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HomeMy WebLinkAboutORTH LT 2Onsite File Orth Lot 2 #015-342-05 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211445 PID Number: 015-342-05 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name BRENT & JOY FERGUSON ABSORPTION FIELD ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5900 ORTH CIRCLE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.45 GPD/SF 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.8 Ft. Gravel depth beneath pipe 10.2 Ft. Subdivision Block Lot ORTH 2 Fill added above original grade VARIES 1.71-1.76 Ft. Gravel length 67 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1366 Ft2 1 Ft. Well 100 100'+25 + TANK ® Septic ElS.T.E.P. ElHolding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 51+ 10'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by Installer MIKE ANDERSON PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection Vt 1/10/22 2�d 1/11/2022 da:3rd Location and description 1/13/22 4`h 1/13/22 TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL ��\`\ A,��1 Conditional Approval: Date .W Ape TH Septic System % CuHuffman / _ Date Z2 I+����� • CE128991 [ •14/22 ..... NP��� �l F�F'0 � k�t ROFESSIO�� Note: this approval does not include well permit requirements. trcev UD/UZ/ 1 a) PID: 015-342-05 PERMIT A -C=34,4' B -C=53,8' FCO DCO,H CD1 A -D=34,9' BM 99.91 B -D=51,8' 95.80 A -E=35,1' B -E=49,4' 95. A -F=38,7' 1'HDSPE T NKK B -F=51,3' A -G=41.6' B -G=53,6' A -H=68.3' B -H=83,7' CO MMT 61-3', , - FINAL GRADE FILTER FABRIC 11 11 1'8• SEWER ROCK 10.0' Si 4BR GAT III RESERVE 2GPD=667 SF SAS 667 SAS / 2X10' 34'L X 2'W X 10'ED SM/ML TH21-1 - DRY NO GRND. WATER 10/8/21 SEPTIC SECTION t8, SCALEt NTS BOH A -I=86.3' ORTH LOT 2 B -I=79,1' PREPARED FOR: A -J=86.0' BRENT & JOY FERGUSON B -J=78,9' 5900 ORTH CIRCLE ANCHORAGE, AK 99507 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAKOgmail.com SUPPORTS SERVICES: . �<; g TH 0. TH DATE: 1/17/2022 is Huffman SURVEY: KGLr CE 128991 DRAWN: FWCS 1/17/2022 SCALE: 1" = 30'eAr `� EssIDN� WELL �, tk G / • •;iso DECK �N 5v �1`Lfo ado / SE SE 9.9' / x7.6' SHEV SHED \ 100' PROTECTNE Lot 1 \ WELL RADIUS �\ MANHOLE 2 ^ SEPTIC � _ 1PIPES to GAZEBOP ?I P> 10' UTILITY EASEMENT 1 '12.0'x16.0' SHED Lot 2 51,527 S.F. 0.0' SHED Lot 3 'J> S 89'54'22"W 250. . q_. — HOUSE DETAIL Scale: 1"=30' 3.6'x7 CAI EASEMENTS UTILITY EASEMENTS Lot 1 1. 81 JL _ _� — ao — rri L4 0 0 PLOT PLAN M_ AS BUILT _X_ SCALE _1"-_50__ GRID _ SW 2538Project No. 22-010�R1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates' i n C o (907) 522-6476 Phone `' (907) 522-4625 Fax OF Professional Land Surveyors ken®langsurvey.com Jonothen0langsurvey.com 1 hereby certify that I have, surveyed the following described e pro 49TH*" gV LOT 2, ORTH SUBDIVISION (PLAT No. 74-223) p p TH �* Q� Anchorage Recording District, Alaska, and that the improvements situated thereon are """"""""" "...... within the property lines and do not encroach onto the property adjacent thereto, that l no improvements on the property lying adjacent thereto encroach on the surveyed KENNETH G. LAN premises and that there are no roadways, transmission lines or other visible �' o G easements on said property except as indicated hereon.VL�� Dated this the Day of ��-�����'u2z- •LS -5202. '' SJp� �at Anchorage, Alaska 1 4UQR�FeSSI0NA1- ao It is the responsibility of the owner to determine the existence of any easements, ©4pppoaQ covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Was tewafgr Program PK) ON 19W1W 000 Elmore PiDad An rade. AJaaka199519-OWD Phone_ �907) 341,nj04 Fax: (907) .43-7997 hitp:0mm.fll .afUwiU� On -Site Wastewater Disposal System Permit Permit Number: OL913211445 Work Type. Septic U pgra,ds T43 )k Cludu Number: 01534205DOD Situ Legal Addrons: ORTH LT 2 C.;2533 S ite V a it i ng Add res s; 5900 ORTH 01R, Anchorage Owner: FERGUSON BRENT W & ,JOY Des ign Engi neer_ FIRST WATER CONSULTING Thls permit; is for tho construction of: Effective Caw Expiration date: 1•: f`�� �J j} b 1• f� ti. eF:ri'kinen# Lot ;size in Sq Ft: Total Bedrooms; 10122(2021 lrlf�'W�1022 .x;527 Q Divosal Field Q 5eplie Tank ❑ Holding Tan? 17 Privy d Private VVell ❑ Water Storage All construction shall be in accordance with: 1. The attaciiad appro-vecil deraig n. 2. Al I requirements s p ified in Anchorage M unicipal code Chapters 15.55 $nd 15-05 $nib th a Slate or Alaska Wastewater Di5po5sr Regulations (1$AAC72) and arinKing Water Regulations (18AAC80) 3. Tho warrtpwotcr pods roquiik;Lj in;spuubun:3 during the inalelletim. The engineer shall notify Me Deve lopinwdo L Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24f7), 4. Fawn October 15 to Apri 19 $, 8 :510 b*iUrf0Ce soi I absorption syetem and er constructipn durin g freezing vweaVier shal I be either - a. ithera. Oponed and Ctuseo on the send day, or b. Caveri3d, sekaled, and heated to prevent freezing Lbelomted l Pravis i -ons. The submitted as-bui It survey is m ing the starid pi pes for the "f 99.9 upgrad e_ Th R tor shall locate the s4Andpipes at each end of the-2yWing absorption field. The new absorpiivn field s.^.arl at least 20 f# from tt'te existing fie Id and shall be within the 30 ft radius of the percolation lets It. Received By, ISSUed Ey- Date; 10/2212021 Dat[�- 10 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I. D. 015-342-05 Property owner(s) BRENT & JOY FERGUSON Day phone Mailing address PO BOX 2282, VALDEZ, AK 99686 Site address 5900 ORTH CIRCLE, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) ORTH LOT 2 Legal description (Township, Range & Section) Lot Size 51,527 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank El Upgrade 0 ❑ (D) Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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: t 59 5 Waiver Fees: Date of Payment: /0// t/21 Receipt Number: 3 IQ 12:L Permit No. OS P 2 11 `-I L/ 5 Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com October 12, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: ORTH LOT 2 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep trench and 1500-gallon tank to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted in September 2021 with October groundwater monitoring. No groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 3-8% to flat at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211445, Rebecca Carroll, 10/22/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211445, Rebecca Carroll, 10/22/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211445, Rebecca Carroll, 10/22/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG PERCOLATION TEST LEGAL DESCRIPTION: ORTH LOT 2 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10/11/2021 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 5 6 SM/ML 7 8 Silt decreasing w/ depth 9 10 11 12 13 14 15 16 17 18 19 BOH 20 Reading Date Gross Time Net Time Depth to Water Net Drop 10/8/21 30 min 6” 9/16” 30 min 6” 8/16” 30 min 6” 9/16” PERCOLATION RATE 54 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 10/8/2021 TESTHOLE # 21-1 DATE PERFORMED: 9/14/21 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: BRENT & JOY FERGUSON 10/11/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211445, Rebecca Carroll, 10/22/21 I F— U) o - C13 i us C) Cf) 0 71 V "evelopment Services bepartment Building Safety bivision On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 Mayor wwrnumi.orohnsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: (9t5— 3q -2--Cb— Legal Description Property Owner Name & Address: () �T f+ J651 F"OJOAr L+ Pump Instillation Date: Pump Intake Depth Below Top of Well Casing: feet Pump, Manufacturer's Name: Pumo Model: 12, Pump §lze hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: .4) a Well Disinfected Upon Completion? 