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HomeMy WebLinkAboutMADDUX PARK LT 1 Onsite File Maddux Park Lot 1 #018 - 251 - 01 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191086 PID Number: 018-251-01 Dwelling: [' Single Family (SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New ❑� Upgrade Name: ABSORPTION FIELD Stewart Barnes & Kim Moats-Barnes Trust Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 2600 Ivory Drive, Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 632-2400 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. Maddux Park 1 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. Well 90' N/A N/A ' N/A >25' TANK El Septic ❑S.T.E.P. ❑ Holding ❑Other Manufacturer Capacity Surface Water >100' N/A N/A I N/A Anchorage Tank 1,000 Gal. Material Number of compartments Lot Line >5' N/A N/A ' N/A Steel 2 NA Foundation >10' N/A N/A I N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Pump on level at Pump off level at High water alarm at Remarks Tank to well waiver OSV191012. Tank only replaced under this permit in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank Exist. drainfielTank td D3034 Installer PCN Drainfield Exist. CO/MT D3034 Inspector J. Williams BENCH MARK (Assumed elevation) 100 ft Inspection151 4/16/19 2 Location and description 3rd 4th Bottom of siding @ point A. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp .-4. OF Conditional Approval: Date ..,•• •:..... ........ is • 499th • 2L1 tCt - r i • t MICHAEL E. ANDERSON :.i �V'.0•. • No. CE-4381 .••'�i= •1A�(`�f' 4/19/19�...•••�t� a Appro -:� NI,/_ Date l? �vho pROFEss........,kik.. -"I II limiiiitS Inspection Report_9-1-12.doc MADDUX PARK LOT 1 PERMIT # OSP191086 PID # 018-251-01 E. 144th AVENUE — c. — EXISTING WELL \ • > 1 ` O m LOT 1 100,WELL RADII -•\.....,.. ..... //� \ 4, D I o� \ 70 rf (3 G, �` 100'WELL C� RADII \ \ C SV1 \ 1 2C0 2# \ tEXISTING WELL EASEMENT FOR R.O.W. NEW 1000-GAL TANK (BK. 1660,PG 593) EXISTING 1 ABSORPTION TRENCHES 1 LOT 2 s.90� 1 0 9,Q ((`9 illGE ENGINEERING .•.. OF `i i4h4. A B LEGEND :6'.P:••''• •.; ••• SV1 25.4 , 26.8 CO-CLEANOUT :• .....1,-- s� •.• SV2 29.8 30.0 2C0-DOUBLE CLEANOUT ? 49th 2C0 33.4 32.7 FCO-FOUNDATION CLEANOUT • ��^-.� FS-FLOW SPLITTER VALVE 7.3n�+q MICHAEL E. ANDERSON f ; MH-MANHOLE 1.•6%•, 1:.#7, 0 50 100 J •. No. CE-4381 �.,<4;p v19n9��••,r'`rc,, .� MI = = FEET MT-MONITORING TUBE v..Fp •••,,..ESS\•"P� �. SV-SEPTIC VENT -4�1 FESS\-we 1"=50' TH-TEST HOLE MADDUX PARK L1 PERMIT # OSP191086 PID # 018-251-01 o •- CV 0 o > > 0 LL U) (/) CV - - ,/- 99.2 - - 94.8 n -- 86.1 94.2 1000 GAL 94.0 SEPTIC TANK J I '.1. - 90.0 ,60....14%, �•�•�� OF k'9*.1 • P,..••••. ...., _- ••• . :41, 49th ' �% • PROFILE AS-BUILT •• ti1ICHAELE••ANDERSON �• = �illtiiiPGE �• fF •. 4,19/19 • (NO SCALE) ���Fp'....... .....•'•P•.,``.• ENGINEERING /-hYlr ..• -~_ _-_ __ -_~ -~� ' ' �� ^/ ~ J�� . `` ��� / \ . m / E. 144th AVENUE \ � N / / , / \^ \\ r� ` / / b Ki / `` \ / / EDGE OF ROAD / N . ` ^E 70.00' / 1 ���� ^� r-WOODEN 1,,,::.) '' ,04.'' . ' . s• 0*. \40\40A • ~` I -.100' PROTECTIVE RADIUS Cs4 DRIVEWAi' 0' 1 ' -f).-- ��' rn ` . EDGE OF ROAD \ \ �� . 1 �(•,, �� � ' ��` � ijkl\ (i ,7 7'8:� | ,$1p / Lot 1 / 13.549 s.f. \ \�``` ` \ ou',m ,' CANT / \\ N � CI 1 2u',4.4. CANT � / , \ ` CANT <h`• /1/ | -- SEPTIC *� �~ � ^ PIPES � ` �� | /' � , EASEMENT FOR R.O.W.-'/ = Lot 2 (BK. 1560. PG. 593) / `�� \ ' r `-C"^*—uwx FENCE 33.0' � | ' ^ 1 \ \ \ \ \ PLOT PLAN ___ AS BUILT _X_ SCALE 1^ = 40' GRID SW 3034Project No. 19-113/A2 11500 Daryl 4,mnum, Annhorogw, Alaska 98515-3049 | & Associates L_r� �� » inc .| 522-6476 Phone ~^ (907) 522-4626 Fax Professional^ | �� / �{] / 6����[)�C] / Land Surveyors konO�n�u��.com / ]onothonx*|ongyun/my.com I hereby certify that I have surveyed the following described property: /3,-;;.•7 4.. :""/A:C7..:1--...-71)°0°, LOT 1, MADDUX PARK (PLAT No. P-554) Anchorage Recording District, A|ouko, and that the Improvements situated thereon are VA VA within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. ....41 I(l 1 ....le VOi-44� / /.