HomeMy WebLinkAboutTONJESS ESTATES BLK 2 LT 17AOnsite File
Tonj ss
Etsates
Block 2
Lot 17A
#051-832-28
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241262
Work Type: Septic Renewal
Tax Code Number: 05183228000
Site Legal Address: TONJESS ESTATES BLK 2 LT 17A G:1462
Site Mailing Address: 25439 SCHAFF DR, Chugiak
Owner: MOORE KRISTEN A & RICHARD D JR
Design Engineer: ALASKA RIM ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
r
r
Uc�p�n-r�7jf�nr
Lot Size in Sq Ft:
Total Bedrooms:
2/21/2025
2/21/2026
135025
Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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
.Received=13y: L Sit to A ±C) G=
Issued By: _ 22j"a,�,�
G
Date:
Date: 2lz-1le-5
5
MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. # 051-832-28
ANCHORAGE
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Property owner(s) Rick and Kristen Moore
Mailing address 25439 Schaff Dr., Chugiak, AK 99567
Site address Same
Phone: 907-343-7904
Fax. 907-343-7997
Day phone 907.440.9604
Legal description (Sub'd., Block & Lot) Tonjess Estates, Block 2, Lot 17A
Legal description (Township, Range & Section)
Lot Size 135035 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
Initial El
Single Family (SF) F-1
(w/wo ADU)
Septic Tank
F-1
Upgrade El
Duplex (D) ❑
Holding Tank
❑
Renewal ED
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GMevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
ARE, LLC
dba ALASKA RIM ENGINEERING
CONSULTING CIVIL ENGINEERS & PLANNERS
1920 Kentucky Derby Dr.
Palmer Alaska 99645
Telephone: 907.775.2347
Email: alaskarimengineering.llc@gmail.com
Professional Consulting --- Practical Solutions
August 13, 2024
Curtis Townsend
Municipality of Anchorage, D.S.D.,
On-Site Water and Wastewater Department
4700 Elmore Road, Anchorage, AK, 99519
Re: Tonjess Estates, Block 2, Lot 17A
25439 Schaff Drive, Chugiak, AK, 99567.
Subject: Septic System Modification Application
Septic System Design and Permit Application
Dear Mr. Townsend,
The owners of the above referenced property are requesting an extension for their On-Site Wastewater
Disposal Permit OSP231069.
There has been no change to the proposed septic area or the design.
We respectfully request this extension.
Sincerely,
Charles A. Leet, P.E.
Principal Engineer
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241262, Deb Wockenfuss, 02/21/25
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231069
Work Type: Septic Upgrade
Tax Code Number: 05183228000
Site Legal Address: TONJESS ESTATES BLK 2 LT 17A G:1462
Site Mailing Address: 25439 SCHAFF DR, Chugiak
Owner: MOORE KRISTEN A & RICHARD D JR
Design Engineer: ALASKA RIM ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
r1
DeI)aI•till ent
Lot Size in Sq Ft:
Total Bedrooms:
5/3/2023
5/2/2024
135025
Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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
Received By: 5 S VIE -0 7'0 (�-
Issued By:
Date:
5
Date: S/3/4121 1-
3
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. # 051-832-28
Property owner(s) Rick and Kristen Moore
Mailing address 25439 Schaff Dr., Chugiak, AK 99567
Site address Same
Day phone 907.440.9604
Legal description (Sub'd., Block & Lot) Tonjess Estates, Block 2, Lot 17A
Legal description (Township, Range & Section)
Lot Size 135035 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
([D all that apply)
Absorption Field
E]
Initial ❑
Single Family (SF)
Septic Tank
171
Upgrade
(w/wo ADU)
Holding Tank
171
Renewal EJ
Duplex (D) El
Privy
Fl
Multiple Dwellings 171
(SF and/or D)
Private Well
171
Water Storage
171
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
44/A April 17, 2023
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Waiver Fees:
Date of Payment: , , '// � 71 1-9 _L 3 Date of Payment:
Receipt Number: — I b,61"5 & 9 tf
Permit No. (D Ob
Receipt Number:
Waiver No.
G:\Development Services\Building Safety\0n Site Water and WastewaterTorms\Client FormsTermit Application.doc
A�..RE
April 14,202-31
Municipality of Anchorage, D.S.D.,
On -Site Water and Wastewater Department
4700 Elmore Road, Anchorage, AK, 99519
Re: Tonjess Estates, Block 2, Lot 17A
25439 Schaff Drive, Chugiak, AK, 99567.
Subject: Septic System Modification Application
Septic System Design and Permit Application
Dear Plan Reviewer,
Municipality of Anchorage
On-site Wat an a t ter
dba ALASKA RIM EiI u��
CONSULTING ENG&fi9tikf�' 05103123
1920 Kentucky Derby Dr.
Palmer Alaska 99645
Telephone: 907.775.2347
Alt Phone: 608.617.4070
Email: alaskarimengineering.11c(a),gmaii.com
The owners of the above referenced property are planning an addition to their current three bedroom
home. The addition would bring the total number of bedrooms to five. With this submittal we are
requesting to relocate and expand their septic field.
In 2019-2020 they replace their septic tank with a 1500 -gallon septic system. This approval and
subsequent modification will allow the owners to continue with their remodel project.
SOILS
Two test holes were excavated on November 1, 2022, and logged by Charles A. Leet, PE. The test
holes were advanced to a depth of 14 feet. The soils consisted of sand, gravels and some boulder
with traces of silt. No groundwater was observed after 10 -day monitoring.
PERCOLATION TEST
The percolation test was conducted on all both test pits between 6 and 7 feet below the ground surface.
Results from the percolation test were inconclusive. So, samples were obtained and delivered to
Hansen, PE for sieve analysis. The results of the gradation testing indicate the soils to be poorly
graded sand. Based on Section 15.65.10, Table 2 the receiving soils application rate of 1.2 gallons
per square foot, for the proposed 5 -wide trench. Test hole and percolation test locations are indicated
in the site plan accompanying this permit request.
TOPOGRAPHY
The topography of the subject parcel is that the home was constructed at the foot of Chugach
Mountain range. Have provided an overlay of Muni Lidar on the proposed site plans the slopes very
from 2-3% around the current home and proposed addition building pad. The driveway slopes away
from the house at 20 ±%; as does the slopes adjacent to the driveway. We propose an absorption
field and its replacement near the toe of the slope where the slope moderately flattens out, before the
slope tapering off to neighboring Lot 16. We have sited the absorption field parallel the property line
adjacent to Lot 16, see site plan.
Professional Consulting --- Practical Solutions
Tonjess Estates, Block 2, Lot 17A Page 2 of 2
April 14, 2023
SEPTIC TANK REQUIREMENTS
We propose to use the existing 1500 gallon tank in its current location.
DRAIN FIELD DESIGN
We are proposing a 5 -wide absorption field that will be constructed parallel to the property line and
slope in conformance with municipality requirements. The proposed residence is a 5 -bedroom
dwelling with a design flow rate of 750 gallons per day. The prescribed application rate is 1.2
gallons/ft2. The required area is 625 ft2. We are proposing a 4 -foot effective depth, with a trench
drainfield that will be 65 -feet in length for a total of 650 ft2.