5Z Yes F No Method of Disinfection: Comments: Pump Installer Name: ANCHORAGE WELL & PUMP SERV. 330 EAST 76TH AVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Page o f DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S 61`99 C23t��_� PIDNumber: Name: U ir-_C,�( I eL Resxe Wastewater System: [I New N Upgrade Address: ABSORPTION FIELD Phone* No. o drooms: lip J@DeepTrench OShallowTrench DBed CIMound 00ther LEGAL DESCRIPTION Soil Rating: 0-8 Total Depth from original grade: I 9. GPD/Sq.Ft. 0� Lol: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 2. 744 b- Ft. Ft. Township: --Fge Section: Fill added above original grade: Gravel length: 0. Ft. Ft. WELL: 15AtST 0 New 0 Upgrade Gravel width: S.5- Num7r 7of I I �,ne&lwmo between lines: — Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe mp;�a` I -e -f rf S_ Ft. e6- Ft. '730 SQ. Ft. I - n . o!2 E -1 - Driller: P t tw� Date Drilled: 7,� Static Tater Level: -7-7 Installer: S 4,4 ate installed: Idl.99 e Ft, Yield: I Pump Set at: I Casing Height Above Ground: o2 TANK GPM Ft. Ft. SEPARATION DISTANCES R Septic 0 Holding 0 S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank held — Station Tank Sewer Lines hn eA al-e2el e Tan k 1,5.Y & 0 Well, 109' Material: V e Number of Compartments: Surface Water i C,0 ;e LIFT STATION N.,4. Lot <0, Size in gallons: Manufacturer: 1 Line 10, Foundation 0-2, Pump on" level at: Pump off" level at: High water alarm at: Curtain Pump Make & Model Electrical Inspections performed by: I Drain Remarks: .5 r2:kc/e /in (,-c< BENCH MARK Location and Description: /-0 e�g,,t oeee�7)L, Sort( /4 601V&M &jc S-"4,qe el� 1i 6� e, -e c -o 6,r, _r 1-e n 6u. 'F V. 0 J 5 A C�n /9 lein v, e — �,e�4 �,A 1, Assumed Elevation: [>,-f e4cf, e line ;(;­&� I / !:�, ___LL V� ENGINEER'S SEAL I n jr, q 4r;�' �,Irq h. jZ,/, e f�eC , D O"b le 0, 1-4 Me -( wll--j-e ner� e eonnec)�­;! 76 oW Inspections performed by: F11" t��-4 Dates: ist 1,9,'dl9 2nd 110 1 d19 J!� Department of Health and Human Services approval --1/7�,� qA�A_ 109199 Reviewed and approved by: V Date: 72-013 (Re�. 9/91) MOA 25 PERMIT NO: SW990356 PID NO: 015-342-05 SWING TIES: FROM: COR. "A" COR. "B" TO: DBL. C.O. "C" 31' 16' S.T. C.O. "D" 68' 56, S.T. C.O. "E" 72' 62' DBL, C.O. 7" 77' 68' TR. C.O. "G" 72' 67' TR. M.T. "H" 70' 91, TR. C.O. "1" 74' P6' 0\1 LOT 2 PAGE 2 OF 2 :LL -LL 1000 GALLON H" C TANK V -1-Ep-TI T. H. # 1 73'LONG SOIL ABS. TRENCH WITH 6.0'GVL. BELOW PIPE PLAN VIEW SCALE: 1" = 30' 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 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Permit Number: SW990356 Legal Description: ORTH LT 2 Design Engineer: 0019 Flattop Technical Services Owner Name; Ursula Hesse Owner Address: c/o Fuchs 9441 Ponderosa Dr Anchorage , AK 99516-0000 Upgrade j C 'I Date Issued: Sep 27, 1999 Expiration Date: Sep 26, 2000 Parcel ID: 015-342-05 Site Address: 005900 ORTH CIR Lot Size: 51527 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: E Disposal Field [,/] Septic Tank E] Holding Tank [] Privy L] 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. Date: 9 Issued By: j z�_/ Date. F"TTOP TECHNICAL SE�' Civil,& ENVIRONMENTA-L ENGINEERING ENERGY CONS ERVA'HON & ANALYS IS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 September 15, 1999 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sits: ANCHORAGE, ALASKA 99516 The purpose of this letter is to provide the required design narrative in support of our application for a permit to construct wastewater disposal facilities on Lot 2, Orth S/D, located at 5900 Orth Circle. The present system is operating in a surcharged condition. