HomeMy WebLinkAboutCHUGACH PARK ESTATES BLK 1 LT 11Chugach Pa k
Estates
Block
Lot 11
#051-481-44
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page I of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: .OSPI 91114 PID Number: 051-481-44
Dwelling: RM Single Family (SF) R with ADU El Duplex (D) R Two Single Family Project: R New RM Upgrade
Name
CONNIE OXENTENKO
ABSORPTION FIELD
❑Deep Trench R Wide Trench El Bed 0 Mound
Site Address
24217 Platsek Dr
❑ Other
Phone Number of Bedrooms
Soil Rating 7—Total
depth from original grade
406-7065 13
GPDISFI
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
FjGravel depth beneath pipe Ft.
Subdivision , Block Lot
CHUGACH PARK ESTATES BLK 1 LT 11
Fill added above original grade lGravel length
Ft.[ Ft.
Township Range Section
Gravel vAdth
Beds: Number of Lines
Distance between lines
SEPARATION DISTANCES
Ft.1
Ft.1
To; Septic Absorption Lift Station Holding Sewer
Total absorption area
Number of trenches
DisL between trenches
From Tank Field Tank Line
Ftpl
FL
1+
Well 100 na na
na
TANK X Septic ❑E] S.T.E.P. El Holding C3 Other
Manufacturer
Anchorage Tank
Capacity
1000 Gal.
Surface Water 100'+ na na
Material
Number of compartments
Lot Line 10'+1 na na I NA
Steel
1+ ;
Foundation 10 na na
LIFT STATION
Manufacturer
Capacity
Remarks Septic Tank Replacement
Gat,
Alarm location
Electrical installed by
PIPE MATERIAL House Tankto to tank D3034 drainfieldD3034
Installer
Dean
Drainfield CoJr,,iT D3034
inspector NorthRim Eng.
BENCH MARK (Assumed elevation) 100 it
Inspection 1,,4/29/19 4130/19
dates: 21-
Location and description
Peck
3`1 41"
ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp
Conditional Approval: Date OF
---------------9 ui*,
Septic System *
.......Steve ''
OVA
Approved Date 14 kin Q:. 0
Eng'
V
CE -6256
Note: this approval does not include well permit requirements. V& I , - . 0
A; 4W
Ln I !M MWAMMEM11066M
No Conflict
RECORD
MEASUREMENTS
A
B
dcol
55
31
STI
59
37
ST2
62
42
dco2
69
55
30% Slop
Flat Slope
30% Slop
30% Slop _ 10' Utility Easement
Well
0
R100
Platsek Drive
Ow-
NORTHRIM
ENGINEERING �P '
r'9 !
SteveEng.com • ••••••
s
PO Box 770724 SU" Ery
Eagle River, Alaska 99577 fly j, CE -6256
907.694.7028 �1 6•/•3%21
30% Slop
Flat Slope o
Flat Slope
\ Trench Location
NBdrm w w�
d
C,'
Flat Slope
New 1000 Gallon
Septic T nk w/DC❑'s
Decorumioned Old
Septic Tank
PER UP
Flat Slope
No Conflict
Septic
CHUGACH PARK ESTATESI 1" = 50'
BLOCK 1 LOT 11 RECORD
WASTEWATER UPGRADE LAYOUT
REPLACE SEPTIC TANK 6/3/21 z of 3
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N89'58'34"E 320.20'
(N90'00'00"E 320.00' R)
10' UTILITY ESMT
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t HAUS
l,az
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CA
LOT 11
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L 55. WELL
R=50 SHED
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\Cys L=15.50'
R=20.00'
7.
L=15.97'
R=20.00'
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
CHUGACH PARK ESTATES FND 5/8" REBAR
LOT 11 BLOCK i PLAT 72-188
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a �•`�i 0 F AL 1, "'A' I'p R Ley
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should I :' 49Ta
any information on this drawing be used for construction of Fences, • • , • • , , , • , • , • • , • • , , • ; • • • . .
structures, improvements, or for establishing boundary lines.II
IIIA
EXCLUSION NOTES: It is the owners responsibility to determine ' ' :" ..• . • . -' . ' ..• .. • •.
