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HomeMy WebLinkAboutT15N R1W SEC 18 LT 89VIK) I'M,- \Vmlaw,\Ck (Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: PID Number: 051-172-19 Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New © Upgrade Name Burton Bomhoff ABSORPTION FIELD ❑ Deep Trench ❑Wide Trench ❑Bed ound Site Address 19239 Adrian Ave ❑ Other Phone Number of Bedrooms Soil Rating Total depth fr original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot 89 Fill added above original gr e Ft. Gravel length Ft. Township Range Section ;V )!5. N 1 W 18 Gravel width FL Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic AbsorptionAbsorption I Holding Sewer Total or tion area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft' Ft. Well i 100'+ I ( �� } TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1000 Gal. Surface Water 100'+ I Material Steel Number of compartments 2 Lot Line 51+ NA Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Septic Tank is being documented at this time Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer Homeowner Drainfield Co/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 183.5 it Inspection 1s, 7/8/2020Location and description dates: 2" SE Bottom house Trim 3,d 4111 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF A4. 5 Conditional Approval: Date �P�� � $ Steven R. Pannone Septic Syste r.- -� F�,• CE 8149 Appro Date 2-10-20OF-E SS Note: this approval does not include well permit requirements. (Rev 05/02/18) ' K: -9n -mc-, v~A �rm1n0��=Q7 -+z-u v n 0(n D0;u ic 0 z• M o ;U U)o o m D (J} �O , rn-XAm< C I n n N O N0-<� D n z, - D FA -0� O N _. I >0C) c zoa:D `Om o � 0 or'O I m W W N N Z U) D -+ m G ='z cn W J W D O n D Wry (n o z9 D m W W cn Co m OW .. Lo�-<D � zri O �Dr c mD C7 O rn D r I -f' W -A W N N N N Oo D �'I ...{ p Z W 0 J N Z d Eel n (1)mX N N ' z u1 O m I � m r- Oz D O > J �� = O n zr p _ D 00 _ O Em W I n Io D�0m F- o, I mc-)mn 0 o O j 0 O I o o D z D n o? T;Ox D m cn m E t m < I O r* M mTi -zi r U) jI D z I o m r n \ I o I em o I � m � �`--- < m r � I ' � m ( r I i I t I \t _ 1-- NOTES: PAMMOME EMG SVC LLC (C.i. '1088) P.O. BOX 1807 PALMER, AK 9645 „ .."„ �, _ Pq6. �F..gCq'a, - 'S4 ' , REVISIONS DATE 8/7/2020 RECORD DRAWING PH0 !E 907} 745-8200 FAX 07 ) 7 45-8201 SCALE SEPTIC TANK T15N R1 W SEC18 L89 BURTON BOMHOFF 19239 ADRIAN AVE s�' 9t'% ....... St.- R. P-�o.o : = '-"'. cE-11119 �= '',��.. - - 1" = 50' DOCUMENTATION P.I.D. NO 051-172-19 DRAWN ACP PERU,IT N0. OSPxxxxxx SITE PLAN CHUGIAK, AK 99567 .....4gr SHEET OF 0~ } E Z CD 3 Y f: N O O CD nni �O No o O O V V N O O a I 6' O N 1 ...... .. ....... ._.._._ ..._ _._._.._ ___... ..._ ._ _ ..____... � O _.. ...._. . O U, v t t F ` Z''. f0 1 a. ;i f IN IV IV IV - O, N" n( El 3i 3- i Qi cI o f o of Ermp�ro ro"ago a oa xi; U GEFsa 3 m�°i 303oaaoo 3' Qro. roo caro o=tF pro. Soon �o`ocro 3`.�a3c m�a oo.. 3ro��x °.i'c' S�c''m `<a !o ,vsZ a awro' oyrot° - oom Seo; 3 Z O O Li c _ y Kn Y 0~ } E Z CD 3 Y f: N O O CD nni �O No o O O V V N O O x 2, n SU S a a j � f o° O rZi m ;n m N rD d' N N O O O Ow O � �...._ ... _:_. ....__.. :... .. ... N w m I 4 t Ni Z; Z` Zi Z' m O: i �. .2 t I 3 3 3 icy _ rN ° ° o 3°a oo ^my Qr`i5 o. L7 m mi,o om �a 71 0 ° d f N H at ti r o t 75 91 9 y . m; L -` m41 It77 2 t OWNER OF LAND ADDRESS LEGAL DESCRIPTI DATE. - Started — PERMIT NUMBER KIND OF FORMATION: AT ; firb Odtfing, log by DOC Co. dba SULLI"N WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 Ended DEPTH OF WELL STATIC LEVEL OF WATER FT DRAW DOWN FT. GALS. PER HR KIND OF CASING From— Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From_ Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. _ From Ft. to_ Ft. From Ft. to Ft. From Ft. to Ft. _ From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From _Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME rpt 1_1 r-4 I ;C I F DEPARTMENT OF 8'5 `L' PERMIT NO. ( 7903:90 ) �PLICANT RODGER LARSON ]CATION ADRIAN LANE =GAL L89 T15N RSW S18 1L I T' -e (DP Hr -J C:H(. ZI41–iE HEALTH AND ENVIRONMENTAL PROTECTION STREET, ANCHORAGE, AK. 99501 254-4720 WELL F'EF?r-1 I T BOX 211 CHUGIAK AK 688 2135 LOT SIZE 155092 SQUARE FEET ': 0 0 V r,PUOY Sr. (BROWN AK 09 -3j) N \ i rPNO I `� I.YEQARY „1 h I LOT 89 G.r66N NAtXe• /♦ � tip. b k II r• NO'p3'W J30.Op'dr.A+ • 6nRK6R5 CERTIflCATE 0 i SURVEY LO T 90 sueo.Cs+�*+ra AS BU/Gr 1 HEREBY. C911TIP:Y •TN T 1 HAVE SORVEYED THE FOLLOWING OESCRNIED iPROPERTYI SINIVEY *RLE G O r &9 SECTION m T /SIV R l vv S. M. EDALEI Boor NO, IORAWN BYI .�B,-0-_CXECXED BYI .NNo..L.��DC�QGRID NQ. W I/SM1 At RECORDED IN,TXE ANCHORAGE RECORDING PRECINCT, ALASKA, AND THAT THE IMPROVEMENTS DB NW//dS SMATED THEREOH.ARE LOCATED AS SHOWN ON THIS PLAT, APO THAT'THERE ARE NO ROADWAYS, TRANSMISSION- LINES OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT MN%� M INDICATED HEREON. p�•(�. DATED AT ANCHORAGE, ALASXA,.TXU• df�rrrf 1. 1 f 1 I i M o� A b � �Atr♦'. wnoJ 1 M µ (rA[N 31 V Q I ` 1 NI J WooO F.fA ME weasE om CONC, BAS6M6.Vr/PA/O. G.r66N NAtXe• /♦ � tip. b k II r• NO'p3'W J30.Op'dr.A+ • 6nRK6R5 CERTIflCATE 0 i SURVEY LO T 90 sueo.Cs+�*+ra AS BU/Gr 1 HEREBY. C911TIP:Y •TN T 1 HAVE SORVEYED THE FOLLOWING OESCRNIED iPROPERTYI SINIVEY *RLE G O r &9 SECTION m T /SIV R l vv S. M. EDALEI Boor NO, IORAWN BYI .�B,-0-_CXECXED BYI .NNo..L.��DC�QGRID NQ. W I/SM1 At RECORDED IN,TXE ANCHORAGE RECORDING PRECINCT, ALASKA, AND THAT THE IMPROVEMENTS DB NW//dS SMATED THEREOH.ARE LOCATED AS SHOWN ON THIS PLAT, APO THAT'THERE ARE NO ROADWAYS, TRANSMISSION- LINES OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT MN%� M INDICATED HEREON. p�•(�. DATED AT ANCHORAGE, ALASXA,.TXU• df�rrrf 1. 1 f 1 I i M U rnwNf eroe,. l I�e• M 31 y } Q I G.r66N NAtXe• /♦ � tip. b k II r• NO'p3'W J30.Op'dr.A+ • 6nRK6R5 CERTIflCATE 0 i SURVEY LO T 90 sueo.Cs+�*+ra AS BU/Gr 1 HEREBY. C911TIP:Y •TN T 1 HAVE SORVEYED THE FOLLOWING OESCRNIED iPROPERTYI SINIVEY *RLE G O r &9 SECTION m T /SIV R l vv S. M. EDALEI Boor NO, IORAWN BYI .�B,-0-_CXECXED BYI .NNo..L.��DC�QGRID NQ. W I/SM1 At RECORDED IN,TXE ANCHORAGE RECORDING PRECINCT, ALASKA, AND THAT THE IMPROVEMENTS DB NW//dS SMATED THEREOH.ARE LOCATED AS SHOWN ON THIS PLAT, APO THAT'THERE ARE NO ROADWAYS, TRANSMISSION- LINES OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT MN%� M INDICATED HEREON. p�•(�. DATED AT ANCHORAGE, ALASXA,.TXU• df�rrrf 1. 1 f 1 I i Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section �'--' Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 051-172-19 'i. GENERAL INFORMATION Expiration Date: 1 ) r(®'-2 02c) Complete legal -description T1 5N R1 W S18 L89 Location (site address) 19239 Adrian Ave Chugiak, AK 99567 Current property owner(s) Burt BOmhOff Day phone 19239 Adrian Ave Ci•rugiak, Ali 99567 Mailing address Real estate agent 2. TYPE OF DWELLING: F -j .Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private'Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $—q I a' 5D ( coy I �'" I I ) Waiver Fee $ Date of Payment 02o�2o //��t /1 Receipt Numbery RG( -).S�r COSA# 05czo 13 19 Date- of Payment Receipt -Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date 49 TH 6. DSD SIGNATURE �'� !.