^ ` «0' Dated this the |'�� Day of __ '`^� ` , _. , at Anchorage, Alaska ` Os cx It Is the responsibility of the owner to determine the existence of any easements, -»00p' '~ oovwnontn, or restrictions which do not appear on the recorded subdivision plat. AECC963 Carroll, Rebecca M. From: Kenneth Lang <ken@langsurvey.com> Sent: Monday, April 22, 2019 12:09 PM To: Carroll, Rebecca M. Subject: Re: MADDUX PARK LT 1 Follow Up Flag: Follow up Flag Status: Flagged Becca- Based on our survey notes, the center of the well is exactly on the easement line, so half of the well encroaches into the easement. I believe the well was there prior to the taking. tic t►°I�'1 Ken Virus-free. www.avq.com On Mon, Apr 22, 2019 at 11:33 AM Carroll, Rebecca M. <rebecca.carroll(c@anchorageak.gov>wrote: Hello Ken, It is hard to tell if the well is outside the ROW Easement (recorded in Book 1660 Page 593). Could you confirm whether or not it is in the easement? Thank you, Becca Carroll Onsite Water and Wastewater Municipality of Anchorage 343-7908 1 —reuAi---- vociPALlry MUNICIPALITY OF ANCHORAGE C 11 On-Site Water&Wastewater Program n F ..S.• I W1,44 PO Box 196650 4700 Elmore Road k > Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 1 http1/www.muni.org/onsite:147- _ � epartment 44, f PGE On-Site Wastewater Disposal System Permit Permit Number: OSP191086 Effective Date: 4/12/2019 Work Type: SepticTank Upgrade Expiration Date: 4/11/2020 Tax Code Number: 01825101000 Site Legal Address: MADDUX PARK LT 1 G:3034 Site Mailing Address: 2600 IVORY DR, Anchorage Owner: BARNES STEWART A TRUST 50% & Lot Size in Sq Ft: 12907 Design Engineer: FORGE ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: If the as-built survey shows that the well is within the ROW easement, a ROW encroachment permit will be required. hi Received By: 1 � 9-.Y 1 Ie) Date: II Issued By: Csa49 Date: 19 c n( Municipality of Anchorage L)cparrmcn[ P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Department On-Site Water and Wastewater Section **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV191012 COSA#: Permit#: OSP191086 PID#: 018-251-01 Legal Description: Maddux Park Lot 1 Engineer: Forge Engineering Applicant: Stewart Barnes & Kim Moats-Barnes Trust Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 90.0 feet. See engineer's waiver request and calculation for justifications. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: `/ i 2 19 Approved by: /alte-r—( Name of Reviewer **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGss 8 9 ik Community Development DepartmentPh h-: 907-343-7904 Development Services Division : 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-251-01 Property owner(s) Stewart Barnes & Kim Moats-Barnes Trust Day phone 632-2400 Mailing address 2600 Ivory Drive, Anchorage, AK 99516 Site address Same Legal description (Sub'd., Block & Lot) Maddux Park, Lot 1 Legal description (Township, Range & Section) Lot Size 12,907 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (IE all that apply) Absorption Field Initial n Single Family (SF) X (w/wo ADU) Septic Tank X Upgrade �X] Duplex (D) Holding Tank ❑ Renewal Multiple Dwellings Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Well to Septic Tank Distance:90' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. -14/1.....-.12t-1 atrt--j------\ (Signature of property owner or authorized agent) Permit/Rush Fees: 02I 5 Waiver Fees: I t/SO Date of Payment: q/5119 Date of Payment: q/5 /0 Receipt Number: 62 R qJ) Receipt Number: (}2?9gi) Permit No. 15,2/9/Q g , Waiver No. O5Vl9t O l2 Permit App_:- , ..c. GE • ENGINEERING PO BOX 240773 ANCHORAGE,AK 99524 522-7773 677-7766(FAX) April 12, 2019 MOA Development Services Dept, On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Maddux Park, Lot 1 —2600 Ivory Drive Septic System Design and Permit Application Dear On-Site Services Engineer: The owner of Lot 1, Maddux Park Subdivision intends to sell the property. A COSA cannot be issued because the septic tank has exceeded its life expectancy. We are submitting this design and permit application for the replacement of the septic tank. The existing absorption system has been tested and is in good working condition. The attached site plan identifies the location of the home and the existing well and septic system. Well and septic systems on adjacent lots are also shown. The existing septic tank is 90' from the well on the lot. A waiver has been in existence allowing the tank to be at this location since April of 1985. A waiver request is attached to allow placement of the new septic tank at the same location. The new tank will be a minimum of 90' from the well on this lot and 100' from all wells on adjacent lots, 100 from any surface water, and more than 5' away from the absorption trench. Please refer to the attached Site Plan for the septic design. If this design is followed,there will be no adverse impacts to adjacent properties. Sincerely, ••��••oF A���� Com- - • 1 1, Michael Michael E. Anderson, PE ; 49th /N ‘"� • % ♦_,. GE ' ENGINEERING PO BOX 240773 ANCHORAGE,AK 99524 522-7773 677-7766(FAX) April 12. 