HN L. SCHULLER; °
the existence of any easements, covenants, or restrictions which p, �2�
do not appear on the recorded subdivision plat. ����@h'. LS -10408 ��./ +�' "1$1 T�eetAa Street
WORK ORDER NUMBER: DAIS SCAM- E- MU N �' r"7
It rr •3.... a Anchorage, Alaska 98508
MAY 30, 2021 1"=50' sct ulleroak.net , A ['
21— 0 54 DRAW Ur. crqE� 6 OW " � "0a �; O f es8iflrtipl L� X907] 227-1455 office
JL5 NW1161 210158 (907) 274-4992 fax
Y/207
MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program S
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite
I)t•I,artni nt
4 NCHOP AGE
On-Site Wastewater Disposal System Permit
Permit Number: OSP191114 Effective Date: 4/23/2019
Work Type: SepticTank Upgrade Expiration Date: 4/22/2020
Tax Code Number: 05148144000
Site Legal Address: CHUGACH PARK ESTATES BLK 1 LT 11 G:1161
Site Mailing Address: 24217 PLATSEK DR, Chugiak
Owner: OZMENT CONNIE J Lot Size in Sq Ft: 55830
Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field C✓I Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: Please show the 10 ft drainage easement along the west property line on the record
drawing.
--upr 7°-47 cis
Received By: Date:
Issued By: trl�'Wf�3ri i� Date: 1/417/7 7
MUNICIPALITY OF ANCHORAGE
Development Services DepartmentPhone: 907-343-7904
On-Site Water & Wastewater Section " ) Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-481-44
Property owner(s) Ozment Day phone 406-7065
Mailing address 24217 F atsek Drive
Site address same
Legal description (Sub'd., Block & Lot) Chugach Park Estates BLK 1 LT 11
Legal description (Township, Range & Section)
Lot Size 55,830 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(Z all that apply)
Absorption Field ❑ Initial I I Single Family (SF) x
(w/wo ADU)
Septic Tank ❑ Upgrade EDuplex (D)
Holding Tank ❑ Renewal C e
Privy LJ uPrivate Well ❑ Ritpiff ,-,Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FO
A'
``91 8 L , Bance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
,.011110P' i/
(Sig•ature of property ow er or authorized agent)
Permit/Rush Fees: V9-5 Waiver Fees:
Date of Payment: 14l11I 19 Date of Payment:
Receipt Number: Qq/Q9D Receipt Number:
Permit No. QSPAlit'-1 Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
NICRTERI
ENGINEERING SteveEng.com
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 4/17/19 Number of Pages:
To: MOA On-Site Services
Subject: Chugach Park Estates Block 1 Lot 11
Septic Tank Failure
The subject septic tank has failed- a new tank will replace the old one. The existing trench appears
to be working OK. Please issue a permit so the tank can be replaced. The existing trench will
remain. Please review as soon as possible.
If there is need for additional information or clarification please give me a call.
Thanks-Stev
bTFIM
ENGINEERING SteveEng.com Chugach Park Estates Block 1 Lot 11
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 3-bedroom home. Most of the neighboring
lots are developed. The current septic tank has failed- the trench still functions. These lots
are over an acre and are served by the private water wells.No adverse impacts are expected
from tank replacement. The easements are depicted on the lot. The slope is indicated in the
area of the septic system.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications(AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• New 2- compartment, 1000 gallon septic tank. Watertight couplings on inlet& outlet.
• 5' minimum between the tank and trench. 10' to property lines.
• 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot
soil cover. Minimum of 2' soil with insulation. Tank& solid pipe must be set on well
compacted, stable soil.
• 4" diameter cleanouts with airtight caps are required 1' to 4' from foundation wall,
prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10' from
the tank positioned to provide cleanout access towards the tank and towards the
absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
s�`I.�,:•. _..,..,off••• j V},
C• 2 " •••,
• C �i
vICYCn Eng • CCJ�
• V� •o PG 256
q�`� OA �,j /7/f���d
DESIGN NOTES:
1. Existing Trench Remains In Place.
2. Sewer Service Line minimum 2% slope.
3. Replace Septic Tank/Decommission Old Tank Per UPC.
Connect New Tank To Existing Trench.
