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Home My WebLink AboutSPENDLOVE VIEW HEIGHTS #3 BLK 5 LT 1Spendlove View Heights #3 Block 5 Lot 1 #017-401-52 l\ Development Services Department O Eui!ding Surety Division —,I on-Siie ! ctar & Was awater t`�raQrGTI si _ `3 _ 4'00 8 o-- Streer P.O. 6ax 19bb50 -Vfarlc 8egich Anchoraie, AK 9051.9-6650 mayor un!�w muni.ararnnsir+ (907)1_43-79o- Pump Installation Log ;ll Dritline PermitL�lumber: SW_ Date of Issue: _ -cel Identification Number:_ ;al Descripti/ort 5�Oek,J_ 10 V& np Installation Date: Allash q 7 Pro a Owne �e dress: Men np Intake Depth Below Top of Well Casing):> AW / feet np Manufacturer's Name:.lRe� mp Model: cap ,She /bhp Less Adapter Burial Depth: feet Less Adapter Manufacturer's Name: less .AdaPter Installer /b- ell Disinfected Upoa Compleuoa".' Yes ❑ iVd G/J r— mmeats: rap Iastaller Name: E tendon: The pump iastaLler shall provide a ptunp instaliati•an log to the DSD within 30 days of pUmmp Lastallatian. Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 www.cl.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO80080 PID Number: 017401.52 _zjxrt SutherlandWastewater System: ❑ New ® Upgrade Mdrar Spendlove Drive ABSORPTION FIELD Nurnpu of Bulrooma O Daae Trarch O sn.,low Trerrll O Bad D MWW O Oltvx: LEGAL DESCRIPTION soaRap TOWDagneomorgr.,glade 61o.k Ld 6u0dmPonGPDn'tt 5 Daps ro q0a Oatom hom ergo., glade fl. bray., dagn ganaaT pipe S endlove View Heights Add #3 ToanM,P Range swam Ft, Fa added apova ulginal grads fl Gravel Larpm: Well: New El Upgrade Ft. cr.v.,wdN Ft. N meero lma: Datantt Uawlan lnaa CMauMaoon (Pinata. A B. C) Tot., Depd,.Caed to' ExistingPrivate Ft. T.W 61,60".ara R PIMMaten., fl. Ft Drain Data broad sun. W at« Lay., Ft l a j 3 034 PVC lal.,lad Ft Beek Construction 612512008 Y'� Purnp Sat n Cana aNpM Move Crpeal GPM Ft. fl TANK SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption utt Holding ublic/Private aru Mtw.l. uaiWay From Tank Field Station Tank Sewer Line Anchorage Tank 1000" wan122' 135' 85 Steel N.riStalM .rtmn't. 2 Svd..a w.br 100+ 100+ LIFT STATION Lot t..a 10+ 10+ "° N° •<'.„•' c., FaMW.,pn 10+ 10+ w^'P o^ lav« at 'PuiR oK rv.r at wpn w.t« alum., In h In Grrtun Arun 50+ 50+ w V Mata a Mod., El%tn.., lapacppna pertormW by Rli,r a Septic tank replacement only. Existing tank abandoned per code. BENCH MARK 2' Fill added over tank to bring to 4' of cover. L Finished Zloor n , Finished Floor of Basement • 1289.6 M.vr.a MvanM. ��*.A1Y<1!iJ31131�•'f1F• 100.0 FL Inspections performed by: PANNONE ENG. SVC, LLC Dates:. 612512008 Engineers Stamp r1M, 2nd 6/25/2008 �� OF Development Services Department A tiaY�'. arta, t7 �.`p�E.........q..q��.i : �,.• ' �# tl'ppCpyal i�ldtlir.. F Conditional Approval PP Date: • ♦ T.Steven R. Ponnone� �1 '• F 8149: Reviewed and approved by: i` �t Date: —Z -Q oaaa)� �� 4 �: n'�, �.••,•• •''•�ci� cab.. SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: 3 -BEDROOM HOUSE TANK UPGRADE. REUSE EXISTING FIELD. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 15 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. 5. EXISTING TANK SHALL BE INSPECTED & IF FOUND LEAKING, WILL BE ABANDONED IN ACCORDANCE WITH THE CODE BY PUMPING, CRUSHING, AND FILLING WITH COMPACTED CLEAN EARTH MATERIAL. INSTALL NEW 1250G SEPTIC TANK Z OF ¢O 0 Z 'o IJ S ILL U O n Z `jll jll\ W J U QO W= J WO U ma =LLJ 1292.9 0 U 1288.4 NEW 1250 g SEPTIC DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (600 gpd) TANK SIZE: 1,000 gallon W COO �?Z W 002 Z H O n Z W 10 Q 4' Dia Perf Pipe EXISTING ABSORPTION FIELD PROFILE ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C(/ CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER W COO crW � 22 0 Ow j �< U LEGEND w—w— WATER LINE/ WELL RADIUS — N — 60 — EXIST'G SEPTIC —"—"— NEW SEPTIC NOTES: PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 �`OF A \x, ��,•...,CgS,llt/zt�/oe • *� TH i9*��/ ...........P.I.D. / Steven ' annoAe CE 8149 '. �/ () cyf•, '";� 1�'0••...•• �G P �� `�� Date RECORD DRAWING stirs SPendlove View Hts # 3 L1 Bk 5 Robert Sutherland 8800 Spendlove Dr. Anchorage, AK 99516 NO 17-401-5 PERMIT NO. Swo8o080 DETAILS Sheet 30F3 - - - - - -- - - - - - - - - - - - ---- ------------------ - - - - - - - - - - - - - -i[Esmt y r ...... SPENDLOVE-DRIVE-. _4� ---------------- WELV --EXIST-d, WELL E'XI ING f BR-.HOU.SE 122.5 E T G 1000 GALLON �EPTIV N C TANK ABANDONED CODE M I NEW' 000 GALLQ'N• ANK 102.5 64.'l E 1S IN 'DRAIN .�IN IE- go NOTES: PAMONE ENG SVC, LLC Dote RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 7/21/08Scale PHONE (907) 272-8218 FAX (907) 272-8211 - kk I" - 50' Spendlove View Hts # 3 Ll Bk 5 Robert Sutherland 8800 Spendlove Dr. ......... ....... teven norie C 14on9 P.J.D. NO 17-401-5: PERMIT NO. SWO80080 PLAN Anchorage, AK 99516 . ...... Sheet 2 OF 3 MUNICIPALITY OF ANCHORAGE Development Services Department >J� On-Sito Water d Wastewater Program g / tI� 2 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 16, 2008 Expiration Date: Jun 16, 2009 Permit Number: SW080080 Parcel ID: 017-401-52 Legal Description: SPENDLOVE VIEW HEIGHTS #3 BLK 5 LT 1 Design Engineer: 0062 PANNONE ENGINEERING SERVR Owner Name: ROBERT SUTHERLAND Owner Address: 8800 SPENDLOVE DRIVE ANCHORAGE. AK 99516 - Site Address: 008800 SPENDLOVE DR Lot Size: 49588 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907)343-7904(24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. MUST MAINTAIN 5' SEPARATION BETWEEN ABSORPTION FIELD AND TANK. Received By: �l` P� rM 0 A1'4 / Date: O q CI Date: 611 Municipality o4 —n horage Development ServiCr,, Departm,.>rt; Building Safe:y On -Sita Water and Wactseate: Program 4700 Brar,:,r. S;reat P.O. Sox .;8c", Anchorage,;-!ask:-Ost9-�E5C ON-SITE SEWER,MIELL PERIA7 APPLICATION FOR A SINGLE Fi,�,,!_,Y DWELLING Fa. -cel I.O. 0I7- go, -5.;t Properr/ owners) Robert Sutherland &Nicole CdcCulioug�: _.