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HomeMy WebLinkAboutGINAMI HILLS LT 1BGinami Hills Lot 1B #015-461.-45 0!i Municipality of Anchorage Page of 7/ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: y1� 1^19 tp 0157- PID Number: 215 - L/& I -4f 5 Name: F�PO/ q (' n LI�O.�il Wastewater System: .KNew ❑ Upgrade Address: fox /�� � � /-�.�ictr 9 9 �J� ABSORPTION FIELD Phone: No. of Bedrooms: Deep Trench 0 Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 01s Total Depth from original grade: GPD/Sq. Ft./0119, Lot: Q Block: Subdivision: G//tlfJ/ Depth to pipe bottom from original grade: Gravel depth beneath pipe l !� l/ %WI -1- S 7,-, Ft Ft. Township: Range: Section: Fill added above original grade: Gravel length: �J , r Ft. / Ft. WELL: ❑ Newer/ Upgrade Gravel width: / Number of lines:TICistartcebetweenlines: �❑ Ft FL Classification (Private. A.B.C): Total Depth: Cased To: Total absorption area: 757,- Pipe material: ?o P/ Fr.- �F Ft. SO. Ft. Uzi Driller. ate Drilled: Static Water level: Installer: 67 Date installed: Ft. Yield: Pump Set at: Casing Height Above Groune: /i�j TAN K 1%11,4 GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic 13 Holding 0 S.T.E.P. To Septic Absorption Litt Holding Private Manufacturer. Capaci From Tank Field Station Tank Sewer Lines Well- Material: Number of Compartments: Watere LIFT STATION Lot Line N1,A / �L / / 2 r �"/ Size in gallons: / 5oD Manufacturer. XN�,q / A r'/V CO . Foundation n/lA / ,z / / "Pump on" level at: �.' Lir "Pump off' level at: // High water alarm at: Curtain //A Pump Make 3 Model Electrical Inspections performed by: Drain / 05 ZLII. - Zoh•J C" en - -2 444 Remarks: I BENCH MARK ^ INSULA'i�/V ✓ //•rte Location and Description: .O S, - is 5 2 /TIioAl LOT C.012-VSA— Assumed Assumed Elevation: o 7 �U/L7 f/ s-O,L �T ENGINEER jS ' EAL awl Inspections performed by: Dates: 1st O.7OZ%9/ 4 f°" ` ""'•' '°°,l'�� 2nd 910319c' /v/9v�= V'.....v..:..� :..; CZ jo tows .4. 30orc �u ' Department of Heal and Human ervices approval #t ``��°•.,, ce.a;;,is .••'<��.: Csi�'�''f�s`�o+"' Reviewed and approved by: Date: /- 72-013 (Rev. 9/91) MOA 25 _ Permit No.--SW960152 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: GIMANI HILLS LOT 1B PID No.: --015-461-45 ELEVATIONS REHAR 2 NDRTH EAST OF LOT, EDGE DF ROAD (NOT TO SCALE) "n;m ELEV - 103.9' m 4 ORIGINAL 0 GROUND 0 LEVEL AT, ADDED FILL J 99.3 A .a• c�oveR 2.5 33PSI INSULATION NO GWT ANK 82,3 /LIFT 87.3 7.3 9G5 9G5 88.5 S 89.57'29' E 630.22 10' UTILITY EASEMENT 327.11 %Q>> L O T 1B I/ EXISTING I ( N c 1,500 GAL TANK W/LIFT sw;"e- Tirl I D.�_ • TSI' ��D `O A-4 r� o A - 0 . do}' dELL Q - 0 • 23.9' AIr, / Irn D I� I ~o- t1 � C • - MONITOR BE TU m " TH4¢ _ - CLEANOUT WELL - EASEMENT L® - LEACHFIELD r1 3'x47' TRENCH �- EXISTING LEACHFIELD HOLE SPACING, 8.4' I 18' ERFICE SHIELDS IN PLACE r SCALE 1'=60' S 89.56'19' E 7/11/96 A 303.10 ELEVATIONS REHAR 2 NDRTH EAST OF LOT, EDGE DF ROAD (NOT TO SCALE) "n;m ELEV - 103.9' m 4 ORIGINAL 0 GROUND 0 LEVEL AT, ADDED FILL J 99.3 A .a• c�oveR 2.5 33PSI INSULATION NO GWT ANK 82,3 /LIFT 87.3 7.3 9G5 9G5 88.5 MAY -08-97 THU 14:04 5.64603706360.26G 44 907 344 5000 P.02 :• .,.,•: ,i•:.L . • ;1, .. .'44•'f•,���:.'. yid , '��GG7fl'lc, a• • ` . • 'Cis.• • dy;� �'hit•a�Kt.ti :+G:•;•!. ..if'•'I ' �It:;r'�ic:,Yc,r:�:R�.iauiir"" •� hublt;IPAr.1x'! UL n►!t:}�tthilSlC:'�ti7t.ri)?ilt lMO.a'r ii1.)onf , �r(it.:tr, R.01,11 :! :,t►: :•tl). ) ::(1:t'•316A X?1lil101AtV1111 ►••n. I .:rt •Ir!I • •. •:.:.rt.a: t t ►.t t•t.t t. ,.v t.p• t.t t: s:1•tu 'i nQ,}jp t.►t. ►:ii itnu,v;t�t. y{rn•�1 1 s. uat. t. L ► •rt.►, .. •. +.l•::I,iH f'tIR1:'IY �^ �., :,• '% ;,'+�'•' .ryi ` : +,•►• •.. A::t!:1 Gll:rttiX •' �• `:i'• r.t r3y•1)J r ••t, ♦/1. +t.t►t' :: liteM)ol i�,Ion: • tt •,t:t Min :fir. i`S:) t►.•'"r.: ttt:t: : t• i • at.I•! Yr,trt;t i)t aTItVC n . •1:::Ijl' �hLt;i;!Z Y[ii,;s, i P,'i al,1, r.t: t t t , :NI ►t t 1 , t, :• •t t • : Ct: �:�:1)'ftt: s17 :II:X Y 1:+:i1'•Cl:a Y(!2! I: "� ':�(1.:!(flC. •+a1:1[:1:►SS'• It�IY'► 1. i�+:l •.!:. ► •: t.t. t i 3•' ► 1i. • 1 � t�.•. • n••e �;,, rg fit, ,,a�•'y,.; }l;i+,' . t •,,- .:[:• 1 .� '''••ti} vim,{-n�'L�1.�lrwY�iv}'• v .•'• . • i.� a .1 , 'v''�"' y _ _ . . `..,:y.; = z, . :.•Mai ... ::5-,��, ,�f.7 :Xlilll:(i h}!1: KY►Utc '!_t.l.'ro ili;l��il,'1.?if.=(fft�ul�1:91�>:i;•i iltt! `_�_` rttt 7tpt�' tfEr;ttU1'.:f'tr:)i:' •tliir'ti:l;�:. •s• ,.�.. tAX 70 6t, I:IVGk. IiSSl; aft •' 41a:OtN,'.�J�".'�+lY. / MAY -14-97 jT1) 09:29 3.64693706360.26E LOCATION OF WELL 907 344 3900 P.01 STAT. 4V11ASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER Md MT WATER, WELL RECORD 16R000H autorfm6m LOTatocx atetl6NOTlta attmat Towwer rAme NIZAVAM ❑N ❑E ❑S ❑w LOCATIONISKETCH; WELL OWNTR: bEPTHS MEASURED FAO casing top ❑flramd surface WELL OEPTH: DATE OF COMPLETION Depth of hole % ft IiORQiOLE DATA: Depth Depth of c3sing:,4/? It 1, f Material Typo and Color From To DEPTH TO STATIC WATER LEVEL: -._V ft below'01cJ too o1 casing ❑ ground surface Date-. 