HomeMy WebLinkAboutTONJESS ESTATES BLK 2 LT 19Ton jess
Estates
Block 2
Lot 19
#051-832-11
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221369 PID Number: 051-832-11
Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New❑ Upgrade
Name
Gregory Bjorgo
ABSORPTION FIELD
El Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
25388 Homestead Rd - Chugiak
❑ Other
Phone
907-301-6840
Number of Bedrooms
4
Soil Rating
Total depth from original grade
1.2 GPD/SF
7.2 / 10.7 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.2 / 6.7 Ft
Gravel depth beneath pipe
4.0 / 4.0 Ft.
Subdivision Block Lot
Tonjess Estates 2 19
Fill added above original grade
0.3 / -0.2
Gravel length
50
Township Range Section
Ft.
Ft.
Gravel width
5.0 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
500 Ft2
1
N/A Ft.
Well
>100'
>1 00'
N/A
N/A
>25
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Greer 1250 Gal.
Surface Water
>100'
> 1 00'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
> 10'
> 10'
N/A
N/A
L TATION
Manufacturer
Capacity
Remarks Trench constructed against grade per permit
Gal.
Measurements listed shallow end/deep end
Alarm location
Electrica by
Installer
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Hiland Excavation
Drainfield D3034 CO/MTD3034
Inspector B Schiller
BENCH MARK (Assumed elevation) 100 ft
Inspectiones: is' 6/13/23 2�d 6/15/23
Location and description
3'° 6/15/23 4"
Top of conc slab for generator
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
4�0' •'gc0it
i * 49 •n-t *��
Septic System
Approved Date Z 20� "
Benjachiller
/1 '• rrsr S/
(I)��nG,'�rF
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C2/1t3/242 •�������/
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F�PROFESSI�Nt�
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Note: this approval does not include well permit requirements.
/D. nc/nnm O%
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TONJESS ESTATES, BLOCK 2 LOT 19
PERMIT # OSP221369 P_ ID # 051-832-11
LOT18A
10' WALKWAY) � i /
` / \�/ — \� -5`0' LO G x 5' WIDE, 4,' EFFECTIVE
DE � H A SORPTION TRENCH
MT3 \ \
z Co
O / /
//SLOT 19#; \\�
/ It/ / / \ C BM \\\\ OMT2
—� 1510 / / B J VFCO
520 / O CO _
C01 l
2C0 (EXISTING TO OLD FIELD)
53040� / �� A� / / 1250-GAL SEPTIC / `
/ / j / -TANK W/ 25�-MANWAY
550560
E�13TERLY E OF INGREElSS-PESS EASXMENT — — —�
�F_CORDF- AT BOOK 1'21 P)GE 09 /
570 TACT B1
LOT 20 v 580
N • i E : API L �ITRIC-�EIVIEN. T AFFECTING LOT 19 IS RECORDED AT
� o/k�., AC3E 530;WHICH IS ViiRITTEN IN SUCH AN ANIBIGUOUS
li! J iIVNER TF/AT IT 18lh•1POSSIBLE T O DELINE.ATEITS LOC,4TION ON THIS
/ F
,01EGE/)
' ENGINEERING \ ! /
�>l
OF A� ill
PLAN AS -BUILT
. •% 0 50 100
Benja i Schiller / FEET
F 7;17"23 • �
illFO PROFESSIONP��'�'
C01
26.5
17.5
-
MH
28.4
16.5
-
SV
33.7
15.2
-
2CO
35.0
15.4
-
DV
36.4
15.4
CO2
-
1 42.1
62.4
MT2
-
43.2
63.0
CO3
-
43.2
33.5
MT3
-
44.5 1
34.7
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
DV - FLOW DIVERTER VALVE
MH- MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
TONJESS ESTATES, BLOCK 2 LOT 19
PERMIT # OSP221369 PID # 051-832-11
99.7 LOW SIDE 103.1 HIGH SIDE
FINISH GRADE ORIGINAL GRADE F- O
102.9 HIGH SIDE
OE- 99.4 LOW SIDE FINISH GRADE
U� ORIGINAL GRADE
nn /-,
96.2
DRAINPIELD ROCK
96.2
92.2 92.2
50'
NO GROUNDWATER 10/17/2022
83.9
H
.�- wk
0
o ; :: ;
PROFILE AS -BUILT /A. Ben Schiller
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(NO SCALE)
ENGINEER 1 N G �®�_ R�FESC10 �,
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SHANE A. HOLT ..- �m
LS-6914
7p '-•---• pd o
,��o!essional �o
NOTE: AN ELECTRIC EASEMENTAFFECTING LOT 1915 RECORDED AT BOOK 947PAGE530, WHICH IS WRITTEN
IS SUCHANAMBIGOUS MANNER THAT IT 1S IMPOSSIBLE TO DELINEATE IT'S LOCATION ON THIS SURVEY.
