HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 10H LT 9A Municipality of Anchorage
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage,AK 99519-6650•http://www.muni.org/onsite•(907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181324 PID Number: 020-581-35
❑ New ✓❑ Upgrade
Name:
JAMES&AMY STEELE ABSORPTION FIELD
Address
El Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
17150 NICKLEEN ST ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
RABBIT CREEK VIEW& HTS 10H 9A Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic !AbsorptionHolding Sewer Total absorption area Number of trenches Dist.between trenches
From
Tank 1 Field Lift Station Tank Line Ft2 Ft.
Well 101.8 I TANK (]Septic ❑S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
ANCHORAGE TANK 1000Gal.
Surface Water 100+ i
Material Number of compartments
Lot Line 23.9 ` NA STEEL 2
Foundation 10.0 i LIFT STATION
I Manufacturer Capacity
Curtain Drain 50+ Gal.
Remarks Pump on level at Pump off level at High water alarm at
TANK REPLACE ONLY
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to 3034
Installer drainfield
WILCO CONTRACTORS Drainfield 3034 CO/MT 3034
Inspector PANNONE ENGINEERING SERVICES BENCH MARK (Assumed elevation) 1505ft
Inspection 1�' 9/14/2018 ro Location and description
dates: 2 9/18/2018
3""— 4,h — AT HOUSE POINT A
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
�lk
Conditional Approval: Date .r oF At•!4S, xl
. r
•
Steven . I�onnorae Al
ti�t4� CE•8149 �
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Approved _ \( Date _I �� A.�
Inspection Report_1-1-12.doc
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. ' 1I - I —WELL (E) ORTh I SCALE 1-.60' .
10'Else&T Eamt\\\ . — _ ORIVEWA
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1 I W
LOTS TO WEST AND SOUTH DCO REMOV D SEPTI TANK I
NOT DEVELOPED �r��� PLACE CAP ON END OF W
M _�� LINE IN FIELD I J
I 23.9 38R— —� 4
Y
8 SFD Q� U
INSTALLED 1000G SEPTIC TANK a Z
W/ FC BEFORE & DCO AFTER TANK I T2 ?1\_FCO ' I. - 1
1 1 V 1 .
1oi.s 9
A B7 ,
7
WELL (E} ` 1
FC 6.0 22.8 ' WELL (E) 1 1
T1 1 .3 22.2
T2 21.5 24.0 IlI
DCO 23.6 26.6 --
— . 1 • • - . . . -. I
—w —w __ WATER LINE/ a o0 p
WELL RADIUS z Q Q < m z
—ss ss - NEW SEPTIC o o-1
EL.1500
4.0
ABBREVIATIONS , -- ! 1
TH TEST HOLE / 1000 g SEPTIC
(P) PROPOSED 1495.4 /
(E) EXISTING TANK (P) 1495.2
CO CLEAN OUT NO.
FC FOUNDATION CLEANOUT
FS FLOW SPLITTER PROFILE
MT MONITOR TUBE NO. SCALE:NTS
TYP TYPICAL
NOTES: PANNONE ENG SVC LLC Date
RECORD DRAWING 9/22/2018
P.O. BOX 102954 ANCHORAGE, AK 99510 �' ••"'
PHONE (907) 272-8218 FAX (907) 272-8211 e• 1-••_tiy Scale
*. 11' .'�' 1"=50'
'• 416t��� ••• P.I.D. NO
.RABBIT CREEK VIEW & HEIGHTS B1OH L9A • 0-581-35
JAMES & AMY STEELE "kteveri'A.'Pcnriaie' PERMIT NO.
DRAWN ACP 17150 NICKLEEN ST tr �,'� OSP181324
ANCHORAGE, AK 99516 ' ::�, •.•••. • , iSheet
20F2
r 00 MUNICIPALITY OF ANCHORAGE•
enr
On-Site Water&Wastewater Program 1e m So,
-ahme\ PO Box 196650 4700 Elmore Road
! Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax: (907)343-7997 r,
w
;I"... / httpa/www.muni.org/onsite :.
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4 'CHOR�G6
On-Site Wastewater Disposal System Permit
Permit Number: OSP181324 Effective Date: 9/12/2018
Work Type: SepticTank Upgrade Expiration Date: 9/12/2019
Tax Code Number: 02058135000
Site Legal Address: RABBIT CREEK VIEW& HEIGHTS BLK 10H LT 9A G:3341
Site Mailing Address: 17150 NICKLEEN ST, Anchorage
Owner: STEELE JAMES A& AMY M Lot Size in Sq Ft: 19802
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 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
Received By:( Date: I I a
Issued By:
ei
�� Date:
PLANS
MUNICIPALITY OF ANCHORAGE
•
Community Development Department a rr Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 020-581-35
Property owner(s) JAMES & AMY STEELE Day phone
Mailing address 17150 NICKLEEN ST, Anchorage, AK 99516
Site address 17150 NICKLEEN ST
Legal description (Sub'd., Block& Lot) RABBIT CREEK VIEW & HEIGHTS B1 OH L9A
Legal description (Township, Range & Section)
Lot Size 19,802 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy n (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE 1 WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 26 Waiver Fees:
111[11?
Date of Payment: �l [IL II? Date of Payment:
Receipt Number: 0/1354 Receipt Number:
Permit No. 03P(2 )32q Waiver No.
Permit App__-:•.....'c
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181324, Rebecca Carroll, 09/12/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181324, Rebecca Carroll, 09/12/18
MUNICIPALITY F ANCHORAGE
Development Services Department `�'�
P P Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-581-3
1. GENERAL INFORMATION
Expiration Date:_ �r3 - Z522
Complete legal description RABBIT CREEK VIEW & HEIGHTS BLOCK 10H, LOT 9A
Location (site address) 17150 NICKLEEN STREET, ANCHORAGE AK 99516
Current property owner(s) ESTINE RUSK & SAGE NEWCOMB Day phone
Mailing address
Real estate agent
17150 NICKLEEN STREET, ANCHORAGE AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
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 $ 5569 Waiver Fee $
Date of Payment/1Zgl22 Date of Payment
Receipt Number 00'3 2.0 y Receipt Number
COSA# 05G22102.L-� 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 1/27/2022
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
;4 or—
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory ��g�P: • • • • ��
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting& FWCS / *• 9TH
F .. ........