�-�-1... . System #1 Approved for bedrooms Stevan G. Pcr ricl e' System #2 Approved for bedrooms �k�"; �L �� I ll. • n Disapproved Conditional approval for bedrooms, with the following stipulations: B . %--I- Original Certificate Date: g r 10'? ZC� 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: T15N R1 W S18 L89 Parcel ID: 051-172-19 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 7/16/79 Total depth 91'4" ft Cased to 91'4" ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 31 in. Date of flow test for COSA 702020 Static water level at beginning of test 22.1 ft. Comments B. TANK DATA Age of tank(s) +/- 7 years Tank type/material 5"s" Measured operating fluid level in septic tank 4 FE -1 Standpipes/foundation cleanout per record drawing Date of pumping 7/27/19 D. ABSORPTION FIELD DATA Deep Trench. Which system tested (date installed) 12/4/67 0 ALL standpipes present per record drawing Total measured depth from grade 10.2/5.5 ft (max) Measured depth to pipe invert from grade 9.2/4.5 ft (min) ❑ N/A — pressurized field MR Monitor tubes go to bottom of effective. If not, state depth into effective MR Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 2.42 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑✓ No 0 Coliform bacteria is Negative Nitrate mg/L H Nitrate less than MRL (ND) Arsenic 5.046 ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Eng Date of Sample 7/10/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7812020 Results F/]Pass For 3 bedrooms Fluid depth prior to test 77/0 in Water added 453 gal New depth 77/0 in Elapsed time 130 min Final fluid depth 77/0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date no 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' U Yes Community Sewer Manhole/Cleanout > 100' ✓[ 1 Yes if No ft r✓ Yes if No ft Neighboring Tank > 100'✓❑ 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' F,/] Yes if No ft Water Main > 10'[j✓ Animal Containment > 50' Yes if No ft [21 Yes if No ft ✓/ Yes if No ft Water Service Line > 10' Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' �✓ Yes if No ft . ✓V Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' U Yes if No ft Surface Water > 100' 121 Yes if No ft Property Line > 5' Yes Yes if No ft Wells on Adjacent Lots: ❑✓ Absorption Field > 5' if No Yes if No ft Private Wells > 100' F,/] Yes if No ft Water Main > 10'[j✓ ft Yes if No ft Community Wells > 200' ✓/ 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' U Yes if No ft if absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: f Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Service Line > 10' M✓ Yes if No ft Community Wells > 200' QQ Yes if No ft Surface Water > 100' ✓[j Yes if No ft F. ENGINEER'S COMMENTS Drain field has reached aDDroximately 50-60% cif its usahip lifr, G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. j00060 COSA Checklist yellow sheet LT 89 SECTION 18, T15N, R1W, S.M. S 89059'30" E 89.23' 3.77 ACRES N 90°00'00" E 329.90' / / / / / Q / °ryo N � I 0 50' �C-3 / COVERE / PORCH 3.0 EXISTING /v w / BUILDING 5o,. f / DECKS 3.0' 60.0 / / o I / SEPTIC VENTS ^0 100' RAILROAD / ^h' RIGHT OF WAY icl V / N / PORCH-5 ORCH o r O � SHED/OFFICE 41 , — — — — — — — — — — — — — — — — — — — — — — — — — / / 33' PATENT R.O.W. RESERVE BK 201 PG 296 AS -BUILT GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.L.S. 2000 E. DOWLING RD., SUITE 8 ANCHORAGE, ALASKA 99507 PHONE 248-5454 GRID DATE NW1155 7/3/2020 N 89059'00" W 257.40' I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPTAS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. F.B. JOB NO. I ANCHORAGE RECORDING DISTRICT, ALASKA 2020-2-18 IBBOMHOFF NOTE: NO CORNERS SET THIS DATE SHED 2 F SHED U m uiO 4 SHED 0 0 ti rn cV �PIDGEON I L LOFT 00 '�'WELL M O Q SHED O O DVE W 122.4' CONko � _u — OFFICE STOOP '� 43.1' M FND. 518"—1 N 89058'57" W 329.82' (79-33) GRAVEL DRIVE REBAR I 33' DEDICATED R.O.W. ADRIAN AVE. -------------------------------- EDGE A/C EXISTING ADRIAN AVE. CUL DE SAC W CD - 0o �o co o 0 FN D. 3/4" I.P. (HELD) of AC ®® ee -. ®CO ' 49 T" 7®® ° ®. .................. ® ®ee .