HomeMy WebLinkAboutHILLSIDE NORTH #5 BLK 3 LT 9Onsite File
Hillside North
#5
Block 3
Lot 9
#041-031-96
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 o Anchorage, Alaska 99519-6650 o Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW990093 PID Number: 041-031-96
Name:
Wastewater System: )9New ❑ Upgrade
Crown Pointe Inc.
Address: P.O. Box 112313 Anch. , AK 99511
ABSORPTION FIELD
Phone: 345-6277
Nip f ve Bedrooms:(5)
Fi
0 Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
1
Total Depth from original grade:
9.
.2 GPD/Sc. Ft.
g gds Wry
Loc` 9 Block: 3 H 111 S luU Cv's tv V r ttl �% 5
Depth to pipe ootiom from original grade:
Gravel depth beneath pipe
4 Ft.
4 Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
66
.5 Ft.
Ft.
WELL: New El Upgrade
Gravel width: 5
Numblroflines:
Distancebecween lines:
Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Private
12D1 Ft.
121 Ft.
660 so.Ft.
ASTM D3034 PVC
Driller: Alpine Drilling
Dai% Pdi%.99
7
Snt6 Tter Level:
7U
Installer:
Sanders & Sanders
Date installed:
6/4/99
Ft.
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
30 GPM
Ft.
2 Ft,
SEPARATION
DISTANCES
RC Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Aesorption
Lift
Holding
uDlic/Private
Manufacturer.
Capacity in gallons:
From
Tank
Field
station
Tank
SewerLinee
Anchorage Tank
1 500
Welh
>100,
>100'
N/A
N/A
�d-F7C
j��Q�7�
Material: Steel
Number of Compartments:
Two
Surface
>100'
>100,
N/A
N/A
N/A
LIFT STATION - N/A
Water
Lot
>5'
>10.
N/A
N/A
N/A
Size in gallons:
Manufacturer:
Line
Foundation
>51
> 1 0 '
N/A
N / A
N / A
"Pump on" level at:
"Pump off' level at:
High water alarm at:
Curtain
None
Cited
n Lo
Pump Make&Model
Electrical Inspections performed by:
Drain
BENCH MARK
Remarks:
Location and Description: Basement Finished
Floor.
Assumed Elevation:
00.Ft
�0t44
Inspections performed by: A. Harala Dates: lst 6/4/99
., , , .
2nd 6/4/99
Department of Heallp and Human Services approval
Reviewed and approved by: d Date: 77
n4ttl (Rev. 9/91) MOA 25
Municipality of Anchorage Page 2 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SW990093 / r '
PID No. 041-031-96 / I
1 I
o
/ N Z
X �
/ Wa
/ K
' / U
J
/
O
�0 �?� Five
Bedroom
�v 6, ome.
x
fid\ di 5 S C1
S1
C4 C3
A B `l S - Septic Vente
TH2 C _ Cleanout
M1 T4.6 97,7 M _ Monitor Tube
C4 83-2 93.5 M1 TH- Test Hole;
C3 34,2 52,1 W C4
S2 27.0 45.4 -
S1 17,6 37.5
(0 TH3
r•� Alternate
Site
Z
°,F^otrda�eigf
.4t
N
N
U)
W
C
U
in
O
°o
L
z=� S 01 50'22 E 189.48' o L=87-67' R=2338.38'
" 0 .
Lc 1 Z29'
�a R=280.00' -
�- FROLICK WIND ROAD SOUTH
PLAN AS -BUILT.
SCALE 1" = 60'
Municipality of Anchorage Page 3 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SW990093 PID No. 041-031-96
5.0 ;
16.7' 5.5' S' 47.0'
I- I
Ln
U
will
N
x
F E
N
Drainfield Wn Rock
65.6'
PROFILE AS -BUILT
HORIZONTAL SCALE 1" = 10'
NO VERTICAL SCALE
73.0
85.50
MEMORANDUM
DATE: December 28, 1999
TO: Dan Roth
FROM: Mike Anderson, P.E.'
SUBJECT: Lot 9, Block 3, Hillside North, Addn. No. 5
Well Location
The actual location of the well placed on Lot 9, Block 3, Hillside North Subdivision,
Addition No. 5 is approximately 200' northwest of the location shown on the original site
plan submitted with the permit application. A field decision was made by the well driller
to place the well in its current location because of access to the property. The well is
more than 100' from the septic tank and absorption field. It is also more than 100' from
the alternate absorption field site. In addition, the lot contains nearly 3.5 acres of area
and the 100' protective well radius is almost entirely contained within the lot. In
summary, placement of the lot in its current location will have no impact on the septic
system on this lot or those to be placed on adjacent lots. We therefore recommend the
well be accepted in its current location.