1/2 t9 & METHOD OF DRILLING: ❑ akjptwy ❑ cable tool ❑ other {a USE OF WEU. -)Q domestic ❑ irrigation ❑ monitor ❑ public suprly 0 other 8 / CASINO STICK P: !t. rNer". .A in. telt J ��^0 type: kt t ft WELL INTAKE OPENWO TYPE: ❑ open end ❑ screened 17 Perforated X3 open hole Depths of openings: to It r f SCREEN T E: Diam: in. Slot/Mesh S e: Length: ft fi5 GRAVEL PAC TYPE; Volume Used: Depth to top: . GROUT TYPE• voh.no; Depth from ft to �fL DEVELOPMENT' MET D: D::ration: ' PUMPING LEVEL ANDY D: v� ft aft" his pumping lZ� gpm PUMP INTAKE OEPTHvt8, tt HOraepowet: WELL DISINFECTED UPON COMPLETM?4g YES ❑ NO WNTRACTOR INFORM ION: REMARKS: 001, • us,rtess Name 3`�p�ature o ut i:ed Rea JeOG TO: PRDIAIL ICOPY OF �at. IWSIO OF MNwQFAT 3501 ANCHORAGE AK 90503 &ate go A 5935 (90 Phona 7)269-8639, Fat 1907562.1384 �C�IVED � ) . � R . Mu licipality Hama Services Dept. Health U 4&u- PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE \11`io DEPARTMENT OF HEALTH AND HUMAN SERVICES Ct7' ,-ra-'�Lo P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT �l PERMIT NUMBER:SW960152 DATE ISSUED: 6/26/96 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 6/26/97 OWNER NAME:EXPOLAR CORPORATION OWNER ADDRESS:12131 GINAMI ST ANCHORAGE, ALASKA PARCEL ID:01546145 LEGAL DESCRIPTION: GINAMI HILLS LT 1B LOT SIZE: 108196 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: / _ 2 - / MUNICIPALITY.OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PAGE 1 OF 1 PERMIT NUMBER:SW960152 DATE ISSUED: 6/26/96 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 6/26/97 OWNER NAME:EXPOLAR CORPORATION OWNER ADDRESS:12131 GINAMI ST ANCHORAGE, ALASKA 99516 PARCEL ID:01546145 LEGAL DESCRIPTION: `GINAMI HILLS LT 1B LOT SIZE: 108196 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ��'-� DATE • ISSUED BY: aL'z-26-9� • DATE • l.� Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax June 17, 1996 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Ginami Hills Lot 1B Narrative & Permit Application Dear Mr. Cross: The proposed septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, ✓� v Louis Butera, P.E. 00 \1 996%96-043A-NAR.DOC LOT 2B LOT UNAFFECTED BY 1B DEVELOPMENT Aq-S 89.57'29' E 630.22 10' UTILITY EASEMENT .bm rue O . 0••. o 0 .r a • 0 0 O.Os o O0 B 327.11 Cl • 0 PRESSURE PIPE CLEANOUT 12-7% ITH1 _- 5% EXISTING LOT 1B WELL ro o PROP. z �p I I r2-7/. 1,500 GAL HOUSE o w TANK W/LIFTLn A o TH20 A U-M £ o IN I Q-� r25% UNDEVELOPED Id I a LOT 1 A % H ICA � I w N12-7% UNDEVELOPED x 0 ? I~ I TO A , r10% COORDS (X,Y) Z TH30 B 5353.0414,5523.7114 C 5353.1301,5218.6714 D 5053.1629,5218.77 S 89.56'19' E D 303.10 C +100' TO WELLL ❑ T 0 - TEST HOLE - MONITOR TUBE 0 - CLEANOUT (SEE DETAIL) - WELL NO SURFACE WATER — — — EASEMENT LEACHFIELD NO KNOWN CURTAIN DRAINS — PROPOSED ACHFIE � - EXISTING LEACHFIELD SEPTIC SITE PLAN LEGAL: GINAMI HILLS LOT 1 B ���• OF• ,q4�1�,, OWNER: EXPLORER CORPORATION w'`P•'• '•`� CONTRACTOR. SPRING FOREST, INC. C-- :'Poe s 6 66.49 TH ''• �� JOB '96-043A DATE: 06/15/961SCALE 1" = 60' ;• •••,••••••••,•: •„� EAGLE RIVER ENGINEERING SERVICES �I � •• LOUIS A. BUTERA ; '4j AW P.O. Box 773294 �#le ;,�o.••cE.s73s • <, Aw Aw EAGLE RIVER, AK. 99577 4I%,pROFESs10lAN\- (907) 694-5195 FAX. (907) 694-3297 ������� SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Ginami Hills Lot 1B 06/17/96 A. GENERAL 1. The well andseptic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. B. SEPTIC TANK/LIFT STATION 1. Septic tank and lift station shall be 1,500 gallon Orenco/Anchorage Tank model OSI 05-20-111117. 2. Receipt from licensed electrician stating the lift station was wired to applicable codes to be supplied to Engineer, or MOA code inspection, as applicable. 3. Pressure effluent line is to be 1-1/4" HDPE. SDR- 11 graded to drain back to the tank. C. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 11' at any point. 4. The effluent line within the trench shall be 1-1/4" PVC with 1/8" holes 8.4" on center, oriented face up with orifice shields in place. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 11' GRAVEL DEPTH = 8' under pipe, 2" over pipe TRENCH LENGTH = 62' TRENCH WIDTH = 3' SOIL RATING= 0.8 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK = 1,500 gallons with lift station HOLE SPACING = 1/8" holes, 8.4" OC, face up with orifice shields in place Twenty-four (24) hours notice required for all inspections. \ 1996\96-043a-spc. doc EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 96-043 Calculated By: LB Date: 6/14/96 Legal: G101ANI LOT 1 B Single Family 4 Bedroom Dwelling TEST HOLE 4 Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 gallons Percolation rate = 11 minutes per inch Wastewater application rate = 0.8 gallons per day per square foot Required absorption area = 750 square feet Trench width (W) = 3 feet Gravel depth (D) = 8 feet Required length = Required absorption area / 2 / D Required length = 750 / 2 / 8 Required length = 47 feet Total Excavation Depth = 11.0 feet ����• �F �q��suo •. ��� 49 TH ............................... VA LOUIS A. BUTERA .- f'• CE -6736 •' ��� v4 00 4,PROFESWI -'i� SINGLE FAMILY ON-SITE WORKSHEET ERES PROJECT NUMBER: 96-043 CALCULATED BY: LB LEGAL DESCRIPTION: GIMANI LOT 1 B NUMBER OF BEDROOMS: 4 WATER USE PER BEDROOM: 150 GALLONS PERCOLATION RATE: 11 MINUTES PER INCH DEPTH TO GROUNDWATER: 17 FEET DEPTH TO IMPERMEABLE LAYER: 17 FEET USABLE SOIL STRATA ANTICIPATED DEPTH OF COVER: 3 FEET TOTAL USABLE DEPTH: MOUND OR BED SYSTEM WASTEWATER APPLICATION RATE: ABSORPTION AREA REQUIREMENT: MINIMUM BED LENGTH 12 FEET WIDE BED 15 FEET WIDE BED TRENCH SYSTEM WASTEWATER APPLICATION RATE: ABSORPTION AREA REQUIREMENT: SHALLOW TRENCH OPTIONS 5 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH DEPTH (FT) ENGTH (FT) 1 131 2 105 2.5 95 3 88 3.5 81 4 75 DESIGN SPECIFICS FIELD SYSTEM: GRAVEL DEPTH: TRENCH OR BED WIDTH: LENGTH: TOTAL EXCAVATION DEPTH: USABLE SOIL STRATA DEPTH: 0.5 GAUSQ.FT 1200 SQ.FT 100 FEET 80 FEET 0.8 GAUSQ.FT 750 SQ.FT 11 8 DEEP TRENCH OPTIONS 3 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH DEPTH (FT) ENGTH (FT) 4 94 4.5 83 5 75 5.5 68 6 63 7 54 8 47 9 NA D (B=BED, S=SHALLOW TRENCH & D=DEEP TRENCH) 8 FEET 3 FEET 47 FEET 11.0 FEET EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 Job #: 96-043 Legal: Ginami Hills lot 1 B Date: 6/14/96 Press. Effluent Lateral: Assume 5' head at office 25 GPM flow rate .42 GPM per 1/8" office 25 /.42 = 67 orfices Pipe Length 47 Spacing = length/#of orfices 0.70 feet Spacing = 8.4 inches 00 ��• OF'q��9 Ldp ,x.