O
'''
i WELL
/ ASPHALT DRII/EWAY '_3
ss
I '
EASTERL YEDGE OF INGRESS -EGRESS EASEMENT
RECOP,DEDATBOOK1521 PAGE509
LOF20
THEINFORMATIONHEREON ISFOR THE USEOFLENDINGINSTITUTIONSSPECIFICALLYTO SHOWANY
CONFLICTSBETWEEN EXISTING STRUCTURESAND PLATTED LOT LINESAND/OR EASEMENTS,AND IS
NOT TO BE USED FOR POSTT70NINGADDLTIONAL STRUCTURES IMPROVEMENTS, OR FENCELINES.
EASEMENTS OFRECORD, OTHER THAN THOSEAPPEARING ON 77-IERECORD PLAT, ARENOT SHOWN
HEREON ( UNLESS INDICATED)
NOTE.' FENCELINESTHATMAYAPPEARONTHISDRAWINGARENOTTOBEUSEDTODETERMNE
PROPERTYLINESORPOSMONADDITIONAL IMPROVEMENTS.
ANYPAVING SHOWNHEREON MAYBEAPPROXIMATEDUETO FXCESSIVESNOWAND/OR ICE.
LOTIS
AS-BUILTSURVEY I" = 40'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THEFOLLOWING DESCRIBED PROPERTY
L0T19 BLOCK2 TONJESS ESTATES (PLAT82-59)
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLEIMPROVEMENTS SITUATED THEREONAREWITHIN
THEPROPERTYLINESAND NO VISISLEENCROACHMENTS
EXIST OTHER THAN NOTED.
DATEDATANCHORAGE,ALASKA THIS 10 TH DAYOF
AUGUST , 2023
9309GROVERDRIVE
ANCHO9,4GEAK 99507
15577 226-46
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
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221369
Work Type: Septic Upgrade
Tax Code Number: 05183211000
Site Legal Address: TONJESS ESTATES BLK 2 LT 19 G:1462
Site Mailing Address: 25388 HOMESTEAD RD, Chugiak
Owner: BJORGO GREGORY J
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
K Disposal Field Rf Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
t»cnt
S
J fi
Department
Lot Size in Sq Ft:
Total Bedrooms:
V?_9 / Z. Z 2
A2e
CJ/'Z-a5-
/ 5/7O Z3
cilt
44307
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
I. 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
Cc ;�X I -Des,, t �1a+� QAI(10
.l Je /
/ /ZR/2'L
Veronica Pope
RGE 2022.09.29
Received By: "" `
08:50:28 -
Issued By:
Date:
Date: / 2 20 Z Z
4
M UHUPAUTY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-832-11
Property owner(s) Gregory Bjorgo Day phone
Mailing address 25388 Homestead Road, Chugiak, AK 99567
Site address 25388 Homestead Road
Legal description (Sub'd., Block & Lot) Tonjess Estates, Block 2 Lot 19
Legal description (Township, Range & Section)
Lot Size 44,307 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
Initial ❑
Single Family (SF)
❑X
(w/wo ADU)
Septic Tank
Upgrade RDuplex
❑
(D)
Holding Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / 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: 6q6- Waiver Fees:
Date of Payment: 1 �512Z /� Date of Payment:
Receipt Number: 63IC( Id- 'J Receipt Number:
Permit No. 05 e2,,;,- 13 (O� Waiver No.
Perm it App__- :'_.,:c:
September 13, 2022
Municipality of Anchorage
On-site water and Wastewater
REVIEWED FOR CODE COMPUANC
OSP229369, Curtis Townsend, 09,29
PO BOX 240773
ANCHORAGE, AK 99524
522-7773
677-7766 (FAX)
FORG£CIVIL.COM
MOA Development Services, On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Tonjess Estates Block 2 Lot 19 - 25388 Homestead Rd
Septic system design
Dear On -Site Services Engineer:
The owner of the above lot wants to replace the aging septic system on his lot, so we are submitting
this permit application for the construction of a new septic system. The attached site plan identifies
the location of the home as well as the proposed septic location. No conflicts exist between this
proposed system and any other well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot slopes moderately toward the road, with a flatter section where the
home and existing septic system is and a steeper area in front toward the road. Contours are shown
on the site plan showing the grade and direction of slopes. We are proposing to place the septic
alongside the existing trench, with minimum 8' separation. One important point is that the trench
is along the side of the home, and runs perpendicular to the slopes on the property. There is
significantly more cover on the uphill side, as the trench must be set level. Our design provides
sufficient cover on the shallow end of the slope, while allowing for the trench to be set 4' deeper
on the deeper end into the slope. We have specified that the maximum depth must is 11',
maintaining required separation to possible bedrock or groundwater. There are no slopes greater
than 25% within 50 feet downslope of either the primary or alternate site.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100' from all
wells and surface water, and more than 5' away from the septic tank. Stormwater drainage will not
impact this septic system.