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole #1. As can be seen from the soil log, the native materia ' I between 3.5' and 7.5' below ground level is a silty sand with a measured perc rate of 11 minutes per inch. Using the soil application rate of 0.8 gpd/sq. ft. specified in the wastewater ordinance, this 3 bedroom residence requires a total absorption area of (3 x 150)/0.8 = 563 square feet. The proposed 72 foot long trench design with an effective gravel depth of 4 feet has a total absorption area of 576 square feet. To be on the conservative side our design includes an extra foot of sewer gravel to provide space for solids to precipitate and to take advantage of possible fluctuations in the level of the bottom of the designated absorption stratum. The topography of the lot in the area of the proposed construction slopes down towards the south at 15%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space -surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, ar Ted Moore, P.E. RECEIVED SEP 16 1999 MUNICIPALITY Of ANCHUkAGE Ef4VIR0t*"TA1 SERVICE$ WWOk LOT 5 WELL WELL -/1"' LOT 3 R 100' WEL 'VE D IVE ----- 3-2DR -------- - -- HOUSE INSTALL ---- DEL. C.O. INSTALL NEW ABANDON 1000 GALLON EXISTING SEPTIC TAN!(, 1000 GAL. SEPTIC TANK ------ -------- T. H. 0 #1 0 ABANDON CONSTRUCT 72 L.F. EXISTING SOIL ABS. TRENCH TRENCH W. 5.0'SEWER GVL. LOT1 INSTALL BELOW DIST. PIPE (VACANT) DBL. C.O.. LOT 2 -------------------------- --------------------------------------------------------- Ll - - - - - - - - - - 4 -- CRAIG CREEK COURT - - - - - - - - - - - - - - - - - -- - - - - - - LOT 2, ORTH S/D WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 SEPTEMBER, 1999 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. INSTALL NEW 1000 GALLON SEPTIC TANK INSTALL DBL. C.O. "A'$ 7 NOTE: CONNECT DISCHARGE PIPE FROM S.T. INTO PERF. DIST. PIPE WITHIN 50'OF END. CONSTRUCT 72'LONG SOIL ABSORPTION TRENCH W. 5.0'GVL. BELOW DIST. PIPE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - :MT 0. -C.O. 72 PLAN VIEW SCALE: 1" = 10' - MONITOR TUBE -MOUND BACKFI ILL 6" 3 --] 1 \-- ORIGINAL GROUND 0'6 1 1 1 1 - ',\� " FILTER FABRIC L�6 I � I I '*� :1 \- 4" F-810 PERF. PIPE 1/2" - 2 1/2" SEWER GVL. BOTTOM OF EXCAVATION CROSS-SECTION "A - All SCALE: 1" = 5' Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (907) 345-1355 Lot 2, Orth S/D 5900 Orth Circle Wastewater disposal system installation Specifications 1.0 General: 1. 1 The scope of the project consists of abandonment of an existing 1000 gallon septic tank and installation of a new 1000 gallon septic tank followed by a 72' long soil absorption trench containing a total of 5.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities, 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil 2.2 The new 1000 gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4... per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A double cleanout shall be installed upstream of the septic tank at the point where the new waste line is tied into the existing waste line from the residence. Another double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 72' long trench to a depth of 8.5 feet below ground level in the vicinity of the trench. The long axis of the trench shall parallel an existing contour of the land. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration, 3.3 A total of 5.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 5.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2,5" screened gravel, with less than 3% passing the #200 sieve. The 4" non -perforated discharge line from the septic tank shall tie into the perforated distribution pipe at a point no more than 50 feet from either end of the trench. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3,5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours, Fill slopes shall be no steeper than 3: 1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections. 4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer, FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE. ALASKA 99516 TEST SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 2, Orth S/D DATE PERFORMED: August 20,1999 PERFORMED FOR: Ursula Hesse DEPTH SLOPE Pt. (fee , t)�n SM Sandy loam MIL Gray silt Dense, damp SM Gray silty fine sand Loose, dry SM/ML Very silty sand Cohesive Cobbles @ 10' GM Silty gravel Dry, easier digging 3. H. ( 30% 31 150% 0% Depth to Groundwater Date No groundwater 8/20/99 Monitor tube dry 9/8/99 uj 0- 0 0) 17 - SITE PLAN '(�' llq�� 01?