6. DSD SIGNATURE •' . • "'
• • Curtis Huffman
System #1 Approved for bedrooms ����F631'- CE 128991
�Fp'•.1/27/?2••F� r
System #2 Approved for bedrooms ,l,F�PROFESSIONP��
Disapproved
Conditional approval for bedrooms, with the following stipulat;�`�P���Y tOFf ,�,�/�����
J • N - 8 11 E
WATER AND m
WAST`_V%TATER oz
PROUKAM
O�
'ANTS E
Rv\G�5
Certificate Date: Z - < ^ 1027 --
Original
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: RABBIT CREEK VIEW & HEIGHTS BLOCK 10H LOT 9A Parcel ID: 020-581-35
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 7/9/1984
Total depth 130 ft
Cased to 130 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 1/25/2022
Static water level at beginning of test 23 ft.
Comments
B. TANK DATA
Age of tank(s) 3.5 years
Tank type/material SEPTIC f STEEL
Measured operating fluid level in septic tank 50"
Standpipes/foundation cleanout per record drawing
Date of pumping *TBD PREPAID FOR MAY 2022
Structure served by this system
Well production at time of test 4.6 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate 1.38 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by FIFE E
Date of Sample 1/21/2022
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments: *ATTEMPTED TO PUMP, BUT COULD NOT
DUE TO WINTER CONDITIONS. <6" SOLIDS.
D. ABSORPTION FIELD DATA (UPPER / LOWER TRENCHES)
Which system tested (date installed) 7/21/1982 Adequacy test date 1/26/2022
® ALL standpipes present per record drawing Results M Pass For 3 bedrooms
Total measured depth from grade *8.3 / 6.0 ft (max) Fluid depth prior to test 17 / 1 in
Measured depth to pipe invert from grade *6.1 / 6.7 ft Water added 450 gal (300+ GAL ADDED TO TOP TRENCH)
(min)
❑ N/A — pressurized field New depth 30 / 7 in (2" INTO LOWER LATERAL)
❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min
depth into effective "LOWER TR: 0.4' OF THE 2.5' ED Final fluid depth 16 / 1 in
® Code -required soil cover over field Absorption rate 450 gpd
❑ System presoaked Any rejuvenation treatment (past 12 months) N
(Required if vacant for greater than 30 days prior to
date of test) If yes, enter date
Gallons introduced gallons FKS
Comments/Deficiencies: *AT GRADE. **PER ELEVATION SHOTS (CO/MT) OF EACH TRENCH
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
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances
if
less than required)
Manure/Animal Excreta Storage > 100'
Building Foundation > 10'
Community Sewer Main > 75' ®Yes
_
if No
ft
®Yes
if No
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
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells >' 100
_
®Yes if No
Water Main >.10'
Yes
if No
ft
Community Wells > 200'
ISI Yes if No
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
l certify that / 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.
•••
.. ................
Curtis Huffman /s
��j o'c��/•.' CE 128991
12/22
� ROFESS14Na��c-o'er"..
ft
ft
ft
ft
ft
ft
ft
ft
EPLA t'JS
•
•
QL
Vit.
Municipality of Anchorage
•, i•e •
0'
On-Site Water and Wastewater Program
(907)343-7904 Lll ^
Certificate of On-Site Systems Approval
Parcel I.D. 020-581-35 Expiration Date: I " t 9
1. GENERAL INFORMATION
Complete legal description Rabbit Creek View & Heights B1 OH L9A
Location (site address) 17150 Nickleen St.
Current Property owner(s) James & Amy Steele Day phone
Mailing address 17150 Nickleen St. Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
O Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by; Date: ///0/
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5 2� Waiver Fee $
Date of Payment /4576. Date of Payment
Receipt Number 03s8,56) Receipt Number
COSA# 0 60 415-D S 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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R Pannone Date 9/24/2018
1
�.�. •
6. DSD SIGNATURE •••Ire • e
•System#1 Approved for 3 bedrooms %Steveri •.'Pannone• f
System#2 Approved for bedrooms �t • CE-8149
Disapproved Ikl RP SIC==
Conditional approval for bedrooms, with the following stipulations:
oF
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WP�ER ANO z.
o W�R001NWM �:
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MTS
By: d/ Original Certificate Date: lO-�^ 12
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
COSA blue sheet_E
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Rabbit Creek View & Heights B10H L9A Parcel ID:020-581-35
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log(YIN) Y
Date completed 7/9/1984 Sanitary seal (Y/N) Y Wires properly protected(Y/N) Y
Total depth 130 ft. Cased to 130 ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 7/9/1984 8/3/2018
Static water level U N K ft 20.5 ft.
Well production 4 g.p.m. 4 0 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 1 .37 mg/L
Arsenic ND ug/L Date of sample: 9/6/2018 Collected by: PES
•
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 9/14/2018
Tank size 1 000 gal. Number of Compartments 2 Cleanouts(YIN) Y
Foundation cleanout(Y/N) Y Depression over tank(YIN) N High water alarm(Y/N) N/A
Date of pumping Pumper NEW
C. ABSORPTION FIELD DATA
Date installed 7/21/1982 Soil rating (g.p.d./ft2 or ft2/bdrm) 235 SF/BORN System type 5 Wide
Length 90 ft. Width 5 ft. Gravel below pipe 2.5 ft.
Total depth 7 7 ft. Eff. absorption area 703 ft2 Monitoring tube Y** Depression over field N
Date of adequacy test 8/3/2018 Results(Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 26/0 in. Water added 450 gal. New depth 30/3 in.
Elapsed Time: 360 min. Final fluid depth 26/0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment(past 12 mo.)(Y/N&type) None Known If yes,give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YIN)
"Pump on"level at in. "Pump off'level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10+ Property line 1 0+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
Iv\CY 661rw, --o\ne.. e•x.ndc, -P\ppcoxi pixote\,1 I a' i f
6-'ca\c P`ck\ i b2\c \c\\ e r. - - .