Please refer to the attached test hole log, plan and profile pages for the septic design. If this design
is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
TONJESS ESTATES, BLOCK 2 LOT 19 co
LOT 18A
10' WALKWAY
—50' LONG x 5' WIDE, 4' EFFECTIVE
/
Co / / �? / �/ i \ DEPTH ABSORPTION TRENCH
`MAINTAI8' SEPARATION FROM
EXISTING \TRENCH AND 10'
\ \ SEPARATION FROMIPROPERTY LINE
//X13.5
/ i
151 / / POSSIBLE MEA EASEMENT LOCATION I
//� / ADV520 0
\
y
530 �/ / I ��j / / NEW 1250 -GAL
/540` / / SEPTIC TANK W/ 20"
, I / / MANWAY—
550
DECOMMISSION OR, r
/ REMOVE EXISTING 560 i - SEPTIC TANK PER
EEZ'TERLY Eh�E OF INGRESS -EGRESS EASEi14ENT
rF-CORD�[; AT BO01•: 1X21 PAGE S09
570 TRACT BI--
/LOT 20 \ %
11 , E :.AIV �-L�OTRIC �-�`EMEi\!T AFFECTING LCAT -79 IS ,RECORDED AT
/ / fit Oki A ;E SCO,/WHICI� rS bYRITTEN JN SUCH AN APOBIGUOUS
n•,a1INER T; -/AT 1T 0IMPOSS/BLE TO"DFLINEATE ITS Li?CATION ON THIS
' GE/ 5l IRVEl /
ENGINEERING NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE LEGEND
OF A
ll PROPOSED SEPTIC SYSTEM
�,�p'''•••••''•�.F91�� CO - CLEANOUT
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2C0 -DOUBLE CLEANOUT
• • • • • • • • • • PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC FCO -FOUNDATION CLEANOUT
• .. SYSTEMS. DV - FLOW DIVERTER VALVE
/ Benja i Schiller / MH -MANHOLE
P .• .: / 0 50 100
�c .• CE 2592 �� i MT - MONITORING TUBE
OP •,��*0 FEET
1 ROFESSIONP .�mw SV - SEPTIC VENT
l\ PROFNV �' 1 =50 TH - TEST HOLE
TONJESS ESTATES, BLOCK 2 LOT 19 c o 1
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 1 TO 2 MIN/IN
APPLICATION RATE: 1.2 GPD/SF
5.0' WIDE TRENCH SYSTEM
1,250 -GAL GREER SEPTIC TANK
600 GPD / 1.2 GPD/SF /5' WIDE * 0.50 RED. FACTOR = 50.0 LF TRENCH REQUIRED (50 LF SPECIFIED)
USING A BENCHMARK OF 100.0 @ BTM CORNER OF HOUSE:
SHALLOW END (EXISTING GRADE 98.33)
BOTTOM OF TRENCH: (91.83) 6.5' BELOW GRADE (MAX DEPTH IS 13' BELOW GRADE)
FLOW LINE ELEVATION: (95.83) 2.5' BELOW GRADE
TOP OF TRENCH: 1.0' ABOVE GRADE
N
M/
GEOTEXTILE FABRIC
4" PERFORATED PVC
(HOLES DOWN)
DRAINFIELD ROCK
DEEP END (EXISTING GRADE 104.21, 5.88' HIGHER):
BOTTOM OF TRENCH: (91.83) 12.38' BELOW GRADE (MAX DEPTH IS 13' BELOW GRADE)
FLOW LINE ELEVATION: (95.83) 8.38' BELOW GRADE
TOP OF TRENCH: 0.5' ABOVE GRADE
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE & OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
E N G I N E E R I N G
of
*-.-"49 TH �Q ••:yt
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in Schiller
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GE SOILS LOG AND PERCOLATION TEST
E N G I N E E R I N G
LEGAL DESCRIPTION: TONJESS ESTATES, BLOCK 2 LOT 19
PERFORMED FOR: GREGORY BJORGO
DATE: 8/25/22 PARCEL ID#: 051-832-11
DEPTH TEST HOLE 1
(feet)
INET
NO
DATE
READING
START TIME
TIME
DEPTH TO
WATER
NET DROP
OB
(MINUTES)
(INCHES)
(INCHES)
2
---
_
9/1/22
1
10:49
10
0
5—
16
5—
16
3
t ' .