� WELL—� A HOUS 0 1�9 S PTIC E m. T. H. SYSTEM #1 0 Date Reading 0% Net Time (minutes) Percometer Reading Date Reading Clock Time Net Time (minutes) Percometer Reading Net Drop (inches) 6 --- —T2-15-r�esoa /20 27 112 — 8/23 12" Resoak 275/8 Add water & start 12:32 23 1/2 #1 1:02 30 20 11/16 213/16 Add water 1:02:20 235/8 #2 1:32:20 30 ---- T 20 3 -f 2718 Add water 1:33 235/8 #3 1 2:03 30 20 M 27/8 PERCOLATION RATE 11 (minutes/inch) PERC HOLE DIAMETER 511 TEST RUN BETWEEN 5.0 FT AND 5.5 FT PERFORMED BY FLATTOP TECHNICAL SERVICES. I YS,� 91t� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '9 11'5-195� GRE,�. _R ANCHORAGE AREA BM.JGH Department of Environmental Quality ED 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME C i;(Z Nf4rM 14 FS Ir F MA I L I N G ADD RESS Ll- 166 o - PHONE &'Iel- e12 - LOCATION LEGAL DESCRIPTION 461- 12 ?-/-) CNG/e SEPTIC TANK: DISTANCE NUMBER OF FROM WELL MANUFACTURER MATERIAL COMPARTMENTS INSIDE LENGTH-- INSIDE WIDTH-- --LIQUID DEPTH —LIQUID CAPACITY 1660 GALLONS. DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE 4-IrJ TOTAL LENGTH OF LINE -6 3 NUMBER OF LINE9 I DISTANCE BETWEEN LINES __TRENCH WIDTI­L4/_t? IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE 41 MATERIAL BENEATH TILE Py 1*. ABOVE TILE IN. WELL: TYPE CONSTRUCTION DEPTH -----DISTANCE FROM: BUILDING NEAREST FOUNDATION—, LOT LINE CESSPOOL OTHER SOURCES NEAREST SEPTIC SEEPAGE SEWER LINE_ TANK_ SYSTEM- APPROVED-- DISAPPROVED— REMARKS DISTANCES: 6 INSTALLED BY: -SE'p SEWER LINE DEPTH:OV\ SIOP q PIPE MATERIAL: LOTSLOPE: -F-6 qr4lz 2Q(Ira REMARKS: Form EQ -032 DIAGRAM OF SYSTEM I)ATE-'l/"/?(- APPROVED -z' G.A.A.B. > GRE, --R ANCHORAGE AREA Bot UGH �-D DEPARTMENT OF ENVIRONMENTAL. QUALITY PERMIT No. 3330 ''C" STREET' ANCHORAGE, ALASKA 99503 t R TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT kl:.j I r I V I L-1 MAILING ADDRESS INSTALLATION LOCATION C7, c9c LEGAL DESCRIPTION Lo 2 0 INSTALLATION OF: SEPTIC TANK SEEPAGE PlTp,�r) DRAIN FIELD TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO ��.NSTALLED BY ro SOIL TEST R,,U,F.gpo)zlifftt e-, NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE: SUBJECT TO PROSECUTION. I - SEPTIC TANK SIZE f � k ��( .9t TYPE SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS,-, FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. 15— / SEEPAGE PIT WELL TO SEPTIC TANK 10 DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, SEEPAGE PIT —. DRAIN FIELD TO RIVER, LAKE, STREAM. CAST ]RON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL RACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.D. OR O.NSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA 130ROUGH ORDINANCE NO. 2B.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN 42CORPANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM NO. EQ -01 6 Contstwo-tion Sre-st -,Pa� "One test is worth a thousand opinions" 0020 YUDOR ROAD. ANCHORAGE, ALASKA 0OB07 0 TELUNION9 833-0472 Perforilled Date Perforriied.___8,��/.7..5.--.,,--.- Looal 0escrintion: Lot 2 Rl ock S �� —d� —V1 -si 0 n Orth Subdivision -T —o(l �e-r-- - - - i his loriii Renorts Soils �es c o 1 1 t i 0 n Te S t Yes 5 — t 1) Soil Characteristic.s Sandy Silt with occasional cobbles & boulders Sandy Silt - Silty Sand with occasional cobbles & boulders (ML -SM) Bottom of test hole Wa� (-round Water Encountered? No 1 4' V e s , A t t -i h a t Do 1) t h ? 0 Net Dron R (I i n (I Date Gross 'riine Net Titne Denth to 112 — ------ ---- Saturation Period 75 23 hrs. .... . ... ... 