••a.. eee o... sos. e..� ° Jeffery A. Gastaldi o` LS -6091 7/3/2020 °.•° �Jt �®p"Ifessionak MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# HAA#>��/ �/ 7 1. GENERAL INFORMATION Complete legal description LG 5 c -'44 7-1 5 j/,_ %�! �I�/ 5 /Ul, Location (site address or directions) /l-? 3-9 c/rl�ih v� Property owner �4i2 .✓7� 7772 r r �hG AZ Day phone Z ! 7 70 Mailing address MY- _3n�/ '4'wv Lending agency Day phone 2 S2- 7 15 Mailing address S%/!' /-la e lrV�� o ✓ Jr r /i P /�� s e Agent Addres Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well 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 Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA #21 7 5. STATEMENT. OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address or / 111-4 d717 _-- C /!'C l Engineer's signature 7�_ 6. DHHS GNATURE Approved for .5 bedrooms. By: Disapproved. Conditional approval for Additional Comments Phone S�� -- y� /10 k L /lj Date O� OFA V011 Cif `�' •• '� 4'.. •�T \`/ Christopher M. Kinnay •:� bedrooms, with the following stipulations: 7 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 purchasersof homes and thei r lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-=(Pev.1/91) Back MOAN21 e Municipality of Anchorage MVNyCIPA►ITr OFA DEPARTMENT OF HEALTH & HUMAN SERVICES gWIRONMENTAL SER 0 Environmental Services Division APR 04 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-47414 Health Authority Approval Checklist RECEIVED Legal Description: L G7- GP�/y J,'c�T/5� 2M— Parcel A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 4 P S Date completed Total depth % / !�t ./ Cased to 472' Casing height (above ground) z ` Sanitary seal (Y/N) �PL Wires properly protected (Y/N) FROM WELL LOG Date of test —7 0 /4i 7 % Static water level Well production h g.p.m. AT INSPECTION -?- -z e- 97 WATER SAMPLE RESULTS: Coliform I ko C7( c o7L!2K Nitrate 6, 0 yw Other bacteria / Date of sample: r 3 / 97 Collec1-/ ed by: o m �2 ads B. SSPTIC/HOLDING TANK DATA Date installed /7-, 4-67 67, /Tank size %umber of Compartments _L Cleanouts (Y/N) 7 �3 Foundation cleanout (Y/N) Depression (Y/N) NO High water alarm (Y/N) Date of Pumping Pumper ,Ji /C /3 x 74/ mdllYn"/ C. ABSORPTION FIELD DATA Date installed / 2 ` ¢' % Soil rating (g.p.d./W or ft2/bdrm) Z System type 4-erip a'�" Length :2r Width 36 ` Gravel thickness below pipe ! Z ` Total depth Va rie �uA Effective absorption area !S G Monitoring Tube present (YIN)— Depression over field (Y/N) Date of adequacy test 3 2 9 • T 7 Results (Pass/Fail) SS For 3 bedrooms Fluid depth in absorption field before test (in.); % Immediately afterligal. water added (in.): 7 Fluid depth % A (ins) Minutes later: l Wy Absorption rate = jgt*4 g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72.026 (Rev. 3/96)* D. LIFT STATION Date installed &N:� Size in gallons Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot "Pump off" level at* On adjacent lots ZZ On adjacent lots Public sewer main/1/ �ff Public sewer manhole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation / Property line � Absorption field � 5 Water main/service line Surface water/drainage ///Dke_ Wells on adjacent lots Z f b v SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 44 Building foundation 30 r Water main/service line Surface water //�111�e. Driveway, parking/vehicle storage areaC� r Curtain drain &0�ne Wells on adjacent lots 20 b r fi F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of in conformance with MDA HAA guidelines in effect on this date. Signature 1l Engineer's Name C�+P i"51 o ✓i I ey Al. K) h 4 -Cti� Date %y" HAA Fee $ , 5 %jC� o� Waiver Fee $ Date of Payment r) Receipt Number O'2 91 6Sq 72-026 (Rev. 3/96)* Date of Payment Receipt Number X