G. ENGINEER'S CERTIFICATION ..e+~c .OF C\‘`�:416)(
kk
I certify that I have determined through field inspections and '""<P' •-•'.
review of Municipal records that the above systems are in v-Or: .• ' �i\ .�:�/0
conformance with MOA COSA guidelines in effect on this date. 0 =�S'� ip f
Engineer's Printed Name Steven Pannone '':S{eer•)2.•15anriorie.••d
Date
9/24/2018 Elk;-., CE-8149 �,,o'
COSA canary sheet_2.6-15.doc
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NOTES LEGEND i
1. Record information is from the plat of Rabbit Crk View and Rabbit Crk —— C
EASEMENT UNE —i�c—UNDERGROUND ELECTRIC
I leights Subdivision Replat(P2004-91). x REBAR W/2'RED COLLAR CAP —us—UNDERGROUND GAS LINE a
2. Easements of record created after date of filing of the record plat are not
® WELL LOCATION --P—OVERHEAD POWER UNE a
shown. q0., POWER POLE —< CULVERT a
3. Elevation datum is Municipality of Anchorage,1987. Comerelevations =
c
are top of rebar,which protrude approx.0.1'to 0.2'above ground. o:
4. RC record monuments are 5/8"Rebar WI 2"Red Collar Cap SITE PLAN a
5. The 1st floor overhang encroaches onto the easterly 10'property line LOTS 8A & 9A Block 10H v
setback 3.3'and the foundation encroaches 1.0'onto said setback. The
owner states that the MOA has granted a variance for the encroachment but Rabbit Creek View and Rabbit tr
a
no document proving this is the case has been presented. Creek Heights Sub division
SURVEYORS CERTIFICATE (P2004-91) C
I hereby certify that I hove surveyed the property and ♦+V\\ N
fccilities described hereon and that the improvements4. OF p ,, LOCATED WITHIN THE
situated hereon do not encroach on adjacent property. • \..•••..�.q%, LOCATED
W1/2 E1/2 OF SECTION 1, T11N', R3W, S.M., AK v
that improvements on adjacent property do not encroach Q'.••• S ♦ t
on the surveyed premises. end that here are no other a.Lj; �[{�'...,_7♦ ANCHORAGE RECORDING DISTRICT S
visible easements or rights-of-way. /*. TH J7�[ ` PREPARED FOR: SCALE SURVEY DATE: r
EXCEPT AS SHOWN OR NOTED HEREON 0..a• ! r C
0 t,• ki� Jim Steel 1" = 20' /6/ 7 0
EXCLUSIONS 0 Ora, 6321 Paine Rd. 9/23/18
No data presented hereon should be used for building � •• ROBERT T.KEAN •Y • Anchorage. Alaska 99516 DRAM BY: C
fences. or for locotingboundary lines. It is the . / w.0./F.B. C
responsibility of the wner to determine the existence of ♦ �� Na.3943-S NRS RTK W07102 L`
any easement or restriction that does not appear on the 1'O • '�IyA A.A. PREPARED BY: 9/25/18 W18103
recorded subdivision plot and to verify that oil improvements P4 �'EssicmA'
meet all covenants and zoning ordinances. �I/\\�11,� KERN & ASSOCIATES CHECKED BY: GRID:14 °
i `( )..E-1/Y1 ' /Z-1.v/�'l Anchorage. Alaska CANYON RO99516 AD 4
ROBERT T. KEAN. R.C.S. 3943-5 DATE RTK SW3341
[Vtt. JNIGIPAt. I'J Y OF !\N(]F!OHA(-;E
DFPARTMENT OF: HEAI~I~H G ENVI[~Oiq!~EI",~ J'AE PHOT]CTION
FNVIROIgMENI'AI_FNGINI~ERiNG DIVI~ION
825 LStreet-Anchorage, Alaska 99501 Teloph~nr~264--47~0
ON-SITE SEWAGE DISPO'SAt. SYgx'ltF, ft AND/OR WK! I. iNSPECTiON REPORT
MAI LING ADDRESS
LEGAL DESCRIPTION
NO. OF BEDROOMS
Absorption arca PERMIT NO.
.5..~- ~,,z o ~?,~
Inside length
Dwelling
DISTANCE TO:
No. of lines
/
~ op of tile to finish grade ~_~ !
Len§th
Type of crib
DISTANCE TO:
Class
DISTANCE TO:
Well F o u n d a-'~:~'i-o'~ ..... I ~i'M-c;;~Tl?t I i r'~e--~
~o'/-,',, ,~/~- ~/,~, ~ /,,~,~h~ I
Length of ea~t~ line Total lengtl~of lines Trench w;dth
Material benead~ tile
~O roches
WMth
Well
Depth
Depth
Cril) depth
Building foundation
Driller
Sewer tine
Building foundation
No. of compartments
,;.Z.
Liquid depth
PERMI F NO.
Liquid capacity in gallons
PERMIT NO,
] oral effective ab~.orption area
PERMIT NO.
'l-oral effeCtiVe 8bso;-ption aiea
Nearest Io[ line
SCl)tic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOl· TEST RATING
,2 3S~ L7 ~'
INSTALLER
4,4
~<~ /
APPROVED
DATE LEGAL
z/7 /z' //ts z io
::i:;'. ".Z, f::ti",!J:::' i'f-!!~: [%)I'TOP'! 0!::' i',.~!:: !i. NC'!::l'v'!:::iT:i:Ed",l ~".[N
............ "., ~,,, ,.., ~ ,! ",~I '~i ..... ~".*. 'ql-
'Fi. ii:' ~:i[;h:: '.,' ::::i !" ;:'P'".". i: :i;i; "!-! i!i~: H ;!; i''1 ..: HUH
i:::Ji',ii:::' !"HE leu::) i"i'OH .::)F::' '1 HE: ,~::;': :'?vU:i!' ?: ?',!
PERFORMED FOR:_
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Str,ot, Anchorage, Aleske 99501 2(14-4720
SOILS LOG - PERCOLATION TEST
?') , , !> ~- , - ,
J~_l~..~.,Jd.4_.._~___~.~,._, r~_,~.L] DATE PER FORMED:__
'~ ( LOG
p\ SO~LS
LEGAL DESCR PT
SLOPE
PERCOLATION
TES F
2
4
5
8
9
10
11
'12
13
14
15
16
17
18
19
.