2019 MOA Development Services Dept, On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage,AK 99507 Subject: Maddux Park,Lot 1 —2600 Ivory Drive Septic System Design and Permit Application Dear Onsite Services Engineer: The existing septic tank on Lot 1,Maddux Subdivision is located 90' from the existing well on the lot. A waiver was issued by ADEC in April of 1985 allowing the septic tank to remain in this location. Recent water quality tests taken from the well indicate the septic tank is not a source of contamination to the well. The existing septic tank must now be replaced to obtain a COSA for resale. We are requesting a waiver be issued to allow the new septic tank to be placed 90' from the well. The well on the lot is 156' deep with 6"welded steel casing to a depth of 154'. The static water level is noted at 117' on the well log. The soils encountered during well placement consist of sandy gravel with silt and a clay lense from 76' to 96' below the surface. The well is located at the northwest corner of the lot and is approximately 5' higher in ground surface elevation than the septic tank. Septic effluent would flow away from the well in the event of tank failure. We are confident based on the long term performance of the existing septic tank and the water quality from the well that contamination from the new septic tank is not likely. We therefore request that the waiver allowing the proposed septic tank to be constructed 90' from the well be granted. ADEC POINT ANALYSIS Bottom of Tank to Highest Water Table— 100' 7.0 Points Soil Absorption Type—Sand/Gravel w/Silt 2.50 Points Permeability—Silt or Sandy Gravel 1.00 Points Water Table Gradient- +5% 4.50 Points Horizontal Separation— 90' 2.60 Points TOTAL POINTS 17.6 Almost sure to be free from any form of contamination from household sewage. Sincerely, 4P�•` A no. -1A"--it-S- E.,a-L-t9.----1 • Michael E. Anderson, PE a ` 49th t* •0 • r C 0 MICHAEL E. ANDERSON m r.',:f>. N0. CE-4381 i=: ��tc` °•..ti 4/12/19 .••••c*IP 1*4 4 , s,;t44P MADDUX PARK LOT 1 E. 144th AVENUE ( _ EXISTING WELL \ jj r /v m LOT 1 \QP)... 100'WELL 0 R O, RADII -\ ,,,,,,,,I... 0)-I / <,'Z' F _o �o DcL- \ 70s`� 100'wELL C RADII \ \ C \ D \ 2C< 'f' 00.111.1 EXISTING WELL 10000111 EASEMENT FOR R.O.W. REMOVE&DISPOSE OF EXISTING TANK® (BK. 1660,PG 593) PER MOA CODE&REPLACE W/NEW EXISTING 1000 GAL TANK IN SAME LOCATION. ABSORPTION TRENCHES LOT 2 i s'x'7.- 90 F,9 111PGE NOTE: ���.,ojksi%it_ NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND .*`.�P�•0 . ..s •• PROPOSED SEPTIC SYSTEM CO-CLEANOUT 2C0-DOUBLE CLEANOUT a 49th Ik\ �i► ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS ��� FCO-FOUNDATION CLEANOUT PROPERTY ARE SHOWN• .NO CONFLICTS WITH WELLS OR SEPTIC FS-FLOW SPLITTER VALVE • M7 I0 CMAEL E. ANOERSONi SYSTEMS. MH-MANHOLE -,- N0 CE--;81/+/. 0 50 100 SLOPES>25% MT-MONITORING TUBE •j��'QF „�1 �'r► FEET _SLOPES>46% SV-SEPTIC VENT ��i�� ; ��:�� 1'=50' TH-TEST HOLE / E. 144th AVENUE o \ M \ =DGE OF ROAD N 90'00'00"E 70.00' 1 M ITI 0 D EASEMENT FOR R.O.W. 4 (BK. 1660, PG. 593) WELL a ASPHALT s 8.0'x12.1' SHED DRIVEWAY._ '�WOODEN�^y FENCE Qey, o 3.9'x11. IOs l PORCH' F //� �1.3' CANT EDGE OF ROAD 0 ® Nay M FENCE PLOT PLAN AS BUILT X SCALE 1" = 40' GRID SW 3034 Project No. 19-113/A2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 0000ppOO (907) 522-4625 Fax oo F A p�4 Professional Land Surve ors kenOlongsurvey.com Y .......... q 4 jonathanOlangsurvey.com �4P ,.• S 40 I hereby certify that I have surveyed the following described property: LOT 1, MADDUX PARK (PLAT No. P-554)* 49TH*00 Anchorage Recording District, Alaska, and that the Improvements situated thereon are ""•' •.."'•" within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed O'A' KENN premises and that there are no roadways, transmission lines or other visible O QQ o G easements on said property except as Indicated hereon. ik� O 4 .. •' gJp Dated this the 9 Day of Lo at Anchorage, Alaska ....... 