and both lots will be transferred to the new owner of the home, The test holes placed near the location of the proposed absorption trench indicated clean well graded gravel with varying amounts of silt and a percolation rate of 1.4 minutes per inch. No groundwater was found during the placement of the test hole and none has been noted since. We are therefore proposing to construct a deep absorption trench with 7' of drain field rock beneath the distribution pipe. The total depth of the trench will be 10' with the distribution line at 3' below the surface, The ground surface on the lot slopes as shown on the attached Site Plan with faidy shallow slopes from east to west in the area of the new trench. The slope to the east drops off rapidly at a slope greater than 70%. The trench, however, will be a minimum of 50' from this slope. The new absorption trench will be constructed in a fairly fiat area in conformance with Municipal requirements and parallel to ground contours where possible. All components of the new trench will be constructed a minimum of 100' from the well on the lot. The system will also be constructed a minimum of 100' from any surface water in the area. Lot 4, Section 22, T13N, R3W July 15, 2002 Page Two If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. o The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments · m m / l/ ~. ~-asemen~ ~u x.55') Paved Parking Area Five Bedroom llome Existin, Well Absorption Garage zisttng 500 Gal Steep 70%_+ Steep Steep 70%± 10' 6~iii'~y ~.asement NOTE: No Conflicts With Wells or Septic Systems on Neighboring Lots. SITE PLAN SCALE 1" = 30' I'll ITl TH2 Paved Parking Area Exi Well ® Absorption Five Bedroom Home Garage 500 Steep 70%± Steep 70%± Steep 70%± 10' Utility Easement NOTE: No Conflicts With Wells or Septic Systems on Neighboring Lots. SITE PLAN SCALE1"=30' Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For- Wayne [ienhart Legal Descfiption: [ot4. Sedion 22. T13N. R3W SLOPE Date Performed: SITE PLAN W15~2 5 6 7 8 1 11 12 13 14 15 16 17 18 21 OGIOL GW Some Sand Bottom of Hole Was Groundwater Encountered? If Yet, What Depth?, Depth to Water Alter Monitoring Date: See Site Plan No ;I 1% Reading Date Gross Net Depth To Net Time lime Water Drop 1 15-Jul 9:05 .5' 2 9:15 10 Dry 7' 3 9:16 .5' 4 9:26 10 Dry 7" 5 9:27 .5' 6 9:37 10 Dry 7' Perc. Rate: 1.4 MinJInch Perc. HoPe Diameter. 6' Test Run Between 4.5 Ft. and 5.5 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Same Material as TH2. Performed By: F..~L,~.a[~;J~s~ I, ~ Ce~fy That This Test Was Performed In Accordance W~th All State and Municipal Guidelines In Effect On This Date: 7115/02 Municipality of Anchorage Department of Health & Human Services 825 L Street. Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For. Wayne Lienhart Legal Description: Lot 4. Section 22 T13N. R3W SLOPE Date Perfo~Tned: SITE PLAN 1 11 12 13 14 15 16 17 18 21 OGIOL GW Some Sand Bottom of Hole Was Groundwater Encountered? If Yet, What Depth? Depth to Water After Monitoring Date: See Site Plan No sI 1% Reading Date Sross ",let Depth To Net 'ime rime Water Drop 1 15-Jul 8:10 .5' 2 8:20 10 Dry T' 3 8:21 .5' 4 8:31 10 Dry T' 5 8:32 .5' 6 8:42 10 Dry 7' Peru. Rate: 1.4 Min./Inch Perc. Hole Diameter. 6' Test Run Between 4.5 Ft. and 5.5 FL Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: Ed Sandemon. I, ~ Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 7115102 LOT 4, SECTION 22, T13N, R3W DESIGN FACTORS: SYSTEM REQUIREMENTS: Five Bedroom Home Perc. Rate: 1.4 Min./Inch Avg. Application Rate: 1.2 GPDISF Deep Trench System Existing 1,500 Gallon Septic Tank 7' Drain Field Rock 5 Bedrooms X 150 GPD 11.2 GPDISF = 625 SF of Absorption Area 625 SFI14 SF/LF = 44.6 LF Trench Length Therefore: Construct an Absorption Trench 45' in Length by 3' Wide With 7' of Drainfield Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing Ground, Total Depth of Trench to Be 10' Below Existing Surface. Cover Over Septic Tank a Minimum of 4' or 2" of Insulation and 2' of Cover .5' 7.0~ Geotextfle Fabric 4" Perforated .PVC Schedule 40 Drainfleld Rock NOTE: TYPICAL DEEP TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' From Lot Line. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells In the Area. Minimum 10' Separation From Water Service Line. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 4, SECTION 22, T13N, R3W GENERAL: The scope of this project includes the placement of two post tank cleanouts past the existing septic tank and running the new effluent delivery line across the existing paved parking aroa to the new absorption trench as shown on the attached Site Plan. It also includes the construction of a 45' long by 3' wide by 7' effective depth absorption trench also shown on the Site Plan. The total depth of the trench will be 10' below existing ground and the distribution pipe will be placed at 3' below the surface. Ail components of the absorption trench must be constructed a minimum of 100' from the well on the lot. Construction shall be in accordance with the approved site plan, 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 all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contmctom installing wastewator disposal systcms must bc ccrti,r,'cd by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION - EXISTING 1. The existing septic tank is suitable for rouse on this project. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4' cleanouts for pumping access. 3. The septic tank shall be sufr, ciently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct budal insulation. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. Lot 4, Section 22, T13N, R3W July 15, 2002 Page 2 of 3 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabdc must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Contractor shall vedfy the septic tank and drainfield are a minimum 100' away from any pdvate water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall redly this condition prior to placement of the rock. All pockct$ of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer, 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated,' but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. Lot 4, Section 22, T13N, R3W July 15, 2002 Page 3 of 3 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabdc, gravel, .distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) July 16, 2002 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program P,O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 4, Section 22, T13N, R3W Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: We hereby apply for a lot line waiver to allow the new absorption trench on Lot 4, Section 22, T13N, R3W to be constructed within 1' of the existing lot line. The lot directly to the north has the same owner and has been designated as unbuildable due to limited surface area. Soils encountered in the area are poorly graded sands with gravel and some silt. This material is effective in the treatment of septic effluent and migration should be contained in a fairly limited area. Since the lot to the north will never be developed no conflict will ever exist. We therefore recommend the lot line waiver be approved. Sincerely, Michael E. Anderson, P.E. EASEMENT FOR A PRIVATE SEPTIC SYSTEM DRAINFIELD FOR THE BENEFIT OF SW1/4 OF GOVERNMENT SECTION LOT NO. 4, SECTION 22, T13N, R3W, S.M., ANCHORAGE RECORDING DISTRICT, ALASKA LEGAL DESCRIPTON A stdp of land 55 (fifty-five) feet wide and 30 (thirty) feet long lying within the NWl/4 of Government Section Lot No. 4, T13N, R3W, S.M., and beginning more particularly described as follows: Beginning at the southeast comer of said SW1/4 of Government Section Lot No. 4 thence N0°02'W 165.33' along the east line of said SWl/4 of Government Section Lot No. 4 to a point; thence N89°57'W 58 feet to the POINT OF BEGINNING; thence N0°02'W 30' to a point; thence N89°57'W 55' to a point; thence S0°02'E 30' to a point; thence S89°57'E 55' to the POINT OF BEGINNING. GRANTOR: WAYNE LIENHART, OWNER NWl/4 GOVERNMENT SECTION LOT NO. 4, SECTION 22, T13N, R3W, S.M. B~ ~ ~.A~ Dated: ~ STATE OF ALASKA ) )SS: THIRD JUDICIAL DISTRICT ) The foregoing instrum, e.nt was acknowledged before me this ¥-~'~day of--.