PERC TEST LOCATION
211:02
10
0
511
511
4
3
11:14
10
0
4 L24
L2
16
5
4
11:26
10
0
416
4 i6
6
r
5
11:37
10
0
4L2
4L2
16
`�
GM (SILTY SANDY GRAVEL)
6
11:48
10
0
4 L
4 L
7
. .
g
f
4
6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING
9
PERCOLATION RATE:
2.1 (MIN/INCH)
lo
SITE PLAN
11
12
13
".
14
15
16
• •;
17-
7
NO WAS WATER ENCOUNTERED?
- IF YES a WHAT DEPTH?
NONE NONE DEPTH TO WATER AFTER MONITORING
9/1/22 10/17/22 DATE OF MONITORING
COMMENTS: USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
TECHNICIAN: L. TIDWELL
DEPTH
(feet)
1-
2-
N
.1
lJ
7
8
9
10
11
12
13
14
15
16
17
18
1
Co -*::�l
GE SOILS LOG AND PERCOLATION TEST
ENGINEERING
LEGAL DESCRIPTION: TONJESS ESTATES, BLOCK 2 LOT 19
PERFORMED FOR: GREGORY BJORGO
DATE: 10/13/22 PARCEL ID#: 051-832-11
TEST HOLE 2
NO WAS WATER ENCOUNTERED?
IF YES @ WHAT DEPTH?
DEPTH TO WATER AFTER MONITORING
DATE OF MONITORING
NET TIME DEPTH To NET
DATE READING START TIME (MINUTES) WATER (INCHES)
DROP
(INCHES)
6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING
PERCOLATION RATE: N/A (MIN/INCH)
SITE PLAN
TECHNICIAN: L. TIDWELL
COMMENTS: TEST HOLE DRILLED AND LOGGED FOR SEPARATION TO IMPERMEABLES ONLY
OB
GM (SILTY SANDY GRAVEL)
3
_:,_: _ ._
CL (CLAY)
NO WAS WATER ENCOUNTERED?
IF YES @ WHAT DEPTH?
DEPTH TO WATER AFTER MONITORING
DATE OF MONITORING
NET TIME DEPTH To NET
DATE READING START TIME (MINUTES) WATER (INCHES)
DROP
(INCHES)
6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING
PERCOLATION RATE: N/A (MIN/INCH)
SITE PLAN
TECHNICIAN: L. TIDWELL
COMMENTS: TEST HOLE DRILLED AND LOGGED FOR SEPARATION TO IMPERMEABLES ONLY
OF
s4
49 TH`
SHANE A. HOLT
I&,LS-6914
O'ession3� Lsoa
NOTE. ANELECTRICEASEMENTAFFECTINGLOTI9ISRECORDEDATBOOK947PAGE530, WHICHIS WRITTEN
IS SUCH ANAMBIGOUS MANNER THAT IT IS IMPOSSIBLE TO DELINEATEIT'S LOCATION ON THIS SURVEY.
i
/
/
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Op /
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ASPHAL T DRIVE6UAY
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EASTERL YEDGEOFINGRESS-EGRESS EASEMENT
RECORDED AT BOOK 1521 PAGE509
I A /
/
LOT20
/
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LOT18
THE/NFORMATION HEREON IS FOR THE USE OFLENDING INSTITUTIONS SPECIFICALL YTO SHOWANY
CONFLICTS BETWEEN EXISTING STRUCTURESAND PLATTED LOT LINESAND/OR EASEMENTS,' AND IS
NOT TO BE USED FOR POSITIONINGADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES
EASEMENTS OFRECORD, OTHER THAN THOSEAPPEARING ON THE RECORD PLAT, ARE NOT SHOWN
HEREON (UNLESS INDICATED)
NOTE' FENCELINES THAT MAYAPPEAR ON THIS DRAWING ARE NOT TO SE USED TO DETERMNE
PROPERTYLINES OR POSITIONADDITIONAL IMPROVEMENTS.