REPLACEMENT SYSTEM
There is sufficient area for a redundant/ alternate site to be installed within the 30 foot radius of the
test hole. See attached design drawing for the primary and alternate site locations and specifications.
SUJRROUNDING PROPERTIES
There are no water wells within 100 feet of the proposed system. The property is served by a private
well.
SURFACE WATERS
There is no surface water within 100 feet of the proposed system. Drainage arrows on the site plan
indicate the slope and direction of stormwater runoff. (See attached site plan)
We do not anticipate any adverse effects on the neighboring septic systems, reserve areas or drainage
patterns by the installation of the proposed wells and septic system.
Sincerely,
....................
Choles A. Leet
CE 10480
,�00000�� -iu—z3
Charles A. Leet, P.E.
Principal Engineer
Attachments:
• Permit application
• Area Map
• Proposed site plan
• Trench detail
• Hansen PE Sieve Analysis (2)
• Soils log w/ perk test data
Professional Consulting --- Practical Solutions
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241262, Deb Wockenfuss, 02/21/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241262, Deb Wockenfuss, 02/21/25
��oDDDDp�
'tro°9TH l °°g��
> Charles A. Leet
�QQ sw ° CE 10480
Qddn �°PROFESSIO�P�c7�'
Municipality of Anchorage
REVIEWED FOR CODE COMP
OSP231069, Curtis Townsend,
GROUND SURFACE
EARTH
COVER
SEW ERROCK
UNDISTURBED
EARTH
SEASONAL HIGH
GROUN WATER
IMPERMEABLE LAYER
TRENCH SECTION
NOTES:
1. ALL CONSTRUCTION SHALL BE COMPLETED IN ACCORDANCE WITH THE
MUNICIPALITY OF ANCHORAGE WATER AND WASTE WATER DISPOSAL REGULATIONS:
CHAPTER 15.55 WATER WELLS AND CHAPTER 15.65 WASTEWATER DISPOSAL
ALASKA RIM ENGINEERING, LLC.
1920 Kentucky Derby Drive
Palmer, Alaska 99645
PH: (907)775-2347
alaskarimengineering.11c@gmail.com
PAGE: 3 OF 31 APRIL 10, 2023
Consulting Engineers: Planners
SCALE: NTS I W0: 2022Ci26
Conventional Single Family residential
TONJESS ESTATES, BLOCK 2, LOT 17A
TRENCH CROSS SECTION
t f hnr n
Municipality of Anchorage
On-site Water and Wastewater
R CODE COMPLIANCE
3 Town nd. 05/03/23
V
Date I l rncc Time
104
ZrAW ••'9 ��
Development Services Department
Net Drop
49T 00
Building Safety Division
Program
10. • ..
On -Site Water and Wastewater
00:
.004700
South Buragaw .Sit.
0 • • • • • • • ••• . ✓
P.O. Box 196650 Anchorage, AK 991519-6650
!
��
www.muni.org;onsite
c� • Charles A. Leet
(907)343-7904
Iesr�•,, CE10480 •••��A
1 �. ..de�111
Soil's - P2rColI atioln •
pROFESVC, 1`*
Log V-Z-„�.L
`
Performed For: Rick Moore
Legal Description: Tonjess Estates. Block 2, 17A
I
Depth
Date Performed: 11/1%2022
Township, Range, Section:
Site Plan
1- ffPLO 61 L -T
4 -
If ex, to wkeD I�E,9�
5
7— s,
I,
8-
{� 7 WAS GROUND WATER
9- X11 ENCOUNTERED? no
10- + i t IF YES, AT WHAT DEPTH? - L
r ` i Depth to Water After P
11- Monitoring? none/dry `
12-
13-
14-
15-
16-
1.7-
18-
19-
2 0- 1
2-13-14-
15-
16-
17-18-
19-
2u-1 I
COMMENTS
Date: 11/18/2022
Reading
Date I l rncc Time
I Net Time
Depth to Water I
Net Drop
I
!
PERCOLATION RATE 1�6 (minutestinch) PERC HOLE DIAMETER 6"
TEST RUN BETWEEN —�-�FT AND FT
PERFORMED BY: Charles A. Leet 1 Charles A. Leet CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE ANC IMIUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
RA::n{cipailf� of Anchorayc
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
�
4700 CoUth Br agave St.
P.O. i Box 196650 Anchorage, AK 99519-6650
.�„ www.muni.org/onsite
(907)343-7904
Soils Log - Percolation Test—.-'
0 F�A`i���
A0. �.
49T •,,� ,+� I
0.
Q
Ci••, Charles A. Leet ,•2��
CE10480APOFESSIoliA
• rj '-
Performed For: Rick Moore Date Performed: 11/1/2022
Legal Description: Tonjess Estates, Block 2, 17A Township. Range, Section:
Slope Site Plan
I I I I I I 1 I I I I
Depth
(Feet 0_1 6,-MAOLc t
(T) I—'-
1 r c✓S/L.T-
1
2- l 11l p d1q/P CCL)
3- b� ,/`r,__11
1��1`JV I I I I I
C b -''/`t
4 a
t,�
6- J i
7 -iia,
8- �1
9- .s
011 �
10-
1 J
11-Iq n n
12-13-
,
> y V
14-
15-
16-
17-i
18-
19-
20-1 I
WAS GROUND WATER
ENCOUNTERED? t10
s
IF YES, AT WHAT DEPTH? - L
Depth to Water After C
P
Monitoring? none/dry
Date: 11/18/2022
Reading I Date i Gross Time i Net Time i Depth to Water I Net Drop
PERCOLATION RATE IA (minutesRnch)
TEST R N BETWEEN FT AND
PERC HOLE DIAMETER 6'
FT
PERFORMED BY: Charles A. Leet I Charles A. Leet CERTIFY THAT THIS TEST WAS
PERFORMED 1N ACCORDANCE 1TH ALL STATE AND MUNICIPAL GU1DEL1NEE S 1N EFFECT 00N THIS DATE. DATE:
100
90
80
70
i
60
50
m
40
30
2C
1C
G
Client: Alaska Rim Engineering, LLC
Project Tonjess Bk 2, Lt 17A
Sample Location: TH # 2
HANSEN ENGINEERING, INC.
C ONSUl.1 INO I= N6INI F RS 1 I S I INC; LABORA I ORY
2605 N. Old Glenn Hwy, Palmer, AK 99645 Phone: (907) 745-4721
e—mail: mhpe@rntoonline.net
Soil Description: Poorly Graded Sand with Gravel
Unified Classification: SP
� r75
m Finer
I -r 100
Date 11/8/2022
C„= 15 Sample Date: 11/1/2022
C,= 0.8 Proj. no: 22100
2"
50
y 1
1.5"
37.5
91
1"
25.0
87
3/4"
19.0
83
1/2"
12.5
76
i
3/8"
9.5
71
4
4.75
56
10
2.00
38
i
2Q
0.850
20
0
0.425
11
60
0.250
7
100
0.150
5
200
0.075
3.8
Date 11/8/2022
C„= 15 Sample Date: 11/1/2022
C,= 0.8 Proj. no: 22100
100
90
80
70
60
,'. 50
I -n
40
30
20
10
i
cin o
CD V,
Client: Alaska Rim Engineering, LLC Soil Description: Poorly Graded Sand with Gravel
Project Tonjess Bk 2, Lt 17A Unified Classification: SP
Sample Location: TH # 1
HANSEN ENGINEERING, INC.