4. Lots Served by Private Water Wells.
5. No Conflicts Within 200'.
6. Check Condition Of Sewer Service Line— Replace If Necessary.
7. Add Double Cleanouts Before Tank If No FCO.
30% Slope
\ \
30% Slope
\ \
30% Slop _ 10' Utility Easement
\
30% Slop
Flat SlopeAlikk
Flat Slope
Trench Location
3 Bdrm
No Conflict • d o
d Septic
Flat Slope
Q
`G
Flat Slope
O We" New 1000 Fallon
Septic Tok w/DCO's
R10. Decornrniss on Old
Septic T. k No Conflict
PER UPC
Platsek Drive
Flat Slope
400,4610004414. I
NORTHRIM �P�� CHUGACH PARK ESTATES
ENGINEERING I*.49E1 * DESIGN
SteveEng.com $ �; BLOCK 1 LOT 11
PO Box 770724 stew awLAYOUT
Eagle River. Alaska 99577 • x-4234 .• ' WASTEWATER UPGRADE
907.694.7028 Y' I ' REPLACE SEPTIC TANK b'''.4/17/19 �2 0 EETcf 3
Foundation Cleanout j
/ Tank Cleanouts
Fin ^amide Opposing Cleanouts Between Septic Tank & Trench
4 Foot Cover /tel
or Equal
r--
r•----..-
1000 Gallon To Trench
SEPTIC TANK
MOA-Approved
L Pipe
Match Elevations To
DESIGN NOTES: Existing FCD & Line
1. Use Existing Trench.
2. Septic Tank & Solid Pipe to be Placed on Compacted,
Stable Soil, Free from Boulders.
3. Sewer Service Line is Minimum 27. Slope & 3' Cover.
4. Water-Tight Couplings.
5. See Specification Sheet.
6. All Work To Conform to Municipality of Anchorage (AMC)
Requirements & Specifications.
7, Decommission Old Septic Tank Per UPC.
8. If No FCD, Install DCD's.
NOR THRIM .• of %4
ENGINEERING *�4: i. *s SEPTIC TANK PR❑FILE CHUGACH PARK ESTATES
SteveEng.com ,••• • A. ,
Po Box 770724 v..'• Stow Eng .: V BLOCK 1 LOT 11
Eagle 07 .694.7028 River. Alaska 99577 .1'444 L (��fif a" TANK REPLACEMENT Dote[4/17/19 roBY: SE Scale:
1- = 5 SHEET:3 of, 3
IDwn
I I SE
' ~UNICIPALITY OF ANCHORAGE
Heal_ , and Environmental Protec
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
,INSPECTION REPOR! ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL
tl'q 51 DE LEfqQTH ___
MA¢,,;UFACTURER M,ATERIAL _2t_ "~ COMPARTMENTS
INSIDE V','IDI-H "'""-' LIQUID DEPTH ...... LIQUID CAPACITY/g')g'j(] GALLONS.
TILE uR>,,i['4 FI /
TOTAL LENGTH -
,- / ~,~? /z OF LINE
~ of Lines .... f ~ DISTANCE BETWEEN LIPJES TRENCIt WIDTH IN. TOTAL EFFECTIVE
ABSORF'7:O;; At, E* _~~: SQ. FT. LENGTH OF EACH LINE ~ /
DEP7}t: SOF OI; TILE q O FiNISt4 GRADE O / DEPTti OF FILTER
MATERIAL GENEATH TILE__,~' / IN. ABOVE TILE ~' .IN.