•49—� .� ................................ LOUIS A. BUTERA O �'• CE -6736 ' �Q� of °',�RR�B� ' 4e �, �E�� �•,R s s'1:A4q , {red ••• • YY•••• •••••••1. • Municipality of Anchorage III�j1 ' Y " ' """""•' •";'� iA" n Louis A. Bulara • tv DEPARTMENT OF HEALTH & HUMAN SERVICES �� Gi'• CE 6736 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST �6Fop''••••"•'z,�,`',��'� PERFORMED FOR: COLONY 8UI LDF-P-S DATE PERFORMED: S/Z'7 LOT /'8 LEGAL DESCRIPTION: Ly/,y lMI HJU-,S Township, Range. Section: OEPTH • SLOPE SITE PLAN i(FEET) ' 2 / 3 4- s n1 L- A Silly fan�/y 6 4/'avc1� �./qy 1ayerf ✓mvis � �oile•ri✓� 7 8- 12 12 13 14 15 16 17 18 19 =v (3oTTo,1 .f T// WAS GROUND WATER ENCOUNTERED? Yt s S IF YES. AT WHAT,/ // L DEPTH? rl 6yS O P E tkpth to water After Mtonitnringl l!, Reading Date Gross Time Net Time Depth to Water Net Droo Saix OS a L / /: Z /.1515 O M114 to 2 12-//1,,, & /!o '• 67 2 //1lo a 27 30 40 7-; 58 30 &1 20 -{ „ UPERCOLATION RATE 60 (minutes�inch) PERC HOLE DIAMETER TEST RUN BETWEEN 5- FT AND 6 FT COMMENTS / rSr /,/.oze wer %2 1 �.a�-•f�c��. PERFORMED BY: w I '�=- R-1—CS CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOaMANCF WITH -Al 1 STATF ANn MUNCIRA, !:1linrl iNFC jN,FFFFr'T AN THTC f1ATF r10TF PERFORMED FOR: r,01-ONV 8u![-DERS DATE PERFORMED: LoT / 8 LEGAL DESCRIPTION: GlIyAMl f /ILLS Township, Range. Section: ., — i SLOPE SITE PLAN 7�1 2 17 18 19 7o-�So i l G111 Si'/Ty fgnA/y • 9/'avc%�.yc Clgy �ayc�t� NeT ConT.%+c cc,f s Bo rrc�-r TH WAS GROUND WATER ENCOUNTERED? S IF YES. AT WHAT 14 L DEPTH? -� p E OePM to Weer Aller Monitoring? ■■■■■■."■m �y.•yT4i�r►.�0, , Emmmmmmom Net Death to Time Water ■■®mmo■■mm 07 (ENGME'E Sl.ltlTjT � . t Effiiniiimmam ■1.■m■■mma a ,v Municipaiity of Anchorage w�,._,.•,••,���••�� DEPARTMENT OF HEALTH & HUMAN SERVICES tc• ; lovis A. Sviera ,W� f 825"L:* Street. Anchorage. Alaska 99502-0650 j J, IP .CE -6736 a� Z SOILS LOG — PERCOLATION TEST ``�FQ°•...•��...•, ���,®a M)t4 8 /5 )LP 2 11/1(p " PERFORMED FOR: r,01-ONV 8u![-DERS DATE PERFORMED: LoT / 8 LEGAL DESCRIPTION: GlIyAMl f /ILLS Township, Range. Section: ., — i SLOPE SITE PLAN 7�1 2 17 18 19 7o-�So i l G111 Si'/Ty fgnA/y • 9/'avc%�.yc Clgy �ayc�t� NeT ConT.%+c cc,f s Bo rrc�-r TH WAS GROUND WATER ENCOUNTERED? S IF YES. AT WHAT 14 L DEPTH? -� p E OePM to Weer Aller Monitoring? ■■■■■■."■m Date Emmmmmmom Net Death to Time Water ■■®mmo■■mm Effiiniiimmam ■1.■m■■mma -710 Z %55 M)t4 8 /5 )LP 2 11/1(p " 3 3156 4//&„ Reading Date Gross Time Net Death to Time Water Net Drop -710 Z %55 M)t4 8 /5 )LP 2 11/1(p " 3 3156 4//&„ N%OL y110.714" t i / r a;o:3 fv/L;; L ,L" 20 L_j -iyf- PERCOLATION RATE 25' (minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN 5- FTAND 6 FT COMMENTS E�cK %ttT AT ,.,,� TN wsrr r 46 .►..../.;+c.i, /�P,ori.y�c/ /.✓ /ri�re fa✓... Soy / Layer 'Ex 7- -Soy 0- c4,5 r 30 - do 7� �.� /..mac.,. o vera // PERFORMED BY: __/ 1 AES J CERTIFY THAT THIS TEST WAS PERFORMED IN AnCQRnANr F WITH A11 CT6 TC -AN 1 INIr`tPAI Q'InEl INFO IN EFFECT QN TRIC QATF DATE i Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST wLi�i �•�T1.4•'1F. OF 44. �t ztI•b qR•S SEALS to a go to a! Louis A. 8utera ,'.• CE -6736 .��A �v to til.pROFESSO�.'""' PERFORMED FOR: COLONY 8U/LDE/2S DATE PERFORMED: gy�9/m LOT / 13 LEGAL DESCRIPTION:__1,yAml H)uz Township, Range. Section: 1/60TA I SLOPE SITE PLAN 0531 �9� 2 3 4 5 10- 11 •J• . 12- 13 2 13 1� 14 J . 15 D 16 17 18 19 Tol'SD// S/, -Ty SANDY G2¢vGL P0021.Y GRADED, SOME Y g„ si,fy SAND tolTN 6RAVEL MCOwN DENSE, SOME SMCARZ G.4 -'6y' Molsr Spnram Of HnC WAS GROUND WATER ENCOUNTERED? NO S IF YES. AT WHAT L DEPTH? NIA O P E Depth to water Aft _ t Q' I G- 11-7r. Monitoring? Batt Reading Date Gross Time Net Time Depth to Water Net Drop AK D5 IR 7 /9L s'* Z 3 / 5 n1,N ///L / o /� •, 3 2: I LI y 1//(. ' 71 X9 15 737, I (o 20 -{ I UPERCOLATION RATE / 6 (minutes/inch) PERC HOLE DIAMETER 5 TEST RUN BETWEEN S FT AND G FT COMMENTS re ;D i+-+•Ia�G� s.+ii G,�yeypr PERFORMED BY: 0, I R -16:J CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 77 -MA IS d/HSI Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "1:* Street, Anchorage. Alaska 99502-0650 SOILS LOG — PERCOLATION TEST FP YC 4�t o�..: •. • r.• .•s t.. mil Louis A. Butcro i •• CE -6736 S� .• .v AM AV PERFORMED FOR: ("Ot%O),1y /3u/41)E12S DATE PERFORMED: Z' 0-r /13 LEGAL DESCRIPTION: 6//1/!i/!iJ / H/LLj Township. Range, Section: pEpTH SLOPE SITE PLAN 1 -/ 1A %OP So/L 4- 5- 5 v SM WITH 612-14VE111 SOM 5 vol" Gley 6 MEDI vM D0J5C 7 D V 8 -I 10 13- 14-/ 31a / 15 16 T-, . S/t;T Mois7 S�rFlp � 17 80T�oM OF HO -6 18 19 WAS GROUND WATER ENCOUNTERED? o S IF YES. AT WHAT L O DEPTH? p E Depth to Wrier After Moniwngl Wr" Date: C— s _9 ■■■■■■■RMIMMENEWHIME Oat& Gross Time Net Depth to Time Water Net Drop ■■ l Y" �O 3 z/i[. 