(. ONSLA-1 INC, t:NGINf`LR, I f S1 ING I Al 1 )RA I ORY
2605 N. Old Glenn Hwy, Palmer, AK 99645 Phone: (907) 745-4721
e—mail: mhpe®mtoonline.net
fl:.,.r.e4nr mm
1.5"
10
20
Diameter Perec
mm Finer
75 100
50 100
37.5 98
25.0 93
19.0 87
12.5 80
9.5 74
4.75 59
2.00 44
0.850 25
0.425 110
0.250 4
0.150 2
0.075 1.1
Date 11/8/2022
C'= 11 Sample Date: 11/1/2022
C,= 0.5 Proj. no: 22100
kf%vv uuiucr io)
Municipality of Anchorage
On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP 191 �J $' 9
PID Number: 051 832 28
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
Craft
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
25439 SCHAFF
❑ Other
Phone
Number
of Bedrooms
Soil Rating
Total depth from original grade
3
- GPD/SF
- Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
_ Ft.
Gravel depth beneath pipe
- Ft.
Subdivision Block Lot
Tonjess Estates Block 2 Lot 17A
Fill added above original grade
_ Ft.
Gravel length
- Ft.
Township Range
Section
Gravel width
- Ft.
Beds: Number of Lines
-
Distance between lines
- FL
SEPARATION
DISTANCES
0
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
_ Ft2
1
- Ft.
Well
+100
+100
_
_
+25
TANK ❑■ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER TANK
Capacity
1500 Gal.
Surface Water
+100
+100
-
_
Material
Number of compartments
Lot Line
+10
+10
-
-
NA
plastic
2
Foundation
+10
+10
-LIFT
STATION
Manufacturer
Capacity
Remarks old tank demolished per code
Gal.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank pVC Tank to 3034Installer drainfield
J R's
Drainfield CO/MT 3034
Inspector CHARLES BALZARINI
BENCH MARK (Assumed elevation) 100 ft
Inspection 1-` 11/11/19
Location and description
2�a
3rd
deck post
4w
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
'�� OF ALgd'llt
/ 49 TH
TH '•
.z ..
•%
Septic System I
Approved -a-- '
Date
CHARLES G BALZARINI
�+ �F• CE-13854 • ����
s
006',`P,'-11120119 . • �*��
lliF�PROFESSI�NP
Note: this approval does not include
well permit requirements.
��\moi>>1
kf%vv uuiucr io)
SWING TIES A B �'�P•' '.!���
TANK RISER 25.4 27.3 �Gj •;j7 ,
TANK CO 25.7 31.6 *.-,49 TF1 •.
(� ATCO 1 24.6 32.3 NE 1500 AL POLY TANK
\VI ATCO 2 23.6 32.1 �'"--
.... ..
r) CHARLES G BALZARIt4t
\\\ GLEANOUTS NEW AFTER TANK r����. CE -130854. •.,���`
P
E TING TANK MT DECK
DRA FIELD B EXISTING FCO
� A
\ 3 BR HOME
\ \ DRIVEWAY
\ 100' IN RAD
IUs
ApPRO TONJESS E TATES BLOCK 2 LOT 17A
1
100 \NES RPp\US \
�PPPROX•
/ LEGEND
O CLEANOUT
e MONITOR TUBE
NEIGHBORING SEPTIC AREA
TEST HOLE
PLAN — SCALE: 1" = 30'
+100.0' DECK POST
m
5.7' COVER
1500
90.5 AL TANK 90.3
.11
y+vuwn. LLL Vf111 VIV — .HI r= IV 1
LEGAL DESCRIPTION: TONJESS ESTATES BLOCK 2 LOT 17A
C&M ENGINEERING SERVICES OWNER: CRAFT DATE:11/15/19 REV: DRAWN: CB REF:
907-854-5558
SEPTIC RECORD DRAWING
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
t http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP191489
Work Type: SepticTank Upgrade
Tax Code Number: 05183228000
Site Legal Address: TONJESS ESTATES BLK 2 LT 17A G:1462
Site Mailing Address: 25439 SCHAFF DR, Chugiak
Owner: CRAFT CHARLES F
Design Engineer: C & M Engineering
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
,111 L'7Ij
`Oi S�t
Department
11/4/2019
11/3/2020
135025
❑ Private Well ❑ 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: The new tank is to be more than 5' from any deck support.
Received By:
Issued By: plj�,/v'4
Date:
Date: Ll
3
IV UNICIP , UTY OF
Development Services Department
On -Site Water & Wastewater Section --
Parcel I.D. 051 832 28
AHCHORAGE
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Property owner(s) Charles Craft
Mailing address
Site address 25439 Schaff
Phone: 907-343-7904
Fax: 907-343-7997
Day phone 290-3365
Legal description (Sub'd., Block & Lot) Tonjess Estates BLock 2 Lot 17A
Legal description (Township, Range & Section)
Lot Size 135,025 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
F-1
InitialEl
Single Family (SF) El
(w/wo ADU)
Septic Tank
Upgrade 0
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES
A WAIVER REQUEST FOR:
NONE
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
C&M ENGINEERING
(Signature of property owner or authorized agent)
Permit/Rush Fees: 4 3&0 Waiver Fees:
Date of Payment: 161, 16119 Date of Payment:
Receipt Number: !}C.(g"40 Receipt Number:
Permit No. ogle 191,439 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191489, Rebecca Carroll, 11/04/19
C&M ENGINEERING SERVICES
Ph: 907-8545558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System Modification for Tonjess Estates Block 2 Lot 17A
Dear Reviewer,
The above referenced property is currently served by an older septic system. The tank has failed and
needs immediate replacement.
We are proposing that the existing tank be replaced with a new 1000 gallon (minimum) tank constructed
and installed in accordance with MOA requirements. A polyethylene or advanced coated steel tank is
required. The tank will have an insulated riser and meet current code requirements.
The tank shall be covered with a minimum of 2" moa approved insulation and 3' of cover.
The repair shall be performed by a moa certified installer in accordance with MOA requirements.
The engineer will inspect the tank before backfilling.
Repair of the proposed system will not negatively impact adjacent lots.
Upon completion of the installation, a record drawing will be submitted showing the location of the new
tank, leachfield, well, and otherapplicable features.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini(Dgmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE (10/26/19)
or-
r�
CHARLES G BALZARINI
CE13854 ,
0 AW
{�l�1►- PROFESSO0 '4low
LEGEND OLEANOUT
,
�- a
/ASP191489, Re C2r�dll
• MONITOR TUBE /C
r� • CHARLES G BALZARINI
r+�'c6,•. CE -13854 .•��`��
TONJESS Ilk
F•.;oiz;i�.�.���`��
ESTATES �l�- ROFEs`*
BLOCK 2 LOT 16
NOTE: TONJESS ESTATES
\ TRACT B1 TO THE EAST OF
THIS LOT DOES NOT HAVE
A WELL OR SEPTIC WITHIN
200' OF THIS PROJECT \
TONJESS ESTATES BLOCK 2 LOT 17A
REPLACE OLD TANK WITH NEW
1000 GAL (MIN) POLY TANK
MEETING MOA REQUIREMENTS.