WAS GROUND WATER
ENCOUNTERED?
IE YES, AT WHA'r
DEPTH?
Reading Date
Gross Net Depth to Not
Time Water Drop
20~
Al'ION RAI'E
f~ R UN BE TWEEN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20~
/t,E,C,,$,, II'lC,
~220 W, 25Ill, AxA.!~,IUL
ANCt'FAKAGE, AK, 9950].
LOT
'Ftl
6
7
9
11
1 2 '1
]4 -!
17
19
(FEET)
4
5
6
7
8
9-
10 -]
11
1 2
13
14
15
16
17
18
19
2O
SIGNED
SEND PAItT$1 AND ;3 WITH CARBON INTACT -
PART 3 WILl. BI: RI:TIJRNI:D WITH REPLY.
DETACH A~r~ f:lll::
DATE
/ //
OF
Department ~f Health and Environmental Prot,.
SOILS LOG
PERCOLATION TEST
Performed for
Legal Description
0
4
6
8
10
12
]6
Robert Randall Date I arformed 7/6/76
Lo't~ 9 & 10, Block 10, Rabbit Creek Heiq. hts Subdiw[sion
(See back for test hole location.
Organics
· Very moist, red-brown, silty, sandy gravel (GM) with
some clay.
Perc rate = 225 ft.2/~rm.
GM grading finer at -10 feet
Static water at -10 feet, most likely perched melt
I..":,EF'FIRTMENT CIF HEFILTH FIN[:, EN IR_I'-,tHENTHL FI-. TEL. TION
....... L _, FREET., RI'.,It'::HOF.:FiGE., Al.:::
F ERI'II T NO:
[.~R'FE: I .... UEr..
I-.IEIL L
F' EE F-': I'-1 .~ T'
RPF'L I C:RNT:
R[.',DRES$:
CONTF,::T F'FIONE:
L I or..tEL ',,,' LiF,'BRN
BO;.'--',
RNCHOF.'.RGE., RI,,.'.'
Z, 46-2:TZ.':8
LEGRL [:,ESC:R I F':
LOT SIZE::
_LIE,[*I ~ i=,ILN: RHE, E,I I" CREEK HTS.
SEC:TIOI'.~: :L TONNSHIP: :L'IN
21,"~C~L.-~3 ,::SQ. FT. ZF.' RCF.:ES)
LOT:
I;tFtNGE: 2:P.I
E:LOC:K: ::L~
I CERTIFY THRT
2[.. I I:.:I1',I FRHILIRF.' NITH THE REQUIF.:EHENTS FOF.'. ON-'.SITE SEI.,.IEF.:S RN[.', P.IELLS;; RS SET
FORTH B'T' THE HUNICIPRLITV OF RNCHORRGE (HIDFI) RND THE STATE OF RLFISKFI.
2. I NILL INSTRLL THE S"r'STEH IN RCCORDRNCE NITH RLL I"IOR CO[:'ES RND I~:EGULRTIONS.,
RND IN COMF'LIFINCE I.,-IITH THE DESIGN CRITERIR OF' 'THIS PERHIT.
.7.:. I NILL RC'HERE TO RLL HOR RND STRTE OF RLRSKR REQUIF.'.EI"IENTS FOR THE SET BRE:K
C'ISTRNCE2"; FROH RN"F EXI':';TING NELL, NRSTENRTER DISPOSRL SYSTEM OR PUBLIC
RF'PLICFINT: LIONEL ',,,' _F.E, PN -
BIG
DIPPER
DRILLING
7529 Eo 6th Avenue ·
July 9, 1984
Lionel Urban
2481 Belmont Drive
Andnorage, Alaska 99503
Dear Mr. Urban,
Anchorage, Alaska ' DeP~.O~ ~ 7)333-6435
ENVIRONMENTAL pROTECTION
RECEIVED
The following information is your copy of the well log for the property
located at Let 9, Block ]0, Rabbit Creek Heights Subdivision. This
should be retained as your permanent record of i mprovelnents to your
property. ~
WELL LOG
0 To 33
33 37
37 39
39 45
48 55
55 57
57 67
67 83
83 87
87 130
Poe k
Silt, sand, gravel
Rock
Sandy sJ ] t
Silty gravel, water
Rock
Silty sand, gravel
Rock
Silky gravel, water
Rock
SJ It, gravel
Rock, WATER
GALLONS PER MINUTE
STATEMENT
130 Feet drilled and casinq $20.00 per foot
]_20 Feet galvanized pipe @~1.50 per foot
120 Feet wire ~ .50 per foot
Labor to install customers own pump
Total
$2,600.00
180.00
6O.00
150.00
Than]< you for specifying BIG DIPPER DRILLING for your water well needs.
This will entitle you to one chance in the drawing for two round 'trip
airline tickets to Hawaii. The drawing wall be held in Decembeu.
Sincerely,
C. R. Kron
Owner
Licensed · Bonded · Insured
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-113-34
1. GENERAL INFORMATION
Complete legal description
Expiration Date: [" '~/'-- (~ ~
Lot 9 Block 10 Rabbit Creek Heiclhts
Location (site address or directions) 8321 Paine Rd., Anchora(]e, AK 99516
Current Property owner(s) Jeff Be~r--~
Day phone 349-6999
Mailing address
8321 Paine Rd., Anchora(le, AK 99516
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless othemdse requested, HAA will be held by DHH$ for pickup. HAA picked up by:.