2 ' 50 10 MAH y HE 11MEMEM IMMEMENIMEN IME 1 0 / A •, 3 : O -Z ■11■■■■■"■� : 17- / Ll //lr" /S 1& �11MMIMEM11IM® MIEMMUMEMIAMIN M11MMMEM11M�7 Reading Oat& Gross Time Net Depth to Time Water Net Drop l Y" �O 3 z/i[. 2 ' 50 10 MAH y % 1 0 / A •, 3 : O -Z : 17- / Ll //lr" /S 1& 20 -{ I i� ILII PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS—'<�£ec�' E^'o �i� i -.✓c,-- sy,r rE�„ PERFORMED BY. (411-/4 1 '5p—g5 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE OATS 72.008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE Department Health and Environmentalr^^:otection No F� �_: 825 L Street, Anchorage, AK. : _-501 264-4720 lrmit # f33o8r3 # # # HANDWRITTEN PERMIT # # # W AHM6&R ON-SITE SEWER PERMIT pplicant : Mailing Address: 6!2/ 4, ,T,22 Qk S7`. .Location: Phone Number: a 0 4/ -Jr 6-(,.1 "Legal Description: m ((s $z Lot Size: /Type. -of Soil Absorption System Is: Trench: _�% Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: 3 Soil Rating(sq.ft/br) V1174f The. Required Size of the Soil Absorption System Is: DEPTH 9 ,C LENGTH GRAVEL DEPTH WIDTH In" The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width fob trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and thebottom of the excavation(in feet). # # REQUIRED SEPTIC(HOLDING) TANK SIZE = 7D Q 0 GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of' -residences that the well will serve. ' * # * TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection .and approval by*this departmei will' be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee fora private well or 150 to 200 feet from a public well depending upon the type of:public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and".must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper.installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I'. certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3.bedrooms. Signed Issued by: . Ap 1 ' t Date: SWP/024(1/81) GwAA_)'� It- 0?j r7-7 i l U" 1. C= I F• I== L i Ti '-r' C_w F- ID F- H C-3 E DEPARTMENT i''_'�HEALTH AND ENVIRONMENTAL I_�-ITEC:T I ON '.25 ' L. STREET. r Ni_-:HORAGE. fit•'•.. 99-,,t1 264-4720 20 �_i 1'-.6 — •� I T E _• E I-•-1 E E' P' E IF*~• 1 •`I i T r C+ PERH I T NO. t 8310 f 13. APPLICANT JIM BASk:I 5910 JOSEPH ST 99502 344-7562 LOCATION GINAMI HILL' . j. LEGAL LOT 1B GINAMI HILLS LOT SIZE 999999 SQUARE -FEET TYPE OF SOIL ABSORPTION SYSTEH I S : TRENCH HAX I HUM NUMBER OF BEDROOMS = . SOIL• RATING (SC! FTr BR) =. 220 THE F'EQU I RED SIZE OF THE _OIL ABSORPTION SYSTEM I S : CsEF'TI-I= :JL ID L_EF-.$1:5, 1 C-31 ~ i_ CaaF -r r=. THE LENGTH DIMENSION I S THE LENGTH ( I N FEET) OF THE TRENCH OR DRA I NF I ELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE SET14EEN THE SURFACE OF THE GROUND AND -THE BOTTOM OF THE EX.CnVAT I ON (Ira FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE H I N I NUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE, AND THE BOTTOM OF THE EXCAVATION (IN FEET). F=EGy1_I I F:EC■ -•EF'T I !_:' THI'-.I1-- __• I E=-C:it=-tky 1:3nI L_IDf'.1'-. '. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL I -J I LL SERVE. ' --- T1 -•.11D <;2 I F-.1'-tiF'Ei==T 1 rDt-.I"—� t=IF_E • E•E1-!U I F_•EG• =-- i ACt'_F I LL I NG OF ANY SYSTEM WITHOUT FINAL I NSPEC:T I ON ' AND APPROVAL BY THIS C�Er='AF'TME�aT WILL BE SUBJECT TO PROSECUTION. Ili I N I MUM DISTANCE BETWEEN A I -JELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS I' 100 FEET FOR A PRIVATE WELL OR 150 TO 200.1 FEET FROM A PUBLIC. WELL DEPENDING. 'I UPON THE TYPE OF PUBLIC WELL. H I N I HUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEINER LINE IS 25 FEET AND TO A COMMUNITY SE14ER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROP ER INSTALLATION. r= - FEE F=1-1 i T 1-=::-Z F,* i.F--- C-1EC__E1'lE4.EE• 1 CERTIFY THAT . 1: I Ai'1 FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. !� 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE IJ I TH THE CODES. _• : I UNDERSTAND THAT THE ON-SITE SE14ER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN _<: BEDROOMS. IGNED:_ - - ---------------------- APPLICANT ---- HPPLICANT J I hl BASk: I -ISSUED BY - - c -- - ------ DAT E---`-�------- - � 'v'•'+. 0 F ' - (\ {lam 1, "V 92 r` i 7125 OLD SEWARD HWY. O•• •• • S & ENGINEERS, INC. ANCHORAGE, ALASKA 99503 t.EOAI. S--, 349-6561 .•�,: ••o 501• • S()ILS LUG PERGOI.A71()N I'ESi 3y 7 I , 1t, ur 1.1 11(:()1 A11()N It til 3 6 faoAA • 1'1•ttf (,I<MLI) 1 i)11 • - (\ {lam 1, "V 92 r` i •� r,ATE 1.611r/,11MEt) •CP - '7* Aa& O•• •• • it r I•i1QYY1'% / /IS. � 1_/'s Loyipaye jjjts�—* Lot t.EOAI. uESCi11PT1UN SLUT! SITE PLAN .•�,: ••o 501• 01%gv�t2rS •� • • SAhd .W 1 f , S0�71 C/ DEPTH)Li , •b z Death Net 14 4041 • • ' • Gross Net to C.o bb)t-s Rcad•n9 Date T,me Time Water Drop • 4040 15 . / . / . 1� � a . � / 4140. / 1•rr n � ,4141. r � • 4040 p, rlih� �' »�c�iurrl r y I � a 3 0•• _ SCfn� W1�h SoMG q1�1�-I `1 - _ •% •' q hot 60 !'n e. S ir� �"/ �TY'1 `v I" o e 5 • f S. 7 4141 •O ,4140— 10 4140 •- •' _ S � 0 f f I S O•• •• • it ,Q• • •.'�•••��'� WAS GROUND WATER `VCs�+� ENCOUNTERED) L 4141,. 12 .•�,: ••o p E v� ) ! , f0 CoNI^.i jF YES. AT WHAT •� • • SAhd .W 1 f , S0�71 C/ DEPTH)Li , •b z Death Net 14 4041 • • ' • Gross Net to C.o bb)t-s Rcad•n9 Date T,me Time Water Drop • 4040 15 . / . / . 1� � a . � / 4140. / 1•rr n 1 G %bi g®�� F®mom N 3 ./ 019 o A�zn t A •000 �4 -`• :.„� �I !