__. Ja, phone rAailing a:iuressaSUO Soendlove Drive _____ .w__ 71p -t•ca 99516 S ?e eddress 8500 Soendlove Drive Ug"c.' doccriptien (Sub'd., Block & Lo?) _Spendi:;v`N [_,ocK 5 Lo' 1 Legal description (Township, Range & Section) LI -11 Sze /a9588 Sq. Ft. ti;. ua: Of 9edreor..S P Code 99516 ,'-i1S APPU`frAT1GN IS FOR (Z all that apply): THIS IS A1d: Absorption Pield U lnitia! Septic Tank Uo., s, a Hording Tank ] Rencwal rJ PrIVy Private WeN � Water Storage M ! c;;rtliy t.at the above information is correct. I furtn�r .i iiy that this application is boing made for a Single Fem!ly Ovie!ling and is in accordance with aw: i:c:d'.Is Vunicipa' Pannone Engineering SerAces, (S natc.,e of, property owner or authorizes agent) r: •^ilGFusn Fees .....& of r ry ^``' IIy' C t: _-�(!///JO Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers (907) 272-8218 Anchorage, Alaska, 99510 (907) 272-8211 Pax June 13,2008 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Spendlove No. 3 S/D B5 Ll EMERGENCY Septic Tank Replacement Permit Request Ladies and Gentlemen: 1 am writing to request that a permit to install a new septic tank be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a three-bedroom house and is operating adequately for three bedrooms. The tank has collapsed and the Owner is pumping daily to keep sewage off the ground. The surrounding lots are served by private water systems and are over 100 feet from the proposed septic tank. This lot is served by private water and the well is located greater than 100 feet from the proposed system. 1. Upgrade Tank Design. a. Number of Bedrooms: 3 b. Septic Tank Size: 1,000 gallon 2. Surface Water. There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at (cast 100 feet from all surface water and drainage ditches. 3. Topography: Lot 4 slopes to the west at approximately 5-10 percent based on existing contour information. The proposed installation will be located in the southern portion of the lot adjacent to the property line. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: RECE"VEDU V Pannone Engineering Service, LLC PO Box 102954 Anchorage, AK 99510 1�' 7) 18 �� pghil nv: CR :� (�Ir•,TINC. SHOUID«< ' �•-,, PrEfJOLOVI: DRIVE .• JJ + N' &9'S9'•1J" W 165.00 ,; Wim. . • 01 t: � �� r.l, r� � •t�. • L'>uSr'G 3 Bit 4,916 ''`Y�'p i ii r. •• ' . L-� p , �• so.z f .::.. .. i y, '.,P nnath o L. DecGraya ,., II 7 ✓ �i W; 'PYzcoo i c�� IS -820i r ,: u°i GUY ....... l Ai�CI t' .41R*yPr �.... •.. '^e[ pr �O '��'tOR s� w •lL:= g UT e 1r` o�eer':a4ol l°� h 1 31 / • O POWER e� PCLE Se-T-nc -10. u v ►a-rsn�JT,,,'i�+cdOT 7 �� /� �� /�,�t.......5"^ �. LOT 2 .y /O. /d L off/ of + Te'i3L� 2et�S�O L ; 0 N E LOT1 O ' $U.,ec• b �� II moo► `_ ,IL (AOF A4 44 i�j ! O 1 1 .rte. _ ii .......... Cr N k PANNONE 8149POLE NIL 2c�PiAGe.10' UTILITY EASEMCN7o.vcY. S 89'59'5 E 165.00'LOT LOT 1 1 r Lor 2 ! . 1 i MUNICIPALITY OF ANCHORAGE ., DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME----r}--yl----TPHHONEE /fit NEW �` YC ❑UPGRADE \ .\ 1.1/ MAILING ADDRESS .�x I I LEGAL DESCRIPTION LOCATION 1 4 NO. OF BEDROOMS Uy Well )( Absorption area 1 Dwelling / 1 DISTANCE TO: / /Io,_— PERMIT NQA iG Manufacturer B p Material � No. of compartments - rn Liq. capacity in alJIF Inside length Width 1 C� HOMEMADE:DISTANCE Liquid depth . — Ozz TOl Dwelling PERMIT NO(��t, -. -y 2 G 3: H Manufacturer Material Liquid capacity in gallons O r� 61 a O w Well I DISTANCE TO: If.1� No. of lines Length of each Ii J Foundation 1 `_ Total length of lint!76, ��b Nearest lot line I Trench widt PERMIT NQ. b �" (�-1 Distance Ietween lines FZ 1/inches ---_-- a H O Top of tile to finish grade 1 — a 9 Material beneath tile �_-.3c) inches Total effective ab�B.)[loan area _ �[[�-f--- Length Width Depth PERMIT NO. w (D I- w° Type of crib Crib diameter Crib depth Total effective absorption area LA rn DISTANCE TO: Well Building foundation Nearest lot line Class Depth — Driller Distance to lot line PERMIT NO. r �m D— ISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) --®-- --- — OTHER — n PIPE MATERIALS t�``J''J�tb//II .� 1 - l u )�' AT SOIL TEST RATING I '�' dm INSTALLER E4/UO',M a REMARKS e f I / APPROVED` DATE LEGAL 72013 (Rev. 3/78) 9 - II y -_y 11 Al I N:_; :H N y==y 4._. 7[: `ll" ° Q" N_A y ::: y:_ p p:.. y A: : 9 y Irr Nm a -y a :y IEc DEPARTMENT i HEALTH AND ENVIRONMENTAL OTEC:1' ICiN 825 STREET, ANCHORAGE, HK. 99501 264-4720 y ,4 L=L I__ I.._. f=0 9"-°9 l'_: OF) P -::p _ Di::...y... LE: :'S . E:_ 9,".p E? F:_ fl K_� & k: I ](. PERMIT NO, 830802 APPLICANT BE:C;HFIROF CONST. I='O E,CrX lli394 9=151.1.--1.39 349-4040 LOCATION T12N R3W S25 LEGAL LOT I SPEYdC'I_.OVE: #Hq :fi:) LOT E::[ 'E 4:::.113 SQUARE FEET TYPE OF SOIL ABSORPTION .''rSTE.:M IS: C•RAINFIE.LD MAXIMUM NUMBER OF BEDROOMS _ SOIL RATING <SQ FTIBR)= 180 THE REQUIRED SIZE OF THE OIL ABSORPTION SYSTEM IS: - n_• .r' fl_.... E- 9'-°9 0:: v ....IF.. p.._y ==:�:c�, � =� C3�: y'=y "°� " E: � N..._. E:- E:: F" —p— p_ 9 === 12.._a THE LENGTH DIMENSION 15 THE LENGTH (IN FEET) OF THE. TRENCH OR: G'R:FIINFIEI...G. THE DEPTH OF A TRENCH OR: PIT IS THE: DISTANCE BETWEEN THE SURFACE OF THE GROUND AND TT -IE: BOTTOM OF THE EXCAVATION (IN FEET). -9` 9---9 IE_ ..p... II ^_" ILF._ 9"-°9 C 9- 9 K G5 0 y='::" EE 9iiE= "r .. THE GR:FI'vEL.. DEPTH 15 THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFRL_L PIPE:: AND THE Fu_i.F.FOM OF THE EXCAVATION IN FEET). N N_1 N _ N 9_._y 71:: h ''_' E:_ Q':_ 13 9Ic. F-1 g A x.;: .. q"=& hl l< _ y µms, &[ __ : .:8_ n uN G. 1171 N:.In ri L..'• L... KDI VA'_'. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WEL...I._S ADJACENT TO THIS PROPERTYAND THE NUMBER OF R:E::=IDEI''•ICE.:= THAT THE: WELL, WIL_L.. SERVE. _............. K y. "j A.:.0 KZ 12 11 1t 9° 9 :_ w IF—" IEc:. N- "� lE p _N 9 ,d °cco • fl—y 9 E = µ :" �- a a 0.. 8 A. FZ EE N :=e -._ _.... _._. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY "CHI:: DEPARTMENT NT WI.L_.L.. BE SUBJECT TO PROSECUTION. 