DEMOLISH OLD TANK PER
MOA REQUIREMENTS.
SHORE EXISTING DECK AS NECESSARY.
NEW AFTER TANK POSITION TANK SO THAT IT IS MORE THAN
CLEANOUTS DECK 5' FROM ANY DECK SUPPORT. RELOCATE
DECK SUPPORT IF NECESSARY.
`1\
EXTEND/REPAIR -
CLEANOUT EXISTING FCO /
OR DAMAGED
DRIVEWAY
3 BR HOME
TONJESS ESTATES BLOCK 2 LOT 18A
SEPARATION DISTANCE NOTES:
NEIGHBORING SEPTIC AREA
THE PROPOSED SEPTIC TANK MUST BE GREATER THAN:
100' FROM ANY PRIVATE WELLS
200' FROM ANY PUBLIC WELLS
100' FROM ANY SURFACE WATER
10' TO ANY PROPERTY UNE
10' TO THE HOUSE FOUNDATION
5' TO THE DRAINFIELD
5' TO THE DECK FOUNDATION
SCALE: 1" = 40'
LEGAL DESCRIPTION: TONJESS ESTATES BLOCK 2 LOT 17A
C&M ENGINEERING SERVICES OWNER: CRAFT I DATE: 10/28/lq REV: I DRAWN: CBJ REF:
907-854-5558
SITE PLAN
DAILY DRILLING LOG
SA S DRILLING
HCOI 6761 f Palmer, Alaska 99645 (907) 746-0606
OWNER OF LAND.NAT.... .................................................... DEPTH OF WELL.....�l�..F�k3....
M
.�. ADDRESS.LI !!.J ...... M .Z.... ...TS ...... STATIC LEVEL OF WATER FT ........................
........................................
WELL-SITE............................................................................................... DRAW DOWN FT ....................................................... _..............................
DATE -STARTED ... M`......................................................... GALS. PER %
... f?l!1.......................................
' DATE-ENDED......KIND OF CASING
...�Pall{ ..T0...rp..i.I.0...A..T..�Ce
KIND OF FORMATION:
` FROM...... n............FT.
TO...L?...........FT.
FROM........................FT. TO ....................... FT. ..... ......................
FROM...:+ ..............
FT. TO...BG...........
FT...
FROM ........................ FT. TO ....................... FT...................................
FROM13S................FT. TOA Z............FT:3.
F��. �, cs_K)
FROM ........................ FT. TO ....................... FT...................................
FROM........................FT.
TO .......................
FROM ........................ FT. TO ....................... FT...................................
FROM........................FT. TO ....................... FTMP.. C-... WSJ LL W "�FROM........................ FT. TO ....................... FT. ...................... ...........
FROMAti ..............FT. TO ...M ............ FT..S\k�...%-S)�' 5- MC) M_'o FROM ........................ FT. TO .... _................. FT...................................
FROM ............ _.......... FT. TO .............. _....... FT..aiM3�:.........__..
FROM.A%)...............FT.TO. G.._.......FT.�e�.l:i;,j f?E-` D4►3
FROM........................FT. TO ....................... FT .......... R..E.CE.j.V E D
FROM..» ....................FT. TO .................. ..... FT ............. .r �..5..ta5P
FROM........................FT. TO ....................... �`ft ..�'S....;� � P! . CK 1n�I1 • FROM ........................ FT. TO ....................... FT. ............ ... Fill
....I........
Municipality of Anchorage
FROM........................FT. TO .............. ......... FT................................... FROM ........................ FT. TO ....................... FTDapt..Health.&.HUIf..m Services
FROM........................FT. TO ....................... FT................................... FROM ........................ FT. TO ....................... FT...................................
y
FROM........................FT. TO ....................... FT. ............................
...... FROM ........................ FT. TO ....................... FT. ........................ ..........
MISCL. INFORMATION: F7 vvi> -PE IN -TA% ;AC)LZ W (4t,)N LUW C-Lur UFFs, -�Tj 't ta)TE{('
c--
DRILLER'S NAME..- A?N. J ......:�SIRT;m.................................
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 1966501 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910371
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:LARSEN RONALDS C & PATRICIA A
OWNER ADDRESS:P.O. BOX 671768
CHUGIAK, ALASKA 99567
PARCEL ID:05183228
LEGAL DESCRIPTION: TONJESS ESTATES BLK 2 LT 17
A
LOT SIZE: 68000 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED:12/02/91
EXPIRATION DATE:12/02/92
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED B
ISSUED BY:
DATE: 2 / ` l
DATE:/2 4 `/1
FROM:2001 REALTY TO:S&S ENGINEERING
SENT BY:�TCWART TITLE OF AK :11-13-81 18:21PN
1.-119/24
• a'NTS7 ,
NOV 141 1991 9:26AM P.01
W11111 brand tax transmittal memo 76711 otpeael
n
rom
pt•
none 1 •� /� .��.y+,/
ex 6 G 5
ax 1 ;1
N L'cIT 17
11r.w Aai.x= 135,OzS S.F.
+ V 3.10 Ac..
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ri'c�GD Wtli1 �¢ 4 L \� r I IIi
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ss.s NBA/D3'S�'k 214;9:.\ •'
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N�'L i "il�� vLA`T C'K1;%'TIhiC7 Ns wl LrjTS 0 4 IZ I
b
P4Ab NCI'T 'Rx'ZA FtLCu AT 'THIS vK-1-L, ��G A4 vC�A
IT WL• M TXT RMMNSIS-MY OF TM
OWNER 09 BUILDER TO MOVID G;tEMENT 4* - ••••'
DpESf RIPTIttiHy (!n'ENKU"IS AW RE,STRiG •^t• -7 r , �,I;:i-I�: J •• •e1e1 111 1..e1 .:Ii
IDONS WHICH Do HOT APK..JA AN TNt + � • i J ► -
REXCEDS(IFAMWONPLATANDTOVER.FY I \'' M a�"'��'••a 4�a..►t
: 1 1 1• �' 1 1 ••1� 111........•..1.....
FRUtosen NUILGUJa (AikO- RELATP/E TO 1'_I • . r•.i f� Iw•.a�/ ►. w�IW : 1: ,1J
rMIS•1 t:R417r AND LITH ITY GrAVNCCTIL)NS! °•< �' %.
LOT SURVEY, CERTIFICATION
Ot Qg, Block a=� Area : Sq. Ft
'(at File No, Zoning District.
anchorage Recording' Dist tic It Alaska
I.I&I n.1 _ Ir.1 1 1 _ 1 "•-
+rI'�'y 111 • I I i 1•• 1 •' • !•. • ?