� f•.9 @ � 1� 9.36 6 r�/�s So• • 3/9 T 5 ^•ns 4.5 Y2- 19 r--OSWANSON.l 1 D:Z/ Js1 /ns 3. YQ4.E•;20 t It',. �iSSIO�PERCOLATION RATE �(m;nvtcs/nth) ��l�i���Cr TEST RUN BETWEEN 'fr� FT AND 52 0 FT COMMENTS — - PERFORMED BY CEIITIrtEt) av nTE Ee ,�•ooa t�/)DI 7~25 OM sewad H.~/. ~om~e, ~osk~ 99502 SOILS LOG PERCOLATION TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: SLOPE -t SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15- 16- 17 18 19- 20- % E. 1834-E WAS GROUND WATER ~0 SL ENCOUNTERED? 0 P E IF YES, AT WHAT DEPTH? Gross Net Depth [o Net Reading Date Time Time Water Drop ~ __~_/~/_~_~ ._¢_,'_4._~_ .... o o ___ ~ .... ~; ~ ~ ~ ...... _~Jr~ ' ... ~ _ ~ ;~ 5 /~ .......... '~ ..... PERCOLATION RATE ~, "~ (mi,%ul;es/inch~ TEST RUN BETWEEN 4' 0 FT ANO '~"" ~ FT COMMENTS • ^��/'/ Municipality of Anchorages¢ On -Site Water and Wastewater Program < �' (907)343-7904 saerx p15 Certificate of On -Site Systems Approval t f Parcel I.D. W -461 -pr Expiration Date: 1. GENERAL INFORMATION Complete legal description Ginaml Hills, Lot 1 B Location (site address) 12210 Ginami Street Current Property owner(s) Kenny Creed Day phone Mailing address 12210 Ginami Street Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Q Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: � � �� � C��< Y f - Date:� t 3 I � COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 41gU• W Date of Payment 2&.//3 Receipt Number 006-66 C COSA# J6613l6z?a Waiver Fee $ Date of Payment Receipt Number Waiver # 6. 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE t,/ System #1 Approved for 4 bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 272-8218 Date /vD'Z CSS Conditional approval for bedrooms, with the following stipulations: By: _ Original Certificate Date: c2 The Micip n ge 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 Septic System Advisory Well Flow Advisory 00SA blue sheet F 1! s Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # + of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Ginami Hills, Lot 1 B A. WELL DATA Well type Private Date completed UNK Total depth 297 ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 47 ft. Parcel ID: 015-461-45 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 8-19-96 1-24-13 Static water level 20 ft. 34 ft. Well production 1.15 gpm 1.5 g p m WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 0.418 mg/L Arsenic ND ug/L Dateofsample: 1-24-13 B. SEPTIC/HOLDING TANK DATA Collected by: PES Tank Type/Material S.T.E.P./Steel Date installed 7-3-96 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Date of pumping 2-6-13 C. ABSORPTION FIELD DATA Date installed 7-10-96 Length 47 ft. Depression over tank (Y/N) N High water alarm (Y/N) Y Pumper A+ Home Services Soil rating (g.p.d./ft2 or fe/bdrm) 0.8gpd/sf System type Deep Trench Width 3 ft. Gravel below pipe 8 ft. Total depth 113 ft. Eff. absorption area Z52 ftz Monitoring tube Y Depression over field N Date of adequacy test 1-24-13 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 39 in. Elapsed Time: 240 min. Final fluid depth 0 in. Absorption rate , 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 7-10-96 "Pump on" level at 44 in. Datum Bottom of Tank E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons 500 "Pump off"level at 42 Cycles tested 8 Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ Manhole/Access(Y/N) Y in. High water alarm level at 45 Meets alarm & circuit requirements? Yes On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 110+ Water Service line 10+ Curtain drain 50+ F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water 100+ Wells on adjacent lots 100+ I certify that 1 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 Steven R. Pannone Date /�L COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ in. Municipality of Anchorage Development Services Depalitlment-- - - - - - -- Building,Safety Division U On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING -opParcel I.D. 015-461-45 HAA # �T '7 Expiration Date: 1. GENERAL INFORMATION Complete legal description . Ginami Hills Lot 1 B Location (site address or directions) 12,210 Ginami Street, Anchorage Current Property owner(s) Timothy & Debra Baldwin Day phone 348-0847 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 12210 Ginami St., Anchorage, AK 99516 Day phone Mary Tutterow Day phone 261-7682 Dynamic Properties, 3111 C St., Ste. 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well (� Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ✓❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority 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 Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. Date 6 "14'09 bedrooms, with the following stipu Additional Comments - f,!\11.-1 1111 U.w 1111 : WASTEWATERPR( GRAM : • , O� �• •• A J •�� • 14 Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: — 7 (Rev. 01112) 1111` Municipality of Anchorage t z • '"° ' Development Services Department I ; Building Safety Division C@� . Y i S A F[ T 7 .. ;.` On -Site Water & Wastewater Program . 4700 South Bragaw St. I I' P.O.'Box 196650 'Anchorage, AK 99519-6650 ' fi { i ;www.muni.org/onsite. i (907) 343-7904 i 1 HEALTH AUTHORITY APPROVAL CHECKLIST ; Legal Description: Ginami Hills Lot 1B Parcel ID: 015-461-45 ,'. A. WELL DATA i ;Well typi! Pri Jif A, -B, or C provide PWSID # -- Well Lo'g (YIN). N l Datecom Meted unk i Y Y p Sanitary seal',(Y/N) Wires properly protected (YIN) i Total depth 297 ft. # Cased to '47 ft. Casing height (above ground) 34 in. FROM WELL LOG AT INSPECTION r Date�of;test non ei 1 4-16-04 !