2. NUMBEROF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
[]
Community On-site
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with
new water sample results less than 30 days old. 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 ermm or omissions in the
professional engineer's work.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval
application shows that the on-sRo 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 vedfy 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 applicable Municipal and
State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Enq. Svc. Phone 272-8218
Address P.O. Box 102954, Anch, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date
Engineers Comments: In conducting an adecluaC? tesL I attempt to provide a thorough, co~scicmious
engineering analysis o£thc ~lem in accordance ~,~ith MOA DSD Guidelines & Regulations. The
~-portcd rcanlts describe thc lx~'farmance of the s~tcm under tile conditions encountered at the t~c of
tho test. and separation distances mead'ts'ed to readily i&'ndfmble features. Thc operational life ofall
',,,'ells und septic systems depend on thc local soil condition, ground v, uter levels that may fluctuate
during thc year, and tho water usage of the family being .served by the system. These conditions are
outside the control of the evaluator of this .system. All systems eventually fail and satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that there are no
hidden defects or encroachments. P'F~ can therefore not provide any ,~arrunty for future ~'ffomaanco
nor give any estimate of how long the system will continue to meet the operational requirements
ADEC or MOA DSD. Tbe contca]t of lifts report i~ for thc sole b~tct~t of the m~aer listed above. Any
reliance upon or usc of this report by any ether pemott or party is not authorized nor ~ill it confer any
legal riglit ~hat.~(x.wer.
6. DSD SIGNATURE
Approved for ~-~ bedrooms.
Disapproved.
Conditional approval for __
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Expiration Date:
X
,*,..; ..~ · L,/I'~-OI/E .
~.; WATER AND
· . WASTFWATFR -' ::
~ :. PROGRAM :' ~
%%" .......
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Reissue Date:
Municipality of Anchorage
Development Services ,Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Desc~ption:
A. WELL DATA
Well type P
Date completed 71~11984
Total depth t;[11~ It
O
Lot 9 Block 10 Rabbit Creek Heiahts
Date of test
Static water level
Well production 4
WATER SAMPLE RESULTS:
Coliform 0 coloniesZ100 mi
Date of sample: '1012012002
e, SEPTIC/HOLDING TANK DATA
Tank Type/Material Oraer Steel
Parcel I.D.: 020-1t3-34.
IfA. B, otC provide PWSID # Well Log Y
Sanitary seal Y Wires propedy I:xotected Y .
Cased to 1~1) fl Casing height (above ground) r~o In.
FROM WELL LOG AT INSPECTION
7/9119~4 1012012002
fl 35
g.p.m 3.0 g.p.m
Nitrate .1~97 mg/i Other bacteria ~ colonies/100 mi
Collected by: Laura Pannone
Deteinstalled 712t11982 Tanksize 12~0 gal .~_ Number of Compartments ~
Cleanouts ~. ,Fo~ndat. ion cleanout _~ Depression over tank N High water alarm NIA
Date of pumping 101t912002 Pumper Northland Pumoin<:l
C. ABSORPTION FIELD DATA
Date installed 7/21~982 Soil rating (g.p.d./ft~ or It~/brirm) 23~ System type Shalloow Trench
Length
Tolal depth
Date of adequacy test ~ Results (Pa,1~F.ail) p ~ For :3 bedrooms --, I I ~ /- _1
Fluid depth In absorption field before test I?J0* in Water added41~0 gal. - New depth1 ~P in.
Elapsed Time: 0 min Final fluid depth l~J0 in Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (pest 12 mo.) (Y/N & type) N If yes, give date
(Rev. 11
D. LIFT STATION
Date installed
'Pump on' level at
Size in g~allo!
in'Pump o~Je~
Datum .~,Cycles tested
E. SEPARATION DISTANCES
Jn
Manhole/Access
High water alarm level at -- In
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot t00+
On adjacent lots 100+
Absorplion field on lot 100+
On adjacent lots 100+
Public sewer main NIA
Public server manhole/deanout NIA
Sewer/septic service line 25+
Holding tank 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 2.5'
Property line
Absoq~ion field
Water main
Water service line 25+
Smface water 100+
Drainage 100+ Wells on adjacent lots 100
SEPARATION DISTA.NCE FROM ABSOI~PTIQN [=IELD ON LOT TO:
Propeftyline 6. u~)i~l ,B.i;i~ing,~d.~on,,¥~,,~:~..~ .~'~,l,~--(~.~-nA-k¥~ 12' Watermain 25+
Water Service line 25+ Smface water 100+ Driveway. parking/vehicle storage
Curtain drain 25' UI)<3radient Wells on adjacent lots 100+
Date of Payment
Receipt Number
(Rev. 11~
F. COMMENTS
* Oct 02 MT installed ~ middle & end of field. System was excavated & blue
~\~- ...........
G. ENGINEER'S CERTIFICATION
review of Mun/cipa/ records that the above systems are in ~'"~.~"~/~,,~
conformance with MOA HAA guidelines in effect on this date, ~.%-%"~ -~ ~,,..~
' ~ ;~_~.Steven R. 'Ponncne,~.~ ~
Engmeees Pnnted Name Steven ,. P,,,on,. P.E. '~,?d~... N_o.~C~L 81_.49 ....'~
Date / v l z.
/ 0/~C7/0'7~'' Date of Payment
q'=15 0 Receipt Numbe~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description _/OT
Location (site address or directions ~32
Property owner ~ ILL
Mailing address ~52 I
Lending agency 1~.4,
Mailing address
Day phone :3z/5
Day phone
Agent_
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~ "~
TYPE OF WATER SUPPLY:
Individual well u'~
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA ¢¢21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/orwastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverifythatbased 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 I q5'3o
Engineer's signature
DHHS SIGNATURE
F-L,4TTO? T£C/-/. ,SvC <J. Phone
Disapproved.
Conditional approval for
Date
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in 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, 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: Lei, ~ 1o ~qBBFT C~, YJTS ParcelI.D.
A. WELL DATA
Well type PP~[V'/~T~
Log present (Y/N).
Total depth
Sanitary seal
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~ t ,2 ¢ 'Z. Driller _(Z-4-~-
Casedto_.-~_Uo~ or 6ed. r,,¢~ Casing height ..5'1
Wires properly protected (Y/N) 'F'
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
AT INSPECTION
/T/ g.p.m. '~ 'a
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot I
Absorption field on lot
Public sewer main '~ loc
Public sewer service line
; On adjacent lots '-~/oo
; On adjacent lots
g.p.m.
z
Public sewer manhole/cleanout "7 [oo /
Petroleum tank NoNg OeSg,evEb
WATER SAMPLE RESULTS:
Coliform ~ ¢o(/took, Z
Date of sample: ct/[S]qt
_ Nitrate O. 2~ ~, (~ Other bacteria ~ ¢c,(//oc.,~-,(_
Collected by: ~'£/}'rTo P m~c~/ ~L/C~
B. SEPTIC/HOLDING TANK DATA
Date installed 7/~q
Cleanouts (Y/N) Y
High water alarm (Y/N)
Date of pumping _R[G/~/f
Tank size [ 2. 50 &AL Compartments 2..