Municipality ®f Anch®rage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
Rick Mystrom http://w .ci.anctiorage.ak.us
Mayor
Permit Number: #SW 990093 Date of Issue: 5-11-99 Parcel Identification Number: 041-031-96
Date Started: 5-11-99 Date Completed: 5-11-99 Is well located at approved permit location? ® Yes ❑ No
Legal Description) Hillside North blk #5 blk 31t 9
Property Owner Name & Address: Crown Pointe, Inc.
P.O. Box 1123113
Anchorage, Ak 99511
Borehole Data:
Depth (ft)
Method of Drilling ® air rotary ❑ cable tool
Soil Type, Thickness & Water Strata From
To
Casing type: steel
Stick-up
0
2
PJall Thickness: 025 inches
organics
2
4
Diameter: 6 inches Depth: 121 feet
sltygravel
4
29
Liner Type,-
ype:gravel
gravel
29
63
Diameter: inches Depth: feet
Casing stickup above ground: 2 legit
silty gravel
63
74
Static water level (from ground level): 90 feet
Pumping level: 120 feet afler
gravel 74 88
gravelly silt
88
109
2 hoursum in g 30 m
P P 6— 6P
gravelly sandy silt
wet 109
118
Recovery Rate: 30 gpm
water sand gravel
118
121
Method of Testing: airlift
Well Intake Opening Type:
® Open End ❑ Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type. bentonite118 Volume: 2&
Depth: Start 0 feet Stopped 0- feet
Pump: Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: Clorox
Comments:
RECEIVED
Well Driller: Alpine Drilling & Enterprises
P.O. Box 110496
JUL 7 1999
Anchorage, Ak 99511 AK 0
Municipality of Anchorage
Dept. Health & Human Services
Attention: 1'he weudr{IIer4aa4f4tevide o well -log to the property -owner within 30 -days of completion and the property
N. ,, n,P ,.,Nn t ;n , 0L�n .,.,.,,;,IP a ""Al i,.,, f,, n,,. n,•„ nr 61..�If k R, 1.1....,..„ c ,,,;1I,;,, rn
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
6 -V-5/c/ jp:ua X4-7'1
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW990093
Legal Description: HILLSIDE NORTH #5 BILK 3 LT 9
Design Engineer: 0014 Anderson Engineering
Owner Name: Crown Pointe, Inc
Owner Address: PO Box 1123113
ANCHORAGE , AK 99511-2313
Date Issued: May 11, 1999
Expiration Date: May 10, 2000
Parcel ID: 041-031-96
Site Address:
Lot Size: 152024 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: 7I � Date: da 19 9
Issued By:
Date: 5'- I - 91?
r'
MEMORANDUM
DATE: May 1, 1999
TO: Onsite Services Engineer
FROM: Mike Anderson, P.E.
RECEIVED
MAY 5 1999
Municipality ut Ar.cnorage
Dept. Health & Human Services
SUBJECT: Lot 9, Block 3, Hillside North Subdivision, Addn. No. 5
Well and Septic System Permit
The owner of Lot 9, Block 3, Hillside North Subdivision, Addition No. 5 has decided to
construct a five bedroom home on the lot. Our previous application for an onsite well and
septic system construction permit was for a four bedroom home. We have therefore
modified the pertinent pages of the design to reflect the five bedroom home and have
changed the permit application to reflect five bedrooms. Please switch the attached pages
with their counterparts previously submitted and issue the permit for a five bedroom home.
Thank you for your assistance with this matter.
April 29, 1999
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 9, Block 3, Hillside North No. 5
Septic System Design
Impacts to Adjacent Properties
Dear Onsite Services Engineer
We hereby apply for a permit to construct a well and onsite septic system
on Lot 9, Block 3, Hillside North Subdivision No. 5. The attached site plan
and backup documentation identify the size and location of the new septic
system to serve the five bedroom home to be constructed on the lot. The
plan also shows the location of the proposed well and the 100' protective
radius. The lot is nearly 3.5 acres in size and no conflicts exist with
other wells or septic systems in the area.
Testholes placed on the lot revealed clean gravels and sands in most
locations with some silty gravel and sands found in isolated areas.
Percolation rates were very good in the clean sand and gravel areas and
slower in the silty area. No groundwater was encountered during testhole
placement nor was any noted during the monitoring period. We have
therefore designed a 5' wide trench system for the lot in the area with the
best percolation rate. The trench will be 63' in length and 5' wide with a
4' effective depth. The total depth will be 7.5' from the existing ground
surface.