ANYPAVING SHOWN HEREON MAYBEAPPROX/MATE DUE TO EXCESSIVE SNOWAND/OR ICE
ASBUILTSURVEY 1" =40'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THA T l HA VE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT19 SLOCK2 TONJESS ESTA TES (FLA T82-59)
ANCHORAGERECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUA TED THEREON ARE WITHIN
THE PROPERTY L INES AND NO VISISL E ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATEDATANCHORAGE,ALASKA THIS 9 TH DAYOF
AUGUST , 2022
15577 226-46
HOLT bI ND SURVEYING
9.309 GROVER DOVE
ANCHOR9GEAK 99507
223-8615
72-013 (Rev. 3/78)
MUNICIPALITY OF ANCHORAGE
_-1.1-
"�;(;�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 A .k S n(±0NST CTION - APPLICANT
} X {}(X)JFX CO lus—T
PH NE
8._ 767
NEW
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MAILING APD no .6Q� co r. �% 9
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LEGAL RIPTION
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LOCATION
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NO. OF BEDRC}Ofy�S
SEPTIC
TANK
DISTANCE TO:
We /� r (
J
Absorpuory prep !
G C/`
Dwelling 11�
PERMIT w/`7` / -7
C7
Manufacturer
G/�
J
Ask, /
No. of compartments 2
G
Lo�,city L allons
IF HOMEMADE:
Inside length
Width
Liquid depth
GSU
O Y
J.9Z
S� F
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Manufacturer—
Material
Liquid capacity in gallons
TILE
' fl J-NF1Ei0
TRENCH
DISTANCE TO:
Well // 7 /
Foundy72lyp� (
vtp�fJines/
Nearest lo)Jyns— /
PEHMI',v5;// 7 54 -
/'
7`
No.
No. of lines /
Length of.7/
Total Ienn9
iJ
Trenchg6
(� inches
Distancebetweenlinest
Top of the to finish4rade /
g
Material beneath the
¢g ! rinches
gj QTotal effecti a abso ion tea
SEEPAGE
PIT
Length
Width
Depth
PERMIT NO.
Type of crib
Crib diameter t /
r/ epth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
W
3
CI
I
ept
(�
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS iV C
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SOIL TEST RATING %� t fra
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APPROVED . 8 it '‘'T tbitiiI\ICZeINI:4 D•410
ii.:;QLE nIVER, ALASKA T:577 rAf
PH. 694-2970
�/ ,%�[�
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72-013 (Rev. 3/78)
MIJN i C i PAL I -r OE AINICI-1011A1BE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
MIN —SITE .S EWE R $c WELL_ PERM I 11 -
PERMIT
PERMIT NO: 840674
DATE ISSUED: 08/08/84
APPLICANT: A & S CONSTRUCTION
ADDRESS: % S&S ENGINEERING
EAGLE RIVER, AF; 99577
CONTACT PHONE: 688-9675
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
SUBDIVISION: TONJESS
SECTION: 2 TOWNSHIP: 15N
44307 (SQ.FT. OR ACRES)
4
Listed below•are the options available to
system. Choose the option that best fits
LOT: 19
RANGE: 1W
BLOCK: 2.
you in designing your septic
your site.
DEPTH TO PIPE BOTTOM (FT.)
GRAVEL DEPTH (FT.)
TOTAL DEPTH (FT.)
GRAVEL WIDTH (FT.)
GRAVEL LENGTH (FT.),
TANK SIZE (GALS)
SOIL RATING (SQ.FT./BR)
lr 1- 1
4.0
4.0
8.0.
2.5
75.0
1,250.0 **
150
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
ER E D
4.0
0.5
• 4.5
22.0
41.0
1,250.0 **
150
W.. DRAIN
4.0
3.5
7.5
5. 0
65.0
1,250.0 **
150
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as.set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
I will adhere to all MOA and State of Alaska requirements .for the set back
distances from any existing well, wastewater disposal system or public •
sewerage system.on this or any adjacent or nearby lat.
4. I understand that this permit is valid for a maximum af. 4 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED•'BY MOA BUILDING CODES,
THEN (1)' AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNE5)62141,
DS
APPLICANT: A && S RUCTION
ISSUED BY
DATE: 9ig*_'
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: 4 ( ri S CoNSr)vJc'-%O&f
LEGAL DESCRIPTION:
10
11
12
13
ORCP.(y , G
sAAtif
iS/LT
s -e) 4/eic
C-I12l4vy
cL
acr7-oiM of
14
15
16
17
18
4 •4`‘"•111
.bort A..1,/4w
19 ■ L No. 14574
20 �spRol?rc>ar4P
COMMENTS
PERFORMED BY:
72-008 (6/79)
SOILS LOG
❑ PERCOLATION
TEST
DATE PERFORMED: 8/ti
LK Z 7i c s'S 6s -r-
1 E PLAN
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111111111111111111111111121111
11111111111111111111111111
1111111111111111111111111/11111
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1111111111111111111111111111
SLOPE
WAS GROUND WATER S
ENCOUNTERED? L
IF YES, AT WHAT
DEPTH?
