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HomeMy WebLinkAboutT15N R1W SEC 8 LT 179 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: sw030314 PID Number: 051-154-22 Name: Jennifer and Diane Payne Wastewater System: [] New [] Upgrade Address: P.O. Box 671441 Chugiak, AK 99567 ABSORPTION FIELD Phone: Number of Bedrooms: 688-6501 3 [] Deep Trench I~i Shallow Trench [] Bed [] Mound [] Other: LEGAL DESCRIPTION so, Rating: Total Depth from odginal grade: 1.2 GPD/Ft2 4.5 Ft. Block: Lot: BUM 179 Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe: 2.5 Ft. 2 Ft. Township: T15N Range: R1W Secti°n:8 Fill added above original grade: Gravel Length: 1-2 Pt. 53 Ft. Well: [] New [] Upgrade Gravel width: Number of Ii .... Distance between lines: 5 Ft. I - Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Private 82 Ft. 81 Ft. 378.6 Ft2 ASTM D3034 PVC Ddller: Date Drilled: Static Water Level: installer: Date Installed: Sullivan WaterWells 10/25/2000 52 Ft. Owner Installed 8/16/03 Yield: GPM PumpSetat: Ft. CasingHeightAboveGround: 5 2 Ft. TANK SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other: T~.To Septic Absorption Lift Holding )ublic/Private Manufacturer: Capacity: From~ Tank Field Station Tank Sewer Line Greet Tank 1,000 Gal. Material: Number of Compartments: we, > 100' >100' 88 .... N/A >25' Steel Two (2) SurtaceWater >100' >100' >100' N/A ~ / LIFT STATION Size: Manufacturer: Lot Line >5' >10' > 10' N/A Gal. "Pump on" level at: "Pump off" level at: in. High water alarm at: Foundation >5' >1 O' >5' N/A in. in. Curtain Drain None Noted Pump Make & Model Electrical Inspections performed by: Remarks: ***See Waiver - Well to Lift Station. BENCH MARK Location and Description: System Constructed to Serve New House. Quonset Finished Floor. Assumed Elevation: 100.00 Ft. Inspections performed by: J' Quam, P.E. Dates: 1st 8/16/03 Development Services Department Approval Conditional Approval Date: Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT Page 2 of 3 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 PID No.: 051-154-22 Permit Number: SW030314 Lof 158 S 89'56'55"E ,.950.80' I Well I . # ..I CARACE-~ -- ~ . -.' ~/~"--Shed House Construction Complete /~- ' · · · ... ' .: ,' - x 'F'~ . . . '...~/.~: - Dog Kennels:"' ' ' ~~~.-.. -": ...1 1 ~ o ." ~ -' ..... Shed~ ~ o ~....~,~..... ,.j __ o · , .. ,......~. ~ .. ..... . ..,. ... m ~ .- ~.,'.~-~_." ' ' '~c~ rH~ ~ , ~ U Lot / ~~ '"~ s, ,o.~. ,,.o. 4 ~80 ~ ~ ~ ~ ~~ ~ 78.2, ,2.3, ~ ~ ~ ' Line Capped for Futura Use. , BUM LOT 179 ~ T15N, RI W, SECTION 8 ~ LEGEND ~ 2.50 ACRES S1 - Septic Vent ~ MI - Monitor Tube ~ Cl - Clean Out ~ TH - Test Hole 33' B~ RIG~-OF-WAY R~E~A~ON S 89'35'54"W 329.90' TENADA AVENUE ~ 4/'~. Lof A P L A N h 3- B U I L T e~ ~ MICHAEL [. AN~ERSON /~ ee-~,' ~ ..~ SCALE = 50' Anchora.qe, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997 http:llwww.muni.or.q/Onsite Development Services Department On-Site'Water and Wastewater Proqram **** VARIANCE/WAIVER REVIEW **** WP, g: OSP101262 HA#: OSC101278 PID#: 051-154-22 Legal Description: T15N RIW Sec 8 Lot 179 Engineer: Anderson En.qineerin.q Permit: Applicant: Dianna & Jennifer Payne Your request for a waiver of the required 100 feet horizontal separation from the lift station to the private well has been approved. The approved separation distance is 88 feet. This waiver approval applies to the existing lift station to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date:~11/3/2010 Ap prove ~ Name of Reviewer Rer_,g: 094804 Amount: $200.00 Date Paid: 1112110 Recg: o~clt Amount: $850.00 Date Paid: ~,]q **** VARIANCE/WAIVER REVIEW **** ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) November 1,2010 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Attention: On Site Services Engineer Subject: BLM Lot 179, T15N, R1W, Section 8 Separation Distance Waiver Well to Lift Station Dear On Site Services Engineer: A small totally enclosed grinder pump was placed in line between the existing Quonset hut and septic tank on BLM Lot 179 in 2003. The intent at the time was to live temporarily in the Quonset hut and build a new three bedroom home on the lot. The lot is now being sold and the new buyer intends to construct the new home, but may live in the Quonset while the construction is ongoing. The grinder pump is located outside the hut and is considered a source of contamination and is located only 88' from the well on the lot. A waiver must be obtained to allow the pump to remain in its existing location for the current owner to obtain a Certificate of On Site System Approval (COSA). We are therefore requesting a waiver be issued allowing the grinder pump