are 19239 Adrian Ave, Chugiak, Alaska June 30, 1997 I, Timothy P. Montgomery, of 15894 Birchwood Loop Rd., Chugiak, Ak 99567, certify that Mr. Burt Bomhoff retained me to dig a test hole with a back hoe for him on his property at 19239 Adrian Ave, Chugiak, Ak for the purpose of ascertaining the location of the water table in the area occupied by his septic tank and drain field. A location approximately 25 feet north west of the primary leach line and 15 feet north of the northwesterly leach line was dug to a depth of 11'6". Dry earth was encountered all the way down to 10' 6" below the surface at which point moist earth and then the water table was located. Elevations were taken at natural ground and at the top of the septic tank pump out riser and measurements were take from the top of the riser to the water level inside the tank to determine the approximate depth of water table below bottom of leach field. Based on test hole observations, vertical measurements and certified septic system construction documents, the water table is eight feet (8) below the bottom of the drain field system. A sketch showing the location of the test hole and the vertical measurements is attached along with photos taken at the time of excavation. AI / WITUV %�i��i� Burt Bomhoff 19239 Adrian Ave. Chugiak, AK 99567 April 3, 1997 Subject: Field Inspection, Water and Waste Water Systems Lot 89, Sect. 18, T15N, R1W, S.M. On March 28, 1997 field inspection and testing were performed for the water and waste water systems on Lot 89 at 19239 Adrian Avenue in accordance with MOA Health Authority Approval Guidelines as revised August 1992. Both the water system and the waste water system meet MOA requirements for a three bedroom home.. The septic tank was pumped by JR's Pumping Service of Eagle River on March 21, 1997. An inspection of the system indicated a need to repair the pump out riser and place locking caps on the pump out and on two 4" vent pipes. This work has since been completed by Charles Barr of Eagle River. The well was drilled during July, 1979 to a depth of 91'4". The well was pumped at an average rate of 3.88 GPM for four hours on March 28, 1997. Maximum draw down was 14" and the well recovered to its original level within 30 minutes. A total of 930 gallons was pumped. The well produces well in excess of the MOA minimum requirements. Test results for coliform bacteria and nitrates are attached. It is recommended that the electrical supply wires be encased in conduit from the well casing into the ground for safety reasons and to conform to current MOA requirements. Distance from well to waste water system on this property as well as adjoining properties exceeds the minimum required distance of 100'. Surface water drains away from the well. Field inspection of the waste water system was performed coincidental with the well inspection. Our inspection indicates that construction was performed in accordance with the certification documents submitted at the time of construction. The effluent level in the septic tank was at its normal level at the time testing began. 480 gallons of water were pumped into the septic system over a 1 hr. 45 min. period exceeding the 150 gallon per bedroom per day requirement. Effluent levels in the tank as well as the monitor tubes remained constant during the test. The above results are consistent with construction records and past testing of the system which indicate that both the water system and the waste water system exceed the MOA requirements for a three bedroom home. ris Kinney, P.E.9134 OF *.:49TH ��„• hrtstopho. M, Ki... i•. CE -914 .........t•f4`��wr *ARCTIC SLOPE CONSULTING GROUP. INC. tJ Engineers . Architects • Scientists • Surveyors Sol OenMr Anmp MrJve9w Ma.:w "311-J03S T.Nphon.t (Yen 3411-1140 rev: W) 70--1113 WELL LOG LOCATION: Client's Name: TESTER: Initial Reading on Meter: DATE: q' 7 Ey • 97 DRAW TIME GPM GALLONS GALLONS FIELD MONITOR METER DOWN VOLUME TOTAL LEVEL READING O O .,/ 2 ° fa- / / ! z o Yx it . G7 -70 !z •' •.