SEEPAGE PIT:
DIAMETER __OR WIDTH____ LENGTH ., DEPTH
Log Crib Rings Crib Size: DIAMETER DEPTH O STANCE FROM: WELL
- TOT FFECTIVE
BUlL DING FOUNDATIO"',I___ NEAREST LOT L,NE__~--.~. O~'RPTION AREA (WALL AREA)
.---: .... -:.~_-=.::-: ...................... _C.¢_ ~f;
Well
O a,s:
Well Distance To: Lot Line
Bldg: ~¢ · Sewer Line:
Pipe Materials:
~ of Bedrooms: ~ '
Installer:
Remarks: - ~
._SQ. FT.
i,! "H ! {"i U,i -," '::r..'i"6 :-,if:t::' F!:;i::'"" .Jli::'l-::' '-. I:::~ ., Ii!fl.. i. i:::ii',t[':~ :::iiq'-P ("!l",i--'.ii!; ii' "!'E; qt:::'f.,.iF:if]!ii; ii:' T
.............. ~""' 'iTM Mi:ri ~ Oi:' ::;:'P:!¢:! i;:i::.T!i' i:::'i't!:;? F~ i::'i ii::;i T ('[: HE]!...!
'1 ~;::!F~ i:'i:i!'E:;T r"! ii'< r" I'", .... .
F'!"i't-..iF:i~;? i:;~i~ii'i':;li i't :;Ni:'i'1i;::'i'-,i"? ';5 !"!i:::!M i:::!~:' ;'> ~-r' !i;Pt~)R: J i;:; l(2F:l"i' ]' i'li'.iq I:::!1',i1";' il l' i'tS"!'!;~'i Iii:
6¢,,,h;:! TI RI!!N. !::{ 'ii' 'i '.,i':::;t i.~;?P i-:'!:;i'Oi:::' !:( :;: i' Hii!!;TF:!i..i...F:!"[ ii Cfi',!
Depar tree
MUNICIPALITY OF ~CHO~GE
of Health and Environmental P
~ection
Performed for
Legal Description
SOILS LOG
PERCOLATION TEST
JB #77-8
Bill Sullivan Date Performed
Block 1, Lot 11, Chugach Park Estates
5/17/77
6
O'
~ · 10
14
16
Red-brown, clean, sandy gravel (GW)
with cobbles to six inches
2
Perc rate = 85 ft. /bdrm.
Red-brown, clean, gravelly sand (SW)
Perc rate = 12 ft.2/bdrm.
Total Depth = 16 feet
No water table encountered.
AVERAGE PERC RATE FROM SOILS LOG = 95 ft.2/bdrm.
Date Net Time Depth Net Drop
Percolation Rate minute
Per formed By ~~ ~f~, ~H~/~PION DRILLING C0~ANY, INC.
PERN! T NO.
APPLICANT C~H~RLES,,,~U~LIVRN~
LOCATION PLRTZEK DR
LEGAL Lii Bi CHUGIRK PK EST
MUN I C I PAL I TY OF RNCHORRGE
DEPARTMENT 0~ HEALTH AND ENVIRONMENTAL PROTECTION
2518 E. TUDOR RD. .. RNCHORRGE.. AK. ~507
276-222i
WELl-- PERM 'r 'T
( 76iBi >
P 0 BOX 272 - CHUGIRK
688-2759
LOT SIZE 55850 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR R PRIVATE WELL OR 288 FEET FOR R PUBLIC WELL.
WELL LOGS RRE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
PERM I T ~AL I D FOR ONE YEAR FROM ISSUE
I CERTIFY THAT
i' I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE ~EWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED'__ - ~
ISSUED BY ..... DATE_
ENVIRONMENTAL PROTECTION Dy
APR ! 'i lS7X A & L DRILLING COMPANY
RECEIVED
BOX 97, EAGLE RIVER, ALASKA 99577
OWNER OF LAND ~H~q~.£5
ADDRESS
LEGAL DESCRIPTION
DATE-Started /~/d///7
· TELEPHONE 694-2588
DEPTH OF WELL O 7 7'
STATIC LEVEL OF WATER FT.
DRAW DOWN FT. 30 !