5/ _,L__Z_5_Tqst Period 24 hrs. 96" 0 108 28 12 PLrcolation Rate 1,,,/ Z_Q__�linutes Proi)osed Installation: Seenacie Pit Drain Field Delith of Inlet Dep tTi—i­o�­of-toiTi Of P i t f'() fA �A [-- N [* � , ?90' qmlArp fopi- arninnap arpa rpapirgd np��J?edroom. No bedrock or qround water to I es L' Per f ortned B y s D. Mack I s 171 Data Certified t3y:CONSTRUCTION -- TEST LAB Date: 6RLAiLR ANUOUIOWL AI�LA bUKUU� Department of Environmental QUalItY 3330 "C" Street -' Anchorage, Alaska 99503 SOIj,S 1,0(1 - I)EIZOLATION TEST Performed for Gerha,d Hesse Legal Descripti o 2 orth Su vision This form reports: soils log YES perco ation Depth Slightly Damp Grey Silt 2 with occasional boulders 3 4 - 5 - 6 7 - Slightly Damp Grey Sandy Silt with occasional rOOk5 8 - and boulders 9 S.F./B.R. 10 Sample 10-11 :Ot' 11 sandy Gravel +0 13 - v /B R. / � �U -( (--, Date Performed 6/16/7 S/ obe 1,74 10V Q. - I . see Attached Sketch Bottom f t st Pit If yes, at What dePth? Was ground water encountered? Not Time Depth to Water Net UrOP ,at r NetL.)."OP Rea �f e Gross Time ding Dat 1 nute. YES Drain Field wFE01ation rate :p*t� Trench trench !Pa( f Proposed installa_f�io- so, 11 to -b-0-tt011) 0 P' t or of Inlet OL �red _J� o0jah be oc encount( - T �?. - water -75 C01-11.01 S : __ .__ 7-23 9 LAB—., IFVIRTV;�cd BY. 6,Vm- eal Ila R (CIA r� t. NW I t7 P I? 'F 0 Y-41 q(o I . . . . . . IQ no w rs� W'.:V 60 e -,r. �!;,r A� K I 14.� U,5! 4 ,,15�4,. V/P PROJECT R—) —/Z SOILS SIEVE ANALYS I S L.d. NO, DATE OPERATOR TIC— CHECKER SIEVE siz WEIGHT RETAINED --7 —PLUS PERCENT RETAINED % PASSING SPEC FICATION L:MITS REMARKS --4 MINUS 04 SIEVE CUMULATIVE 3/4" 3/8" 4 90 10 J�l 20 40 60 80 100 140 DRY 200 WET Oly WET MATERIAL FINER THAN NO. 200 SIEVE ORIGINAL ORY WEIGHT DRY WEIGHT AFTER WASH DIFFERENCE % FINER THAN 200 PAN q6 TOTAL 19) 1-372 Well Log Gerrlc�yd� 14- Ur, 'For ..... ........................................ ....... .............. I ........................ ....... Location..... .......................................... ............................... ............................... Date completed ......... zlze/ . ....... ........ .............. . v-� . 2). 0 V . -NJ SL4 Depth of well'. ......................... Size of casing.. - xe . . . . ............ ... ......... . Distance to wa ter...,,7,11 ...................... Distance to water while pumping,�..�,.; e� .. at rate of ... per hour. IV W q A/ W W'�- ��ec 14) TQN,(�3vv, '�3M 2 .. .... . ..... .... .. ...... 'vv `7Y - /,�-1 1�610, Driller 4Z -DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE, ALASKA 99507 MUNICIPALITY OF ANCHORAGE t! 4 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-342-05 1. GENERAL INFORMATION Complete Complete legal description ORTH LOT 2 Expiration Date: L / q ^ Z© � -?- Location (site address) 5900 ORTH CIRCLE, ANCHORAGE, AK 99507 Current property owner(s) BRENT & JOY FERGUSON Day phone Mailing address Real estate agent PO BOX 2282, VALDEZ, AK 99686 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 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: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 02 $-O Waiver Fee $ Date of Payment Receipt Number COSA# OSC2 21 a 1 t Date of Payment Receipt Number 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 1/14/2022 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 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 for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & rwPs . 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms —,� of •4�:q�s�`l1 .. ......... __... r • '. Curtis Huffman 61 CE 128991 'kkF, PROFESSIONP�r ���a���_ _ Disapproved Conditional approval for bedrooms, with the following tip lt?Ons:f�r(/r/ Fo !'lAl nrrr WATER AND m WASTEKATER z^ G O SER\J�G��`�\\� By Original Certificate Date: 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: ORTH LOT 2 Parcel ID: 015-342-05 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 7/6/1976 Total depth 85 ft Cased to 85 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 8/17/21 Static water level at beginning of test 69 ft. Well production