� " Static water level ft. 53 i ft j I Welllproduction} g -P.m. - 1.02 ; g.p.m. WATER SAMPLE RESULTS",,;f Coliform 0colonies/100 ml. :.Nitrate Nitrate 0.762 Mg./I. Other bacteria p0 colonies/100 mi. k Arse nic:I NA mg./L' �j Date of sample: s-26-� Collected by Cindy Ellis i B. SEPTIC/HOLDING TANK DATA Tank Type/Material steel STEP tank Date installed '.7/10/96 1. I , r Tank sizle 1500 gal. (a : Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout Y/N Ys, ., 'Depression over tank (YIN) N High water alarm Y/N P ( ) 9 (YIN) F Date of pumping 4-16-04 ', Pumper A Plus } C. ABSORPTION FIELD DATA' SIL: II � ,(� F Date installed 7/96 Soil rating (g.p.d.lft2 or fe/bdrm) 0.8 System type 'deep trench I Lengt 47t ft: Width 3.0 ft. Gravel a lowpipe 8.0 ft. Total depth 11.3 ft. Eff absorption area 752 ft Monitoring tube Y Depression over field N I III , ? Date i f adequacy test 4-16-04 Results (Pass/Fail) PASS i For 4 bedrooms " Fluid depth in absorption fieldlbefore test 73 in. Water added 657 gal. i New depth 81.5 In. t � Elapsed Time: 167 min. i Final fluid depth 79.0 in.' Absorption rate' > 600 g•p,d. . ; Any rejuve nation treatment (past 12 mo.) (YIN & type) none If yes, give date D. LIFT STATION Date installed 7/96 Size in gallons 1500 STEP Manhole/Access (Y/N) Y "Pump on" level at 47 in. "Pump off" level at 44 in. High water alarm level at 50 in. Datum bottom of tank Cycles tested >10 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 126 .On adjacent lots 100+ Absorption field on lot 200+ On adjacent lots 100+ Public sewer main 100+ - Public sewer manhole/cleanout 100+ Sewer /septic service line 100 Holding tank NA t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: i Building foundation 25+ Property line 50+ Absorption field 100 Water main 100+ Water service line 50+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 50+ Building foundation 100+ Water main 100+ i. Water Service line 100+ . Surface water .100+ Driveway, parking/vehicle storage 100+ Curtain drain none known Wells on adjacent lots 100+ , F. COMMENTS FCO is inside and was approved in May 2000. Well TD & csg depth determined 8/96 by Alpine Drlg. G. ENGINEER'S CERTIFICATION O � • •!4 � � •-(�..• • .S c I certify that/ have determined, through field inspections and ��' •:� 4 review of Municipal records that the above systems are In *' 9TH conformance with MOA HAA guidelines in effect on this date. ••• •�• •��- • Cindy M.Ellis -Engineers Printed Name Y- .._ _.•. ,,� y`V�:'�Ilis Date 6/4/04 CE .los» HAA Fee $ Waiver Fee $�� i 'Date of Payment I Date of Payment Receipt Number 7ZG7y Receipt Number G (Rev. 12/01) _ ... I ti f n 84/26/2ee4 18:24 9873409996 M e> r 4 � Z � N m C Z a F0 E � v � 0 1t� Z •� �i� iR gyp D It =$ ;0 :4: a� mm &\C: � *QQ 1 E31 BALDWD4 PAM 83 War M .00.to.00 N 'IM3 AVmo+roa 301M SZ :1SDX3 0 1t� '4 tm Z Sol m VIP; - b o 13381S INVNIO I SO ` :4: ;m I Z Sol m VIP; - b o 13381S INVNIO �s MUNICIPALITY`OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES a Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 015-4 1-45 HAA #ljlqL�Cna D �7 1. GENERAL INFORMATION Complete legal description GINAMI HILLS SUBDIVISION: LOT 1 B Location (site address or directions) 1221 o GINAMI STREET, ANCORAGE. AK 99516 Property owner DR. BILAN Day phone (907) 562-2236 Mailing address 12210 GINAMI STREET. ANCORAGE, AK 99516 Lending agency Day phone Mailing address Agent CAROL BUTLER w/ REMAX PROPERTIES Day phone (907) 257-0116 Address 2600 CORDOVA STREET. ANCHORAGE. AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $900.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto'and as of the validation date shown below, I verify that my Investigation of this Health Authority'Approval'application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from' my investigation and inspec i n, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal State codes, ordinances, and regulations in effect on the date of this inspection. "ER /Name of Firm ALASKA WWAST ER ONSULTANTS INC. Phone (907) 337-6179 / 11 ! i Address 6901 DEBARR ROADS IT ANCHO GE ALASKA 99504 Engineer's Signature ' Date: 5j17/0 . In conducting this evaluation, AWWC, Inc. �ltferpt to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MO�4 D�1H uldelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance o O F -A / of the system, nor do they guarantee that there are no hidden defects or encroachments. pv •' i •., �� AWWC, Inc. can therefore not provide an warranty for future estimate of how long the P Y tY 9 system will continue to meet the. operational requirements of the ADEC or MOA DHHS. , , , , , , . , , .r .. ....... ...... The content of this report is for the sole benefit of the owner listed above. Any I reliance upon or use of this report by any other person or party is not authorized, .... ... • • ........ nor will it confer any legal right whatsoever.oo '� fff A. 53 ness; 6. DHHS SIGNATURE 0 j�•., % , •' ��°a� _L Approved for bedrooms 4\eoProfesslore\ Disapproved Conditional approval for bedrooms, with the followin-g stipulatioris:` Additional Comments By: Date T= 11-00 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72-025 (Rev. 1/91) Back MOA #21 Computer Version RECEIEp , f 11; MAY 1 g Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES MUNICIPAUTY rwce Environmental Services Division �; ^MRONMENT 11 825 "L" Street, Rm 502:'Anchorage, Alaska 99501 (907 343-'4744 Nisl Health Authority Approval Checklist Legal Description: GINAMI HILLS S/D; LOT 1 B Parcel LD.: �� 015-481-45 A. WELL DATA ° Well Type, i PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A ' I I Log present (Y/N) N0 Date completed UNKNOWN Total depth I I; a 297' i Cased to 47' Casing height (above ground) 33.5" Sanitary seal �(Y/N) YES Wires properly protected (Y/N) YES I I 'i FROM WELL LOG ATt INSPECTION Date of test .; 8/19/96 4/3o/99 Static water I vel 20' I: X21 Weilproduction1.15 g.p.m. �'1 r3 g.p.m. WATER SAMPLE RESULTS Coliform f 0 Nitrate 0.97 m4/L Othec bacteria— ,1! acteria O j Date of saniple4 F 4/30/99 Collected by: '. A.W.W.C., INC. v: II II,I,. B. SEPTIC/HOLDING TANK DATA F�kAOIA ,INSIDE DWELLING. JIAA CROSS WANED r ( I • NG ONE PUT OUTSIDE PER LOU BUTERA I .:Date installed'' _ 7/10/96' Tank size` -1500 Number of Compartments ^ _ 2 Cleanouts (Y/N) YES I ,II L ,I :Foundation' cleanout (Y/N) *YES Depression (Y/N) NO High water alarm (Y/N) YES ;Date of Pumping 5/11/2000 Pumper NORTHLAND r � C. ABSORPTION FIELD DATA' L 7/10/96 Date installed'Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type TRENCH Length 47' Width 3' Gravel thickness below pipe 8' Total depth 11.4' 752 S Fr YES NO Effective absorption area Q Monitoring Tube present (Y/N) Depression over field (Y/N) Date of ad I qua y test 5/11 %2000 Results (Pass/Fail) PASS For ' 111 4 Bedrooms ;;;; Fluid depthin absorption field before test (in.); 64 Immediately after 761 gal. water added (in.): 75.5 r Fluid depth ' i''71 (ins) Minutes later 320 Absorption rate = �' 600+ i IIS � ' ., 't i NONE KNOWN ;I Peroxide treatment (past 12 months) (Y/N) � if yes, give date ----- krr� i•I � 72-026 (Rev. 3196r Computer vemlon r i D. LIFT STATION Date installed 7/96 Size in gallons 1500 Manhole/Access (Y/N) YES "Pump on" level at' 44" "Pump off' level at' 42" High water alarm level at" 45" "Datum BOTTOM OF TANK Cycles tested MULTIPLE E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Lift station 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:' . Foundation 5'+ Property line 5'+ Absorption field 5'+ Water maintservice line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main/service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage area 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ oodO�pOk F. ENGINEER'S CERTIFICA 10 1' - v OF ,At � � certify that l ve d to n d /d inspections and review p �� of Municipal corns ve ysterns are in conformance �'`:' ..• �Q with MOA H 9uid li n, t n this date...:. .......... ........ Signature 0 Engineer's Nam JEFFREY A. GARNESS o e A.� Garness: Date i Lb 4OK . _ -7953 HAA Fee $ Waiver Fee $ Date of Payment S g Date of Payment Receipt Number. lo7s� ����� Receipt Number 72-026 (Rev. 3/96r Computer Version 05-15-J0 17:06 FROM -CTE ENVIRONMENTAL 5615301 T-076 P.02/03 F-558 'AL. CT&E Environmental Services Inc. CT&E Rei# 1002083001 Client Name AK Water & Wastewater Consultants Inc. Project Name/p LT 1 B Giaami Mlls Ginami St. Client Sample ID Lt 18 Ginami Hills Ginami St. Matrix. Drinking Water Ordcrrd By PWSID 0 Sample Remarks: Client PON Printed Daze/Time Collected Date>•rime Received DatrJTime Technical Director Released B�I�YY/, 05/152000 13:34 05/112000 8:15 05/11/2000 10:25 Stephen C. Ede G-� -4VA" Allowable Prep Analysts Parameter Results POL units Method Limits Date Date Inir WATERS DEPT Nitrate -N 0.988 0.500 wt. EPA 300.0 10 max 05/11/OD SCL MICRO LAS Total Coliform 0 col/100mL SM13 92228 05/11/00 JOT 05-15-00 17:06 FROM -CTE ENVIRONWENTAI 5615301 T-076 P.03/03 F-558 zI CT&E Environmental Services Inc. hm laboratory Division 200 W Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria Anchorage. 07) 2 2343618-,1>06 READ INSTRL'CTIONSOIVR.AVERS£S1DEBEFORE COLLECTING SAMPLE Fax -1907)561-5301 MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY o PUBLIC WATER SYSTEM I.D. # TTI 1 PRIVATE WATER SYSTEM Q Send ReSAFf" l] Scold Ixroled w" .... wo uu P Aft - Lay Cl S R In Q Sex? Ixvdlee 15cb S o -- SAMPLE DATE: Month Day S MPLE TYPE - Routine o Repeat Sample (for routine sample with lab ref. ao. o Special Purpose SAMP LOCATION J, f 0 &if7,XIIA 1tfZy Year p Treated Water 4 Untreated Water Time Collected Collleectted� By PM+cce Pr9u An ysls Shows this Witter SAMPLE•to be Satisfactory CI Unsatisfactory O Sample over 30 hours old, results may be cnreliable 0 Sample too long In transit; sample should not be over 48 boars old at exammation to indicate reliable results. Please send new sample via special delivery mall. Date Received Time Received Analysis B09211— Analytical Method; O MMeema> ae Filter • Numher of 9410 1. 1100 ml. Result` Analyst 5 I Q= FTnv „nch FCta Jun Cl FAX04 Mid. T&me• Client notified of unsatisfactory results: Phoned Spoke with late . T►me: BACTY.RIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Rssd : Total Conform F- Coll Membrane Feta. Wreet Ceunt _ © .��- Coloaieulllfl ml Verification: LTB BG13 COLIFIRM Fecal Coliform Confirmation Final Membrane HI esuits S j Califolm,100 ml Reported By �-e--�"Dxtr ���_''r'�'� Time �'�� brs Comments: Faxes rNrc- r.. Nomm . r. G -Ar 08 - owe adma Memper of rite SOS Group lSoclete Generale qe Sun4e1I1arroe) ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA. FLORIDA. ILLINOIS. MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY. OHIO. WEST VIRGINIA Address Unless otherwise requested, HAA will be held for pickup. f •. .: .. _.. : �•: •,:: ...:. _ BER OF BEDROOMS. '/ 2. ,NUM. . RECEIVED . 