to remain in its current location. The well is 82' deep with casing to 81'. The well is drilled through what appears to be impermeable clay classified as hardpan by the driller from 7' to the bottom of the well with only an 8' layer of sand and gravel encountered from 53' to 61'. The static water level stabilized at 52' below the surface and more than 48' below the bottom elevation of the grinder pump. The grinder pump was manufactured by Anchorage Tank to the Uniform Plumbing Code and is totally enclosed in a steel case which can only be accessed with the removal of the plumbing at the entrance to the pump. The bottom of the pump is approximately 4' below ground. The original ground surface on the lot slopes from the well and toward the septic tank at an approximate 10% slope. The ground elevation at the septic tank is approximately 9' lower than the well head. We assume the water gradient slopes away from the well at a slope similar the original ground surface. A recent water quality test taken from the well indicated no presence of nitrates and no presence of arsenic. The absence of nitrates would indicate no contamination of the well water from septic effluent from either the grinder pump or the septic tank and absorption trench on the BLM Lot 179, T15N, R1W, Section 8 November 2, 2010 Page 2 of 2 lot. No coliform or bacteria was found in the water further indicating contamination is not present in the well. ADEC POINT ANALYSIS Bottom of Tank to Highest Water Table - 48' Soil Absorption Type - Clay and Sand Equal Permeability - Clayey Sand Water Table Gradient - +10% Horizontal Separation - 88' 5.17 Points 4.50 Points 3.00 Points 6.00 Points 2.50 Points TOTAL POINTS 21.17 Almost sure to be free from any form of contamination from household sewage. Attached are the well log, water quality results and other drawings showing the proximity of the existing septic system to the well. We hereby request the waiver be issued and the Certificate of On Site System Approval (COSA) be approved. Sincerely, Michael E. Anderson, P.E. Attachments Existlng Grinder Pure Impermeable Hardpan 7' Static Water Level 52' PRDFILE A3-~UILT SCALE 1' = 30' Monday Nov 1, 2010 North Birchwood, Lot '179, SECTION 8 Sun Oct 3'1 I went to the site to uncover the Lift Station at 92 ' from the well and determined that it is a liquid tight installation: approx 18" dia. X 3' deep steel cylinder that contains a grinder pump, energized by power that travels in underground wiring at a burial depth of 18" below grade. The sewer discharges from the Lift Sta to the Septic Tank in 2" schedule 40 ABS pipe. MUNICIPALITY OF ANCHORA GE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Aug 15, 2003 Expiration Date: Aug 14, 2004 Permit Number: SW030314 Legal Description: T15N RIW SEC 8 LT 179 Design Engineer: 0014 Anderson Engineering Owner Name: JENNIFER & DIANE PAYNE Owner Address: PO Box 671441 Chugiak, AK 99567- Parcel ID: 051-154-22 Site Address: 019831 CRABTREE ST Lot Size: 108900 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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. August8,2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: . BLM Lot 179, Section 8, T15N, RIW Septic System Design and Permit Application Impacts to Adjacent Propedies Dear Onsite Services Engineer: The owner of the subject lot intends to construct a three-bedroom home in the near future. We are therefore applying for a permit to construct a new well and septic system on the lot to serve the new home. The attached Site Plan and backup documentation identify the location and configuration of the new well and septic system and the parameters used in the design. It also shows the 100' protective radius of the well and indicates the location of the reserve 'system to be used if the primary system requires replacement. Two test holes were placed on the lot in the area of the new absorption trench. Well graded sand was encountered with some gravel and trace amounts of Silt. The material percolated at a rate of 1.7 minutes per inch. Groundwater was encountered in the excavation at depths of 9.5' and remained at that depth during the monitoring period. We have therefore designed a 5' wide absorption trench with 2' of gravel beneath the distribution pipe, The total length of the trench will be 52'. The total depth of the trench from original grade will be 4.5' which will be a minimum of 5' above the present level of the groundwater. The ground surface on the lot is very flat in the middle podion. The ground surface rises at a 10% slope toward the southern boundary where the new house will be placed. The new trench will be constructed at the