4 MINIMUM DISTANCE BETWEEN A WELL FIY'df..:' ANY ON—SITE SEWAGE C'I'A+PiJSAL SYSTEM IS :i_OO FEET FOR; A PRIVATE. WELL 01 i5w Tf200 FEET FROM A PUBLIC WELL.. DEPENDING UPON THE TYPE. OF PUBLIC WELL. MI:Y'J1:1'IUM DISTANCE FROM N PRIVATE WELL. TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS. 75 FEET. L+TELL. LOGS ARE REQUIRED AND MUST BE:: RETURNED TO THE: DEPARTMENT WITHIN 30 DAYS OF THE WELL.. COMPLETION. OTHER: REQUIREMENTS NAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO IY'd'_UR:E PROPER INSTALLATION. F-, E= 9 ai 9-1 :1 .. y.... II _ "--o F" :y: 9 ^__ E.E = ; - r=: A:__- EE 9 w 19_. &__ F7 _'.:;: N_ :: : d _ =Y "ED I CERTIFY THAT l: I AN FAMILIAR WITH THE: REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE:. 2: I WILL II''•ISTALL. THE SYSTEM IN ACCORDANCE WITH THE CODE'S. 1 UNDERSTAND THAT THE ON --',ITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN _ BEDROOMS. ._........._..._... --......_..—.-----..7....----. APPLICANT E,E:CHAROF CONST. i l� V4, 0 ,o i•4+_er•� :i o, � iLL,t::a!_� x 'i<''T +�+4= �r=ti�Je��:I-ll_+�:ri��t� DEPARTMeNY OF HEowr,o ANO ENVfR+StJM NT0L PROTECTION ONC•U:7f26651 AK. 9950•t 164-4720 4-�4��_!_. 1�Y•.!Ct t`+4'°d---'.::= g '4"Ee '=.� �°JR=F�: �"!= �.I'•f JC `i' PTRW I r Nt2. i Ss4�sC�0's r�fiPf_TC•€�YJT E3G'��WAR=�F C�3YJsT, p0 SOK 1.11314 99SIl--:I 9 349-4041' l�r"�;�ATT!aN T11P4 R31-1 :,25 LC:GOL LOT 2 1:3PENbLOVE ,tot- ,'!= _J l or 5ffG 54000 SQUARE PC! Y"iPE OF $OIs HKORPTION SYSTEM 15; TRINCH MAXIMUM NOMi;ER OF OEOROL7NS s • GOIL RATING <SO FT/BR)m 1.55 THE-RIOUtRID SIZE OF THE SOLL. H85ORPffON 9YSTEM IS: < d I !-! 3 a {._ =i-ia F t {.� a,n`+ ��4'<:Fiti,•'i='L. C°1 { 1.4 T'HF Lf-_NGTH DIMENSION 15 THE -LENGTH SIN K T OF THE .TRENCH OR-DRRINF-Iut L. `1 me DEPTH OF A TRENCH 13tR PIT 15 THE DISTANCE BETWEEN THE SURFACE LSF>THE I GROUND AND THE BOTTOM OF THE` -c:`i4`PVArION <IN F%T). THERE 1:5 No wET'W4bfH FOR TRENCHES. THE 6ROVEL. DEPTH is THEEZNfr-IXMUM -DEPTH OF ORAVEL SETWEEN THE QUTFOLL .PIF' AND THE BOTTOM OF THE- EXCAVATION <IN FE=ET). PCRWIT• APPLICANT HnS SHO `f4=tl . bERMTMENT DURlNti T"Ha INSTAL;LATION IN'ePECTIONS OF, ANY WELLS tlD.rt'CENF T4 THI ,PRGPERTY HND.THE_ NUMBER OF RESIDENCES THAT THE HELL WILL SERVE~. s E3ECKFILL.INQ OF ANY 5'r'50M"RI'PHOUT FINAL INSPECTION AND APPROVAL BY -THIS 0�4PFiF VMINT WELL BE SUBJECT TO PROSECUTION. mimmUta DISTrNCE BETWEEN A Wi';t.O AND ANY ON-3iTt" SEWAGE DISPOSAL, KOCH ES :Lk30 TC! r FOR KPRIVATE WELL OR 1.51 TO 200 FEET, FROM A PUOLIC WELL DECPENr?IN6 1 UPON THE TYPE OF PUBLIC WELL. g jyjf19Ut4 51STANQ FROM A'PRIVATE WELL TO A PRIVATE %W&L,iNE ;-5 IS Pelr SND TO 0 COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND iUJ'=T 0E RIVURNE0 TO THE DEPORTMENT WITHIn 30 0A` M OF THF WELL COMPLU f QN, . OTHER._,f?EQUI fENFNT'S MAY APPLY. 5PE&EPICATIONS AND CONSTRUCTION DIAGRAM$ ORS ,AVAILABLE TO INSURE PROPER Ifa'a"rata; H't'IF3N. I'i lk:Y•� I -F L : ,.0 I 71K, fl - is to0 I C RVIPY THAT 1: Z AN FANILIAR WITH THE REQUIRENENr5 FOR ON-SITE KHRR5 7ORTH S'Y THE MUNICIPALITY *OF 1lNrA,U3i:i1GF_. a: I WELL INSTTHLL_ THE SYSTEM IN 8t;Ct.J4fiANt:E WITH THE CODES. 3: I UNDERS AND.'THAr THE ON -SETS •vita€R SYSTEM MAY RF,;.UIRE: PCs TOCPI":L.tJr "-I "IRE THAI 3 BE0190111115, (g) l 1 1 � APPLICANT eEt_:HAROF c'ONIST. - D SUEC) i3'r't �yf(,/. JJ�z i1i•.c , DATE:,.,'..e'/� AN& W>~ &I AS SET V�A SOILS LOG *lrj= - MUNICIPALITY OF ANCHORAGE N A DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION I TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: .7 ADATE PERFORMED: I - Zt/ L.EGALDESCRIPTION: SPE/JlDl_0VF, VIC6ti% !•ITS -5/b ADD-7,-T��ALA _Di L — I &= I SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS i7\etpy SILr�Y G KAVEL "ClGbl7 Iry SA L_ WAS GROUND WATER S ENCOU NTER ED7,_,_ALl2 _ 0 P IF YES, AT WHAT E DEPTH? _ A%// n i e m: v _Reading Date Gross �— Time Net Time Depth to Net Water Drop 1=T IN v I i_ry� IBJ ,Z-; .36 t 'ice a_ 16 x_77 35 —_fi el PERCOLATION RATE__ _--)minutes/inch) TEST RUN BETWEEN _�? _ F'I- AND FT PERFORMED BY: COJ4.4b 2 p V A.kry CERTIFIED BY: 72008 (6/79) DATE,��J�C Je- // WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either to, Ib or to.) A.D.L. No. la. Borou h Subdivision Lot Block Ib. t/n qt re. Section No. Towns hl Ran a Meridian �� P N ❑ g E ❑ nch pendlove 1 5 a1—of—of — s❑ W❑ Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Beacharof Const. Address: Street Address and Arco of Well Location Feet Below 2. WELL LOG Surface Material Type Top Bottom 4. WELL DEPTH: (final) 1 651 ll. 5. DATE OF COMPLL"YIO,z l — — // --� grave y 0 16 6. []Cable tool nRotary ❑ Driven ❑ Dug E] Auger []Jetted ❑Bored ❑Other: bedrock decomposed 16 28 bedrock 1 3/4 gpm— 28 165 T. UscY-.)n Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commerical ❑ Test Well ❑ Other: _ _— 11. CASING: ❑ Threaded )M Welded diam.L_in. t03o l Milt. Depth Weight __Ibs./ft. dlam, in. to ft. Depth Stickup ft. 9. FINISH OF WELL. Type: — Diameter: Slot/Mesh Size: Length:._ Set between ft. and ft. Backfilling Gravel pack _ _ 10. STATIC WATER LEVEL: 81 _11. ❑ Above or xnolow land surface Data Equipment used: — — II. PUMPING LEVEL below land surface and YIELD 1, f I. of ler _—hrs. pumping 13/4 g.p. on. _ft. offer_ hrs, pumping—_ g.p.m. 12. GROUTING Well Grouted: ❑ Yeexn No Material: ❑ Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe ft, capacity g. P. an ❑ Subm. ❑ Jet ❑ Centrifical ❑ Other 14. REMARKS: lined 411 plastic to 1651 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperalure _—° ❑ F ❑ C This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Alaska Now—Well—Vernls Drilling & Ent AA3327 Registered Business Name Contract License Number Address; SRA Box 1560 AA,nncho�r�aage a Ak 99507 Signed ytr9•-a I/ Date: le)-23-1?3 -- Authorized Representalive Form 02-WWR (11/81) Copy Distribution: WHITE' State DGGS, PINK -Driller, CANARY -Customer i • `j Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 017-401-52 1. GENERAL INFORMATION Expiration Date: -7-Aq- Complete legal description Spendlove View Heights #3; Block 5, Lot 1 Location (site address) 8800 Spendlove Drive Current Property owner(s) Robert Southerland Day phone 336-1717 Mailing address Real Estate Agent 8800 Spendlove Drive, Anchorage, AK 99516 n/a 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 !tii 11X914'd/_11114.;I&Yrl;l1lRF Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for: We Day phone n/a UBMITTAL APR 2 4 2015 TOMMY CORNELL TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: �-Y/ L/ if COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee I Date of Payment 4194 t15 Receipt Number 4:V02Cv-1 COSA# f51tic; Date: Waiver Fee $ _ 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. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorape AK, 99507-1259 Engineer's Printed Name Jeffrey A. Garness Date q17 conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the Family utilizing the system/s. These conditions can vary, and are outside the Control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property In the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the Information provided in this report by any other person orparty, including but not limited to subsequent property purchasere, Is not authorized. in short, GEG disavows any legal duty to anyone other than the persoeparty who paid for this report. ��\1111(ilfl (OF me- I 6. DSD SIGNATURE\VQ O`Y�ii _ System #1 Approved for bedrooms = ��' ON-SITE fi System #2 Approved for bedrooms g WATER AND �= 'v iNASTEWATER Disapproved S� PROGRAM Conditional approval for bedrooms, with the following stlt J ons: oJ FM' By:/ Original Certificate Date: The i nici li o chorage 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9.1-12.Oc If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SPENDLOVE VIEW HEIGHTS S/D #3; BLOCK 5, LOT I Parcel ID: 017-401-52 A. WELL DATA `CASED INTO BEDROCK. BEDROCK AT 16 FEET BELOW SURFACE. Well type PRIVATE If A, B, or C provide PWSID# NA Well Log (Y/N) YES Date completed 10/23/1983 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 165 ft. Cased to '30.5 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test 10/23/1983 Static water level 8 ft. Well production 1.75 g.p.m. WATER SAMPLE RESULTS: AT INSPECTION 4/2/2015 50 1.95 Coliform 0 colonies/100 ml. Nitrate 1.78 mg./L. Collected by: GEG, Ltd. Arsenic: ND ug./L. Date of sample: 4/2/2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/25/2008 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 4/6/2015 Pumper ISAACS PUMPING C. ABSORPTION FIELD DATA VBELOW EXISTING GRADE Date installed 11/11/1983 Soil rating (g.p.d./ft`or bdrm 180 System type TRENCH Length 70 ft. Width 5 ft. Gravel below pipe 2.5 ft. Total depth '8.2 ft. Eff. absorption area 547 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/2/2015 Results (Pass/Fail) PASS For s bedrooms Fluid depth in absorption field before test 4. in. Water added 590 gal. New depth gin. Elapsed Time: 120 min. Final fluid depth 4 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 "Pump on" level at in. "Pump oft" level E. SEPARATION DISTANCES level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent Absorption field on Public sewer main Sewer /septic service line 100'+ N/A 25'+ On adjacent lots Public sewer manhole/cleanout 100'+ 100'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field *51+ Water main NIA Water service line 10'+ Surface water 109+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 1004 Driveway, parking/vehicle storage 104 Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS "ASSUMED BASED UPON PANNONE ENGINEERING AS -BUILT DRAWING (DATED 7/21/2008) 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. Engineer's Printed Name JEFFREY A. GARNESS Date 4C12 ///S— (Rev. 10112/12) Spendlove Drive 0 M 0 M 589'59'43"E 165.00' x\ x p Ezisting -.- ry0' `�d'S, Povetl 8,5' Existing House - - Drive op. o ,e� S.. 7 7. O m I /cl(CY o S Lot 2 ? Lot 1 = 49,588 sf Lot 2 o o o Z I ocoWpp� OF qcoop A P' �* 49TH T �... _nomas LS -7676 25 04p®'ic�`�o.� 10' Utility Easement Lot 1 N89°59'54"W 165.00' Lot 2 Lot 1 Ordered by. Nicole McCullough Legal Description: Asbullt Rebor Rebar with Cap 8 Un AL. Monument 0 7� Lot 1 Block 5 Existing Well > > Existing Stand Pipes Q Spendlove View Heights Addn. 3 Pavement 0 Survey Certification: I hereby certify that a Mortgagee's Overhang (— Inspection was performed on the described property. Wood Deck FUM Notes: It is the owners responsibility to determine the existence of any easements, covenants, or restriction Concrete which are not on the recorded subdivision plat. This ..built shall not be used for construction or for establishing property lines. r Checked by. THD Drawn by: TM Scale 1" = 40' Grid SW2841 Jab 2015-14 EB: 121/19 Plat 83-224 Date: 4/13/2015 Unless otherwise requested, HAA will be he for pickup: 2. NUMBER OF BEDROOMS. _3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water - NOTE: If community well system, provide written confirmation frorn State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADE:C attesting to the legality and status of system. ]2-025(Fev. 1/91) Front MOA X21 5. STATEMENT OF INSPECTION ZY ENGINEER of the validation date shown below, I verify t)., As certified by my seal affixed hereto and as al application shows that the on-site water su, investigation of this Health Authority Approv and/or wastewater disposal system is safe, functional and adequate for the number of bedroo.. and type of structure indicated herein. I furtherverify that based on the information on site water ' . the Municipality of Anchorage files and from my investigation and inspection, l tem`is in compliance with all Municipal and State codes, supply and/or wastewater disposasys ordinances, and regulations in effect on the date of his inspection. \ Alaska Wa' Phone 737�6/ii Name of Firm Wa p a S, Address e 9 0 Date Engineer's signature Alaska Water & . Of Q� Wastewater. COnsultant, Inc. .