GALS. PER HR 3000
KIND OF CASING ~.; ~O
KIND OF FORMATION:
From ~ Ft. to ~ Ft. Oo~'~ 8odt9£~
From ~ Ft. to 70 Ft. ,~/~l~j~ ~- ~~
From 70 Ft. to ~J Ft. ~&~ ~' ~~
From ~/ Ft. tog ~ Ft. ~
From ~ Ft. to /~- Ft. ~~,/~O~c
From j~C Ft. to lq0 Ft. 5~O~do~'c
From_ {~0 Ft. to [~ Ft. ~oZ C'dt~
From Iff~ Ft. to ~/~ Ft. ~0 ~/ (~ b~
From ~)/3- Ft. to c-)go Ft ~ t ~ff~vZ~
From ~ Ft. to ~6~_Ft. qa~ 6~,~a~ ~0o~O~
From ~6~Ft. to D73 Ft. ~wO 6~ ~ ~F~
From ~)7~ Ft. to~ Ft. ~'~ ~ ~Z~
From .Ft. to~Ft
From Ft. to Ft.
From Ft. to__Ft.
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft.
From__ Ft. to.__Ft
From__ Ft. to__Ft
From__ Ft. to.__Ft
From Ft. to Ft
From Ft. to.__Ft
From__ Ft. to Ft,
From__Ft. to Ft.
From__Ft. to Ft.
From__Ft. to.__Ft.
From__Ft. to Ft.
From Ft. to Ft.
From__Ft. to Ft.
From Ft. to Ft
From Ft. to__Ft
From Ft. to Ft.
From Ft. to Ft
MISCL. INFORMATION:
DRILLER'S NAME · '
MUNM�PAUTY OF ANCHORAGE
Development Services Department r Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I. D. 051-481-44
Certificate of On -Site Systems Approval
Expiration Date: l r 'cl— 2-1
1. GENERAL INFORMATION
Complete legal description CHUGACH PARK ESTATES BLOCK 1, LOT 11
Location (site address) 24217 PLATSEK DRIVE, CHUGIAK, AK 99567
Current property owner(s) CONNIE OZMENT I Day phone
Mailing address PO BOX 671527, CHUGIAK, AK 99567
Real estate agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 550 Waiver Fee $
Date of Payment/Z6/-�2 b,a 1 Date of Payment
Receipt Number. 21 (0 2 91 Receipt Number
COSA # OS C a 1 1) t 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 5/24/2021
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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 in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to + pF A,��1��
these various and dynamic characteristics and are outside the control of the evaluator of the �q
well and septic system. Therefore, any estimate of how long a system will function satisfactory ..
for current or future occupants or guarantee that no unseen encroachments, deficiencies or JJ
discrepancies exist can be given by First Water Consulting & FWr.5 ' / * • Q TH .......*
•
6. DSD SIGNATURE? r Curtis Huffman /
System #1 Approved for J bedrooms ����sT. ,CE128991
System #2 Approved for bedrooms >> PROF S ONP
Disapproved
Conditional approval for bedrooms, with the following stipulation
ea,S e err I~f IOk
�� u� ���P�ITY�pF���ii,
2 v-�:!A``� `�
WATER E
ATER _
A lt4
9J� SERVIC�S�,�
v� Original Certificate Date: 'C�, — Cy 2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: CHUGACH PARK ESTATES BLOCK 1 LOT 11 Parcel ID: 051-481-44
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 12/23/1976
Total depth 278 ft
Cased to 40+ ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 5/17/2021
Static water level at beginning of test 159 ft.
Well production at time of test 5+ gpm
Comments
B. TANK DATA
Age of tank(s) 2 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 50"
® Standpipes/foundation cleanout per record drawing
Date of pumping 5/1712021-
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/8/1977
® ALL standpipes present per record drawing
Total measured depth from grade 13.3 ft (max)
Measured depth to pipe invert from grade *7.4 ft (min)
❑ N/A - pressurized field
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® Nc
® Coliform bacteria is Negative
Nitrate 1.49 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
FW
Collected by 2__
Date of Sample 5/17/2021,
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 5/17/2021
Results r;� Pass For 3 bedrooms
Fluid depth prior to test 2 in
Water added 510 gal
New depth 7 in
® Monitor tubes go to bottom of effective. If not, state
depth into effective 5.9' INTO THE 8' ED
Elapsed time <20 min
® Code -required soil cover over field
Final fluid depth 2 in
❑ System presoaked
Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons
If yes, enter date
FWD
Comments/Deficiencies: *SUMP INVERT
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
® Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® 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
From Absorption Field on Lot
to: (Please enter distances
if
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® 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:
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
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
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
low
®
• Curtis Huffman
��� �'c"c�•.. CE 128991����
JlF�•.�5/28/21..•�.