0
P
E
Reading
Date
Gross
Time
Ne
Time
Depth to
Water
Net
Drop
i.-yirl
--
•
PERCOLATION RATE
TEST RUN BETWEEN
a8 EVGINexI�lNa
rt� s>as �a
CERTIFIE
FT AND
(minutes/inch)
FT
DATE:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak.us
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL cg90_
FOR A SINGLE FAMILY DWELLING _04,3
Parcel I.D. 051-832-11
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
'Mailing address
Real Estate Agent
Mailing address
COSA#
0 Se13IU49
Expiration Date: (9 — ) 3
TONJESS ESTATES- BLOCK 2 LOT 19
25388 HOMESTEAD ROAD *CHUGIAK, AK 99567
KRISTIN MILLER Day phone 301-8936
25388 HOMESTEAD ROAD *CHUGIAK, AK 99567
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
•
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that ray
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. t further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation. GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for
Disapproved.
Conditional approval for
14
bedrooms.
Date
OFA
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev 11/05)
Original Certificate Date:
3 ~�2 g-/ 3
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: TONJESS ESTATES; BLOCK 2, LOT 19 Parcel ID: 051-832-11
A. WELL DATA *PER ARCTIC PUMP AND WELL INSPECTION. SEE ATTACHED. **CASED I� BEDROCK
ASiuM
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO
Date completed 1984 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth *182 ft. Cased to **29.5 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test NO WELL LOG 6/29/12
Static water level ft. 93 ft.
Well production g.p.m. 2.17 g.p.m.
WATER SAMPLE RESULTS: —7
Coliform 0 colonies/100 ml. Nitrate T• 3Omg./L. Collected by: GEG. Ltd.
Arsenic:N O ug./L. Date of sample: _ 3/ 7 i 3
B. SEPTIC/HOLDING TANK DATA r
Tank Type/Material
Tank size 1250 gal.
SEPTIC/STEEL
Number of Compartments 2
Foundation cleanout (Y/N)IYES Depression over tank (Y/N) NO
Date of pumping !.z 3) 1 D- Pumper f� ' 5
C. ABSORPTION FIELD DATA
Date installed 9/28/84
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
rYi el /t y
*BELOW EXISTING GRADE TO BOTTOM OF MT I
Date installed 9/28/84 Soil rating (g.p.d./ft2or (/bdri 150
Length 75 ft
System type TRENCH
Width 2.5 ft. Gravel below pipe 4 ft.
Total depth *9.6 ft. Eff. absorption area 600 ft2
Date of adequacy test 6/29/12
Monitoring tube **YES
Results (Pass/Fail) PASS
Fluid depth in absorption field before test 11.5 in. Water added 630 gal
Elapsed Time: 120 min. Final fluid depth******24in.
Depression over field NO
For 4 bedrooms
New depth ***29.5 in.
Absorption rate >= 600+
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date
**MONITORING TUBE ONLY EXTENDS 2.25' INTO EFFECTIVE. ***2.5" ABOVE .INVERT. ****3" BELOW INVERT.
WONT/SUMP AT WEST END OF TRENCH APPEARS TO NOT EXTEND TO THE BOTTOM OF SYSTEM, LIQUID
LEVEL HOWEVER MATCHES EASTEND OF THE DRAINFIELDS MT/SUMP.
g.p.d.
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump offlevel
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
100'+
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
100'+
N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
Manhole/Access (Y/N
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank
N/A
Manure/animal excrete storage areas 1001+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A
Wells on adjacent lots 100'+
Water service line 10'+ Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain
F. COMMENTS
NONE KNOWN Wells on adjacent Tots 100'+
100'+
Water main N/A
Driveway, parking/vehide storage 10'+
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and
review of Municipal records that the above systems am in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date -7/241f2
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 131099
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 19 of
Tonjess Estates subdivision. This inspection revealed a nitrate concentration
of 7.3 milligrams per liter (mg/L) was reported for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 mg/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
ARCTIC PUMP & WELL INC.
Jim Sullivan
PO Box 770197
Eagle River, AK 99577
(907) 688-2510
(907) 258-2510
(907) 745-2510
apw,l gei.net
Pump Installation Log
Well Drilling Permit Number: SW
Parcel Identification Number:
Date of Issue:
Arctic Pump & Well, lnc.