~J~, 2002 by -[ .t..~3.~t,,JL I.~-.,~v%,~- ' ! s,.,e oj I DONNA K..DA~'~LS. ! ~"~~"~-~~'~(~ ; .~ c~,~,,~ ,,~,~,, ~ ~ ] Nota~ Pub c n and for~ aska .......... ~ ~mm,ss,~: ~ ~.OH ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522°7773 522-6779 (FAX) July 16, 2002 Municipality of Anchorage Building Safety Division On-Site Water and Wastewater Program 4700 S. Bragaw Street Anchorage, AK 99507 Subject: Lot 4, Section 22, T13N, R3W Septic System Easement Dear On Site Services Engineer: The absorption trench for the septic system on the subject lot is constructed on the lot to the north. Both lots are owned by the same person and the lot to the north is undevelopable due to limited surface area. We will, however, furnish a recorded absorption trench easement within the next month allowing the absorption trench to be constructed on the lot to the north. The approximate location of the easement is shown on the attached Site Plan. Sincerely, Michael E. Anderson, P.E. Attachments ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522..6779 (FAX) July 9, 2002 Municipality of Anchorage Building Safety Division On-Site Water and Wastewater Program 4700 S. Bragaw Street Anchorage, AK 99507 Subject: Lot 4, Section 22, TI3N, R3W Certificate of Health Authority Approval Dear On Site Services Engineer: The owner of the subject property recently sold his home and must complete a Certificate of Health Authority Approval on the well and septic system on the property. In September of 1999 he applied for a bed and breakfast certification from ADEC. At the same time he replaced the leaking septic tank with a new 1,500 gallon tank. Due to some confusion a permit was never granted for the placement of the tank. We are therefore, applying for the permit after the fact. A copy of the as-built of the tank installation is attached for your review. The tank is also only 65' from the well. A waiver request to allow the tank within the 100' protective radius is also attached. The well was originally placed nearly 8' below ground with a well house over the top. The casing has now been raised to 2' above grade and a sanitary seal installed. The wiring is now encased in conduit and the pit backfilled to the ground surface. A flow test performed on the well revealed a production rate of nearly 5.6 gallons per minute. The static water level was found at 110'. The absorption pit was installed in 1971 near the west property line. The property slopes rapidly at a 1:1 grade for nearly 80' from approximately 10' past the property line. The pit was therefore constructed less than 50' from a break in grade greater than 25%. No trace of effluent was noted on the slope, however. The pit appears to be functioning adequately as of this date. The water level was noted at 65" prior to the adequacy test. Water was constantly flowing into the pit during our test from cleaning operations ongoing in the house. The water level rose to 96" or nearly full depth of the pit after an injection of 750 gallons of water. The water level dropped to 61" slightly more than 15 hours later. Please review the attached information and advise if further data is required. Sincerely, Mich,'el E. Anderson, P.E. Attachments ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) July 9, 2002 Municipality of Anchorage Building Safety Division On-Site Water and Wastewater Program 4700 S. Bragaw Street Anchorage, AK 99507 Su~e~: Lot4, Section 22, T13N, R3W, S.M. Separation Distance Waiver Septic Tank to Well Dear On Site Services Engineer:, The septic tank on Lot 4, Section 22, T13N, R3W was originally placed on the lot in 1971. At that time the separation distance requirements between a well and septic tank were only 50'. The absorption pit was also originally constructed in 1971. A garage was later constructed on the lot and the absorption pit was located below the concrete slab of the garage. The attached site plan shows the current configuration of the well and septic system on the lot. In 1999, the owner of the property applied to ADEC for