HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 5 LT 11River Vi
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I states
Block 5
Lot 11
#050-792-24
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 WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Renewal
Date Issued: Apr 03, 2003
Expiration Date: Apr 02, 2004
Permit Number: SW030062
Legal Description: RIVER VIEW ESTATES BLK 5 LT 11
Design Engineer: 0007 Tobben Spurkland, PE
Owner Name: WM Construction
Owner Address: PO Box 4042
Palmer, AK 99645-
Parcel ID: 050-792-24
Site Address: 021140 RIVER PARK DR
Lot Size: 40135 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] SepticTank [] 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Net 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: 0 ,~ Date:
Issued By: ~
\
Date:
Parcel I.D.
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 99519-6550
www.ci.anchorage:ak.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number SW
Property owner(s). ~ ~'- C¢*45~r~c---~v~,~',-/
Mailing address (1) ?o ~G'Y" t-J(o H '7..._
Mailing address (2).
Legal description (Lot, Block & Sub'd.) /,,d"~
Legal description (Section, Township & Range)
AY
Day phone
Zip Code
Lot Size H 0 \'-~.~-.~
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Acre~
Numberof Bedrooms ~ ~ (-~
[] 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: //_r~, ~
Date of Payment: q -/~ ~) ~
Receipt Number: _"~'~ ~ ,~---~
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
May 15, 2O03
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HE,eJ_TH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
&FLOWTEST
SITE PLAN~
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHAN~..N.
INSPECTIONS
ONSITE
W~TEWATER
DISPOSAL SYSTEM
OER~N
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 11, Block 5, Riverview Estates
-g~ Sk/o "500 6;L
It is requested that you .'£~,sg permittto install a well and a septic system to serve the
proposed four bedroom dwelling on the referenced property.
Two test holes were excavated and percolation tests pgrformed. The approximate locations
of the test holes are located on the attached site plan. At the time of excavation (5/1/03),
water was found at 11.5 feet. After seven days of monitoring, ground water was found at
11 feet.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/bjj
Enclosure
17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RIVER, ALASKA 99577
1"=60'
S AL
DESIGN
SITE-PLAN
WILDWATER CIRCLE
Z r~'l r'q -g l~-"j
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II II
I I I~1
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Performed For:
Municipality of Anchorage
Development Services Department
Building Safely Division
On-Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
v,~w.d.enchoraqe.ak.us
(~7) 3437904
Soils Log - Percolation Test
Date.Performed:
LegaiDescription: ~07'"' )j t~]-~ Ct,( j~' ~OIV£~V~i'v
Township,' Range, Section:'
Stope Site Plan
2-
3-
4-
7:
8- ~ L
1~ / ,I~,4-,'~.~ WAS GROUNDWATER
Depth to Water A~er
1- Monitoring? ~ ~ ~ P
15- ~,~z~ '~ ~'&,,'l ' /o
~-~. ,,/~,~,~, ~,~,~,,,,,, ,,'"'~°~ ~l~, I~,.'" ,, ~o~° I~0ro. I ~ I '~"1'",~,,~,.' .... ''~'~--~'' ~l ~',~'~ ""~ --
2O-
PERCOLAT~OH P~TE ~'. ~ (minuteCn¢) PERC HOLE DIAMETER
~ ~a c:x ~ AND
COMMENTS
'~ ~ = · it //~.¥~r ~..,, -- CERT FY TH,~T TH S TEST,_~/'W~,:,~,~.
P:, ,FORMED BY. I=~1~ River L~
17034 .......... 20;4 - - - j
Municipality of Anchorage
Development Services Department
Bui]a3ng Safety Divlsien
On-Site Water and Wastewater Program
4700 South Bragaw St.
P,O. Box 196650 A~chorage, AK 9951~650
~?vw.d.anchoraqe.ak.us
(~7) 343-7~34
Soils Log - Percolation Test
Legal Descriptian:~0'T' /J ~-0 c,~ ~ ~i'¢~4.~¥~ ~¢.~,J'~'% Township. Range, Section:
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
19-
20-
COMMENTS
Slope Site Plan
I I
iF YES, AT WPAT DEPTH? 0
Depth to Water ARer p
Monitoring? E
Date:
pEP, COL&T~OH P.~.TE ~ , i.j (mlrute¢~ah) FERC HOLE DIAMETER
TEST RUN B~,"/EEN ~- F~ AND ~ Fi'
S & S EICGi NEERING
PERFORME0 B~lr034 Eigle River Loop R~d No. 2~ I CERTIFY THAT THiS TEST WAS
PERFORMEDI~~~ZCATEANDMUNIC?ALGUIDELINESINEFFECTONTHiSDATE. DATE: ~/]/0 S
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUOIES
AND REPOFffS
WELL INSPECTION
& FLOWTEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
W~TEWATER
DIspOSAL $~TEM
DESIGN
CIVIL EI~IGINEERS
(907) 694-2979
FAX (907) 694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 11, Block 5, Riverview Estates
May 15, 2003
GENERAL:
1. The scope of this project incindes the installation of a sewage pump, a 1300
gallon HDPE septic tank, and new trenches to serve the proposed four
bedroom residence located on the referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
o
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing their
own systems must also receive prior approval fxom the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent .settling or shifting of
the tank.