-Vat Shall be' PAID $ ( 1_702f or prior to, closing for the Engineering Services Provided, �y 's. C. 6. DHHS SIGNATURE Approved for Fi Disapproved.` Conditional approval for Additional Comments 0 arnT� bedrooms. . `bedrooms, with the following stipulations: Date 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 courtesyto 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-M(Rev.1,91) Back MOAM21 RECEIVED ID Municipality of Anchorage SEP 0-199 DEPARTMENT OF HEALTH HUMAN SERVICES MUNlavnurvoFAN Environmental Services Division ENVIRONMENTALSERVI J1 825 L Street, Room 502 • Anchorage, Alaska 99501 * (907) 343-4744 Health Authority Approval Checklist .$I- Legal $Z Legal Description: SPENDLOVE VIEW HEIGHTS LOT 1, BLOCK 5 Parcel LD.:_— 017=401=52 _ A. WELL DATA Well type _ PRIVATE— If A, B, or C, attach ADEC letter. ADEC water system number — N/A Log present (Y/N) .--YES Date completed __9/83 —_ Total depth _— 165'____ Cased to _ 30.5' _ Casing height (above ground) _ 18"+ _ Sanitary seal (Y/N) _`—_YES FROM WELL LOG Date of test --^ 9 B3__+ Static water level Well production WATER SAMPLE RESULTS: Wires properly protected (Y/N) YES—_ AT INSPECTION __ 8/30/99 8/30 99 46' 9 -P.M. ----a.i 9 -P.M. Coliform _ n _ Nitrate _ 9.4 mgt__ Other bacteria Date of sample: _— gq _ Collected by: _-- AXVJ_C. B. SEPTIC/HOLDING TANK DATA Date installed 1jLiiZ83 Tank size _ 1 non Number of Compartments 2 Cleanouts (Y/N)_ YES__ Foundation cleanout (Y/N) --YESDepression (Y/N) No _ High water alarm (Y/N) Date of Pumping --8/-18/99 _ Purnper __ ISAACS —_ C. ABSORPTION FIELD DATA *MT EXTENDS 31.5" BELOW INVERT. **SEE ATl-ACHED REPORT_— Date installed 11 Zwa.3 _ Soil rating (g.p.d./ft2 or ft2/bdrm) --1RO – System type _ TQC_ Length __ V _Width Gravel thickness below pipe _,„5_ Total depth _ 13.5 _ - (EAST END)- Effective absorption area 547 SO Fr Monitoring Tube present (Y/N) YFS Depression over field (Y/N) _,N0_._ Date of adequacy test _ faa _ Results (Pass/Fail) _ PASS _For_ 3—_bedrooms Fluid depth in absorption field before test (in.); "'12.25 Immediately after&Aa gal. water added (in.): _ 14„ _ Fluid depth --1 (ins) Minutes later:_—** `'P4 Absorption rate =.—_4503—g.p.d. Peroxide treatment (past 12 months) (Y/N) _�LgNE KNOWN If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Size in at* Septic/holding tank on lot 100'+ On adjacent lots Absorption field on lot 100'+ On adjacent lots Public sewer main Sewer /septic service line "Pump off" level at* 100'+ Public sewer manhole/cleanout N/A Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ 1721 Water main/service line 10'+ Surface water/drainage ` 1 nn'4- Wells on adjacent lots 100'& ' J (SEE ATTACHED REPORT) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10'+ Building foundation 10'+ Water main/service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage area 25'+ Curtain drain NONE KNOWN Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I in conforma/n Signature l Engineer's N Date field inspections and review of Municipal felines in effect on this date. HAA Fee $ -3&t�, , &V Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CE -7953 , eo° are Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-13 — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers September 9, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: HAA for Private Well & Septic System. Spendlove View Heights 42, Lot 1, Bk 5. To whom it may concern: We performed an evaluation of the subject well and septic system for the purpose of obtaining a Health Authority Approval (HAA). When pulling DHHS records on this lot, the subdivision was identified as both addn #2 and addn #3. The address of the property is 8800 Spendlove Drive. We used the inspection report dated 11/11/83 (which has Addn #2 crossed out and Addn #3 written in) as the basis for our evaluation. Please confirm this is correct based upon the DHHS hard file records. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: On the day of our test (8/30/99) the static water level was 46 feet below the top of the casing. Over a period of 155 minutes, 640 gallons was pumped (4.13 gpm average). After the fust 80 minutes of pumping the water level in the casing stabilized at 75 feet below the top of the casing (BTC) and remained at that level throughout the rest of the test. Based upon this data it was determined that the well production exceeds the MOA requirements for a 3 bedroom house (450 gallons per day). B. SEPTIC SYSTEM ADEQUACY TEST: According to MOA records, the septic system consists of a 1000 gallon septic tank and a single deep trench. The trench is 70 feet long and has an effective depth of 30 inches. Upon our initial inspection it was discovered that there was no monitoring tube or sump in the trench, consequently, a steel monitoring tube was driven near the beginning of the trench (west end). Prior to the start of the adequacy test the liquid level in the trench was 19.25 inches below the drainpipe invert. After the introduction of 640 gallons of water, over a period of 155 minutes, the level only rose 1.75 inches. Given the fact that the pore space in 1.75 inches of drainrock is only about 127 gallons, it can be concluded that more than 500 gallons of water was absorbed during a 155 minute period. Based upon this data it was determined that the absorption rate of the system exceeds the MOA requirements for a 3 bedroom house (450 gallons per day). C: NEIGHBOR'S WELL LOCATED ON PROPERTY LINE: The well which serves Lot 2, Bk 5, Spendlove 42 is located directly on the lot line between the two subject lots. Attached is a copy of the 9/16/95 as -built survey (Lantech). The scaled separation distance (using the Survey) from the subject well to the septic tank on Lot 1 is almost exactly 100 feet. Because of the lot topography it is not possible to take a straight line field measurement of the separation distance. In order to be 100% positive of the separation distance it would be necessary to expose the sidewall of the septic tank and have the distance shot with a surveying instrument. Please provide direction from your department. If you have any questioty�)please contact us at 337-6179. P.E., M.S. SEP' -08-99 WI7D 10123 AM Dynamic Properties FAX N0. REGE:NED SEF 131^9 • nneth L. Oreya�; e LS-8202•i'rc,��. o�e b w • •.'