a bed and breakfast certification. He also replaced the septic tank as the original tank had deteriorated and was leaking. Unfortunately, he did not obtain a permit to replace the tank. We are therefore requesting a permit be issued after the fact for the construction of the new tank. Due to the configuration of the septic system and the location of the garage and parking area it is extremely difficult to place the tank outside the 100' radius of the well so the tank was replaced in the same location as originally constructed. It is now situated approximately 65' from the existing well. We are also requesting a waiver be issued to allow the new septic tank to remain in its current location. The well is located approximately 10' upslope from the septic tank with the surface drainage of the area from east to west at steep grades approximating 15%. The well and home are situated on a hill approximately 30' above the surrounding area. All surface water drains swiftly away from the property in all directions. The soil under the house is primarily a silty gravel which percolates at between 6 and 15 minutes per inch. The absorption pit constructed in 1971 is still in good condition and absorbs water at a rate much faster than 750 gallons per day. The flow from the absorption pit appears to be in an easterly direction and away from the well following the surface slope of the area. The surface slopes dramatically at close to 100% away from the absorption pit on Lot 4, Section 22, T13N, R3W, S.M. Separation Distance Waiver July 9, 2002 Page Two the east side of the property. It is highly unlikely any effluent escaping from either the septic tan or absorption pit would flow in the direction of the well. No log exists for the well, but the current owner of the house has been familiar with the property since it was originally constructed. He has stated the well is 270' deep. The static water level was recently measured at 110' below the surface. Separation Distance Waiver Guidelines Water Table 110' Below Tank 7.1 Soil Type Sand & Gravel with Silt 2.5 Permeability Sandy Gravel with Silt 1.0 Water Table Gradient 10% 6.0 Horizontal Separation 65' 1.6 Total 17.1 The conclusion based on the aforementioned point totals is that almost surely no form of contamination can be expected from household sewage. It is therefore recommended the waiver be approved to allow the existing septic tank to be 65' from the existing well. A recent water sample taken from the well indicated very little concentration of Nitrates. This compares with the sample taken in 1999. It is apparent the neither the absorption crib nor the septic tank are influencing the quality of the water from the well. Sincerely, Michael E. Anderson, P.E. Attachments Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 99519-6650. ~43-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW020 PID No. 006-314-02 Page2 of 3 41.7 S2 9.9 31.5 .Exist! Well Gara( t S2 S1 Five House -%. PLAN AS-BUILT SCALE 1" =40' I JUL~O2-O2 O:):54PU FROIJ-CT&E ENVIROfl~NTkL S~V m.CT&EEnvimnmentalServiceslnc, 9075515301 T-544 P.02/03 F-471 CT&I: RtL# Client Name Project Name/~ Client Sample ID Matrix Ordered Ily PWSID Sample Remarks: 1023855001 A~dcnon Engineering Lot 4, Sec. 22. T13N. R3W Lot 4. Sec. 22, TI3N. R3W Drinking Wa~er Results All Dare,Times are Alaska Standard Time Printed Dare,Time 07/01/2002 11:08 Collected Date/Time 0~27/2002 10:30 Received Date~rime 06/27/2002 11:20 Technical Director Stephen C. £de Released By~~~/~ ~ PQL Units Method AHowablc Pr~p Analysi:. Lin~ Date Da~e Init Nitr~te-N 0.200 U 0.200 mgfL EPA 300.0 06/27/b2 JDT l~:Lc~-ob~oZ o9¥ ~.abo~:at:oz'~ Total Coh form 3 OB, No Coli col/lOOmL SMI8 9222B 06/27/~2 RAP Received TiRe Jul. 2. 3:04PM TWENTIETH R.., II II II E ~ ST. 29 $9 38 42 4~ 44 , CT $.t 58 6'2 GR. 120 99 SEE OVERVIEW MAP ACE, F~ ST. 39 3~ 42 29 1 33 58 GR. ~$? 