0� �a • doo 40oROFESSIONAL �o It Is the responsibility of the owner to determine the existence of any easements, �Opppooa covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 y F�k Lot 1 / 13,549 s.f. \\ 6.6'x CANT 2.0'x4.4' / \ CAM 1.0'x9.0' II —CANT _ I SEPTIC PIPES 6 I 5? s Lot 2 FENCE PLOT PLAN AS BUILT X SCALE 1" = 40' GRID SW 3034 Project No. 19-113/A2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 0000ppOO (907) 522-4625 Fax oo F A p�4 Professional Land Surve ors kenOlongsurvey.com Y .......... q 4 jonathanOlangsurvey.com �4P ,.• S 40 I hereby certify that I have surveyed the following described property: LOT 1, MADDUX PARK (PLAT No. P-554)* 49TH*00 Anchorage Recording District, Alaska, and that the Improvements situated thereon are ""•' •.."'•" within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed O'A' KENN premises and that there are no roadways, transmission lines or other visible O QQ o G easements on said property except as Indicated hereon. ik� O 4 .. •' gJp Dated this the 9 Day of Lo at Anchorage, Alaska ....... 0� �a • doo 40oROFESSIONAL �o It Is the responsibility of the owner to determine the existence of any easements, �Opppooa covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 · (~ MtJNICIPALITY 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 PHONE ~NEW MAILING ADDRESS LEGAL DESCRIPTION ~ I ' ' !LUCATIuN NO. OF BEDROOMS W Absorpfio~ area D~lling PERMI%~O. ~ ~ Manufacturer/. Materia{ No. of compartments Liq. capacity JR ga/ions Inside length WiDth ~ Liquid depth //)¢ ~ IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~O ~ ~ Manufacturer Material Liquid capacity in gallons Q Well ,,, ~/ Foun~tion Nearest lot Hne PERMIT NO. ~ ~ DISTANCE TO: /VD'+ /~//4~ ~- / 0 ~C)/O f ~ IL ~ No. of lines Lengthpf each line Total length of lines Trench width Distance between lines R ~ ~ Top of tile to finish~rade ¢ Material beneath tile Total effective absorption area Length Width Depth PERMIT NO. ~ P Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line ¢ DISTANCE TO: Class -- Depth Driller Distance to lot line PERMIT NO. Bui)¢ing foundation Sewer line Septic tank Absorption area(si ~ DISTANCE TO: OTHER PIPE MATERIALS b3o3 _ SOl L TEST RATING INSTALLER REMARKS .. /'X ' 72-013 (Rev. 3/78) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Seophysicol Surveys LOCATION OF WELL {Piease complete either Io, [b or lc.) lSorouph Suhd,v,,,o. .o, lB,Dc, HI ,, i i_o,_o,_o, ~IDrSTANCE AND DIRECTIO~ FROM ROAD INTERSECTIONS Street Address and Area of Well Location WELL LOG Malerial Type · ::.. -,-.....~h ,.,.~ :' Feet Below Surface Drilling Permit Ne. A.D.L. NO. Sectlon No. Townehip N~] Range Er='] Meridian srl wE) 3. OWNER OF WELL: 4. WELL DEPTH: (final) 5. DATE OF COMPLETION 6. []Cable tool []Rotary [] Drlvan [] Dug E] Au~e~ E] Je,,ed I--I eo~ed[] O,he~: 7. USE: ~ Oomeltia [] Public Supply [] Induslry [] Irrigation [] Recharge [] Commericol [] Taint Well [] Olher: 8. CASING: [] Threaded ~ Welded diam. ~ in. to i/',.~?/ft. Depth Waight / .7 Ihs./ ft. dial,, in. to ff. Depth Stickup ¥~ ft. 9. FINISH OF WELL: STATIC WATER LEVEL: / / /'Z ft. ~ /, J /,d'~S [] Above or (~ Below land lurface Date I~.GROUTING Wall Grouted: [] Yes ~] No Materiel: [] Neet Cement [] Other: IS. PUMP: (if available) HP ~'~? Length of Drop Pipe fl. capacity g.p.m ,~ Subm. [] del [] Cenlrificol [] Other I 14 REMARKS: 16 /YATE,~ WEL~ CONTRACTSR'S C[RTIFICATION: Tn;s(~./4~,~,J..~.r~_~:'!i~'~¢~wes dm:~e~ ,U~der ~ ~ ~/~'~ ~l'~m l r isdic~ion.~._~onn~is~ report is true to tr, e/~)be st~.~ f~,/~Y/k nowJ.~dge~ ?~ end belief; Water Temperature __o [] F [] C )])ihTl!ii: :I: c:*c:, I::"') , C' 4/' ! ::5 / ~!!i~ DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIE~.D, GOVERNOR 274-2533 April 9, 1985 Alaska Envirionmental Control Services 1200 West 33rd Avenue Suit B Anchorage, Alaska 99503 SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Lot 1, Maddox Subdivision, Anchorage, Alaska 8521-WA-132 Dear Si r: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 90 feet on the subject property for a 3 bedroom single family residence only. Sincerely, Steve Eng, . .~ District Engineer SE/dd !:~2:'.