HomeMy WebLinkAboutT12N R3W SEC 33 LT 188 W2Rick Mystrom.
Ma vor
Municipality of Anchorage
Department of Health and Human Services
625 "L" Street
P.O. Box 196650 Anchorage. Alaska 99519-6650
http://www.ci.anchorage,ak.us
August 10, 1999
Lloyd & Joanne Crow
15131 LOC LOMAN LN
ANCHORAGE, AK 99516-4030
Subject:
TI2N R3W SEC 33 LT 188 W2
Permit # SW980378 PID # 01828214
The subject permit #SW980378, issued by this office for a single family well and/or on-site
wastewater system, is due to expire as of 9/22/99.
If this is a well permit and you have drilled the well, a well log must be sent to this office
for documentation of the installation and to close the permit.
If this is an on-site wastewater systm and a licensed Professional Engineer has inspected
the installation, the original as-built inspection report must be sent to this office for review,
approval and documentation. All inspection reports must be submitted within 30 days of
construction completion.
A new permit must be obtained from this office for a well and/or on-site wastewater
system NOT installed by the expiration date. However a new permit can be issued free of
charge for a second year if the application for the renewal is received on or before the
date of expiration of the original permit for which a fee was paid.
When applying for a new permit after the original permit has expired or for more than a
second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well
permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
James Cross, PE
Program Manager
On-site Services
enc: Copy of Permit
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 995~9-6650
(907) 343-4744
ON-,SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 22, 1998
Expiration Date: Sep 22, 1999
Permit Number: SW980378
Legal Description: T12N R3W SEC 33 LT 188 W2
Design Engineer: 0007 Tobben Spurkland, P.E.
Owner Name: Lloyd Crow
Owner Address: 15131 Loc Loman Lane
Anchorage, AK 99516-4030
Parcel ID: 018-282-14
Site Address: 003801 RABBIT CREEK RD
Lot Size: 54450 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special previsions.
The separation distance between the STEP tank and the West property line has been waived to 0 feet.
Waiver #WR980063
Issued By: Date:
,Rick Mystrom,
Mayor
Municipat t of Lnchoragc
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage. Alaska 99519-6650
September 22, 1998
Tobben Spurldand, P.E.
203 West 15th Ave. #203
Anchorage, AK 99501
Subject: Waiver Request for T12N, R3W, Sec 33, West ½ of Lot 188
Waiver Request #WR980063, PIE) #1 I8 282 14 Permit #SW980378
Dear Mr. Spurldand:
Your request for a waiver of the required 10 feet horizontal separation from the
S.T.E.P. tank to a property line has been approved. The approved separation distance is
0.0 feet.
This waiver approval applies to the existing S.T.E.P. tank to property line separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from tNs department.
If there are any further concerns or questions regarding this waiver, please call our oftlce
at 343-4744.
Sincerely,
Civil Engineer
On-Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Date Received:
Legal Description:
Engineer:
Waiver Review Worksheet
Permit
Applicant: L\OfA~
Waiver'Requested: ~2~ ~-~"~
Criteria:
2.
1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
Points:
3. Other:
Waiver is Granted: ~/ Waiver is NOT Granted:
List Conditions or Reasons for above:
Date:
Rec #: O~O~q Amount:
Name of Reviewer
$ \\~' Date Paid: q'[~ '~
ToSP jP LAND
203 W lSth. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
W ~ LOT 188 SEC 33 T12N R3W
LLOYD CROW
Municipality of Anchorage
Department of Health and Social Services
820 1 Street
Anchorage, Alaska 99501
We am submitting an application for the installation septic system upgrade for this lot. The submittal consists of three
(3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed
improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a
schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed.
The septic system design is based on the following:
Ground Water ~ 9 fi during breakup.
Use 5- wide Standard Trench
Soil Rating. From Testhole August 4, 1998
7 min/in = 0.8 gal per sq.lVday
No. of Bedrooms 4
Required Area per Bedroom: 150/0.8 = 187.5 sq.fi.
Total area required: 187.5 x 4 = 750 sqfi
Use 3 feet of rock. Reduction factor .58
Required Length: 750 x .58 / 5 - 87 fi
SYSTEM CONFIGURATION
STANDARD 5-WIDE TRENCH
TOTAL LENGTH 90 FT
TOTAL WIDTH 5 FT
TOTAL DEPTH 5 FT
ROCK DEPTH 3 FT
COVER 3 FT
SEPTICTANK 1500 GAL STEP
The installation of this septic system will not prevent wells from being installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff
will not result from this installation.