`R.1 V. rr.`►
& Of0$ Cop Llonwn n
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• $I4eI Pin
4 Survey hub A Tack
Reildence ot:--
1
1�
0
0
P4Ab NCI'T 'Rx'ZA FtLCu AT 'THIS vK-1-L, ��G A4 vC�A
IT WL• M TXT RMMNSIS-MY OF TM
OWNER 09 BUILDER TO MOVID G;tEMENT 4* - ••••'
DpESf RIPTIttiHy (!n'ENKU"IS AW RE,STRiG •^t• -7 r , �,I;:i-I�: J •• •e1e1 111 1..e1 .:Ii
IDONS WHICH Do HOT APK..JA AN TNt + � • i J ► -
REXCEDS(IFAMWONPLATANDTOVER.FY I \'' M a�"'��'••a 4�a..►t
: 1 1 1• �' 1 1 ••1� 111........•..1.....
FRUtosen NUILGUJa (AikO- RELATP/E TO 1'_I • . r•.i f� Iw•.a�/ ►. w�IW : 1: ,1J
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LOT SURVEY, CERTIFICATION
Ot Qg, Block a=� Area : Sq. Ft
'(at File No, Zoning District.
anchorage Recording' Dist tic It Alaska
I.I&I n.1 _ Ir.1 1 1 _ 1 "•-
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`R.1 V. rr.`►
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• $I4eI Pin
4 Survey hub A Tack
Reildence ot:--
10
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
NEW
Cetp/ C GOl�151'ruG—r,D&A
OUPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
Lo7- 7 L Tori '
LOCATION
NO. OF BEDROOMS
Peler.15 ree
DISTANCE TO:
Well •
Absorption area /
S•
Dwelling /
,� �
PERMIT NO. 2l
g�3�
V
100 + p/V`ewj
L�' 02
Y
I— Z
W F
Manufacturer
AhAosw
Material
ST�e�
No. of compartments
rn
Liq. capacity in gallons
TInside
IF HOMEMADE:
length
Width
Liquid depth
le
DISTANCE TO:
Well
Dwelling
PERMIT NO.
JZ2
_ _ F
Manufacturer
Material
Liquid capacity in gallons
O
Lu
DISTANCE TO:
Well j
)(O Qn sl
Foundation. Jr /
Foundation.,/:
Nearest lot Iin16 3/
PERMIT NO.
ul LL Z
No. of lines
Length of each I' a
Total length�f lint's
Trench width
Distance between lines
Z w
inches
Top finish
Material beneath tile
Total effectiveg;�ption area
I..
of tile to grade
Q, /
Z
p
U iwebes
Length
Width
Depth
PERMIT NO.
W
u
F
Type of crib
Crib diameter
Crib depth
Total effective absorption area
Q.
wd
W
Well
Building foundation
Nearest lot line
DISTANCE T0:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
WBuilding
3
DISTANCETO:
foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
to UG
SOIL TEST RATING.
25'
INSTALLER
4!�rola y- GoNsT 7ibl
REMARKS
Sy3Tp to a5 I 5 pcl
a bed 1.00 14
•• •'• O
*; 49th •= �'
t
• mes L Thode
CE 5035 •:
ra► Ft' '••....••.• Ii
APPROVED DATE LEGAL
�t-Iz-�3 LoT !7 6ZK 2 Tonjess CsTa1'r
,?�.
72-013 (Rev. 3/78)
-' -- INVOICE NO.
Cfa rr �7C1° W C 34 1- 6144
°-� 1442
CNdcK vow2�c v 13 L,,> 04-t}ricM
(1 (IG/JSTrlUCT1 D �V rsmrrm;;4 c : I" hl, IA/b �
SOLD TO �.� n �-
STREET& NO. STREET & NO. ` RR 7 26 Ahles 1nLnsRti i
CITY (!HtM7lAIC ak CITY -Amf1 AL, $gTo4'
CUSTOMER'S ORDER
—CHWIZ &gWn k
SALESMAN
4J
TERSJS
10 '' 3 vat
VIA
F.O.D.
DATE
2MAY S'S I
4.- V Y 120TV JZ I VL -7-I -'
¢
Jhlc1
J-6 00
TIC -r-
1-667
-D..�.' Af—(
NO WATOZ
EWE 6RAIN.1Lfzc 6)?c- Y. GLASSY LY Dol a 2NANITIL��'
PAT16NAL CHIA)NC,,0
.�G3�i'�ALK
RIM z-7 PDwrg . AY-,; APPfWX x.S� WhI f2 IN HOLE
I> f
H,�
Aad
-
"A p
'
--
3-119121,1T.1Ar12rN6 1 I 14 A 17 0 J?
WATE►? Lt vE Z '# s 4 rco Y 4 ci-
_
7H 736 INVOICE
LOCATION OF WELL (Please complete either la. ID or Ic.)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological 8 Geophysical Surveys
Drilling Permit No.
A.D.L. No.
1/4glrSection No. Township 140 Rongs E[3 Moridlon
la. Borough Subdivision Lot Block P—of—cf—:'
Anch Tonjees 17 2f� sp wp
Ic. DISTANCE AN�F�ai FROM ROAD INTERSECTIONS 3. OWNER OF WELL:Mr. Chuck Dowrick
Address: SR 2, Box 7327
Street Address and Area of Well Location i Eagle River, Ak. 99577
2. WELL LOG
Material Type
Feel Below
Sur/ace
4. WELL DEPTH: (final)
-t
S. DATE OF COMPLETION
Too Bottom
Black ar rock
6. OCobls tool afjotary Driven 0Dug
❑ Auger ❑Jstled ❑ Bored ❑ Other:
Black roc crevices water
470 473
T. USE)komootic C] Public Supply ❑ Industry
0 Irrigation 0 Recharge_., Commerical
E] Test Well 0 Other:
r
S. CASING: 0 Threaded X9 Welded
diam. in. to It. Depth Weight lbs./fl.
diam._—_In. Oto ft. Depth Stickup fl.
\
9. FINISH OF WELL:
TYDe=— Diameter:
Slot/Mesh Size: Length: —^~
Sat between fl. and ft.
Backfilling Gravel pact
_
10. STATIC WATER LEVEL: ft.
O Above or D Below land surface Date
Equipment used:
_
I I . PUMPING LEVEL below land surface and YIELD
It. ofler hry, pumping g.p.m.
11. after hre, pumping 9.9 m.
12.GROUTING Well Growled: O Yes C] No
Material: LJ Neat Cement C] Other:
13, PUMP: (if available) HP _
Length of Drop Pipe It. capacity g. p. M.
0 Subm. O Jet (3 Centriyical 0 Other
14.REMARKS:
Bail tested at 1 GPM
Good recovery '—
16. WATER WELL CONTRACTORS CERTIFICATION:
IS. Water Temperature F C] C
This well was drillod under my )utlsdlclioh and this report IS true to In* best of my knowledge and belief;
&"uj9,g_W1ling AA 5385
Reghtered Busies s Name 99577 Contract License Number
...,«.: P.O. Boz 504 Eagle River, Ak. � J
si6.a: c" . Une 29 1963
A.IIV, ye ee s st �� )
Q)1 (�/�� Clrp 4'11•:+''�•' AYi7C'B't rs r>SS, 1a. •G.w• CA Y1K(•CrHis.�r
i
L
MUNICIPALITY OF ANCHORAGE
Departmentw^� Health and Environmenta,""?rotection
825 Street, Anchorage, AK.' .9501
p264-4720
Permit # I * # * HANDWRITTEN PERMIT
WELL ANDV ON-SITE SEWER PERMIT
Applicant: :C: Mailing Address:
Location: 1:P7 Phone Number: A G.