~:i L.. S'l'T~li:i:l!i!ZT !, iqhl[',HEJF;hq(!Zff~: :, ¢'::fl'::: ?l?!.:?O :L F:'I!!!]::;'.H ]: 'T' )':) fY'I"IE ¢::fl='F:'l... :1: [;;ANT ~', ¢'::~ '.0 '.0 F:;; E: !;:; S ',', [][)I',I'I"¢iCT F::'H[)I".IE: :', L. EF:'hqL.. :[)E:!!!ff]F:;~ :1: F' r, StJ!i':lD ]: V ]: !:; :[ Eff',l = FI{.~DDU X SIE[:I" :[ [)N ~ :3::!!; "l"(::)Mhl~!i~l'"l :[ I:::' ~ :L 21',I :L::f!;[:.~O0 (SI,!,, F::"I',, (]F~ ALASKA ENVIRONr '-NTAL CONTROL SERVICe..,, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. CALCULATED BY ~"~0- ~','~ CHECKED BY SCALE / .v = ~ · OF "~"- DATE · ! %- ALASKA ENVIRON'-'NTAL CONTROL SERVICe.,, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. CALCULATED BY CHECKED BY OF 5~' DATE' DATE ALASKA ENVIRONI ATAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO, CALCULATED BY CHECKED BY SCALE OF DATE DATE. ALASKA ENVIRON' '-NTAL CONTROL SERVIC~,~, INC. ]200 West 33rd Avenue, Suite B ANCHORAGE. ALASKA 99503 (907) 561-5040 SHEET NO. OALCULATED CHECKED BY SCALE OF DATE. DATE ALASKA ENVIRON~P -NTAL CONTROL SERVICB, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB SHEET NO CALCULATED BY CHECKED BY SCALE OF DATE MtJN~CIPALiT¥ OF ANCHORAGE DEPARTIVIENT OF HEALTH AND ENVIRONMENTAL 82.5 L. Stre~, Anchora§o, Alaska 99501 264-4720 SOILS LOG--PERCOLATION TEST SOILS LOG PERCOLATION LEGAl_ DESCRIPTION: ~ /. ~,'-'~ .~2.~ '& ,~t[./,~t .~ .~._~. SLOPE SIT[.-: PLAN '1 WAS I'_;ROLIND WATER ENCOUNfERED? IF YES, f\']' WHAT [)EPTH? F eiJdln j )ore ~ .... ! / ' ' · ( ~ . s t De ~ h to: Net PERCOLATION RATE (minutes/inch) TEST R N BETWEEN ............... FF AND PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE DATE PERFORMED: SOILS LOG [] PERCOLATION TEST SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED B Y :~---['~fq''~ 72-008 (6f79) ENCOUNTERED? O O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ~ ^~ 1,~ PERCOLATION RATE ' ~'~ ' ~" ~, ' (minut,es/inch) TEST RUN BETWEEN '"'.'/FT AND :~T~ k-,~4c-,Fr~-, ~ ;~,x~:F~'¢.¢'~.,-~''''' , .~ f~.,, ',. ~ff-E~/ CERTIFI~DB~: ~.~ t', · , ,', ,DATE ..~b. ,.~, . ,. / '-' ...... Bill Schreck/Broker April 15, 1985 Department of Environmental Health Municipality of Anchorage 825 "L" Street Anchorage, Alaska 99501 Dear Si~: As owner of Lot 2 Maddux Subdivision, I have no objection to Mr. Stewart Barnes locating his septic system within five (5) feet of our co.non property line. Sincerely, William R. Schreck cc: Stewart Barnes MUNICIPALITY OF ANCHOP,,AOI~ DEPT. OF HEALTH ENVIRONMENTAl. PROTECTION :APR RECEIVED 2601 Blueberry Rd, Anchorage, AK 99503 (907) 276-7048 ALASKA 6iIUIROFIm6F1TAL CONTROL $1 r LIIC $, IFIL ~aclineeri~cI $ ~l~uironmental Studies April 11, 1985 Keith Bandt Department of Health and Environmental Protection 825 L. Street Anchorage, Ak 99501 Dear Keith: This is in regards to Maddox Subdivision Lot 1. Due to the fact that all adjacent lots have already been built upon, this lot is severely restricted as to available space for a septic system and well. After careful measurements of all neighboring wells and septic systems, we have determined that the only place to put a septic system would be in the SW corner of the lot. Because there is a 10-foot high cut bank there, we want to build the system as far away from it as possible to avoid daylighting. Now, to do so, while keeping the leach field 100' away from the proposed well, it will be necessary to bring a small length of the system within 5 feet of the south lot line. The design is attached, showing how this will be. I have met with Steve Eng on the lot and showed him the cut bank and explained the situation, in an effort to obtain a waiver of the well-to-septic tank distance to be only 90 feet. He has granted this waiver, seeing no problem with the cut bank. Now, therefore, we are requesting from you a waiver of the lot line distance to be only 5 feet on the south lot line, only towards the one end, so that this wonderful lot can be developed. Sincerely, Engineering Geologist Approved by: ~Jr~., PhD, PE 1200 I~Ucsl 33rd Aaenue, Suite B, Anchara¥, Alaska ggSO3o(gO7) 561-50z10 ALASKA iiUII Ofllll6F1TAL COF1TROL $6I uIC65, IIqC. SPECIFICATIONS FOR A FIVE-FOOT WIDE WASTEWATER TREATMENT SYSTEM- LOT 1 MADDOX SUBDIVISION 1.0 GENERAL 1.1 The drawings, sheets 1 through 5, shall be a part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Environmental Protection (DHEP), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 All elevations and depths are advisory, and are to be verified or modified in the field by a DHEP approved inspector. 