We are requesting a lot line waiver for the STEP tank. The topography of the lot prevents a standard tank to be installed
outside of the 100 foot well radius. The cover over the tank would be more than ten feet if located away from the lot
line.
N
SCALE: l' ~ 100 FT,
Ltl? 187
~,, r- ...'~-~';¢ x ~ , ...' ............... ~ ~;' ... '..~ ~ ~ VACANT
~,.....~.....~.~z~_~_ ',....~
...~~ ~
**~?~............~5~ ~
£1/£
-- -- ~ NelJ
TOEEEN SPURKLAND P.E,
205 Id 15TH. AVENUE
ANDN. AK. 9950!
(907) 279.$916
Wl/2 LOT 188 SEC. 33, T12N R3W
LLOYD CROW
15151 LOC LOMAN LANE
SEPTIC SYSTEM DESIGN
DATE: S£PL 14, 1998
SHEET: !/5 GRID: 5155
PERNIT # SV98XXXX P[D fl 018-28:°-14
1.500 OAL STEP
STANDARD 5-WIDE TRENCHES
TOTAL LENOTH 90 FT
T~TA~_D£OZ. ~ Fx_ --
EFFECTIVE ROCK DEPTH $ FT
COVER $ FT
I
ABANDON ~XISE
I
TRENCH
N
f 25
~ABANDON~
~)- ~e11
I
I
_
Well
TOBBEN SPURKLAND P.E.
205 W 15TH. AVENUE
ANCH. AK. 99501
(907) 279-3916
IIWl/2 LOT 188 SEC. 33, T12N R3~f
LLOYD CROW
15151 LOC LO/dAN LANE
SEPtiC SYSTE/d DES/ON
DATE: SEPT. 14, 1998
SHEEt 2/5 GRID: 5155
PERMI~ # SW98XXXX PIE # 0~8-282 14 23331882,DW0
S ?ANDAI~D 5- F/IDE ff~EN£HES
90' Long
5' Deep
3,0' Se~/er rock
3' Cover (INSULATE)
NZI SCALE
/
3' Cover
o
1500 5AL STEP TANK
4" ?nsulotion
3.0 Pt oF Sepi. ic P~ock
Effective
NB SCALE
1500 6AL STEP TANK
TOBBEN SPURKLAND P.E,
203 ~dlSth Ave
Anchopoge Ak 99501
PERMIT// Sl'F9800X.,,v
15151 LOC LO,VAN LANE
LLOYD CROP/
SEPTIC SYSTEM DESIGN
DATE: SEPL l& 1998
SHEET: 3~'3 GRID: 3]35
2533188~DWG
PARCEL ID Z7 XX
Municipality of Anchorage
DEPARTMENT OF ~-'EALTH & HUMAN SERVICES
825 "L" Street, Ar'chorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: L
LEGAL DESCRIPTION:
1
4-
5-
6-
7-
8-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
O P-'&,~/I; c, .S
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
iF YES, AT WHAT
DEP rH?
OepthtoWaterAIter JJT~- Date:
Reading Date Gross Net Depth to Net
PERCOLATION RATE __
TES~ RUN BETWEEN
(minutes/inch} PERC HOLE DIAMETER
FTAND .~ FT
PERFORMED BY: J' ~'' ' ~ ~'~, CERTIFY THAT..~./THIS!TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUH'ELINES IN EFFECT ON THIS DATE. DATE: 0/17.,/ ~--~
72-008 (Rev. 4/85)
ANCHORAGE AREA BORi GH
Depsrtment of EnvironmentsI QusIKy
3330 C Street
Anchorsge, AIssk8 gus03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~'.~2/4~, ~,?~/~_.~' MAILING ADDRESS,~''///~//~,~'~/__2~, ...~/~/~/~ PHONE '~ '~/"~'~-(~-~'"
LOCATION /~'~'~'~ ¢~/~', /~'~'~-"~¢ LEGAL DESCRIPTION ~':'~///~'
SEPTIC TANK:
DISTANCE NUMBER OF
FROM WELL///~, / MANUFACTURER ~//~/-////~'// MATERIA-L/~/~"~?//~-~'-~COMPARTMENTS ~::"/~-
IN~,:J~E~.EN GT H -~ / ~" /
INSIDE WIDTH ~/ ~' LIQUID DEPTH LIQUID CAPACITY~/~-,/~/~GALLONS.