Foundation cleanout (Y/N) N :g Depression (Y/N) N
N,, A. Alarm tested (Y/N) ~. ,ar.
~"{ ISAAC5 ¥ WYE IN D~A~LI~E', dq CleA~¢l.. SPAoE~
tql. I..ov,.,$ froze CLE.,~NtNG L. INE To '3EPT~c- TFJ/',Lk
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I ~ ~ ~
To property line .'50~
Surface water/drainage
Onadjacentlots )1oo Foundation 2,5 FRo~ 0.o.
Absorption field .~.$¢ ?~¢ ~rs 8~-T Water main/service line 24)¢
I00"
72-028 (Rev, 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION N, A-.
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed 7
Length c~0 ' Width
Total absorption area 70'7
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating :235 ~'~t>RA/-
Gravel thickness
Cleanouts present (Y/N)
Date of adequacy test
for
NoNE K~ow,4 of= If yes, give date
System type $~A'z4o~,
Total depth
Y
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I I 5
To building foundation 1:2.~
On adjacent lots
Surface water ~
Curtain drain 14oN(:
On adjacent lots ;~ IOo Propertyline ~2 G~At4,TCb N./*2, ~'~
To existing or abandoned system on lot N,A.
Cutbank ,-~[oo Water main/service line 30
Driveway, parking/vehicle storage area ~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
HAA Fee $ /
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev, 3/91) Back MOA 21
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
O---~O~ //-:7-'~'¢ HAA# A~ ¢¢~ ~ / 0~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location 'address or~directl'ons~'~,,'
(b) Property owner,.
Mailing Add~'ess
(c) Lending Institution
Mailing Address
/~,, 2"/¢V~x/'~'5 Telephone: (home) Business
Telephone
(d) Real Estate Company and Agent
Address ,Z-~¢"¢ ~,~,8,~ V~
Telephone
(e) Mail the HAA to the following address: (or check heretiC, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family'ZL Number of bedrooms
3, WATER SUPPLY
Individual WeII~L 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~L 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-o25 (Rev. 7/88) Page 1 of 2
~ ~.o ~ abed
'~Jo/~ s,Jeau!6ue leUO!SSejoJd aq~ u!
SUO!SS!LUO JO SJO~Ja JOJ alq!suodse~ ~ou si aSe~oqouv jo ,~liled!o!un~ eqj_ 'penss! s! e~,eoffR~ao e e~ojeq elep aZ/`leUe Jo
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pue led!o!un~ lie q~,!/~ aoUe!ldLuoo u! s! LUa~S/`S lesodsip Jale~e~se~ Jo/pue/`lddns Jale/~ ai!s-uo aq~ 'uoRoadsu!
puc uoi~e6!~sa^u! /,gu guoJj pue seHJ ebeJoqouv jo X),!led!o!unv~ aq~, guoJj pau!e~qo uo!leguJoju] aql uo paseq
),eq~/`~iJa^ J@q~Jn~ I 'u!eJaq paleo!pu! eJn~onJls jo ad/`~ pue sguooJpaq jo Jaqgunu aq~ Joj elenbape pue leuo!~ounj
'ajes s! gue~s/`s leSOdS!p Ja~e~a~se~ Jo/pue /`lddns J@),e~ a~!s-uo aq~ leq~ s/~oqs le^oJddv X~!Joq~nv q~leaH
s!q~jo uo!~e6Rsa^u!/`uJ~eqlXHJ@^l '~olaq u/~oqse~ep uoReP!leAaq),jose pueo~aJaq Pe×!~4eleaS/`LU Xq PaiJRJaos¥
NOI/~INIJO_-INI C]N~' ~'J.¥Q 'HOEI¥=IS =1'11-1 'SIS=II 'SNOIJ. O=IdSNI 9NIQIAOtJd t~1~1:1 9NIEI3=INIgN~ 'g
JOB
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO. OF
CALCULATED BY ~,4~, ~//~;:;--,~ DATE
CHECKEDBY DATE
MUNICIPALITY OF ANCtt~JJ~-.~
DEPT. OF HEALTH &
ENVIRONMENTAL .PROTECTIO~
~J UL ~ '7 tg8g
RECEIVED
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Se~ices
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. # ("", ~,(''~ - \ \ 'T'~" ''~ L'i NAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
(b)
Location (address or directions)
o..-,, ..... L-_-%
Property owner-~/'f"// ~'~'
Mail.lng Address ~'¢'
(c) Lending Institution
Telephone: (home) Business
Telephone
Mailing Address
(d) Real Estate Company and Agent
Address 2'~ '¢~ g,~,g~ t/A-
(e)
Telephone /~ 'L/6'-O~ 'b~'/
Mail the HAA to the following address: (or check here ~, if hold for pick up.)
List contact person and day phone number below:
p d<.
2. TYPE OF RESIDENCE __~
Single-Family ~ Number of bedrooms '--
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 ¢] 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 sh°wn below, Iverifythat 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 flies and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with alt Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Telephone
Name of Firm
Address ?'1~
Date
6. DHHS APPROVAL
Approved for
Approved ~-
Terms of Conditional Approval
/// -~ /~EF-
u~,~-~--~-' ~ Date
_bedrooms by --
. Disapproved - - ~-(...~ ~/- ~
The Municipality of Anchorage Department of Health and Human Services (DHHS) issuesHealthAuth°rityAppr°val
cerificated based only upon the representations given in paragraph S 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 inspecti°ns
or analyze data before a certificate is issued' The Municipality °f Anch°rage is n°t responsible for errors or omissions
in the professional engineer's work.
Page 2 of 2
72-025 (Rev. 7188) Back
A. WELL DATA
Well Classifica~}~'~:t;t
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description:-~ICcK
Well Log Present i~-'}N) ____
Total Depth 1~¢' Cased to
Static Water Level ~(9 ~
Casing Height Above Ground
Electrical Wiring in Conduit eN)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot __lO
To Nearest Edge of Absorption Field on Lot lOCh ' L~*
Date Completed 0~
Depth of Grouting
Pump Set At
Sanitary Seal on Casing ~)N)
Depression Around Wellhead (Ye
If A, B, C, D.E.C. Approved (Y/N) Yield '~' 6 ~/~.