1.4 It is the responsibility of the installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. 1.5 If the installation is not inspected by an A_ECS engineer, AECS will not be responsible for the design. An engineer at AECS should be consulted prior to construction, to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC SYSTEM 2.1 The septic tank shall be a UPC approved two- compartment tank, constructed of 12-gauge steel with bitumastic coating, set level, and insulated with an overlying layer of 2-inch burial type polystyrene. The septic tank shall rest on undisturbed soil. 2.2 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. 2.3 The septic tank and 5-foot wide drainfield shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C wells, and 200 feet from Class A or B wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by Alaska Department of Environmental Conservation (ADEC). 2.4 Piping shall be fitted with a mechanical watertight Calder coupling on the outlet and inlet of the septic tank. Piping shall be 4-1nch ASTM D3034 or 1200 UJcsl 33rd ~ucnue, $uii¢ [~, Ancbra9¢, AI,ska 99503, [907) 581-50/40 2.5 cast iron, sloped a minimum of 1/4 inch per foot. Cleanouts shall be installed as designated, capped with air-tight rain caps (jim caps or equivalent), and extend a minimum of 2 feet above ground level. 3.0 FIVE-FOOT WIDE DRAINFIELD 3.1 The gravel for the 5-foot wide drainfield shall be 0.5 to 2.5 inch, screened rock with less than 3% passing the #200 sieve. All substitutes must have prior DHEP approval. 3.2 The bottom and sides of the excavation shall be raked with the backhoe blade to insure that it has not been compacted during excavation. The bottom elevation shall be level. 3.3 Monitor standpipe(s) shall be placed as shown in the drawings, and shall be rigid PVC ASTM D3034, or 4 inch cast iron. The section shown with holes may be drilled 0.5 inch holes on the 6-inch centers on opposite sides of the pipe, or a regular section of perforated sewer pipe, clamped to a solid section, with either a no-hub coupling or a solvent joint. A rubber rain cap (Jim cap or equivalent) shall be placed over the top of the pipe. 3.4 The distribution pipe shall be 4-inch rigid PVC with a minimum crush strength of 1500 lbs. All distribution pipes shall be laid level. 3.5 Five-foot wide drainfields may be paralleled, but must have a minimum separation distance between the drainfields of 6 feet or 2 times the gravel depth (whichever is greater). 75 feet is the maximum linear length of any drainfield. 3.6 If the final grade over the dralnfield is less than 4 feet above the gravel, insulation is required, using DOW extruded blue styrofoam board. There shall be 1" of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 18" of soil cover even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall also have 4 feet of cover or an equivalent layer of insulation to prevent freezing of the line. 3.7 If insulation is not necessary, the gravel shall be covered with a layer of nonwoven fabric (such as M~rafai, Fibretex 200 grade, Poly-filter X or equivalent). 3.8 It is recommended that the area excavated in the vicinity of the drainfield shall be planted with a white cover, red rescue mix, and Kentucky Blue grass. EPUW.S4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 018-251-01 Expiration Date: 7-22—/ 1. GENERAL INFORMATION Complete legal description Maddux Park Lot 1 Location (site address) 2600 Ivory Drive Current property owner(s) Stewart & Kim Barnes Day phone 632-2400 Mailing address 2600 Ivory Drive, Anchorage, AK 99516 Real estate agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community n Public Water System ❑ Public Sewer Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 557) Waiver Fee $ Date of Payment til[-9//9 Date of Payment Receipt Number 10709b Receipt Number COSA# (9c5�/9/ Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date •••�E OF 4474. 6. DSD SIGNATURE 1A•�� 4 � ' al• • System #1 Approved for 3 bedrooms o. ;MICHAEL E ANDERSON •• No. CE-4381 •,��_� System #2 Approved for bedrooms • .•F�••.•,�:i--i-- •r,••'a" .