TILE DRAIN FIELD:
/ ,///--,~,~.,~/-, TOTAL LENGTH
DISTANCE FROM WELL~-/~ ~' FOUNDATION ¢,,~ .NEAREST LOT LINE.~__~/~ ~'~/~'~-- OF LINES
NUMBER OF LINES ~,///~-~ DISTANCE BETWEEN LINES /~//~ TRENCH WIDTH~'~'~¢ IN. TOTAL EFFECTIVE
ABSORPTION AREA '~'~%~ SQ. FT, LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE ~/ / MATERIAL BENEATH TILE ~'~'~' IN. ABOVE TILE ~ IN.
WELL:
BUILDING
FOUNDATION/~
CESSPOO L~/
APPROVED
CONSTRUCTION ~'z'~/tL //~'-- /~/'/g'¢'"~'~//~'/// DEPTH ~[?/~;C DISTANCE FROM:
NEAREST NEAREST ~_ TANK~/~SEPTIC / SEEPAGE .-) (~
LOT LINE /~ ~ SEWER LINE ~ , SYSTEM /~ -' --
OTHER SOURCES ~///' ~//~/~
DISAPPROVED REMARKS ~/~/~_~,~/~//~2~-~ ~¢~'///J~Z~
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:,
PIPE MATERIAL:
LOT SLOPE: ..~r ~.~,
REMARKS: //J/'~). ,./J/:e,"~ ~?~e"
DIAGRAM OF SYSTEM
Form EQ-032
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [] NEW
D & B GENERAL, INC. 349-6965 [~]UPGRADE
MAILING ADDRESS
P.O. BOX 10-1349 ANCHORAGE, AK. 99511
LEGAL DESCRIPTION
W ½ L188 SEC 35 T12N R3W
LOCATION NO. OF BEDROOMS
LOCLO~AN AND RABBIT CREEK 5
J Well I AbsorlStion area Dwelling PERMIT NO.
DISTANCE TO: T03 ' 12 ' 60 ' 820423
F- ~ Manufacturer Material No. of compartments
~< GREER STL 2
~ I- Liq. capacity in galJons Inside length Width Liquid depth
750 IF HOMEMADE:
'& ~ DISTANCE TO: Well Dwelling PERMIT NO.
DISTANCE TO: Well 130 t + Foundation 90 ~ + Nearest Jot line 50 ~ PERMIT NO, 820423
~ ~ ~ No. of lines ~ Length of each line ~0
~ 72 Total effective absor~rea
~ DISTANCE TO:
OTHER
PIPE MATERIALS I'
PVC/CAST
SOl L TEST RATING
225
INSTAELER
D &'B GENERAL, INC.
":C
No. 2100 - E ' ~ '~....
OdT. 74. lq7N _'~
APPROVED DATE
72-013 (Rev. 3/78)
F'ER!:d Z T
FIPPL I CFINT
LOCF!TION
LEGFIL
DEB GENERRL INC: F'O BOX :1.E~-i. 349 E~95:1.:1.
LOCL. OHFIN & F..'RBBIT CREEK RE:,
M2 L~L88 S:~:2. T'l_2NR:ii:t4 LOT Si~E
FEET
T'?'F'E OF SOIL. FIE~SORPTION SYSTEM ZS: TRENCH
MRXi'MUM NUMBER OF BEDROOMS
SOiL RRT.!NG 4:56! FT,-.'BR)= 2.'Z-:5
THE RE:g!U:EF..'EC, SIZE OF THE SOIL RBSORF'TZON S¥STEH IS:
THE LENGTH DIMENSION IS 'THE LENGTH ,:;IN FEET) OF THE TRENCH OR DRFilNFIELD.
'THE E:,EPTH OF R TRENCH OR P);]" IS THE D!STRNCE BETP~EEN THE SURFFtCE: OF THE
GRCHJND R[4P THE BOTTOI','! OF' THE EXCR',,,'F~TZON (IN FEET>.