at time of test 5.5 gpm Comments B. TANK DATA Age of tank(s) *NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping * D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ® ALL standpipes present per record drawing Total measured depth from grade 13.8 ft (max) Measured depth to pipe invert from grade 3_6 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Structure served by this system _ Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 3.97 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by U'S Date of Sample 12/16/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: *NEW SYSTEM Adequacy test date NEW SYSTEM Results ❑ Pass For bedrooms Fluid depth prior to test _ in Water added gal New depth in Elapsed time min ®Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons FEES Comments/Deficiencies: ;; 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' If absorption field is under driveway comment below ® 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' Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' 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 .,Wa.ter NAain >_.10' _ Yes if No ft Commun!ty.VUeIIG >. 200' ®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 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. Aw AW ow .°� •• ........•....�...... . . Curtis Huffman / ��``�%•. CE 128991 � fF,Q• • JJ14/2;. •' �11�1IO ROFESS�1� ft ft ft ft ft ft ft ft KEICEIV � 1.) NOV [_ Municipality of Anchorage 1 J5 1999 0� DEPARTMENT OF HEALTH & HUMAN SERVlCg%CIpAI.i I Y k ANL UN Environmental Services Division ENVIRONMEN TAL SERVICE DI 825 L Street, Room 502 9 Anchorage, Alaska 99501 a (907) 343-4744 Health Authority Approval Checklist Legal Description: r �-h _�- I -D Parcel I.D.: (:57 Y Z - A. WELL DATA Well type Ae If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Date completed 7 / 5� / / 9 7,<- Casedto— Casing height (above ground) FA FROM WELL LOG -7 16' / 7 i�' WATER SAMPLE RESULTS: Wires properly protected (Y/N) AT INSPECTION 5,9 7/. g.p.m. q. 9 g.p.m. Coliform- Nitrate 1. 9 7 �'ya Other bacteria T Date of sample: I 1 1579 Collectedby: r14r146?,e 7_ec4�;cal B. SEPTIC/HOLDING TANK DATA Dateinstalled le)IdIP9 Tanksize 100�� Number of Compartments '2—Cleanouts(Y/N) �f' Foundation cleanout (Y/N) r Depression (Y/N) 1Y High water alarm (Y/N) Al -A. Date of Pumping Al. 4. ( N,e-, I Pumper C. ABSORPTION FIELD DATA Date installed 10 lerl 9 9 - Soil rating (g.p.d./ft' or ftl/bdrm) 0..5 System type Length __2_?�_Width 2. s7' Gravel thickness below pipe Total depth Effective absorption area 0' Monitoring Tube present (Y/N) Y Depression over field (Y/N) Al Date of adequacy test P.A. (Nz—� Results (Pass/Fail) 1'axz For ? —bedrooms Fluid depth in absorption field before test (in.); 0 Immediately after— gal. water added (in.): - Fluid depth — (ins) Minutes later: Absorption rate = > g.p.d. Peroxide treatment (past 12 months) (Y/N) A/ 72-026 (Rev. 3/96)* If yes, give date /-J. 4. D. LIFTSTATION IV -A. Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line 1 '99, On adjacent lots "Pump off" level at* On adjacent lots > / Public sewer manhole/cleanout -:-- i ::, e- , Lift station IV -4. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Y.? Property line Absorption field -7 / Water main/service line -> -5-6, ' Surface water/drainage > Wells on adjacent lots > SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line to' Building foundation 6' Z' Water main/service line > S -e5' Surface water -� 16,0' Driveway, parking/vehicle storage area '> N -e, ' Curtain drain 1V0^e S.e v^ F. ENGINEER'S CERTIFICATION Wells on adjacent lots > ( C� C, I / certify that / have determined thru field inspections and review of Municipal records that the qbo�o systems are in conformance with MCA HAA guidelines in effect on this date. Signature Engineer's Name Date 11 Is- 1,99 HAA Fee $ 7 0,9 Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number