Legal Description: /.rrT / r/ &Ks� TON,TEKS Lot Size: .c 0 Ar- ,
Type of Soil Absorption System Is:
Trench: Drainfield: _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: 2 Soil Rating(sq.ft/br) /2 s
The Required Size of the Soil Absorption System Is:'
DEPTH LENGTH v#2 y GRAVEL DEPTH o WIDTH �-
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 for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet). .
* * REQUIRED SEPTIC(HOLDING) TANK SIZE _ ��� 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 M INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection.and approval by this departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a 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 enlar ement if
the r i ence is remo ed to include more that3 bedroom .
Signed: C Issued by
Applic t
Date: 'T
SWP/024(1/81)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:DATE PERFORMED:s/s/ 1g'3
LEGAL
SLOPE
' 47'" FzoSr AT r' aEGo+.I
2 -
:o
3-
4-
5-
6-
7 45 6 7
10-
11
0 11
12
13-
'14
•� J 1
15-
16-
17
5 1617 +r,
18
19
14C41 q 4A o EA SA d4 3,
(qza vCzC v1 6,44(,661
/ay6p frt 1,6eoknotj
'ot
C'ss TNMAI a °/a SCOPE
Ar 1-66T- PiT
SITE
I
S�NAFF 4z1VC J
Reading
Date
Gross
Time
Net
Net o Drop
Time
,teet%•4
PERCOLATION RATE �(Z�k
/
(minutes/inch)
TEST RUN BETWEEN
FT AND FT
COMMENTS�.<.nePilZ)rlI
Xjem
TO o6e //t/�r�L'lCCli KCrcJt:EKI
p
•.®®O�MNON
�e•1i•QN• ••a v ••M•• i•••61
T /1�'S� f�/BFC1PooM
AT-
9I_
.■■US20■■■
C .t(STPc/B.7-/
/J; -Td//_CERTIFIED BY:
NI■M■..B®E,
na
c'X 83-0o j
67- 63 -002
MINMERNMITHIN
Q F� •., .r s
■INNOMP.Polumm
RNMENUMMEN
XURAM
■.■■■■
S�NAFF 4z1VC J
Reading
Date
Gross
Time
Net
Net o Drop
Time
,teet%•4
PERCOLATION RATE �(Z�k
/
(minutes/inch)
TEST RUN BETWEEN
FT AND FT
COMMENTS�.<.nePilZ)rlI
Xjem
TO o6e //t/�r�L'lCCli KCrcJt:EKI
p
�e•1i•QN• ••a v ••M•• i•••61
T /1�'S� f�/BFC1PooM
AT-
.e.r. s°
,v?t
C .t(STPc/B.7-/
/J; -Td//_CERTIFIED BY:
��
d. t" GnP NS/Fp DATE: 417"t'9--
na
c'X 83-0o j
67- 63 -002
�J,•� I'o. CE -532
•
Q F� •., .r s
20 -{
U
PERCOLATION RATE �(Z�k
/
(minutes/inch)
TEST RUN BETWEEN
FT AND FT
COMMENTS�.<.nePilZ)rlI
Xjem
TO o6e //t/�r�L'lCCli KCrcJt:EKI
4'ArJl1 (3'14FcocJ SU,E'F.ic,F
ze6lS'(ICLS
T /1�'S� f�/BFC1PooM
AT-
PERFORMED
PERFORMED BY: GX---,e
C .t(STPc/B.7-/
/J; -Td//_CERTIFIED BY:
��
d. t" GnP NS/Fp DATE: 417"t'9--
c'X 83-0o j
67- 63 -002
72-008 (6/79)
MUNICIPALITY OF /ANCHORAGE 5jlos
Development Services Department AW Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051 832 28
1. GENERAL INFORMATION
Expiration Date: - -_Li'20 Z ()
Complete legal description TONJESS ESTATES BLOCK 2 LOT 17A
Location (site address) 25439 SCHAFF
Current property owner(s) CRAFT
Mailing address
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ J5b — 3 3 D Waiver Fee $
Date of Payment ll - QO-M �Z�3� Date of Payment
Receipt Number oca'-iqO of 1612 Receipt Number
COSA # oeD C 10�t 5 � 2 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation.
Name of Firm C&M ENGINEERING Phone 8545558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 1120/2019
r
•S
*: 49 TH •.
6. DSD SIGNATURE... " " . "
• rI�
System #1 Approved for 3 bedrooms rr • CHARLES G BALZARI(u(•
System #2 Approved for bedrooms �� �F�•.• CE -13854 .•c`�i
Disaroved iFi�
�jisTF�FOP • • • A����"'
pp ll�\\t�`-�
Conditional approval for bedrooms, with the following stipulations:
.,I(tcccftrrf/_
'>>P�F91%s•'
By: _ 1_ —C Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory C Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: Tonjess Estates Block 2 Lot 17 Parcel ID: 051 832 28
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 5/83
Total depth 395 ft
Cased to 48 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) +12 in.
Date of flow test for COSA 11/719
Static water level at beginning of test 114 ft.
Comments
B. TANK DATA
Age of tank(s) 0 years
Tank type/material plastic
❑ Standpipes/foundation cleanout per record drawing
Date of pumping na
D. ABSORPTION FIELD DATA Trench
Which system tested (date installed) 83
❑ ALL standpipes present per record drawing
Total measured depth from grade 12 ft (max)
Measured depth to pipe invert from grade 4 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of drainfield. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced na gallons
Comments/Deficiencies: monitor tube / sumo repaired
COSA Checklist yellow sheet
Well production at time of test 0.50 gpm
Water storage tank volume 500 gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by C&M ENGINEERING
Date of Sample 11/7/19
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 11/7/19
Results ID Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 0 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate 450 god
Any rejuvenation treatment (past 12 months)
If yes, enter date N/A
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'
❑7 Yes
if No
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
Q✓ Yes
if No ft
Neighboring Tank > 100' QYes
if No
ft
Private Sewer/Septic Line > 25' ❑✓ Yes
if No ft
Absorption Field on Lot > 100' Q✓ Yes
if No
ft
Holding Tank > 100' Q✓ Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' Q✓ Yes
if No ft
Q Yes
if No
ft
ft
Community Wells > 200'
Q✓ Yes if No ft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Q Yes
if No
ft
Qy/ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑7 Yes
if No
ft
Surface Water > 100'
Q✓ Yes if No ft
Property Line > 5'
Fv Yes
if No
ft
Driveway/Parking > 0'
Q✓ Yes if No, comment
Absorption Field > 5'
O✓ Yes
if No
ft
Wells on Adjacent Lots:
0 Yes if No ft
Water Main > 10'
Q7 Yes
if No
ft
Private Wells > 100'
Q✓ Yes if No ft
Water Service Line > 10'
0 Yes
if No
ft
Community Wells > 200'
Q✓ Yes if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Q✓ Yes
if No
ft
Driveway/Parking > 0'
Q7 Yes if No, comment
Property Line > 10'
❑✓ Yes
if No
ft
Wells on Adjacent Lots:
CE 13854 AW
Water Main > 10'
0✓ Yes
if No
ft
Private Wells > 100'
0 Yes if No ft
Water Service Line > 10'
Q✓ Yes
if No
ft
Community Wells > 200'
F7 Yes if No ft
Surface Water > 100'
Q Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEERS CERTIFICATION
'
OF At,gkkl
AW
�
1 certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance with
'low
O co
d* .� TH *��r
MOA COSA guidelines in effect on this date. 11/20/19
r
CHARLES G BALZARINI
CE 13854 AW
COSA Checklist yellow sheet
ARCTIC PUMP & WELL INC.