THERE IS NO SET 14tDTH FOR TRENCHES.
'THE GRRVEL. DEPTH IS 'FHE HINiP1UH DEF:']"H OF GRR',,,'EL 8ETI.,.IEEN THE OUTFFILL PIPE
FIND THE BOTTOI'd OF THE EXCR',,,'R'f'ZON ,.'.'~N FEET).
PERP'I.IT RPPLICFIN-F HF~S THE RESPONSiB!LIT¥ 'TO INFORM ]'HIS; DEP"'FiRTMENT DURING THE
INSTRLLRTZON INSF'EC:TION$ OF R!'.,W [4ELLS FiD..fRCEN'f' TO TPIIS PROPERT'.~' RN[:, THE
NUMBER OF RESi'DENCE'.'5 THRT THE !..IELL [4IL. L SEF.:',/E.
E:FICKFILLZNG OF' FtN'T' S'-FSTEM P!tTHOUT FIbifiL ZNE;PEC'1"ZON RN£:, RPPROVflL.. B'¢ THZS
DEF'RP".tT!'IENT 1.4ZLL BE SUB.'rEC:T TO PROSEECUTION.
MINZMUP! DISTRNCE BE"F~.qEEN R [4ELL FIND Fllq'.¢ ON-SITE SEkIRGE DiSPOSRL S"r'E;TEt'd IS
:L(.i~ FEET FOR I-~ F'RI'..,'FITE !.4ELL OR ::L5£~ TO ;2E~C.'~ FEET FROH Fi PUE~LIC 14ELL [:,EF:'E~.,!E:,ING
UF'ON THE] T'T'PE OF PUBLIC !,,,!EL.L.
I"!Ii".ilMUH DISTRi",ICE FIE:OH FI PRZVFITE I4EL.L TO F'~ PR'_r',,,'RTE SE!.,.1ER L. ZNE :IS 25 FEET P,!'.,!L;,
I'O Fl C:Cd"!PILIN:ET'¢ SE!..!EI:~'. LINE IS 'TEl FEET.
OTHEF: F:EI;!UIREHEhtTS h!R'T' RF'PL'¢. SPEC:ZFZCRTiOI"4S RI",ID CONSTRUCTION E:,I!:ILSRF~!"!S FtF4:E
FtVRZLRBLE TO INSURE PF.:OF'EF..: ZNS']'RL.LRTZON.
! CERTIFY THRT
±: i Fif"l FRt"IZLIRR !4ITH THE REE:!LliREHENTS FOR ON-SiTE SEIqEIE'.S RND i,!ELL.S RS SET
FORTH Eft' THE MUNZC;EPRL. ZT'¢ OF Fff.,iCHORRGE.
2: I !,.!I!_L INSTRLL THE S'¢STEM IN RE:E:ORD!~NCE P.!ITH THE CODES.
~:: Z LI!'.4E:,ERSTRND THF!T THE ON-.E;!TE E;EI,.IER S;'¢STEM f,!FI'¢ RE6~LIZRE E~.,I!~..R~E'.E~EI~!E:f..IT iF THE
RESIDENCE ZS RE!'dODELED TO INCLUDE HORE THRH 5 BED~'.OO!',IS.
......................
~:~EE' GENE~.F!L Z NC:
GreaTer ANChorage Area BorOugh ~.'oo ~'~'
DEPARTMENT Of ENVIRONMENTAL QUALITY PER IT NOT.~
3330 "C" STREET ANCHORAGE, ALASKA 99503 /;7~ ~' ?
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. EACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK /~O ~
DRAIN FIELD
WATER MAIN TO SEPTIC TANK SEEPAGE PIT ~
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UND]STURBeD SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
~-~ SOILS LOG PEROI,ATION I 4. 1
This form reports:-' SoilsTo~.)< Percolation test
L._/' GREATER ANCtlORAGE AREA B'~uk[)U~/
Department of Environmental Quality
3330 "C" Street
Anchorage, Alaska 99503
Date Perfor,,,:d f_2?_f~] z~_[/
Depth
Feet
1~
Was ground water encountered?
If yes, at what depth?
Reading Date Gross Time Net Time F---pLh to-- _,. __.__._._.._._____--
................. ~[i-n u t e-. ....
Percolation rate
-Proposed installation: Seepage Pit Drain Field
Inlet . Depth~'~t~F~)it or trench
Depth of ......................