17034 NoRTH EAGLE RIVER LOOP * SUITE 204 * EAGLE RIVER, ALASKA 99577
Page 2
Lot tl, Block 5, Riverview Estates
May 15, 2003
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock)
placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
o
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 3
Lot t t, Block 5, Riverview Estates
May 15, 2003
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use ora type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
Page 4
Lot tl, Block 5, RiverviewEstates
May15,2003
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required dur'mg the installation of the
wastewater disposal system. These inspections will occur as follows:
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement exist'mg between the contractor and S & S Engineering. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
George P. Wuerch.
3layor
March 11, 2003
Municipality ofAnchorage
.Building Safety Di;-ision
Anchorage
Ali-America .City
2002
Lee's Cust0m'Des~gn
.11517 Old Glerm
Eagle River AK 99577
Subject:
On-Site Water and/or Wastewater Permit:
Permit Number: SW020049
Legal Description: River. View Estates Block 5 Lot 11
Dear Lee's Custom Design:
An On-Site Water/Wastewater Permit, number SW020049, issued by'thiS Office for a single-family
system, will expire on April 8, 2003. This permit was valid for 365 calendar days.
. If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit..
If this permit was for a wastewat~r disposal system, an original as-built inspection repsrt must be sent to
this office for review, approval and documentation. This as-built inspection report must be signed 'by
the licensed Professional Engineer who inspected the installation of the system. As-built inspection
reports are required to be submitted within 30 days of the completion of the system.
If no system was installed under this'permit, and you are still planning to install a well or.wastewater
disposal system, a new permit must be obtained from this office. A new permit for a second year may'
be issued for a fee of $100.00 if the renewal applicatior~ is received on or before the expiration date of
the original peuuit.
When applying for a new permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well
permit.
If you have any questions, please call this offic~ at 343-7904.
Manager
On-Site Water and Wastewater Program
Enc: Copy of permit
P.O. Box 196650 · :h~chorage, Alaska 99519-6650 · Telephone: (907) 343-8301 · Fax: (907) 343-8200
4700 South Bragaw Street · Anchorage, Alaska 99507
http://www.ci.anchorage.ak.us
MUNICIPALITY OF ANCHORAGE
Deve/opment Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Apr 08, 2002
Expiration Date: Apr 08, 2003
Permit Number: SW020049
Legal Description: RIVER VIEW ESTATES BLK 5 LT 11
Design Engineer: 0007 Tobben Spurkland, PE
Owner Name: Lee's Custom Design
Owner Address: 11517 Old Glenn
Eagle River, AK 99577-
Parcel ID: 050-792-24
Site Address: 021140 RIVER PARK DR
Lot Size: 40135 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
~ Disposal Field ~ SepticTank [] 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 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:
Date:
Date:
Parcel I.D.
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
Permit Number swOZOO4~¢'
Property owner(s)
Mailing address (1)
~ddress (2)
Legal description (Lot, Block & Sub'd.) /-aT
Legal description (Section, Township & Range)
Lot Size tl/Z)/~,-~ Acres/Sq. Ft.
Day phone
i~_ ~
Zip Code
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only [] Well Only
Sewer and Well ~L Water Storage
Sewer Upgrade
THIS PROPi~RTY CONTAINS:
Hot Tub [] Jacuzzi
Swimmin9 Pool [] Water Softening Unit
Therapy Pool []
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.
Permit Fees:
Date of Payment: ~/7/~
Receipt Number:
(Rev 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 11 BLOCK 5 RIVERVIEW ESTATE
Municipality of Anchorage
Development Services Department
On Site Water and Wastewater Program
4700 South Bmgaw Street
Anchorage, Alaska 99519
April 2, 2002
We are submitting an application for the installation of a well and septic system for this lot. The
submittal consists of three (3) drawings showing the present improvements on the lot and the
adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and
septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system,
(sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic
system design is based on the following:
Groundwater at 6 Ft.
Use Standard Bed with BioCycle
Soil Rating. From Testhole 06/09/99.
< mirdin = 4 gal per sq. ff/day
No. of Bedrooms 4
Required Area per Bedroom: 150/4 =37.50 sq.fi.