Page l of I
Legal Description:Tonjess Est
Lot:19
Block:2
Property Owner Name & Address:
Kristin Miller
PO BX 671167
rhnaialr Au QQSA7
Pump Installation Date: 7-912
Pump Intake Depth Below Top of Well Casing:136 Feet
Pump Manufacturer's Name: Red Jacket
Pump Model: 13 ad
Pump Size:1/2 hp
Pitless Adapter Burial Depth:10 feet
Pitless Adapter Manufacturer's Name: Harvard
Pitless Adapter Installer: U/K
Well Disinfected Upon Completion? Yes
Method of Disinfection: Chlorine
Comments:Static 91'
Liner 29.5' Perforations 159-182
Depth 182'
MOA Seal and conduit installed
Pump Installer Name:
Arctic Pump & Well, Inc.
Arctic Pump & Well, lnc.
Page l of I
0
•
4'X7'
Rtck
copy
.,sr
F. GPC
AS -BUILT -a
] hereby certify that I have surveyed the following described
property- 1 -et i 7, !reek
-ton
Sr..r, r t s,: a_ . ?" i t ill R u S/Li,
Anchorage Recording Precinct, Alaska; and that the improve-
ments situated thereon are within the property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements an property lying adjacent thereto encroach
on the premises in question and that there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
this. _ . A., „r
a 192
ROBERT C. JOHNSON
SCALE: Registered Land Surveyor No7880-LS
l = _
Box 77-0456, Eagle River, Alaska 99577
Phone 907) 694-2543
r • MUNICIPALITY OF ANCHORAGE ("
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date September 5, 1986
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 19 Block 2 Tonjess Estates T15N R1W Sec. 2
Location (address or directions)
Anchorage
(b) Applicant Name Graham Young Telephone: Home N/A Business 276-2761
Applicant Address 2600 Cordova St. Anchorage,Alaska 99503
(c) Applicant is (check one): Lending Institution 0 ; Owner/builder ❑ ; Buyer 0 ; Other ® (explain). realtor
(d) Lending Institution Alaska Mutual Bank
Address
(e) Real Estate Company and Agent Re/Max Graham Ynung
Address 2600 Cordova St. Anchorage, Alaska . 99503
' 6 i... "SO
:0 1•
Telephone 333-3011
t ,r: • • 1.
(1)
Telephone 276-2761
Mail the HAA to the following address:
pickup by engineer
2. TYPE OF RESIDENCE
Single -Family El Multi -Fa lily 0 Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well 0 Community 0 Public 0
Note: If community well system, must have written confirmation from the State Department of Erivironmental Conservation
attesting to the legality and status. 0,„;;;;;,
`1
4. • SEWAGE DISPOSAL
Onsite ® Public 0 Community 0 Holding Tarikloi; I' L
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72-025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA i A AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further 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 Telephone
Address EAGLE.RIVERGINEERR4GSERVICES
Date 9/ '1./Ce EAGLE RIVER, AK 99577
P. 0. BOX 773294
694-5195
:,,�,� Or Ai Atilt, . .•
,.
r7r..4 e. �� ��.GO�PO.V'II SAG ,.,`.,. e; Yt •'•L:., .
t.A : L.. A.5urera j +T•��{ C4 **•
`.6 C.� .n �e iti)N ,. C'1 G c.:... -.:*.:1::,
VnGrc o - y ti �;.so
6. DHEP APPROVAL
Approved for "7 bedrooms by
Approved Disapproved
Terms of Conditional Approval
•
11!/1/
^�•,
...CAUTION
The Muncipality of Anchorage Department `of, •Health and Environmental Protection (DHEP) issues Health Authority
•
Approval certificates based solely upon the represei tatipps given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state re'qui'rements. Employees of DHEP.do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 t11/84)
•/,)
T y•
MUNICIPALITY OF ANCHORAGE �1
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY - (D�`�
264-4720
Application Date Sentember 5 . 1986
1. GENERAL INFORMATION c�1�
(a) Legal Description (include lot, block, subc&Ision, section, township, range)
Lot 19 Block 2 Ton.iess T15N R1W Sec.2
Location (address or directions)
Anchorage
(b) Applicant NameCraham Young Telephone: Home 276-2761 Business N/A
Applicant Address 2600 Cordova St Anchorage , Alaska 99508
(c) Applicant is (check one): Lending Institution O ; Owner/builder 0 ; Buyer 0 ; Other ® (explain); realtor
(d) Lending Institution Al aska Mutual Bank
Address
1 :.. •'11 'II s•
Telephone X33-3011
•• 1•
(e) Real Estate Company and Agent ReMaX Graham Ynting
(f)
Address 2600 Cnrdnva Anr•hnrag- r Alaska 99503
Telephone 276-2761
Mail the HAA to the following address:
pickup by engineer
2. TYPE OF RESIDENCE
Single-Family121 Multi -Family 0 Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well ® Community 0 Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the'legality and status.