._-
Jim Sullivan, CPI
-'—�_ PO Box 770197
Sias MW �..:� Eagle River, AK 99577
(907)688-2510
(907) 243-2282
jint ri_lrcticpumm coil
Well Decommissioning Log
Legal Address:
Subdivision: Tonjess Estates Block: 2
Lot: 17A
T: R Section
Lot:
On-site Water & Wastewater Program certified contractor performing the well decommissioning:
Name: Signature:
Jim Sullivan
Company:
Arctic Pump & Well, Inc
Well Decommissioning Date 11-20-19 Method of Decommissioning: AMC 15.55.0601.,1 a.0 b.❑ c.[Kl
Location: Use the space below to provide a drawing of the property showing the following items:
• North Arrow
• Decommissioned well
• Other water wells on the property
• Two separate swing tie distances for each wet] shown on the drawing
Note: the swing tie distances`shall be measured from either permanent structures or the property corners.
f `p ;J
11. }
0,
t
-
`> Ar,..
�f 17H
p
t s
Arctic Pump & Well Inc.
Page 1 of 1
--- SEWARD &ASSOCIATES LAND SURVEYING 694-0829
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE',
FOLLOWING DESCRIBED PROPERTY' ."' 1
AND THAT NO ENC�GoT>ROACHMENTS EXIST EXCEPT A5 i)ATL
//
INDICATED. IT 15 THE RESPONSIBILITY OF THE „ � �fH � • �'
OWNER TO DETERMINE THE Exis*I'ENCE OF ANY GRID- • • • ..�
EASEMENTS, COVENANTS., OR RESTRICTIONS ,/141, zjli'6Z
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. tJNOERNOCIRCUMSTANCES SHOULD FB' -o ;'•, �s Mere So and
ANY DATA HEREON BE USED FOR CONSTRUCTION �y6 '� # ��: • /i/?e� �,ati i
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. DRAWN.
Well Water Advisory
Certificate of On -Site Systems Approval # OSC191568
Subdivision: Tonjess estates, Block: 2, Lot: 17A
I
This well's productivity was determined to be .5 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31
gallons per minute or 150 gallons per day per bedroom. Although the subject well
currently exceeds this minimum requirement, the production capacity can
fluctuate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
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 # i -`A 1l l(11�2L'
1. GENERAL INFORMATION
Complete legal descriptionLot 17A; Stock 2; Tongeaa Ea-tatea
Location (site address or directions)
Property owner Patio -a Lanaen
25439 Schabj Uhi.ve
Mailing address Guam, USA Tehnitom/
Lending agency
Mailing address.
Day phone
Day phone
Agent Chantene McLean 2001 Reatto Day phone 276-2001
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: - ' 3
3. TYPE OF WATER SUPPLY:
Individual well XX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (A". 1N1) Front MOA #21
5.
6.
By:
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 furtherverify 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 S & S ENGINEERING Phone
17034 Eagle River Loop Road No. 204
Address Faalm River- A1:%&299577
Engineer's signature
DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Date 1-k2-`jZ
Or A1j
rV,r 4.5�
CC273 • �y �
31�� Op
i�� N ' .'
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
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 engineer's work.
72-M (Rev. 191) Beek MOA e21
Attachment
Health Authority Approval
#HA920024
During a recent Health Authority Approval on-site inspection of
the well and septic system on Lot 17A Block 2 Tongess Estates
Subdivision, the well flow and recovery test showed the well's
sustained productivity varied from 0.05 to 0.8 gallons per
minute. The minimum well productivity required by this
department to satisfy the requirements of Municipal Codes (AMC
15.55) and Health Authority Approval guidelines, is 150 gallons
per day per bedroom. This equates to 0.1042 gallons per minute
per bedroom or 0.313 gallons per minute for a three (3) bedroom
residence. The recently determined productivity of 0.8 gallons
per minute marginally satisfies this requirement. The
financing entity and prospective buyers should be made aware of
the marginal productivity of the well, and recognize the
probability of an inadequate water.supply during certain times
of the year.
There are measures which can be taken to minimize the adverse
impact of the low well productivity, such as:
1. A water storage tank serving as a supplemental reserve
reservoir.
2. Curtailment of non-critical water uses (washing cars,
lawn and garden watering, etc.).
3. Installation of water saving devices on showers and
toilets.
4. Restricted or controlled use of laundry facilities and
dishwashers.
5. Self imposed water conservation practices.
6. Connect the new well into the existing water collection
and storage facilities for the old well.
While the subject well meets the
comments herein contained should
Author-ity Approval ertification
Robert W. Robinson
Civil Engineer
On-site Services
ljm:398 1/22/92
minimum MOA requirements, the
be attached to the Health
and all copies thereof.
y, Municipality of Anchorage
..Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 1-ef 1'I U' t-��- Z- T�,�rfss Esrparcel I.O.
f'f't
A. WELL DATA ..._. .. I
Well type Q' -%y ArC- If A, B, or C, attach ADEC letter. ADEC water system number alb
Log present (DN) Date completed U -11S'> Driller MP�t�rJ
Total depth `t 1'7r Cased to 4$1 Casing height
Sanitary seal &N) J Wires properly protected($/N)y
Date of test
Static water level
FROM WELL LOG
U-
Well flow p 9.p -m.
Pump level01L
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
1- � - X12
,�
`v .
•,
%�_:
o
m
O
O 7u
G7
N �
0
z
Septic/holding tank on lot 1 dog ; On adjacent lots IoD `t
Absorption field on lot �� (� ; On adjacent lots 100 ,�
Public sewer main � Public sewer manhole/cleanout '1�a
. 5
Sewer service line Petroleum tank 'L
WATER SAMPLE RESULTS:
C> e_o�%Aoo MA. Nitrate; 3.� Imo. "Jo �E
Coliform Other bacteria
Date of sample: 1 -lam -9Z S & S ENGINEERING
p Collected by:17034 ragle River L cap Rand No 00.4
Eagle River, Alaska 99577
B. SEPTIC/HOLDING TANK DATA
Date installed I2-$3 Tank size 00 0 4,on.._ Compartments '2-
Cleanouts ON) Foundation cleanout &N) Depression (Yo �
High water alarm (Y,[D!-Alarm tested (Y/N) -
Date of pumping t 1- `I 1 - •
Pumper S f Less Po o f,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 100 On adjacent lots 100 Foundation _ I I I
To property line I c> Absorption field 65.1 Watermain/service line • 101 4 -
Surface water/drainage % 00 lk
72.026 (Rev,7M) Front .. . _ CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at i '_`P p off' level
High water alarm level
Meets MOA electrical codes
S=1ot
W
NCE FROM LIFT STATION TO:
On adjacent lots
D. ABSORPTION FIELD DATA
Cycles tested
Surface water' '
Date installed Soil rating 125�`t r�� System type
Length Width '� Gravel thickness `3 Total depth IZ
Total absorption area Cleanouts present ON)y
Depression over field (Y(� Date of adequacy test —-92
Results ail) P `> for "1�rtRs;� �3� bedrooms
Peroxide treatment (past 12 months) (Y& rJE'^fE <<�°�^r If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot X t On adjacent lots c'p Property line tv t k
To building foundation 10 To existing or abandoned system on lot ',�a
On adjacent lots a� Cutbank ti. Watermain/service line %O t
Surface water foo ts- Drivewa arkin /vehicle stora a area t S 1
J
Curtain drain
E. ENGINEER'S CERTIFICATION:._ -
P 9 9
. ' ..