99 SE ll4 ScC. 22. TITM R~W SEE OVERVlEWMAP'H" Municipality of Anchorage Development Services Department Building Safe~y Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet VVR~: 020047 PID~: 006-314-02 Date Received: 7115102 Legal Description: TI~IN I~:[IW Section 22 Lot 4 Engineer:. MI a P Allderag[t Enalneedna Applicant: Wayne Lelnha~t Waiver Requested: Q feet from -roeen'v line to absomflon Field Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: Waiver is Granted: List Conditions or Reasons for above: Waiver is not Granted: Date: By: ~"a~' R~eviewer Rec~: 22425 Amount: $0.00 Date Paid: 711612002 MunicipaliW of Anchorage George P. IVuerch. Mayor Btfilding $,-Lfcty Dix'ision P.O. I~}x 19(~1~-30 * 21.701) S. Bragaw Street 3a~chomgc, Alaslm ~)519-66,'30 * ((,)t)7) 3-1-:1-8tl)1 ]~ttp://www.ci.m~ch,~ragc.ak.us 7/I 6/2002 Michael E. Anderson, P.E. Anderson Engineering PO Box 240773 Anchorage, AK 99524 Subject: Waiver Request for T13N R3W Section 22 Lot 4 Waiver Request #WR020047 Parcel ID #006-314-02 Dear Mr. Anderson: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved ~eparation distance is 1.0 foot. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concems or questions regarding this xvaiver, please call our office at 343-7904. Sincerely, c~vil Engineer On-Site Water & Wastewater Program Municipali , of Anchorage George P. Wuerch. Mayor Buildh~g Sttfi2ty Dirision P.O. Ih)x 19('>6,50 * -~700 $. Bragaw Street Anchorage, ~Maska .°A.)519-C~,50 · (91)7) 3-~8-8301 h t t p://www.cl.anchorag¢.uk.us 7/16/2002 lVlichael E. Anderson, P.E. Anderson Engineering PO Box 240773 Anchorage, AK 99524 SubJect: Waiver Request for TI3N R3W Section 22 Lot 4 Waiver Request #WR020041 Parcel ID #006-314-02 Dear Mr. Anderson: Your request for a ;vaiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 65.0 feet. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system ;vill require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jpq Gb, c~dall Ci4il Efigineer On-Site Water & Wastewater Program Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wa~tewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#: WR020041 PID~: 00641402 HA#: HA020321 Date Received: 71t0102 Legal Description: Tt3N R3W Section 22 Lot 4 SW4 Engineer:. Michael E. Anderson. PE nd I Applicant: Wayne Llenhart Vermit~: ~ OZo2Z ~ Waiver Requested: I~!~' fr~ w~ll I;9 aeDtlc tank Criteria: Geology A. Water Table B. ,Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: Total: Waiver Is Granted: ~ List Conditions or Reasons f~ above: Waiver Is not Granted: Ret#: 22425 Amount: S800.00 Date Paid: 7/10~302~ lb unicipality, ®i Anchor e On -Site Water and Wastewater Prog JUL 17 20 19 D (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS OV hw 0[ 6 g L0, Parcel I.D. 006-314-02Expiration Date: t Q' `l 1. GENERAL INFORMATION Complete legal description T13NR3W SEC 22 LOT 4 Location (site address) 2051 GLACIER ST. Current Property owner(s) ROALOFS CHRISTINE Day phone Mailing address 2051 GLACIER ST. Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple`D.Wellings (Single Family and/or Duplex)_ 3. NUMBER OF BEDROOMS: 5 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual ® Holding Tank ❑ IndivldualWater Storage ❑ Community ❑ Commugtty Class Well''.-, " ❑ Public Sewer Public Water System, ❑ WaiverNaribhCe req'ue`st for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment���1 Date of Payment Receipt Number << /`� Receipt Number COSA # Q�C �� Waiver 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen .� 0L' j \ encroachments, deficiencies or discrepancies exist. /K TiI� 77 - 6. DSD SIGNATURE System #1 Approved for bedrooms. I K;Nner" „'. GF System #2 Approved for bedrooms. Disapproved.\•�+� Conditional approval for bedrooms, with the following stipulations: .,Iiit(((Wi.,. WN STEWATER z= PROGRAM a A O` l \ By: OriginalCertificat9dX),g1 L 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 engineers work. 14, _1L rb 7. ATTACHMENTS: w COSA Checklist X Nitrate Advisor; Septic System Advisory Arsenic Adviso +�J�c Well Flow Advisory Other (b' e ». COSA blue sheet 10-10-12.doc Legal Description: COSA Checklist T13NR3W SEC 22 LOT 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5/1/1959 Total depth 270* ft Cased to 270* ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 7/6/19 Static water level at beginning of test 118 ft. Comments * Per MOA record documents B. TANK DATA Age of tank(s) 20 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49.. Stand pipes/foundation cleanout p�e-rr record drawing F� Date of pumping ? "( �'1 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/17/2002 ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 2'9 ft (min) ❑ NIA — pressurized field . . . Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: 5 c COSA Checklist yellow sheet Parcel ID: 006-314-02 Structure served by this system 1 Well production at time of test 5.0 gpm Water storage tank volume gallons We,disinfected for coliform test? ❑ Yes No N2 Coliform bacteria is Negative Nitrate — mg -/L ❑ Nitrate less than MRL (ND) Arsenic. 2 7 ug/L ❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of SampleB C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7/6/19 Results 0 Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 750 gal New depth 0 in Elapsed time 151 min Final fluid depth 0 in Absorption rate 750+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date . n • , /�-' 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' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft [0 Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'k] Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below * Waiver # WR020047, 7/16/2002 Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' ® 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' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes 1* if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS * Waiver # WR020047, 7/16/2002 G. ENGINEER'S CERTIFICATION l 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 DEVELOPMENT SERVICES DEPARTMENT Ga�\s On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC191313 Subdivision: T13N R3W Sec 22 Lot 4 01 t 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 $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. x , WOW � y ,� B k � �Mu°� t m P 'S� MM"�.. � G s �� 4 DEVELOPMENT SERVICES DEPARTMENT 4� On -Site Water and Wastewater Section www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC191313 Subdivision: T13N R3W Sec. 22 lot 4 907-343-7904 Fax: 343-7997 A water sample revealed an arsenic concentration of 27 micrograms per liter (ug/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. g'�ggg" "'S`, r - y Q CL cn CD z_// 1n1 � -- � t- 11<1 U w Ll O �d V.S_F a I N 00'02'00"W 165.33' 14-50'01'30'W 165.3j' k� N N /eF \e 9 O z z 3:: —j x Z W Y x J Z L V x x In S 00'02'00"E 165.33' Z zW Oy 1^ <n � I J 3102id ,00 7' #30. YO�C H. N N 0 za � x S 00'02'00"E 165.33' a� N () 0 ©vGj �s 4 a C". J�M O Z � 000 Chi �� La S j1; rn�V O p Q d Oa:3? q v� 'o ao � o v m o .. O C y Oy O. C C 4 V; C1,1 En M yhNT� OC ®C m0E > d ®% N 040" € .1.2" v c v 1A 111 Q p ° ®�. p 7 o 0 r- O ...." a M "- :3 0 0p 0Ix 41 e O O C a C C p O m O O C,4 D m O C C x 6 st C1 N -- O E m m .mC � °v-omr�® r . C to:a o �' '� C o � fn C -v �m p°p�C x! -01 C) c aOc c v ` .•. E ro ® N Q 'O o. C. ® >. ox M _ a�Lvav0 _ m ° c Q Qrn- ® C O • Z7 C1 '. •- O d C .a- C t_ sz� V? m$aoE0co` 0 .o L' a m O0 � m Z L C E�® (D� fy C .S N y- .— A .. � . • to ui a0 `—ate :r .. :. ,• ,:: Z zW Oy 1^ <n � I J 3102id ,00 7' #30. YO�C H. N N 0 za � x S 00'02'00"E 165.33' a� N () 0 ©vGj �s 4 a C". J�M O Z � 000 Chi �� La S j1; rn�V O p Q d Oa:3? q v� 'o ao � o v m o .. O C y Oy O. C C 4 V; C1,1 En M yhNT� OC ®C m0E > d ®% N 040" € .1.2" v c v 1A 111 Q p ° ®�. p 7 o 0 r- O ...." a M "- :3 0 0p 0Ix 41 e O O C a C C p O m O O C,4 D m O C C x 6 st C1 N -- O E m m .mC � °v-omr�® r . C to:a o �' '� C o � fn C -v �m p°p�C x! -01 C) c aOc c v ` .•. E ro ® N Q 'O o. C. ® >. ox M _ a�Lvav0 _ m ° c Q Qrn- ® C O • Z7 C1 '. •- O d C .a- C t_ sz� V? m$aoE0co` 0 .o L' a m O0 � m Z L C E�® (D� fy C .S N y- .— Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. O¢ 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. 