+. n . • • •... _dae�y� FR Of: E%lrTING SHODUO C. M N'69'59'43" W , , DR P. 01 SrENDI.OVI: DRIVE LOT 2 POWER POLE , LOT 1 to it GUY I ANCHOR �d N1 POWER ! POLE 7 M 0 71 , 11 �. i 1 � A 1 /w / LOT 2 i 1 I w 1 1 SEww E� LOT 1 �/o scans $out' lu +.l 10' UTILITY EASEMENT S 69'59'54" E 165,00' LOT LOi 2 EM ZSiON NOTarPonrlhfl—Y+�� CND 5ET F onoato w. �ES; II b tha ewtur' !o ticlem,inr J1 M C L.. ^ F1 K E lho auhtmcc ar any rangy mu, roHnaAle, a rernittlonr 5/1 Rf w/CcP� tp" M which no net dpow an the nodded nub dlaGlon plot. HO n:: 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 y , and type of structure indicated herein. I furtherverify that based on the information obtained from - the Municipality of Anchorage files and from my invest!gation 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. 5 & S ENGINEERING r7 7 Name of Firm --17014 segt� gaq--- Phone _— Engle River, Alaska 99577 Address --�— -- -- Engineer's signature . fk` ---- Date 9 S 1'"��ROBERT C. COWAN •. GE By: -- �--_. Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approved Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The D HHS 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-M(RW.1191) Back MOA41 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L." Street, Room 502 O Anchorage, Alaska 99501 • (907) 343-4744 Ak Health Authority Approval Checklist ®0 Legal Description:4 a r 7 herr S SY'iN"vv% vr[w He r t V 3 Parcel I.D.: 01 7 - °/ o/ - 3' rriri rn A. WELL DATA Well type N i v4 'r E If A, B, or C. attach ADEC letter. ADDEC water system number r5'Y Log present ((9/N) _ YE'J- Date completed y / 5- 3 Total depth � (. S / Cased to 30 /A Casing freight (above ground) Sanitary seal ON) Y&S Wires properly protected Eft _Y,6 1 FROM WELL LOG AT INSPECTION Date of test `t Y 3 rI A 5' Static water level )-/5- Well 1S` Well production WATER SAMPLE RESULTS: g.p.m. Coliform _ -�— Nitrate , 0 'kma,& _ Other bacteria Date of sample: _ 8 3/ 95 Collected by: S & S ENGINEERING 1.:034 Eagle River Loop Road No. 204 B. SI PTIC/H9tBRV6 TANK DATA aglo River, Alaska 99577 Date installed �t / /t 8 3 Tank size )Q 0 V Number of Compartments I Cleanouts 6" y'1; J Foundation cleanout &N) _Y15- J _ Depression (Y/® /✓ U High water alarm (Y/6 w O Date of Pumping _ 7 6-Y r cls Pumper R 47 o Ro c ; i4 C. ABSORPTION FIELD DATA / 594baa w Date installed I / / t / 3 Soil rating (g.p.d./ftZ o tZPodrr j System type _I A#�'- C' 14 Length I n Width S _ Gravel thickness below pipe ) S' Total depth _q _ Effective absorption areaS 4 7- Monitoring Tube present(Y/N)_ Depression over field (Y/N) J Date of adequacy test q I i /6).5- ResultsC(PnsFail) _/ 4- 1 S For 3 bedrooms Fluid depth in absorption field before test (in.); 0 Immediately after3 gal. water added (in.): 1 Fluid depth _ N7A* Minutes later: NSR (in.) Absorption rate = SO 'fg.p.d. Peroxide treatment (past 12 months) (Y�95 _ n/ 0 If yes, give date _ %t- A/)S6,ed V',D 4-7- W6rq,it 1iv!'v 1` 1?.1T# w/ rvD L -✓'viz- n,56 , D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES "Pump Size in gallons *Datum SEPARATION DISTANCES FROM WELL ON LOT TO i Septic/Wid* tank on lot / 0 0 f ; On adjacent lots Absorption field on lot l0 0 l f ; On adjacent lots "Pump off' level at* i > o J 4— lot711-,'- Public sewer main N i{ Public sewer manhole/cleanout •," 1,q Sewer /septic service line U i t Lift station /✓ 44 SEPARATION DISTANCES FROM SEPTIC/1-IOL-RING TANK ON LOT TO: Foundation I t Property line S � Absorption field S - Water main/service line a?0 if Surface water/drainage /f Wells on adjacent lots > d r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Building foundation / � � Water main service line 0 � Surface water Driveway, parking/vehicle storage area � t Curtain drain ""v a k ^ oW i✓ Wells on adjacent lots F. ENGINEER'S CERTIFICATION of I certify that I have determined thru field inspections and review of Municipal6�ttl e a$' Sry3te {rC are in conformance wit N A 1, es in effect on this date. rly FY Signature aye•• t."IEngineer's NameA0 b a 6 x c�9.� RT G COWAN "O CE -8801 Date �lfD •.•... %%4 Dp�OfE..S HAA Fee $ ' ao e 0 Waiver Fee $ Date of Payment e Z-- G,� Date of Payment Receipt Number -71, �� Receipt Number Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGEANS • Department of Health &Human Services X'I 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 LID. #C))-�S2 HAA# �� 99 L) 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, tohip, range) Location (address or directions) 01 (b) Property owner Mailing Address ,. 1/. 1- n�7g (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone pf — (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and clay phone number below: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 5 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 -sitz 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 Z;o Z abed Xea9(SOIL 'e'9)SZO-Z[ ' AOM s,jeouibuo leuo!ssa;oad ay; ui suo!ssiwo ao slam jo; elq!suodsaa lou si 96ejoyouy;o Aj!!Bdio!unw ayl'panssi si aleoillpoo B eAolaq elep az (leue ao suoiloodsui lonpuoo lou op SHHO;o saa (oldw3 ,s;uawaa!nbaa alels pueleaapa; u!elaao A;s!les of iapio ui suoppisui bu!pual Jiayl pue sawoy;o saaseyoand of Asalinoo a se s!yl saop SHHO ayl T lsely;o 81e1S aql u! paaals16aa aaauibuo ieuoissa;oid luapuadapui ue (q anoge 9 gdeaBejed u! 