Perforaed By.~ ~.~--~ Certified By:,
EQ-040 (6/74)
Test Pit on Ten Year Old Seepage Pit
Owner:
William Davis
Box 480 SRA
Anchorage, Alaska
344-5854
Location:
Soil Sample:
DeArmoun and Loc Loman (northeast corner)
w 1/2 lot 188, sec 33, T12NR3W
225
Conditions:
2 first 4' silty sand & gravel
3 -
soil 4 -_-
depth 5
in feet 6' - ~ remaining depth silty sand
7' -- ~ gravel with blue clay mixture.
, ~ '. "~ 4,~ .~ .,~8 .~' ,, ... ,'./:; '.
%, ~7Z-~7
New Septic System approved 10/16/74.
1,O00 gallon septic tank and 70' of drainfield put in with extremely good backfill.
By Robert Neale
MUNICIPALITY OF ANCHORAGE
i
Development Services Department �\ Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 018-282-14-000
Expiration Date: 9/17/2025
Legal description T12N R3W SEC 33 LT 188 W2
Site address 15131 LOC LOMAN LN Anchorage AK 99516
Current property owner(s) CROW LLOYD & JOANNE V
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
M
Original Certificate Date: 11/21/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory X Arsenic Advisory
Other
COSA Approval—June 2022
MUNICIPALITY OF ANCHORAGE
r 1
Development Services Department _J Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 018-282-14
Complete legal description T12N R3W SEC 33 LOT 188 W2
Location (site address) 15131 LOC LOMAN LANE, ANCHORAGE, AK 99516
Current property owner(s) CROW LLOYD & JOANNE Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 26 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ SQL
Date of Payment Z
COSA # S C 2 y 1-0 9
Waiver Fee $
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: T12N R3W SEC 33 LOT 188 W2 Parcel ID: 018-282-14
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled UNKNOWN Total depth UNKNOWN ft
Cased to UNKNOWN ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) *18+ in.
Date of flow test for COSA 9/20/24
Static water level at beginning of test 32 ft.
Well production at time of test 3 gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 5.30 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 9/20/24
Comments *Casing height from the bottom floor of cement well pit with sump pump. The well extends several feet above
bottom of this cement floor. The top of the well is approximately 4’+ below exterior grade.
B. TANK DATA
Measured operating fluid level in septic tank *NA
Date of pumping 9/17/24
Required maintenance completed, if AWWTS
Comments: *STEP / FLOATS
C. LIFT STATION
Required maintenance completed
Age of lift station 26 years
Lift station material STEEL
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/22/1998
ALL standpipes present per record drawing*
Total measured depth from existing grade 6 ft (max)
Measured depth to pipe invert from grade NA ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 9/20/24
Results Pass (South Trench / North Trench)
Fluid depth prior to test 23 / 7 in
Water added 600 gal
New fluid depth 28 / 30 in
Elapsed time 1440 min
Final fluid depth 22 / 5 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 36 / 36 in (MOA 3’ ED)
Effective depth used 22 / 5 in (Final Fluid Depth)
Effective depth (ED) remaining 14 / 31 in
Comments/Deficiencies: *No foundation cleanout was found & the owner has never seen. Approximate total measured
depths from existing grade. ED per elevation measured shots, visual observations, MOA records & appears approximate.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No *0 ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*MOA WAIVER - #WR980063
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 11/19/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
11/19/24
MUNICIPALITY OF ANCHORAGE
or
Development Services Department
Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Owner
Lift Station/Pump Vault
Maintenance Log
Street Address 1,$_'/ 3
Septic Tank:
-Sludge level inches -Pumping: required e no -Pumping completed es no
Lift station: SCP P21
-Pump basket cleanedresno
-Effluent filter cleaned es no
-Control floats cleaned -Proper float settings confirmed e no
-Operation satisfactory
Alarm System:
•Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling
-Alarm system operation Qatisfacto not satisfactory
Manhole Riser
-Ground water intrusion at riser to tank connection es no
-Ground water intrusion around pipe penetrations es o
-Manhole lid: Functional es no Insulated es no
Other
-Weep hole functional es no
Properly Secured s no
-All manufacturer required inspections and maintenance completed es no
Comments:
Qualified Maintenance Provider:
Technician L ac (`)L_\A). BekJ
Company &S
Signature
Date of maintenance A_*4
SSMH
SPEED LIMIT SIGN
POWER OUTLET
"NO OUTLET" SIGN
ROAD SIGN
CL MON
40
.