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Line _ ~ To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot ~-~-/~
Water Sample Collected by ~l~l..'~i~ ~'~l~v~,bt_.~)~,~.(3,~. ;Date
Water Sample Test Results .j(.);~¢~'~'1¢5 0,~ ) '~etO¥~.(;¢,.
SEPTIC/HOLDING TANK DATA
B. Date Installed O~"~[~ ~'~ Size ]~O ~ No. of Compartments
Standpipes (~N) Air-tight Caps ~N)
Depression over Tank (Y~))
Pumping/Maintenance Contact on File (Y/N)
Holding Tank' High-Water Alarm (Y/N) ?~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well /(~ ¢~'
To Property Line /~ / +
To Water Main/Service Line ~ ~ ~
To Stream, Pond, Lake or Major Drainage Course
Comments 'j~ ~!.? ~f~(~J¢ ~f~
~.~..~ ~ -.-_/
Temporary Holding Tank Permit (Y/N) ,,f./[/~ /
/
/
To Building Foundation
To Disposal Field
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
Type of System Design
Length of Field (2'~ ¢
Depth of Field ~'"~',/!f
Gravel Bed Thickness ~O"
Statndpipes Present CN)
Date of Last Adequacy Test
Depression over Field (Y~
Results of Last Adequacy Test /z~-~'u-q
SEPARATION DISTANCE FROM ABSORPTION FIELD' _/ ............ : ............
To Water-Supply Well IObo ',4- (~T~o Property Line
To Building Foundation /O'4" To Existing or Abandoned System on
Lot /~ ;On Adjoining Lots ,~¢
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course /(~gd.') /'~
To Driveway, Parking Area, or Vehicle Storage Area /~..3 L¢~
Comments ~' ~,~A¢- )'~.G~'~'~Oc- ~(c[~ iix '~f~"~
dATION
,').._,~ ~ .L TO Cutback (if present)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that l have checked, verified, or conformed to all MOA and NAA guideli~s.~f"~t~.n the date of th s
inspecti°n.,4 /) ~, ~ / ,-~, ~J',¢'. ~'~b ·
Date ~ "~ ~ ~ ~~o ~(~eer's Seal
Receipt No ~/O ¢ / Receipt No.
Amount:$ :?O-~(5 Date of Payment
72-028 (Rev. 7/88) Back Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASI t, iNC.
-' 5633'B S]%RE~T ANCHORAGE, ALASKA 99518 TI~LEPHONE (907)562-2343
,~..~~ FEDERAL TAX ID# 92-0040440
ANM, YSIS RF, POgT BY Sh~P~g fo~ Work O~der
Date gepott P~lnted: FEB 15 89 fi
Client Sample ID:L9, Bi0, RABBIT
PWSID :UA
Collected FEB 14 89 ~ 11:30 hfs,
ReceiYed FEB 14 89 ~ 14:00
Preserved with :hS ~ZQUIRED
Client Name : A E C S
Client Acet : AKECSRP
?.O.tl NONE REC'D
Req ~
0zdered By : 1,. REID
Analysis Completed :FEB 15 89 Send Repo~ts to:
1)A E C S
Laboratory Supe[¥iso~ :STE?HEN C. EDE
Released Ey :~ C~ ~ 2)
SDecial
Instruct:
Chemlab Rei ~: 4251 tab Smpl ID: I Mattix: WATER
ALlowable
Pa~arseter Tested Result/Units t4ethod Limits
NITRATE-N 0.43 mg/1 EPA 353.2 lO
Sample ROUTIttZ SM,iPLE.
Remarks: SMIPLI'i COLLECTED BY L.R.
Tests Performed See Special Instructions Above UA-Unavailable
None Detected "See Sample Remarks Above
Not Analyzed LT=Less Than, GT=Oreate~ Than
A CHEMICAL & G'EOLOGICAL LABORATORIES ~F, ALASKA, INC.
TELEPHONE (907) 562-2343 ' 5633 B Street:
Anchorage Alasl~ 995t8
~'~~ Drinking Water Analysis Report for Total Colifor,,'~ Bacteria
TO BE COMPLETED BY WATER SUPPLIER
I~ PR~/ATE WATER SYSTEM
Mailing Address
City
SAMPLE DATE:
Phone No.
Stato
Mo. Day Year
Zip Code
SAMPLE TYPE:
,~ Routine ~
Check Sample (for routine sa~nple
with lab ref. no.
[] Special Purpose
.) [] Treated Water
.~ Untreated Water
'rime Collected
Collected
I /.5.
SAMPLE
NO. ^ LOCATION
ol I
TO B~,COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~ Sa~i sfactory
[] Ulr~atisfactory
[] S~mpletoo long in transit; sample should
nqt be over 30 hours old at examination
to'indicate reliable results. Please send
new sample via special delivery mail.
Date Deceived
Time Received ¢" ~, ~-'~
Analytical Method:
* No. 0f colonies/100 mi.
Membrane Filter
Lab Ref. No, Result*
I FTq
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPL~
TNTC = Too Num s
OB = Other Bacte¢
/
BACTERIOLOGICAL WATER~J~NALYSIS RECORD
Membrane Filter: Direct Count (--~ , CoilformllOOml
Verification: LTD BGB
Final Membrane Filter Results ~ , ~ CoilformllOOml
Reported By te
Time: ~ a.m.
To Count
PART ! OF g
REMAINDER TO FOLLOW
Tom Fink,
Mayor
fiAunicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
April 12, 1989
Lee Reid, P.E.
Alaska Environmental Control
Services, Inc.
1412 West 33 Avenue
Anchorage, Alaska 99503
Subject: Waiver Request for Lot 9 Block 10 Rabbit Creek Heights
Waiver Request #WR890015, HA890103, PID~ 020-113-34
Dear Mr. Reid:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 6 feet.