4. SEWAGE DISPOSAL
Onsite ® Public 0 Community 0 Holding Tank 0
Note: if community well system, must have written confirmation from the State Department of Environmental Conservation ;
attesting to the legality and status.
Page 1 of 2
72-025 (11/84)
ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DH I A AND INFORMATION •
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further 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 Telephone
Address
Date
EAG, F RIVER ENGINEERING SERVIGEe
EAGLE RIVER, AK 99577
P.C. BOX 73294
694-5195
6. DHEP APPROVA
Approved for bedrooms by
Approved Disapproved
Terms of Conditional Approval
: 0
r1-,{: : e.,_•.... --....,„
i3 C ('1
(1,•
1^�',3,'
ii �;c--- �F. , - Engineer's Seal
( pOO°OCJOC o •1 0•eY.••0 1
-I :.
_ .0
-It i�00 Yb Y••
` t ; G.-,•
�n L_ !s A. E C I •c rtl ' `V
<` CPA D so CE.6736 �� " •C ~c.,,
< �ao .•
�"•('V Pr's• 00.0; •,a•' 2�aP
Z^, „ 0FESS,..;�
Conditions
Date //�-
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions In order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
_r
A. WELL DATA
fl
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description. o f' /9
_-1'1441-e-r 7-/s- A/ 2 rw Sec
Well Classification P'eir/A TC 1f A, B, C, D.E.C. Approved (Y/N) 44
Well Log Present (Y/N) A1 Date Completed /9."' 4-rs-.., e.,C Yield Z Gee., res Ye -c.4"
Total Depth *leg A Cased to fya °' bedc`aDepth of Grouting X14
Static Water Level 9y 'b5'//.... 7'r, c� e'v";'s Pump Set At rte'"
Casing Height Above Ground y� �� Sanitary Seal on Casing (Y/N) i
Electrical Wiring in Conduit (Y/N) / Depression Around Wellhead (Y/N) N
Separation Distances from Well:
To Septic/Holding Tank on Lot tic` ' • On Adjoining Lots +/et '
To Nearest Edge of Absorption Field on Lot / 3.1' • On Adjoining Lots 'f /`C,'
To Nearest Public Sewer Line w/+ To Nearest Public Sewer
Cleanout/Manhole A/4
To Nearest Sewer Service Line on Lot
Water Sample Collected by E4fli 2•� �.K .✓eorrf ; Date -5- S
Water Sample Test Results S4) 's r5c4to .y
&e// //0.5 No7` Q✓4, 746/e b.ai/ce-
Comments
e ep
C4Seei •*4,' or
CjrrJGLi
,4S7ar7I-t . we// 1/cS
B. SEPTIC/HOLDING TANK DATA
Date Installed V4F.y Size /•)S" S4 / No. of Compartments
Standpipes (Y/N) % Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) -
Depression over Tank (Y/N) N Date Last Pumped 7/-v6
Pumping/Maintenance Contract on File (Y/N) ^'/4 • for
Holding Tank High -Water Alarm (Y/N) 7✓,/4
Separation Distances from Septic/Holding Tank:
To Water -Supply Well r'"vo ' To Building Foundation /v /
.."//4
Temporary Holding Tank Permit (Y/N)
N�4
To Property Line '/O To Disposal Field 3`/ /
To Water Main/Service Line i'/e ' To Stream, Pond, Lake, or Major Drainage
Course / 24
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata J'S D r�' 2 Type of System Design
,/may
Date Installed
Width of Field 3a
Length of Field 7-5—
Ir
/
Square Feet of Absorption Area
Coo
Depth of Field 8
9
Gravel Bed Thickness
Standpipes Present (Y/N) Y
Depression over Field (Y/N) Date of Last Adequacy Test V.r
Results of Last Adequacy Test
.->~ fe 74.- v .Liq;.e.
Separation Distance from Absorption Field:
To Water -Supply Well "3? / To Property Line
To Building Foundation / 7 To Existing or Abandoned System on
Lot /V/q ; On Adjoining Lots 1-34
To Water Main/Service Line 470
To Cutbank (if present)
NV4
To Stream/Pond/Lake/or Major Drainage Course Nuc
To Driveway, Parking Area, or Vehicle Storage Area
Comments 5tw..•I,'1 J
re 147"k/45
D. LIFT STATION ,-
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
•• Check Permitted Bedroom Rating Against HAA Request ••
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed - Date 0i/ere
Company fi /e/G' s' ' MOA No. Sr a6S
Receipt No 4,00/ 0 0 0 C
Date of Payment
Amount. S C
Page 2 of 2
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