3 TYPE OF WATER SUPPLY. _.. MAY_ 16 1997. Individual well - X Municipality of Anchorage ._.. OeAt Health &Human well Services Community • :-:._Public water ..:.: _.:.. . NOTE: if community well system, stem, provide written confirmation from State ADEC attest _ ng to the legality and status of system - s 4 TYPE OF WASTEWATER DISPOSAL. Individual on site X rf � ' H Iding'tank It Community onsit�e S ..t mat I �, .. . t• S :{ ,. r 1 Public 1'.i / 1 sewer. a l iS.�i' 'a � 1 ',R 1. 1 � ai k f� t it IA jt♦ /1 ( k I 1 I Y. { } yi � ', .l Y .'.. .1 r;<"NOTE elf community;w6s'tewatei'system, provide.written , 1 - ..',1! itYv. ,lt• , + confirmation from State ADEC attesting to the legality and status of system 72-025 (Rev. 1/91) Front MOA N21, i t 5 '.STATEMENT OF INSPECTION;BY.,ENGINEER, certified by my,seal affixed hereto and as of the validation date shown below, I verify that my 4: • rr - ...:: a ,• ,.. ". investigation of this Health Authority Approval application shows that the'on-site water supply and/o`r wastewater disposal 'system is safe; functional'and adequate for the number of bedrooms and type of structure indicated he' erein. I further Verify that based on information obtained from ,. the Munici alit of Anchora ,files and from m investigation and inspection,-the on site water :.supply.and/or wastewater disposal system is in.compl.iance, with all Municipal and State codes, ordinances,' and regulations in'effect on the date of this inspection I� % Vim✓ ' 'E,. ' I?G��/L/ �!/C CIj- Name of Firm Eag"lc� 9 Phone .: ... Address Engineer's signature Date 64 s. •• `' ''CE-673 6. DHHS S IGNATURE --p. X ..Approved for ¢ bedrooms. Disapproved. ,Conditional approval for bedrooms, with' the following stipulations: Additional Comments' - 4 . Date C: 0. �� ::,.�f..a:jei,,".1 s..__. � '#.. .'»`• ::.; r,f ..,c .•nta_' '` {',: 4;.:':r he Municipality`of Anchorage Department -of Heal4h and Human Services (DHHS) issues" Health Authority .1 Approval }Certificates based only upon,th'e representations;given in paragraph 5 above ;by ari independent rprOMSSIonal engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes ` • and their lending institutions in order satisfy certain federal and state requirements Employees of DHHS do not conducf,mspections oranalyze data'before.a certificater",is�issued The Municipality of Anchorage is not responsible for errors or. omissions in the professional engineer's work ' 72-025 (Rev. t/91) : Baek . MOA F OF ANCHORAGE' MUNICIPALITY Municipality of.Anchorage E j : NVIRONMENTALSERVICESDIVISlO A DEPARTMENT OF, HEALTH & HUMAN SERVICES1 Environmental Service's DlvisiMAY 9 on 5 1997 _ 825 L Street, Room 502 • Anchora e, Alaska 99501 •(907P,)-34.3 Health Authority Approval Checklist Description: Legal 9 P IoParcel LD.: A. WELL DATA Well type JyA rr If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) No Date completed UA k" H Total depth Cased to 4 Casing height (above ground) 30 " Sanitary seal (Y/N) res Wires properly protected (Y/N) Yts FROM WELL LOG AT INSPECTION i Date of test 8__j5_ 91C 5­13 – 97 Static water level aO ;2, 9 Well production g.p.m. 1.3 g.p.m! WATER SAMPLE RESULTS: Coliform Nitrate ''Z' &s "' z, Other bacteria i Date of sample: S– 9 ` r Collected by: t i 4 B. SEPTIC/HOLDING TANK DATA j Date installed Tank size lS"o o Number of Compartments 2 Cleanouts (Y/N) " Foundation cleanout (Y/N) y Depression (Y/N) N High water alarm (Y/N)1 Date of Pumping N1 &f-A Pumper !A C. ABSORPTION FIELD DATA Date installed Soil ratin (g.p.d./ft2 r ft2/bdrm) System type /r�.✓a� Length Width 3� Gravel thickness below pipe Total depth /d8 Effective absorption area 7-'a' � Monitoring Tube present (Y/N) % Depression over field (Y/N) Date of adequacy test 'uP`' r>s tc— Results (Pass/Fail) For bedrooms '! ! Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): i Fluid depth (ins) Minutes later: Absorption rate = — a.p.d. k '. Peroxide treatment (past 12 months) (Y/N) ^� If yes, give date 72-026 (Rev. 3/96)* E ` D. LIFT STATION Date installed 71ye' Size in gallons /Sda Manhole/Access (Y/N) i "Pump on" level at* til "Pump off' level at* 'Y/ High water alarm level at* 4/6 *Datum /god TA.�.►r Cycles tested /vow RECEIVED E. SEPARATION DISTANCES MAY 6 1997 Municipality of Anchorage SEPARATION DISTANCES FROM WELL ON LOT TO: Dept. Health & Human Services Septic/holding tank on lot /mss On adjacent lots t<oo < I Absorption field on lot ago On adjacent lots<ov� Public sewer main Neil Public sewer manhole/cleanout Sewer /septic service line t ;I S- Lift station' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation a 7 Property line Absorption field 9/ S' Water main/service line t/v Surface water/drainage f�o�� ' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation X33 Driveway, parking/vehicle storage area 1-16 Surface water �U1' Curtain drain N I� Water main/service line ",10 " Wells on adjacent lots 7`ivo F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal ra�s•rhat>th�e,�t qq i�stems are in conformance with MOA HAA guidelines in effect on this date. �+ r`�t`,; `'. �• ��+." Signature rs...� . ....:.. Engineer's Name �vs�.:. .ice Win: .. .. .. •� ," t�• , tum Date HAA Fee Date of Payment Receipt Number 41 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number