This appro.val applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljw%7
~ ~' ~ ! ~ ~ ~ ~ MUFtTC~PALITY OF ANCHORAGE
ALASKA e UIRO me I'AL CONTROL
~n~ineeri~ 8 ~nui~0nm~nld $ludie$
/~o,~ ~ ~. ]989
RECEIVED
Apri). Lt. 1, 1989
Munic:i pal. ity (::)'f Ancl']orage
Depar"'Ltmi?l"it (::)'f: Heal. th & Sec.'La]. Ser'vii:::es
On-s.L'E~:* Se::,rwZces/Ma'b. er Qua:l. zt.y
I:::'. 0,, Box 19665()
Ar'to hcu.-'age, AK 995 J..D-bb~50
AT'TN ',', Dan I::Roth
RI!ii:: I...c~t. <:~ Block 10 Rabbit Dreek H[~tiql'yEs Subdivision
The al::)SOl'-i:)'!:ic)r'l 'f:ic.~ld on the sul::,jec:t lot :Ls 6 'feet 'fr-c,m the
west ;Lot 1J. ne. ]"he i:.cyN?:~l deptl~ cyf the sysi:.em J..s 4.5 feet
tN:i. tl'~f,?~5 feet of sewer rock. '1"he lot i:o i:.he ~est is vacar'tt.
~J.'Ltl'i tho shal].o~,-,, i'"c)c:l.:: cJE, pth~ thJ. s S¥'~F.t(.:.?d/ doe!T~ r'/o'~ gZ,.l']crc}ach
on i':l"~e r'ie:i..ghbclr's reserve area.
We r",z.~:,(::luef.~t '[':l"h~'k'. yc, u (~jF'arlt a wativet-'" o'f 6 'f(.:.~,~t for ,absc)rpi:.ior'~
,::}t r (.:.~ ~,_'t t c:, ]. e t ]. J. iq e.
:l:'f yell have any qLbsestJ, c)ns~ pi. ease
ACW / s r
A].arl C. Wien
Senior Er'~gil"~eer":Lng
'l'ec hn .._i, c i al"/
1412 WESt 331~ch ,~V~gl]U~. · ,~nchoR,~q¢, &lzsk& 99503 · (907) 279-5553
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
(a) Legal Description (include lot, block, subdivision, section, to~mship, range)
Location (address or directions)
(b) Applicants Name L;mbl;~_.~
Applicants Address
(c) Applicant is (check one) Lending Institution
Buyer ~ ; Other ~ (~plain);
(d) Lending Institution
Address
(e) Real Estate Co. & Agent
Address
Telephone - Home
Business
~--~ ; Owner/builder~ ;
~,,~ ~? Telephone ~7%-/~'~/
(f)
Telephone
Mail the HAA to the following address:
2o ~ype of Residence
Single-Family~
Number of Bedrooms
Individual Well~-~
Multi-Family.~-~
Other (describe)
Community~ Public ~
Note: If community well system, must have written co,~irmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage DisRobe1
Onsite ~ Public ~ Community ~ Holding Tank !-----[
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
ns' irm_Providing Inspections,....Tests~ File Search~ Data and Info~a. tion
m that the on-mite
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 inspecgion, the on-site water supply and/or w~astewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm ~-~b~% ~..,~u~'~~ ~. E. Telephone
(ENGINEER SEAL) ',~*.° 4"E ~"'~
....... <~): I'~ro. 2225-E '."
~ ~, .,4 ~,t',~.,, juice 2,..,, t~.t <. ,,
.,... /-/ '
Approved _~ Disapproved _~_ Conditional
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
A®
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLI~ - FEBRUARY 1984
~LL DATA
Well Classification _ ~ .
Well Log P~esent (Y/N) y
Total Depth / ~50 _ Cased to
Static Water I~vel ~/O
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) y
Separation Distances from Well:
To Septic/Holding Tank on Lot / ~ ~
Date Completed
90
Pump Set At
¥,
Legal Description: .]-~D~ 9
If A, B, or C, D.E.C. Approved(Y~)
7~ g ~ Yield
~pth of Grouting ~ ~ ~
Sanit~y ~al on Casing (Y~)
~pression ~ound ~llhead (Y~)
; On Adjoining Lots,_
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~-~ To Nearest Public Sewer
Cleancut/Manhole
Water Sample Collected By ~-.~ ; Date ~' ~' ~/'
Water Sample Test Rssults
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
No. of Compartm~=nts 7'~O
Standpipes (Y/N) '~'(Q Air-tight Caps (Y/N) ~/ Foundat. i0n Cleanout (Y/N) ~q ~'
Depression over Tank (Y/N) ~ Date Last P~d ,,<'~ ~/~ ~ ~ ~~ L ~
P~ing~aintenan~ Contract on File (Y~) ~/~ ; for' '~ ~/~ '
Holding Tank High-Water Ala~ (Y~) ~/~ Te~ra~y Holding Tank Permit (Y~) ~/A
separation Distances from Septic/Holding Tank:
To Water-Supply Well
TO Property Line ....
To Water Main/Service Line
course IW
To Building Foundation
To Disposal Field ,
TO Stream, Pond, Lake, or Major Drainage
Conments
Receipt
Date Paia:
Amount:
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in ~sorption Strata
Date Installed 7' ~/. ~
Width of Field /~fD
Square Feet of A~_~orption Area.
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Depression over Field (Y/N) ~\ Date of Last Adequacy Test
Results of Last Adequacy Test .. ~/~
Separation Distance from Absorption Field:
To Water-Supply Wall
To Building Foundation
Lot ~ 0 N h~
TO Water Main/Service Line
To Stream/Pond/Lake~6~ Major Drainage Course
To Driveway, ParkingArea,iOr Vehicle Storage Area
Commsnts
; On Adjoining Lots ~_~ ~-
To Cutbank(if present)
To Property Line
To Existing or Abandoned System cn
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Leva~t
High Water Alarm Le~l at
Tested for '
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Meets YDA
Comments
Check Permitted Bedrocm Rating Against HAARequest
I certify that I have checked, verified, or conformed to all MOA HA~A Guidelines in effect
on the date of this inspection.
KB1/d5/s
[Page 2 of 2]
Date
MOA
No.
2-15-84