��>�F�pROFESS10�4 ..�
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as o~' Ihe valk~ation da{e shown below. I verify that my Investigation,
based on procedures outlined In the Health Authorily Approval Guidelines for this application, shows that Ihe
on-site wa~er supply and/or wastewater disposal system Is(are) safe, functional and adequale for Ihe number of
bedrooms and type of structure indicated herein. I [urfi]er Verify that based on Ihe Information obtained from Ihe
Municipality of Anchorage flies and from my tnves{iga[ion end Inspection. Ihe on-site water supply and/or
wastewaler disposal system is(are) In compliance Wilh all applicable Municipal and State codes, ordinances.
and regulations In effect at Ihe lime of Inslallafion.
Name of Firm s & $ FnF~neerin~. "
Address17034 N. EaRle River Loop Ste.
Eng{neer's Printed Name Robert C. Cowan
DSD SIGNATURE
~ Approved for .'~
Disapproved.
Conditional approval for
bedrooms.
Phone 696-2979
20/4 EaRle River, AK 99577
¥%%
bedrooms, with the following stipulations:
Additional Comments
Altachments:
HA,& Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
O~her
Odginal Certificate Dale:
cf_/ 1-o
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewa~r Program
4700 South Bmgaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchomge.ak.u$
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
A, WELL DATA '-'.
Well type '~:::; If A, B, or C provide PWSID # --' Well Log (Y/N) ~
Date completed17 1 5/ sa.a./,MI (Y/N) 7' Wry, property protected (Y/N) ~
Totaldepth ~"~ft.' Casedto_~_~ Casing height (above ground) /_~:~ '(-lin.
FROM WELL LOG
AT INSPECTION
Static water level ft. ] (,o I ft.
Well production ~ gp.m. 4- ~ g.p.m
WATER SAMPLE RESULTS:
Coliform 0 .colonies/100 mi.
Arsenic: '-" mg./I.
Nitrate ~/~,~g./I.. Other bacter~ / colonies/lO0 mi.
Date of sample:~_.~ Collec~ by:
e. SEPTIC/HOLDING. TANK DATA .
Tank $ize~,~._mgal. ' .:.Nu~.ber of Compartments ~=. Cleanouts (Y/N) Y
/
Foundation cleanout (Y/N) ~/.":' D~xession over tank (Y/N)
Date of ~um,Pin'g q/4/~_~..-' !. Pumper J~-~'
C. ABSORI~TION FIELD DATA ~
High water alarm (Y/N) ~
Date install~l Soil rating (g.p.d.lft2 ~ ~.~ System type ~TJC
Length 3r~' · .E ~ ~ fl. Gravelbe~ pi~ ~
T~ldep~ 15 E Eff. a~nam~ Mon;rin~ / Depr~ion over fieldr
Fluid dep~ in aborn ~eld ~r, te~ ~ in. ~r add~ ~gal. N~ de~ ~in.
Elapsad Time: ~ ~n. Fina ,ud depth~ in. A~o~,on rate >= 4~ g.p.d.
Any rejuvenation ~nt (~st 12 ~.) (Y/N & ~) ~ I~ yes. give date
Do LIFT STATION
'Pump on level at _7/__ in.