� rG n Q /lZGo 110 K1!'z- d0 d 880 0 o NOTES: Production Rate: 3 J d`'' o GPM 24 -Hour Capacity 5 -5 -go Gallons 0 9 R 3' Lof P91 S��f. /e'� T/SNj ';?/ W) 5.M, AA a-- 0 lune 30,19117. A. :5, L .1 4 .1-rom lYl�ASor�^.�h5 t4h/[ C%I�acs� ayd 1 L � �P✓�1'rI A� d .SG'r 'GT�oh 6 � COYJ i�/'GltTI4h. LL o t 89, Sem f• j8, T i S A/, 72 / GV .SAI, /jar.,SCA/2 ^r/d' VC/-/ . .5e-.vl® / = S. 2G' /6-1 /D S. LEOALDESCRIPTIO -MUNICIPALITY OF ANCHORAb MUNICIPALITY OF ANT" -GP Ti DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIWI DEPT. OF HEALTH :& PROTECTION - 826 L Street -Anchorage, Alaska 99601 fir ENVIRONMENTAL ENVIRONMENTAL ENGINEERING DIVISION JUL 19 1979 Telephone 264.4720 ,,// CC REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW&OOFFA D DIRECTIONS: complete all parts on page 1. Incomplete requests will not be processed. Please allow ten NO) days for processing, 1. PRbPERTYOW R P,JiONE !/D MAILING ADDR SS PROPERTY ESIDENT (If differ n. from above) H E YER - PHONE FMAILINGADDRESB 5 E D NG INS PHONE MAILING ADDRESS ^ - l/•r PHUNP 4. REALTOR/AGENT - A el MAILING ADDRESS S. LEOALDESCRIPTIO STREET LOCATION - S. TY E OF RESIDENCE NUMBER OF BEDROOMS E3 One E3 Four ED other SINGLE FAMILY '.❑.- Two . ❑: Five El MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY s ,?5 INDIVIDUAL" "ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1976. For wells drilled prior to that date, give well PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM �p 1.75-0 / 4 �� "--'71<_ INDIVIDUAL/ON•SITE"" ""If individual/on-site, give installation date . If system is over two (2) years old an adequacy test is required E3 PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED - TIME TIME TIME - DATE DATE DATE INSPECTOR .. INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED - LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection :Verified PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING - ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade. give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL i 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Ares Sewer LinaNearest Lot Line Absorption Area to nearest Lot Line 6. COMMENTS nxp LI/APPROVED FOR _y BEDROOMS ❑ CONDITIONAL APPROVAL (letter must acc any certificate) 05- DISAPPROVED DATE 2 q r BY (Title) rc LEGAL DESCRIPTION .. �.. �� ,a..,i Mr. Roger Larson South Birchwood Loop Box 211 Chugiak, Alaska 99567 Dear Mr. Larson, DAVID A. SLENKAMP MECHANICAL ENGINEER 694-9055 August 2, 1979 Reference: TV S9, Section 38; TION; R1.W ROBERT A. SHAFER CIVIL ENGINEER 6942979 MUNICIPALITY OF ANCHORAGE DEPT. OF I!:A1-TH S ENVIRONMENTAL PROTECTION AUG 71979 RECEIVED A sewer system adequacy test was performed on the sewer system located on the referenced property as requested by Marlene Nicholnyson, Sun Realty. The test was started on July 28, 1979 by charging the absorption trench, through the septic tank with a cont.i.ncu.s flout of gator for a neri_od of /,S hours. After the first 24 hour period the flow was motored .for an additional 24 hours. Flow over this period resulted in approximately 603 gallons being added to the system without any adverse effect. As a result of this test it can be concluded that, the system (septic tank and trench) are adequate to serve the existing 3 bedroom home. CF: Darlene Ni.cholaymon Sun Realty M nJ.cipnlity of Anchora.po_ Depnrtment of Health and lInvi.ornmentnl. Protection Sinc .� A R I ERT A SHVERP E. SRB fP4X EAGL.L HIVL11, ALASKA