1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in ef%Lpo the dat�of this inspection.
OF.,:At.4 1 ,lQ
$ A 5 ENGINEERING •�.�'�' •• ••'
19034 Bogle River Loop Road No. 204
Signature F,E1A River, Alaakft 99677• C�TH , •,//
/ /
Engineer's Name
Date
HAA Fee $
Date of Payment 13 jCl -,7—
Receipt
Receipt Number
72-028 (Rev. 3/91) Back MOA 21
/d rc•,• 1£215
f sr •. ,W .
Waiver Fee: $ —
Date of Payment _
Receipt Number _
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELLINSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
January 8, 1992
Municipati.ty o6 Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, AZaaka 99519-6650
REFERENCE: Lot 17A; Block 2; Ton1esa Estates;
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694.2979
FAX 694-1211
Request you .issue the attached Heatth Authority Approval Jot the
4e6erenced property.
This tetter is to desaci.be the water weft situation and o66er well 6Zow
testing rezuP.ta 6or the property.
The orig.inat well aerv.ing this property was dkitted on May 2, 1983 to a
depth o5 395 6t. with a dtitter'a estimate o6 1/3 gatton per minute
(GPM). The weft was then deepened on June 1, 1983 to a depth o6 473
6t. with a drieee%'a estimated 6Zow nate o6 1 GPM.
On November 19, 1991 we measured the water Levet within the weft at 441
d"6t. betow the top o6 the well casing. We drew the water teveZ down to
the pump, turned the pump o66 and allowed the water Levet to recover.
A6ter 45.13 houra a total o6 45.8 gaCZons had recovered to the wet Jot
a production rate o6 3 ga tons per hour (GPH) . This proceaa was
repeated with a recovery time o6 5.93 hours and a a.cm.c Zan nate
obtained.
Thus, we appti.ed 6or, and obtained, a permit to dniU a new we t. A
new wet was drifted between December 26, 1991 to December 31, 1991.
This 'new well was located appkox.imateey 20 6t. 6rom the existing weft
on'the opposite side o6 the dni.veway. The dnifter'a estimate 6or this
new wet is k GPM. when excavators were contacted to connect the new
weft to the existing water Zine the property owners were .in6ormed that
per6orm.ing the work would be .cmpracti.cat at this time since the water
tine would need to cross the 6rozen driveway in which severat utiti.ti.ea
are buried.
However, since the new wet was do i tted, the ownera o6 the property
have bound the 500 gallon storage tank within the garage constantly
rema.im butt as opposed to the prior condition o6 a conttnuouaty
parti.aP,ey 6uU hotding tank. with this new condition, the owners
suspected the 6Zow nate o6 the existing weU to have .i.ncneaaed due to
the d4itt,ing o6 the new we t. There6ore, on January 6, 1992 we
pe%6ormed another 6Zow teat on the existing wet aerv.ing the property.
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
d.'- I,
�00IniN
0. t5SCpr
Page Two
Lot 17A; Stock 2; Tonjeaa Eatatea
January 8, 1992
At 12:20 p.m. on January 6, 1992 we meaaured the water ,teve.t within the welt at
appnox.imatety 121 6t. betow the top ob the ca,6ing. A mete? waa connected to
the water ayatem and the 6tow funned on 6uU. At 5:00 p.m. the water .tevet was
b.inat ty drawn down to the pump. Oven the next 2k hound (a total 6.tow time os
nean.ty 7 howca) we monitored the water .tevet .in the weZt and the 6tow nate. We
bound that oven th,ia period o6 time the 6.tow nate ob the weU atab-cP,ized at 48
19PH. There6one, with the dtitti.ng o6 the new wettt, it appeana the production
o6 the oaig.inat weiZ has .incAeased to 48 GPH which .is nean.ty ats otiginat
capacity and .in exceas o6 the amount %equiked to obtain a Heatth Centi6icate
bon a 3 bedroom house.
Since the b.tow rate o6 thta welt, az with any weZZ, may ituctuate, we w.iah to
on.ty temponan.ity abandon the new weU by the .inata tati.on o6 a aan,itary welt
4W to attow bon po66ib.te 6utune use.
16 you have any queat.iona on %equiAe add c iiona.t .in6onmati.on bon your tev.iew,
p.teaae contact ua.
S.inceAe.e y,
ROGER J. SHAPER, P.E.
RJS/gm
4b f"{ l0r
O Gi
Time
APPLIC. 'IT FILLS
OUT UPPER'HAL ONLY
Time
Pioperty Slwner
4a r /P 5 12o (�
Date
Phone
Date
Mailing Address
Date
r e-�(Zip Code 1 Chi —
( ��
'j,13 /
Buyer
Inspector
Field Notes: ((
MUNICIPALI
CEPT. OP tl=t.'_T!1 i
Address
Zip Code 'p /
Lending Institution
h 'S T/
wd %ibxrd
Phone
Address
Zip Code
,2 ' 6 —
6 D
Realty Co. 3 Agent
CGS
^11
BY: . .
Phone
tt��� ��
OC.% r, VVI
" �1�
Address
Date Sewer Installed
Zip Code
—�,
Legal Description
7 / — %1' .2
S5
/
Well to Tank
Street Location
2 _ /
e,3 O pC7/ If61/1r
X
^
Type of Residence
Q Single Family
Multiple
Multiple Family
No. of Bedrooms
❑ Other
Water Supply
Cj5 Individual
QUI 1
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log
If available).
❑ Public Utility
Sewer Disposal
/ 9 sI
G:/Individual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes: ((
MUNICIPALI
CEPT. OP tl=t.'_T!1 i
+�^
EVVZO�l �J,-NTAL PKO7EC7lON
)
DEC 2 '_'03'
RECEIVED
( /,-)APPROVED BEDROOMS`
( ) DISAPPROVED
• •Cj1NQIAPP
V��� h �.. (T�'t((''''' C%A9
( CONDITIONAL APPROVAL'
DATE � " � I ' � �
\ `� CO�T�^
CGS
^11
BY: . .
V �e�R—
tt��� ��
OC.% r, VVI
" �1�
Solis Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
?2-0x3 IM