Datum /
E. SEPARATION DISTANCES
Size in gallons
'Pump off' level at
Cycles tested
Manhole/Access (Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanlUliff~ on lot
Absorption field on lot
Public sewer main
~'~septic sewice line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding lank
SEP~TION DmANCES FROM SE~nC~OLO~.G TANK ON LOTTO:
Wel~ on adjamnt ~ / ~ / ~
SEP~TION DIST~CE FROM ~OR~ON FIELD ON LOT TO:
Pm~ line / ~/~ Build~g ~unda~n / ~ ~ Wa~r main
Wa~rSe~mllne /O I~ Su~r /~O ~ D~y, paffi~hides~mge
Cu~in drain ~&~ ~,"s on .dja~nt ~ ~¢
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined througJl field inspections and
review of Municipal records that the ebove systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's printed Namert ~'4-~- ~' ~' -
Date '~/~ f / o -,-
HAA Fee $ 3 ? 3"'. o,,~
(~v. 1~1)
Waiver Fee $
Date of Payment __
Receipt Number
,)
~UG ~B ~002 1~:54P~
HP LRSER3ET ~00
p.t
. .-.. · · i aSSOfi~A~s s~w'Y~d
ASBUILT .... ~ 69t~ 08~9
I HE'REDY. CEETI'F~' .'I'RAT I HAVE SURVEYED TI~E'. ~E~/~_. ~ " .,.'-'~,.
'OWN~ To D~INE ~'-~qOF ~' ~; ~lp,' "'";~/ ...... ~/~ ~
WH ~ ~ NOT ~E~ ON THE RE~'~I~."~ '"::;~ ' ~~~~ ~ '5 · ~'} ~--~ / ~ ~
VISION P~.~UND~'NO BIRCUMSTANCES"'S~ :[~} '" f~.. [s,69la ,.. ~
~ .,~, ,~m~;'.~.us~ ~o, eo:~smm'o, ~? ~::,.?-r~ '-~;~... ........ ..'~;~
OF FENCE LINES,' OR FOR E~LISHING ~ND'.~ ~u, ~ ' ~ ~
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # C":~'~ - t_\~\ _ Li ~t
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lOt, block, subdivision, section, township, range)
Lot 11; Block I; Ch~ach Pa~k Estat~
Location (address or directions)
(b) Property owner A~asha USA F.C.U.
I.D.# 148
Mailing Address
P,O. Box
Telephone · (home) Business
196613 Anchorage, Ak. 99517
(c) Lending Institution
Telephone
Mailing Address
(d) Real Estate Company and Agent
Telephone 694-4200
(e) Mail the HAA to the following address: (or check here,'i~ if hold for pick up.)
List contact person and day phone number below:
~i & $ ENGINEERING
17034 I~aa. ta Ri.vet
~a~lle River. Alaska 99577
2. TYPE OF RESIDENCE
Single-Family ~x. Number of bedrooms --~ '.4
3. WATER SUPPLY
Individual Well
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site E~x. 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.
72-025 (Rev. 7/88) Page 1 of 2
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
Address
Date
Telephone
S & S ENGINEERING
Ea~l~ [~.iver, Alaska 99577 ~ -'~,.'2.-- ~ '~' ~
6. DHHS APPROVAL
~Approved for_ ~ bedrooms by
Approved i~-Disapproved
Terms of Conditional Approval
~-~ ~l-/--f Date
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back
Page 2 of 2
',"~ MUNICIPALITY OF ANCHORAGE (MOA)
...:J'~j~ Health Authority Approval (NAA)
~-;' &~"~,~,'~ CN CHECKLIST - FEBRUARY 1984
~.;~? ? ,~.%"~ 343-4744
A. WELL DATA
Well Classification ~..~,~'~ (C~ ~'~N~I )1,~ If A, B, C, D.E.C. Approved (Y/N)
~ I
Well Log Present (Y/N) L/ Date Completed (~ -_-~_-~ -- "7.
Total Depth,2.'lT"z ~Cased to '~/0 Depth of Grouting
Static Water Level ,/ ~ .'~ Pump Set At
Casing Height Above Ground / -~.
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
Yield O p M
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
; On Adjoining Lots
/ OO '/- ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ~.. -~''~'~' Size
Standpipes (Y/N) t.1
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
I ¢:)~20 No. of Compartments ~-~
Air-tight Caps (Y/N) c~ Foundation Cleanout (Y/N) ~,
/~J Date Last Pumped ~_ ~ / ~ -- ~O
,
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well / ~ '/- To Building Foundation
To Property Line .~ O ?L To Disposal Field
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments ...~ ~_.~) "~/~...
r
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
B ~ ~¢a//~3~. Type of System Design "T-"~..~A.~--..~
~ - ~ - '~- 7 Length of Field
_ Depth of Field ! 2..