• Disapproved �+hi��:F—Fs5:�••• Conditional approval for bedrooms, with the following stipulations: \`\`0 Y tOF«4/0(7,/ aCc- ON-SITE 'PVm ▪ WATER AND PROGRAM • WASTEWATER oz 0 05 `� )))))))))11111 By: Original Certificate Date: -z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Chealist blue sheet COSA Checklist Legal Description: Maddux Park Lot 1 Parcel ID: 018-251-01 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA El Well log is filed with Onsite (or attached) Well production at time of test 5.1 gpm Date drilled 4-13-85 Water storage tank volume NA gallons Total depth 156 ft Well disinfected for coliform test? ❑ Yes ❑■ No Cased to 154 ft Coliform bacteria is Negative ❑■ Sanitary seal is functioning correctly Nitrate .290 mg/L ❑ Nitrate less than MRL(ND) ❑■ Wires are properly protected Arsenic ug/L ❑■ Arsenic less than MRL (ND) Casing height(above ground) 26 in. Collected by Forge Engineering Date of flow test for COSA 3/20/19 Date of Sample 4/2/19 Static water level at beginning of test 115 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) New years 0 Required maintenance completed Tank type/material s"''S'O Age of lift station years Measured operating fluid level in septic tank New Lift station material ❑■ Standpipes/foundation cleanout per record drawing Comments: NA Date of pumping New D. ABSORPTION FIELD DATA Trench Which system tested (date installed) 5/8/85 Adequacy test date 3/21/19 ❑ ALL standpipes present per record drawing Results Q Pass For 3 bedrooms Total measured depth from grade 7 ft (max) Fluid depth prior to test 0/0 in Measured depth to pipe invert from grade ft(min) Water added 300/318 gal 0 N/A—pressurized field 5/0.5 New depth in ❑■ Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective ❑� Code-required soil cover over field Final fluid depth 0/0 in ❑■ Absorption rate >450 gpd System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) 1125/1200 If yes, enter date Gallons introduced gallons Comments/Deficiencies:North/South trenches respectively. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' Yes if No 90 ft 7:1 Yes if No ft Neighboring Tank > 100' NJ Yes if No ft Private Sewer/Septic Line >25' Yes if No ft Absorption Field on Lot> 100' ®Yes if No ft Holding Tank > 100' ®Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' ®Yes if No ft V Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 1X3 Yes if No ft p Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' IS Yes if No ft Surface Water> 100' (1 Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' tg Yes if No ft Private Wells> 100' I7j Yes if No ft Water Main > 10' El Yes if No ft Community Wells > 200' fJ Yes if No ft Water Service Line> 10' ®Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' EL Yes if No ft If absorption field is under driveway comment below Property Line > 10' [ ] Yes if No ft Wells on Adjacent Lots: Water Main > 10' L1 Yes if No ft Private Wells> 100' K] Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells>200' [J Yes if No ft Surface Water> 100' K1 Yes if No ft F. ENGINEER'S COMMENTS Waiver on file for well to septic tank distance 4/9/85. .****�E A 141 G. ENGINEER'S CERTIFICATION `��P� ••OF••••q•<�s•�� I certify that/have determined through field inspections and review c,_, ..0 `4--- �/. of Municipal records that the above systems are in conformance with 49th i� / MOA COSA guidelines in effect on this date. ,,,, „ ,,,, S. / // MICHAEL E. ANDERSON l Li j • -L-c./i •v -L No. CE-4381 ••'._/ Sf . • •. 4118119 • C1�4 COSA Checklist yellow sheet • �v.'1-eo•• ••< •'••............. ... ..4P IV1UNICIPAL.ITY OF ANCHOFtAGE DEPARTMENT OF NEALTFI AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIFIONMENTAL HEALTH CEWFIFICATE OF INSPECTION FOR HEAl_TH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 "~... Application Date GENERAL INFORMATION (a) Legal Descripti~¢nclude lot, block, subdivision, section, ~wnship, range) Location (address or directions) (b) Applicant Name ~ Fe-t~¢~/%'b 8~]O(a Telephone: Home ~_L~_~]j___ gustoes (c) Applicant is (check one): Lending institution ~; Owner/builder~; Buyer (d) Lending Institution __ __.~O~.~.".~(-fk~:~q. ~'* ~1',- ]V°.?~_~_-'~ Telephone ................................ Address (e) Real Estate Company and Agent ~/_"~t~}.-7,2. ...... Address ................................................................................... Telephone ............................................................................................ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single.-Family~ Multi.-Family ['_3 Other __. Number of Bedrooms .'~"'-:_ ................ WATER SUPPLY Individual Well F.~* Community [~ Public [3 Note: If community well system, must have written confirmation from the State Depa[tm ~n, o, En.~.~ _,nmenta Conservation attesting to the legality and status. Page 1 of 2 SEWAGE DISPOSAL Onsite,,~[''~ Public L~ Community El Holding 'rank 1'51 Note: If community well system, must have written confirmation from the State Dep~rtment o, Environn enta} Cons._r~ation attesting to the legality and status. 72525(1~ 84j ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARC].'I, DATA AN[) As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat my ir~vestiga! on of Authority Approval shows that the on-site water supply and/or wa,';tewater disposal system ~s safe, funct~o~,a: for the number of bedrooms and type of structure indicated herein. I further verify that based on the nforrca~ on from the Municipality of Anchorage files and from my investigation and inspection, the on-site w~ter wastewater disposal system is in compliance with all Municipal and Stste codes, ordnances, and regulations ~ effect ,~ the date of this inspection, Name oi Firm ~_--~ Telephone _~_ ~ L:? ~,~ Engineer's Seal DHEP APPROVAL ,,..-' '. ...../-._'~ ..) Approved for _~/_/t-'.r.., ..,,:. I..~.7 bedrooms by Approved _ ?'~ ..... Disapproved 'Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Proteclion (DHEP) issues H~a'.!~,~; Approval certificates based solely upon the representations given in paragraph 5 above by an indeper]de~ engineer registered in the State of Alaska. 'The DHEP does this as a courtesy to purchasers of homes a~d institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduc~ insFec~.i:o~:5 ~r analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omiss~o];~; i¢ t~h~ professional engineer's work. Page 2 of 2 72-025 (11/84) tTf OF AN RAGE C~?AL L1~-, ~ ItU'¢~ ,.,;~-f OF '¢E~,,¢,-~EC'[~OFtMUNICIPALITY OF ANCHORAGE (MOA) ~.~V~N~.~t1AL rr.~ HEALTH AUTHORITY APPROVAL (HAA) .... ~ ~ CHECKLIST- FEBRUARY 1984 I', 0'0 264-4720 1~/..C~/..\'~/..9 Legal Descrip~on: A..¢~_~.~, "~"~g /_,.~Jl~ / R., uJ % ' WELL DATA Date Completed _/-'/-/~'/-¢-~,"'~" Yield Depth of Grouting Pump Set A't Sanitary Seal on Casing~N) Depression Around Wellhead (Y~.~ Well Classification Well Log Present ~"~N) Total Depth /,_~' Cased to I_~'L'/f Static Water Level ~ I*-'/ ¢ Casing Height Above Ground ~ ~ Electrical Wiring in ConduitS]N) If A, B, C, D.E.C. Approved (Y/N) Separation Distances from Well: ,~ To Septic/Holding Tank on Lot ~/~-'- ;On Adjoining Lots To Nearest Edge of Absorption Field on Lot/~¢~) ''~ ; On Adjoining Lots To Nearest Public Sewer Line ~ ~'¢} To Nearest Public Sewer Cleanout/Manhole ~]¢2r' , TO Nearest Sewer Service Line on Water Sample Collected by ~/~,~¢,/,-'b. ;Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes~) Air-tight Caps~N) Depression over Tank (YC"~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well qS To Property Line To Water Main/Service Line Course Comments ,~"---c4:~"8~'- Size /'~';)~4~) No, of Compartments ~ Foundation Cleanou (t~/~) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ~""'/-- To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'~'-~'"'~ ¢~ Width of Field ~ ! I DS'" p ' Square Feet of Absorption Area Depression over Field (Y/~. Results of Last Adequacy Test .~_~ Separation Distance from Absorption Field: To Water-Supply Well //~ O''~'-' To Building Foundation ~_ Lo, To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of Systerp Design Length of Field~f Depth of Field 7~ ~'' ! Gravel Bed Thickness 2~ ~ ! Standpipes Present~N) Date of Last Adequacy Test To Property Line ¢/'4~ ¢'' To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) /~")"¢- Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High'Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions .4"~4Manhole/Access (Y/N) ""'.,,,,.~nt (Y/N) . Pum~uring Adequa~;y Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that. I have.ch, gck~ed, verified or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'/'~¢~~ ' Date ~ Company F~"J____ -~ MOA No~----~ Date of Payment ~- ~'- g~ ~:." A ~%¢'~' Amount: $ ~pgineer's Seal ~a-~ [e~ C. Reid, Jr,