5
'
28.6'10
.
4
'
3.7'
6.4'
3.7'
43
.
7
'
4.3'
24.3'
WOODEN
FENCE
GRAVEL
PAD
BRICK
PAD
SECOND
STORY
DECK
CANT.
ROCK
RET.
WALL
ROCK
RET.
WALL
WOODEN
PAD
WOODEN
PAD
GRAVEL
PAD
ELEC.
SAFETY
SWITCH
OPEN
AIR
SHED
GABION
WALL
GARDEN
AREA
SURROUNDED
BY ROCK
RET. WALL
FENCED
GARDENGRAVEL
PAD
LANDSCAPING
SHED
SHED
DECK
GRAVEL
DRIVE
BRICK
PAD
BRICK
PAD
ROCK
RET.
WALL
CINDER
BLOCK
RET. WALL
CINDER
BLOCK
RET. WALL
CINDER
BLOCK
RET. WALL
SEPTIC
DIRT
DRIVE
GAS
METER
ELEC.
METER
WEST 1/2 BLM
LOT 188
54,450 SQ. FT.
1.25 ACRES
3-STORY
HOUSE
33
'
R
O
A
D
W
A
Y
A
N
D
P
U
B
L
I
C
UT
I
L
I
T
I
E
S
E
S
M
T
.
P
E
R
PA
T
E
N
T
ROCK
RET. WALL
GABION
WALL
WOODEN
RET. WALL
ROCK
RET.
WALL
GARDEN
SURROUNDED
BY ROCK
RET. WALL
EAST 1/2
BLM LOT 188
BLM LOT 187
50' ROAD R.O.W.
PER PUBLIC LAND
ORDER 601
BLM LOT 165
N90° 00' 00"W 164.92'
N0
°
0
8
'
0
0
"
W
33
0
.
0
0
'
33' ROADWAY AND PUBLIC
UTILITIES ESMT. PER
PATENT
RABBIT CREEK RD. CL
LO
C
L
O
M
A
N
L
N
.
R.
O
.
W
.
65.1'
74
.
6
'
67.8'
18
7
.
1
'
N90° 00' 00"E 164.92'
S0
°
0
8
'
0
0
"
E
33
0
.
0
0
'
33
.
0
'
50
.
0
'
33.0'
WELL IN
WELLHOUSE
SEPTIC
100.0'
Alaska Construction Surveys
907 E Dowling Rd, Suite 10
Anchorage, Alaska 99518
Office: (907) 344-5505
Fax: (907) 344-4775
Email: mcrow@akconstsurveys.com
Site: RESIDENTIAL
Address: 15131 Loc Loman Ln., Anchorage AK
Field Survey Date: August 15th, 2024
Crew: F.C.
Drawn by: F.C.
Checked by: M.C., A.V.
Scale: 1" = 25'
Sheet: 1 of 1
ASBUILT SURVEY
WEST 1
2 BLM LOT 188
LOCATED IN
SE1/4, SEC. 33, T12N, R3W SEWARD MERIDIAN, ALASKA
PREPARED FOR:
LLOYD CROW
EXCLUSIONS
IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENENTS,OR RESTRICTIONS WHICH DO NOT APPEAR ON
THE RECORDED PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR ESTABLISHING
BOUNDARY OR FENCE LINES.
ASBUILT CERTIFICATION
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING PROPERTY: WEST 1
2 BLM LOT 188, AND THAT
NO ENCROACHMENTS EXIST, EXCEPT AS NOTED.
ALASKA
C
CONSTRUCTION
A
SURVEYS
S
24 Sep 2024
Feet
0 25 50
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT o,
On -Site Water and Wastewater Section
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC241479
Subdivision: T12N R3W Section 33 Block: , Lot: 188 W2
907-343-7904
Fax: 343-7997
The septic tank for this property is 26 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT Y 907-343-7904
On -Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC241479
Subdivision: T12N R3W Section 33, Block: , Lot: 188 W2
A water sample revealed a nitrate concentration of 5.30 milligrams per liter (mg/Q.
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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. 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.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org 7
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.