·
Gravel Bed Thickness
__~-'~O ~ Statndpipes Present (Y/N) I.1
/0 Date of Last Adequacy Test 2. - /~'-w
I
SEPARATION DISTANCE FROM ABSORPTION FIELD:
·
To Water-Supply Well [
To Building Foundation
Lot ~U/~/::~'
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
; On Adjoining Lots
To Cutback (if present)
!
f '1-
To Existing or Abandoned System on
/
/oo
!
Comments
D. LIFT STATION
Date Installed t~
Size in Gallons
"Pump On" Level at
High Water Alarm Level a r~
Tested for ~'XJ '~-'"~
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HA,
inspection.
Signed
Company
Date
MOA No.
$ & S ENGiNEERiNG
17034 Eagle River Loop Reid No. 2134
Eagle
River,
Alaska
9957]Z--- 7-7_ -
Receipt NO. c>~
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
k~.-g~k; ines in effect
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
on the date of this
Engineer's Seal
' ' ' ~ ' ' DATE RiZC~EIVE'6
TIME TIME TIME ,.
DATE DATE DATE
INSPECTOR
NS, CTO NS. CTO
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~IRONMENTAL i< OTECTJON
ENVIRONMENTAL SAN ITATION DI VISION
Telephone 264-4720 RECE! ED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proceed. Please allow ten (10) days for processing.
MAI LI N~A~R ESS ·
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER ~ ~ ~/ PHONE
MAILIN~ ADDRESS
3. LENDING INSTI N
~ - PHONE
MAILING ADDRESS
4.
MAILING ADDRESS
Ii. LEGALI~S~PTION t I (r"~ tO (_~C~
STREET LOCATION
6. TYPE OF RESIDENCE
[] MULTIPLE FAMILY
¢._ h,_.,3,.-,,: k.
NUMBER OF,,BEDROOMS
[] One [] Four []
[] Five
e [] Six
Other
7. WATER SUPP~,~Y~ [~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~"~DI V I DUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE [] OTHER
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: ~ OL~ If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
PERMIT NUMBER
DATE INSTALLED ~ ~-- (~ ~- ,-.~..~
INSTALLER
SOl ES RATING
MANUFACTURER
MATERIAL
Septic/Holding Tank Absorption Area ISewer Line
I
INearest Lot Line
5. COMMENTS
DATE
~PPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)
MUNICIPALITY ~F' A~CHO~GE
~U~ICI~A~ITY OF A~CHO~AGE DEPT, OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL PROTE~ION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION 0CT~ 1978
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proces~d. Please allow ten (10) days for processing.
1. PROPERTY OWNER ~ PHONE
PR~RTY RESIDENT Jif diff~t from a:o~e~ ~ /
2. BUYER ~ / ~ ~ PHONE
MAILING ADDRESS
3, LEN~IN~INSTIT~TION ~ j ~ PHONE
MAILING ADDRESS
STRE CA'fl, -FV ' :
6. TYPE OF RES~CE - ' -
AU LY
NUMBER OF BEDROOMS
[] One [] Four
Two [] Five
Three [] Six
[] Other
7. WATER SUPPLY
~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to__that date, give well
depth (attach log if available.) ~ ~v/~)
8, SEI/~DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY
**If individual/on-site, give installation date '-~ ?
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
FIME
INSPECTION APPOINTMENTS
TIME
DATE RECEIVED
TIME
)ATE DATE DATE
I NSPEOTOR INSPECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified__
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: i(~ ¢-~(~ If Tank is homemade
give dimensions:
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SiX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
MATERIAL
[] OTHER
Septic/Holding Tank
IAbsorption Area
lSewer Line
INearest Lot Line
5. COMMENTS
[~APPROVED FOR _ _"~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
BY (Title)
LEGAL DESCRIPTION
72-01 0 (Rev. 3/78)