006-314-02 1. GENERAL INFORMATION Complete legal description Lot 4, Section 22. TI3N, R3W Expiration Date: Location (site address or directions) 2051 Glacier Street Current Property owner(s) Wayne Lienhart Day phone Mailing address 2051 Glacier Street Anchoraqe~ AK 99508 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless othen/vise requested, HAA wi//be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Five (5) 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 Sen/ices Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representaticns 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 sen/ed 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 Aoproval are v~tid for 90 days from the date of issue for properties served by a private or C~ass 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 omissicns 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 adequa~ for the number of bedrooms andJa¢~.~ of structure indicated herein. I further verify that based on the informatic~,e~, aiR.ed from the Mumc~pahtye~rage files and from my investigation and ~nspect~on, the on-sRe water. ~ppI~;"and/or wastewat~"~i~al system is(are) in compliance with all applicable Municipal and State coded;,~3rd~a~eS'~, and r,~.'ul~in effect at the time of installation. ~"~ ~"~ '~1~' of Firm Anderson Enqineednq Phone 522.77'/3 Address P.O. Box 240773 Anchora,qe. AK 99524 Engineer's Printed Name Michael E. Anderson. P.E. 5. DSD SIGNATURE v/' Approved for ~' bedrooms. Disapproved. Conditional approval for .__ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Repcrt Other By: Original Certificate Date: # Legal Description: A. WELL DATA Ce Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519~650 www.ci.anchorage.ak, us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST SWll4 of Section Lot 4, ,Section 22, T13N, R3W Well type Prlv~e Date completed 5/1/1959 Total depth 270 It. ParcellD: 006-31402 IfA, B, or C provide PWSID # Sanitary seal (Y/N) _Y Cased to. ~0 ft. FROM WELL LOG Data of test Static water level Well production WATER SAMPLE RESULTS: Coliform ,, Iii colonies/lO0 mi. Date of sample: 6/27/2002 SEPTIC/HOLDING TANK DATA Tank Type/Material 8eotlcJSteel Tank size 1.500 gal. Foundation cleanout (Y/N) Y Date of pumping '10/1/2001" ABSORPTION FIELD DATA g.p.m. Nitrate .~ mg/L Collected by: MER Number of Compartments ~ Depression over tank (Y/N) N Pumper Denali 8ewer and Drain Date installed 7/17/2002 Soil rating (g.p.d./~ or ft21bdrm) 1,2 GPD/SF Length 41} ft. Width ~1 ft. Total depth 10.5 ft. Date of adequacy test Fluid depth in absorption field before test in. Elapsed Time: min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (YIN & type) Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) >24 AT INSPECTION 6/27/2O02 110 ft. ~,$ g.p.m. in. Other bacteria 3 colonies/100 mi. Date installed 10/5-8/1~J9 Cleanouts (Y/N) Y High water alarm (Y/N) N System type DeeoTrench Gravel below pipe 7 ft. Eft. absorption ama 644 · Monitoring tube Y Depression over field N Results (Pass/Fail) For bedrooms Water added gal. New depth in. in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed 'Pump on' level at__ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off' level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tenk/lift station on lot 65" Absorption field on lot Public sewer main N/A Sewer/septic service line Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots >loft On adjacent lots >100' Public sewer manhole/cteanout N/A Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line >~i' Absorption field >~' Building foundation >~' Water service line Surface water >1 Off Water main N/A Wells on adjacent lots >loft SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation >10' Surface water >100' Wells on adjacent lots >loft Water main >1~ Driveway, parking/vehicle storage >~' Property line >11;1' Water Service line >t0' Cu~tein drain None Nqted F. COMMENTS Well Io~ data from owner. See SeoaralJon Distance Waiw~r [gr W~II t9 T{~nk. G. ENGINEER'S CERTIFICATION ·" I certify Ihat I t~eve deten-nined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael I~. Andewgn, P.E. Date 7117/2~2 Waiver Fee $ HAA Fee $ Date of Payment Receipt Number Date of Payment Receipt Number (Rev. 12/00) in.