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Aw woj; pue sal!; ebeaoyouy ;o Al!ledlo!unw ayl woa; pau!elgo uo!;ewao;ui ay; uo paseq ley; Aj!aaA aagljn; l -u!aaaq poleo!pui a}nlonals;o ads(; pue swooapaq;o aagwnu ayl ao; alenbape pue leuo!loun; 'ales s! wags (s !esodslp aalennalsem }o/pue lddns Lalem 9;!s-uo ayl leyl smoLis lenojddy Al!aoylny ylleaH s!y;;o u01le61isanu1 (w leyl l;uaA l'nnolaq uAAoys a;ep uo!lep!leA ay; ;o se pue o;aaay pax!;;e !Bas (w Aq pailpao sy N011VAHOdNI ONV VIVO'HOUV3S 311d'S1S31'SNOI103dSNI J"'LOIAOlid Wdld JN1HREINION3 '9 MUNICIPALITY OF ANCHORAGE (MOA) rtv OF ANOtl uthrityApprovalHI �5o LN* NKAGSeRVKgJJW.343-4744 1909 Legal Description: OE j 13 L. r A. WELL DATA RECEIVED Well Classification _r� 21 VAT F_ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (YI/-N) S Date Completed _ 3 ---Yield Z. Total Depth—L66—Cased - to _CC Depth of Grouting (16LK e�z JAK Static Water Level _�1 Pump Set At OKI V_AXA K1 Casing Height Above Ground Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL.: To Septic/Holding Tank on Lot I .1-C), ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 3(2, ; On Adjoining Lots > To Nearest Public Sewer Lined To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service' Line on Lot 'Co � Water Sample Collected by �u L'V ✓eyiS ; Date /,7� 1 Water Sample Test Results SAT) / Ar_ %0/1 / Alit Fife ,._ �Q Comments 4) llydiu�K B. SEPTIC/HOLDING TANK DATA Date Installed _41—S Size I (ZDau! No. of Compartments 7 _ Standpipes (Y/N) _�_—Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) _u Date Last Pumped Pumping/Maintenance Contact on File (Y/N) IN / W ; for 7 1 /A Holding Tank High -Water Alarm (Y/N) �A 1A_ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation ZZ ' + To Property Line -75'- To Disposal Field To Water Main/Service Line/La To Stream, Pond, Lake or Major Drainage Course - Comments — 12-02e (Rev. vaa) From Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1E05� -C4 16dl-m Type of System Design S'01 UE ,tt4ti /ccD Date Installed 11.103 Length of Field 70 1 Width of Field Depth of Field Gravel Bed Thickness _32 Square Feet of Absortion Area 54-7 - x'o � + Statndpipes Present (Y/N) Y Depression over Field (Y/N) kt Date of Last Adequacy Test 9,124,169 Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well r 30 ` To Property Line %8 To Building Foundation 40 ' To Existing or Abandoned System on Lot N /A ; On Adjoining Lots ;> _'U ` To Water Main/Service Line 6 0 1 To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course )Q)l To Driveway, Parking Area, or Vehicle Storage Area Z S Comments D. LIFT STATION t , Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access(Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ` qb; Q� e2tu, f o�pQa, oaeeaaoepaa Company G �r G� eo o r Date C — Doo °00000anoeea MOA No. GE o�Y—OLy 0 eaea�a a (% Gao Robeii E. I<nQe No. 4149 � E Receipt No. �U 5 �a� �� r Receipt No. P?2 Date of Payment cz" Sl rY / — Waiver Fee: $ Amount: $ 'rZLfi Date of Payment 72-026 (Rev. ]dee) Back Page 2 of 2 Engineer's Seal MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL- HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-SITE SEWER AND WATER FACILITY 204-4720 Application Date /O—(/ C3'' 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) ,SS pend luvc V,e,j /3 /o e- S" Lp��re z s r iz n' Location (address or directions) to 10'e D"Lr_ _— -- — (b) Applicant Name_ �7Cc�` Telephone: Home — Business%9 Y0`/0— Applicant Address -20 ''�� "11 i`L& Tyt-1/ — (c) Applicant is (check one): Lending Institution't F Owner/builBuyer El Other ❑ (explain); --. (d) Lending Institution —_--_.—---- Telephone— Address __---.-- -- — (e) Real Estate Company and Agent ---------- Address _ -- ---- — Telephone _ _---.— -- - – (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Familyyx Multi -Family fl Other Number of Bedrooms - 3 ____ 3. WATER SUPPLY Individual Well N911 Community [7 Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite'q' 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 (11,84) Page 1 of 2 .S/yen://wC we,jr 1 awl 5. ENGINEERING FIRM PROVIDING ,jSPECIIDNS, TESTS, FILE SEARCH, DAT,, AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verity 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 — 4 E_cs -- Telephone --_S. S-07 o Address —. lzoo W 33' /1 A A/. ---- Date--— D14EP APPROVAL Approved for h f bedrooms by -� ate Approved — Disapproved _ Conditional Terms of Conditional Approval CAUTION OF 'a uaaeuco oococ�eoo ,00 ao oaoeo 000 dq'aeo ee No. 2257•E The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in Paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DFIEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1964 264-4720 HIVED( Legal Description: /ove 31.,,- 'a v ' A. WELL DATA Well Classification _ dome s/i If A. 6, C, D.E.C. Approved (Y/N) — 3 Well Log Present Y l) - Date Completed 10 -23--'63 — Yield Total Depth 16 Y" Cased to 36 6 Depth of Grouting Static Water Level _ 8 Pump Set At — Casing Height Above Ground —_y"y Sanitary Seal on Casin 2�(Y)N) — Electrical Wiring in Conduiom) -- — Depression Around Wellhead— Separation Distances from Well: To Septic/Holding Tank on Lot gy On Adjoining Lots —yob To Nearest Edge of Absorption Field on Lot On Adjoining Lots (OO t To Nearest Public Sewer Line - To Nearest Public Sewer Cleanout/Manhole — To Nearest Sewer Service Line on Lot Water Sample Collected by — — ; Date— Water Sample Test Results - ,'re 6.s /-c 1"7 Comments B. SEPTIC/HOLDING TANK DATA Date Installed /1`213 Size /O°r— _ No. of Compartments 2_ - Standpipes 6Y �) Air -tight CapsbY �) Foundation Cleanout&II)N) Depression over Tank (Y/62 Pumping/Maintenance Contract on File (Y/N) Holding 'Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well / S1 To Property Line _— 3 0 "r To Water Main/Service Line Course fU0 Date Last Pumped + for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field — Comments =# ,S0.e 21'11 "cl,r { ce, h{r 1 e C" p .,,c Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata t �J-O C7 Date Installed r, - & Z Width of Field Type of System Design 4 n-fei l Length of Field }"U Depth of Field /7" Gravel Bed Thickness z i�_ Square Feet of Absorption Area `s L/i V, Standpipes Present 0N) Depression over Field (Y/� Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 1+5 - To Property Line J0 To Building Foundation 6 3 To Existing or Abandoned System on Lot : On Adjoining Lots 3 O t To Water Main/Service Line 04 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /bo To Driveway, Parking Area, or Vehicle Storage Area S Comments + cL, ee,441_t0:1 J D. LIFT STATION Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical i — Dimensions Manhole/Access (Y/N) "Pump Off" Level al Vent(Y/N) during Adequacy Test, Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that ve checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date U. % Company /iC-cs; MOA No. 5% P s- 0'z Y F O� 4y ®8n •s•e°ea••ee V Receipt No. �� % ��% ,e. �Q'•a •°• O G'J� �•e ' rfC.' •i B Date of Pay ment 1 `DJ TN /O� �• ee•e•1 e n•eb° y •e•® Amount: $Ub �- O_ -, / n9i4er's Seal Lamy C. Reld, Jr. ° No. 2251-a .: Page 2 of 2 72-028 (11/84) MUNICIPALITY OF ANCHORAGI: DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Application Date (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Narm Applicants Address QW(7/r� �t' n"n"!! t1q t�i)/�})�__ (c) Applicant is (check one) Lending 7:nst� �t�ut��ion Owner/builder G� Buyer Other} (explain) ; E5. 4u1n�_ (d) Lending Institution Address (e) Real Estate Co, & Agent Address Ye (vy Telephone_ Ls u_- 2. Type of Residence Single --Family Number of eedrocais 3. Water Supe Individual Wallrz Multi -Family Community 1___1 Other (describe) Pub.li.c e Note: If' cramunity wall. system, must have written confirmation from the State Department of Environmental. Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA (YAK) 4. Sewage Disposal Onsite C Public r__j Community Holding Tank Is the wastewater disposal system adequate for the number of tedrooms 'Y/N) 3 [Page 1 of 2) 2-15-84 5. En.gL. , erirg Fi l Providing Inspections, 'lbsts, Data and Infonnation I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Da to 3/:L Name of risco v Teleph(2�; AddressA. 3�_ Signed by Date (ENGINEER SEAL) 6.DHEPApproval / l Approved for^� tedrocros By Date ��.a c�t-�cDat:e X5c'AL Approved [—:j Disapprowd F:::l Conditional�� The Municipality of Anchorage Department of R1=alth and Environm ntal Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shoran above, based on the data and information furnished Ly an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and fungi tional for the number of bedroom and type of structure indicated. (DHEP SEAL) a 7. Mail. the HAA to the follcwLng address: KB2/d5/s [Page 2 of 21 2-15-84 MUNICIPALITY OF ANCHORAGE -DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 0 Fl RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) C:HECKLISP -FEBRUARY 1984 r /. , 1 F�4 ice/ S j �..v�' t ;�rKs•' ;�nc� to � � 5�� Well Classification A6.L614, If A, B, or C, D.E.C. Approved(YM) 01ji Well Log Present 4k) v Date Completed iO/R�'39/Pr,3 Yield /,3A °- Total Dept4_,aM4.165� Cased to . do, S7 Depth of Grouting Static Water Ieve1 Pump Sot At�jJwGl9.(�%C� Casing Height Above Ground / �/� Sanitary Seal on Casing T) 6 Electrical Wiring in Conduit (YM) Depression Around Wellhead (Y J Separation Distances from Well: To Septic/Holding Tank on Lot_.zZ1w On Adjoining Lots ZLvo_ To Nearest Edge of Absorption Field on Lot _mt)f _; On Adjoining Lots_yicjo" To Nearest: Public Sewer Line rvi� _ To Nearest Public Sewer Cleanout:/Manhole � _ To Nearest SawerService Line on Lot tiA Water Sample Collected By �; Date Water Sample Test Results .56¢_ 5"�® ®� Ccmmsnts,Knso A)rt( /nn'. PA.sF-A dulq/dcd tr, 36.5", /;,ue.d 11''11014sllc �o 16S:1' • alt n . - .* 9( B. SEPTIC fiOLDING TANK DATA Date Installed r L -- Size X00 ('> No. o£ Compartments _ 2 i rn• Standpipes y/N)^ Air -tight Caps (YM) 1K W Foundation Cleanout Depression over Tank (Y Date Last Pumped _ NIAA• Pumping/Maintenance Contract on File (y/N) A%; for AJ fA- Holding Tank High -Water Alarm (Y ) Temporary Holding Tank Permit (Y V) st)IA� Separation Distances from Septic/Holding Tank: To Water -Supply TAbll T ovf To Building Foundation 2,J To Property Line ;7 -30 _�_ To Disposal Field �Is— To Water Main/Service Line ("t'�—To Stream, Pond, Lake, or Major Drainage Course (Page 1 of: 21 2-]5-E9 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1&)pfVrl2�v Type of System Design f ,�h Date Installed 1118 :3 Length of Field 701 Width of Field Ii Depth of Field � 7 Gravel Bed Thickness Q,5 Square Feet of Absorption Area '%A42- Standpipes Present �/N) Depression over Field (Y6) aA Date of Last Adequacy Test 'U/tF Results of Last Adequacy Test /V(,4 Separation Distance from Absorption Field: To Water -Supply Wall 74eid To Property Lire To Building Foundation 5-�3t To Existing or Abandoned System on Lot A,J�c On Adjoining Lots ' .30" To Water Main/Service Line A -I%- To Cutbank(i£ present) /U/, To Stream/Pond/Lake/or Major Drainage Course 11ilh To Driveway, Parking Q Area, ornVehicle Storage Area G, AJ (A- / (� ( J Comments K1ie C' r'v,)t{ttA�F-c�� ti,V , lnus�� 04'4 rex_ 1 �5 YtF I- 1--T� �kAYiwa h�a D. LIFT STATION Date Installed /U/,L Dimensions N(A- Size in Gallons �I A: Manhole/Access (Y/N) ��a+ "Pump On" Level at N/,P "Pump Off" Level at AJ(.k High Water Alarm Level at 10 Vent (YM) NJc, -z Tested for �� Pumping Cycles during Adequacy Test. Meets MDA Electrical Codes(Y/N) N/A Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date �T_��`_ •_ Date 11, Company_, MOA No. -Uz KB1 /d5/s s4—„A_ yes C -A) (Page 2 of 21 � _ naas (W bz ..C7 "Lta ENGINEERS SEAL 2-15-84