Total area required: 37.50 x 4 = 150 sqft
Bottom Rock At 3 feet
Top Rock At 2.5 feet
Rock Depth 0.5 feet
Total Bed Length 150 /5 = 30
USE 50 FT
SYSTEM CONFIGURATION
BIOCYCLE
STANDARD 5-WIDE
TOTAL LENGTH 50 FT
TOTAL WIDTH 5 FT
TOTAL DEPTH 2 FT
ROCK DEPTH 0.5 FT
COVER 3 FT
The installation of this well and septic system will not prevent wells and septic systems fi~om being installed on the
adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Pond'mg and/or concentration of surface
runoff will not result fi.om this installation.
Lo~: 7
VACANT VACANT
SCALE; 1' = 100 FE
Lot 10
Well
I ~ I
I I
Lot: II
\\
\\
LOT i2
SEPTIC SYSTEM DESIGN
DATE: 1~,4RCH 10, 2002
SHEET: I/$ GRID: SV/035~
PERMIT # SIv'9800XX PI.B # YY RVEOS111,BIKG
ALTERNATIVE URAINtT£LD
PROPOSED DR41NRELD
IOTAL OEPTIt: 2 FT.
TOTAL LENG~: 50 FI'
EFFECT/V~ ROCK DEPTlt.
COVER: $ r~.
PROPOSED BIOCYCLE 6000
SINGL~ £AMILY
4-B£OROOM HOUSE
PROPOSED
~ Well
49th
SCALE; ]' = ~ FT,
TOBBEN SPURKLAND P.E.
205 1¢ 15TH. AVENUE
ANCH. AK. 99501
(907; 279-$916
I
II/" 11 B£OCK 5 RIVERVIEW ESTATES
leg's COSTOM DESIGN
SPURKLAN~
No, CE-2225
SEPTIC SYSTEIv/ DESIGN
DATE: MARCH 10, 2002
SHEET: 2/5 GRID:
PERMIT # SWgBOOXX
PID # YY
, RVEO51I$,gWG
,~~~.~ 4-INCH INSULATION
2 f7 TOTAL DEPTH
_ A/~COWP~£SSO# .5 ir'/' EFFECTIVE ROCK
I'
ND SCALE
BIOCYCLE 6000
LEGEND:
1. PR/WARY TREATI~ENT, SEPTIC TANK
2. AERATION TANK
$. CLARIFICATION TANK
4. DISCHARGE TANK
SOIL ABSORPTION
TOBBEN SPURKLAND P.E.
203 W15th Ave
Anchoro~/e Ak 99501
279-$970
RIVERVIE~ ESTATE, BLOCK 5, LOT 11
BIOCYCLE ,WASTE WATER SYSTEM
LEES COSOW DESIGN
WAST£W,~r~R SYSr£W
DATE: JUNE 16, 1998
SHEEr: Z/Z GRID:
PERMIT # SW9800XX
PIfl # YY
PERFORMED FOR:
LEGAL DESCRIPTION:
I
2
3
4
5
6-
7
8
9
10
11
12
13
14
15
16
17,
18-
19-
20-
Municipality of Anchorage
DEPARTMENT OF '-~EALTH & HUMAN SERVICES
825 "L' Street, Ar, chorage, Alaska 99502-0650
SOILS LOG --, PERCOLATION TEST
Lo-tL I I, ~:~1(' ~ Township, Range, Section:
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, ATWHAT
DEPTH?
Deplh ~o Water After...~./~
Monil~ing? t"' fZ,- Date:
P
E
Time Time Water Drop
.~ (minutes/inch} PERC HOLE DIAMETER
"~ FT AND FT
PERCOLATION RATE
TEST RUN BFzTWEEN
CERTIFY THAT THiS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THiS DATE. DATE:
72-008 (Rev, 4/85)
Municipality of Anchorage
Development Services Department
Building Safety 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
PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE
WASTEWATER DISPOSAL SYSTEM
This agreement, dated ~\<~,~) , is made between the Municipality of Anchorage
Development Services Department ti)SD) and the property owner(s) of:
This agreement is made for the purpose of maintaining an on-site wastewater disposal system on
the subject property.
The property owners agree to the following:
Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation
statement from a registered professional engineer. This inspection and operation statement shall
verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any
deficiencies have been repaired and that the system is functioning as designed.
(Printed Name)
The Foregoing Instrument was acknowledged before me by
C,4ox-~,cqx o._ cx.r-cxc~.\.~,~ th/s \<~'**'-'day of
X-'X~,~9--c_,~ ,20 ~.~-
~~'messmy an seal. .
gqta 'uUic
~ot~ printed nme) '~
My Co~ission Expire~.q; Commission ~ims
November 09.2004