The surface of the lot slopes from the southeast to the northwest at
varying grades. The absorption trench will be constructed perpendicular
to the surface slope as shown on the site plan.
Lot 9, Block 3, Hillside North No. 5
April 29, 1999
Page Two
If the system is constructed as designed the following statements apply:
1. The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the future.
3. The system, if constructed as designed, will have no adverse
impact on reserved space, either surface or subsurface, on any lots
located in the area.
4. The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
4 ... � �e9
........... TM • r--�� 5Y
LE MOUMN
4381.E
HILLSIDE NORTH SUBD., ADDN. NO. 5
LOT 9, BLOCK 3
3.49 OGRES / (�ia .
o{
o$
p� 500-0
30
84
I J
O
J_
TH1
P
0
o
Alternate
g
Site
x
TH3
o{
o$
0
30
i
I J
O
J_
A
■
IN4�
Py
P
575A
1 „=s0.,
TH2\\cam \
1allon ti
.,500 Septic \\ 'k
• Tank --
le l l®
N
rg l
NOTE: NO NEIGHBORING WELLS OR SEPTIC
200' OF NEW WELL AND SEPTIC SYSTEM.
SITE PLAN
SCALE 1" = 80'
SSO u
SYSTEMS WITHIN
SCOPE OF WORK:
1 . PROCURE AND PLACE NEW 1,500 GALLON SEPTIC W
2. CONSTRUCT 50' LONG BY 5' WIDE BY 4' EFFECTIVE DEPTH
ABSORPTION TRENCH.
LOT 9, BLOCK 3, HILLSIDE NORTH NO. 5
DESIGN FACTORS:
Five Bedroom Home
Perc. Rate: 2 Min./Inch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,500 Gallon Septic Tank
4' Drainfield Rock
5 Bedrooms X 150 GPD / 1.2 GPD/SF = 625 SF of Absorption Area
625 SF/5 LF (Width) X .5 (Red. Factor) = 62.5 LF Trench Length
Therefore: Construct a 5' Wide By 63' Long Absorption Trench System
With One Lateral As Shown on the Site Plan with 4' of Drainfield Rock
Beneath the Lateral. Distribution Pipe in Trench Placed at 3.0' Below
Original Ground Surface. Mound Over Trench to Provide Cover and
Positive Drainage Away From Area.
5'
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 3' of Cover over Septic System.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
,n)
4 `$ 4 ��
a: 49TH ,,.. ,
P E AiPI
�. 4381
LEGAL DESCRIPTION:
PE) PTH
NN a�
1
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
625 "L7 Street. Anchorage, Alaska 49502-DE50
SOILS LOG — PERCOLATION TEST
DATE
1, Range. Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED? IN0
S
L
IF YES, AT WHAT O
DEPTH? P
E
mw=r g? Batt
Reading Date G
_ ma I Time
Net
Time
Depth m
Water
Net
Dmp
30
I ,L
I
i I-II.
30
I
I
I
I
20 'lDIAMETER
PERCOLATION RATE C/(/ ut� (rnutevuull) PEAL HOLE DIAMETER �� L
TEST RUN BETWEEN FT AND 60 FT
COMMENTS Perc. Cavity presoaked prior to testing..
PERFORMED I R i Y TH �T�-IIS TEST WAS PERFORMED IN
Michael E. Anderson
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE -S IN EFFECT ON THIS DATE DATE:
72-008 (Rev. 4/85)
PERFORMED
LEGAL
2
3
4
J, 5
I/ a6
111 7
8
9
10-
11 -
,2-
13-
14-
15-
16.
3-
14-7516•
17-
18
19
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 -L- Street. Anchorage. Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
DATE PER
). Range. Section
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES. AT WHAT L
O
DEPTH? P
• E
Dep m WYu Ahu
mmIrIanng? Qbt
ReadingDate Gros
Time
Net
Time
I Depth w
- Water
Dmp
i8 99 %,Z,3
i G•(03
I -�
S
I 2•(oIrI
o4
5; r , d+
t i �'111.,'5 a
7v
I r 4
I I ILyo/13
I
I
(
I
I
I
I
20 PERCOLATION RATE Z(muunevinch) PERC HOLE DIAMETER IR 11
TEST RUN BETWEEN FT AND FT
COMMENTS Pert. Cavity presoaked prior to testing..
PERFORMED Bi� l� - I r �� �"`4-RTIF'Y THAT yHIS T T WAS PERFORMED IN
Michael E. Anderson �./� %
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DA l c
72-008 (Rev. 4/p.5)
PERFORMED
LEGAL
7-
8 -
9 -
10
11
12
13
14
1s
16
17
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street. Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
Subs./ AM
DATE
I. Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES. AT WHAT - 0
DEPTH? P
E
Dep m Wsc ALv
Kwmring7 Dmt
19
20 j
PERCOLATION RATE �" (mw"evmrlt)//PP�ERC HOLE DIAMETER
//
TEST RUN BETWEEN /2 FT AND SFT
COMMENTS' Perc. Cavity presoaked prior to testing..
Reading Dale I Gros
Time
Na
Tihro
I Depth m
- Wam
I Net
Drop
ji2
I I �`E
I 3v
I S
Sr$1
i I 52
3n
I /.s
I
I
I
I
I
I
I
PERFORMED : I w1"�za^'66R'61FY HA THIS EST WAS PERFORMED IN
Michael E. Anderson �q 9
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE
72-008 (Rev. 4185)
O MUNICIPALITY ANCHORAGE
• DEPARTMENT OF HEALTH 8 HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
$43-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
nq
Parcel I.D.# 041-031-96 HAA #1LIF]
1. GENERAL INFORMATION
Complete legal description Lot 9, Block 3, Hillside North No. 5
Location (site address or directions)
Property owner Crown Pointe, Inc.. Day phone 345-6277
Mailing address P.O. Box 112313 Anchorage, AK 99511-2313
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: Five (5 )
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
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.
n2 5(Fiev. V91) Front MOAR 1
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Anderson Engineering Phone 522-7773
Address
P.O. Box 24077
Engineer's signature 711cck44k E� Date 12/26/99
6. DHH6 SIGNATURE
Approved for S bedrooms.
Disapproved.
Conditional approval for
Additional Comments
0
bedrooms, with the following stipulations:
Date/Z-28—/9
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineers work.
n-025 (Rev. 191) Back MOA e21
Municipality of Anchorage Utu 27 1999
• —
DEPARTMENT OF HEALTH &HUMAN SERVICE�,,
�,,,;,, ' .
Environmental Services Division ENVIRCNMENtA. SLnV eD
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: Lot 9, Block 5 Hillside North Parcel I.D.: 041 -031-96
No. 5
A. WELL DATA
Well type Private If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) _ Y Date completed 5/11/99
Total depth 121 '
Sanitary seal (Y/N)
Date of test
Static water level
Well production
Cased to 121 '
Y
FROM WELL LOG
5/11/99
WATER SAMPLE RESULTS:
Coliform 0
M
30
g.p.m.
Casing height (above ground) 2
Wires properly protected (Y/N) Y
AT INSPECTION
Nitrate 2.14 mg /L Other bacteria
Date of sample: 12/23/99 Collected by:
A. Harala
0
B. SEPTIC/HOLDING TANK DATA
Date installed 6/4/99 Tank size 1 , 5 00 Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N
Date of Pumping New
Pumper Constructi
C. ABSORPTION FIELD DATA
Date installed 6/4/99 Soil rating (g.p.d./W or ft2/bdrm) 1.2 Systemtype Shallow 5' Wide
Trench
Length 66' Width 5' Gravel thickness below pipe 4 ' Total depth 9 '
Effective absorption area 660 SF Monitoring Tube present (Y/N) Y Depression over field (Y/N) N
Date of adequacy test New Const Results(Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate = o.p.d.
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)"
If yes, give date N / n
D. LIFT STATION - None on Lot
Date installed
Size in gallons
Manhole/Access (Y/N) "Pump on" level at'
High water alarm level at' `Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot >100'
Absorption field on lot _
Public sewer main
>100'
N/A
"Pump off" level at'
_ On adjacent lots _>>I
0
On adjacent lots > 10 0,
Public sewer manhole/cleanout
Sewer /septic service line >25' Lift station N / A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation >51 Property line > S ' Absorption field F
Water main/service line > 10 ' Surface water/drainage > 1 no ' Wells on adjacent lots > 10 0 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line > 1 0 ' Building foundation > 1 0 ' Water main/service line > 1 0 '
Surface water >100' Driveway, parking/vehicle storage area >25'
Curtain drain None Noted on Lot Wells on adjacent lots >100'
F. ENGINEER'S CERTIFICATION
• ' OF bo �s
/certify that I have determined thru field inspections and review of Municipal recordshthat the vg�syoems are
in conformance with MOA HAA guidelines in effect on this date.
Signature py .. � s
Engineer's Name Michael R_ Anderson_, P r, r� •'`':.
Date 12/26/99 ��@d
J _ �o
HAA Fee $ V �� • Waiver Fee $
Date of Payment 'Z UU— q-7/ �/ Date of Payment
Receipt Number ��T / (. Receipt Number
72-026 (Rev. 3/96)'