base of the slope parallel to the contours of the surface in conformance with Municipal requirements. Grading will be accomplished to assure surface drainage is away from the new trench. If the system is constructed in accordance with our design the f,')llowing statements apply: The system, if const~'ucted as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. BLM Lot 179, Section 8, T15N, R1W August 8, 2000 Page Two The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. o The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments Actual Well Locatfon ~' (See~Suryey°r. As-~ui~ 'Three' Bedroo./ Proposed Well · ~ 'TH2 " . · ' ~i" X 2' L fi ' "~-2 ~fec~ge B~th ' ~bsorption.Trencn 'l,'O0'b.'~hllon Septic Tank 'f TENADA AVENUE SITE PLAN SCALE 1" = 50' NOTE: No Conflicts With Wells or Septic Systems in the Area. BLM LOT 179, SECTION 8, T15N, R1W DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home Perc. Rate: 2 Min./Inch Applicat~.on Rate: 1.2 GPDISF 5' Wide Trench System 1,000 Gallon Septic Tank 2' Drainfie!d Rock 3 Bedrooms X 150 GPD 11.2 GPDISF = 375 SF of Absorption Area 375 SFI5 LF (Width)*.7 (Red. Factor) = 52.5 LI: l'rench Length Therefore: Construct 53' Long X 5' Wide X 2' Effective Depth Absorption Trench. FIowline Elevation in Trench to be 2.5' Below Original Ground Surface. Total Depth to be 4.5'. Mound Over Trench to Provide Minimum of 3' of Cover. 615 at '. .:Insulation .. i'. ' '6r-'.3' 'Cover :" ,. . · '"' ';1'~ ~P~C (lloles 'Downl ·.. Draififie'l~' Ro~k · :...?:... : ..'!." I' NOTE: TYPICAL WIDE TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. Municlpality of Anchorage Depadment of Hearth & Human Services 825 L Street, Anchora9e, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed Fqr: Ch~ck B.~rr Iegal De,~criptlon: BLM Int 179. Section 8 T15N. R1W .......... SLOPE 13 14 15 17 21 OG/OL SW Well Graded Sand with Gravel Was Groundwater Encountered? Yes S Ii' Yes, What Depth? 9.5' Deplh to Water Alter Monitqdng 9.5' Bottom of Date: 8116100 E Hole · t~~'~' ,-,-,,';~,.-= 5'-~ '.~ Date Pedo~ed: 6D1/0( ~~~~~ SITE PLAN See Site Plan Reading Date Gross ~let Depth To Net Time ]'ime ~/Vater Drop 1 21-Jun 1:00 2' 2 1:05 5 5' 3 1:06 2" 6 1:17 5 5' 3' Parc. Rate: 1.7 Min./inch Parc. Hole Diameter: 6' Test Run Between 4 Ft. and 5 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: Tim Kimbrouah. I, Michae! E. Andemon Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effecl On This Date: 816100 Municipality of Anchorage Department of Health & Human Se~ices 825 L Sb'eet. Anchorage. AK 99502-0650 SOILS LOG - PERCOLATION TEST Pedormed For: Chuck Ban' Legal Description: BLM Lot 179 Section 8 T15N. R1W OG/OL SW Well Graded Sand with Gravel 11 12 13 ;LOPE Was Groundwater Encountered? Yes If Yes, What Depth? 9.5' Depth to Water After Monitoring 9.5' Bottom of Date: 8116100 Hole Date Performed: SITE PLAN See Site Plan 14 1[ 17 18 21 Reading :)ate ;mss Net Depth To ',let Time Time Water 3rep I 21-Jun 1:35 2' 2 1:40 5 5' 3' 3 1:41 2" 4 1:46 5 5' 3" 5 1:47 2' 6 1:52 5 5' 3' Perc. Rate: 1.7 MinJInch Perc. Hole Diameter:. 6' Test Run Be~een 4 Ft. end 5 Ft. Comments: Percolation Cavity Presoaked Pdor to Testing. Materials Identical in Both Test Holes. Performed By: Tim Kirpbrormh. I, ~ichael E. Andemoe Cedify Thai This Test Was Performed In Accordance With All State and Municipal Guidelines In Effecl On This Date: 8~6~00 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, R~om 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Aug 29, 2000 Expiration Date: Aug 29, 2001 Permit Number: SW000341 Legal Description: T15N. R1W, Section 8, Lot 179 Design Engineer: 0014 Anderson Engineering Owner Name: Steven Weeks Owner Address: PO Box 671441 Chugiak, AK 99567- Parcel ID: 051-154-22 Site Address: 19831 Crabtree St, Lot Size: 108900 SQ. FT, Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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. 1~5~'The'following special provisions. ...... [?AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM AN ADDITIONAL PERCOLATION TEST L IN CONFORMANCE WITH AMC 15.65 AND SUBMIT IT WITH THE AS-BUILT INSPECTION REPORT. Received By: Issued By: Date: MUNICIPALITY OF ANCHORAGE Aftw Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 051 -154-22 Certificate of On -Site Systems Approval OSC251268 Expiration Date: 6/30/2026 Legal description T1 5N R1 W SEC 8 LT 179 Site address 19831 CRABTREE ST Current property owner(s) CALBICK REVOCABLE TRUST X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments By: Original Certificate Date: 7/17/2025 Thi cate of Site System Approval (COSA) is intended to demonstrate the subject sys m(snilis/are in substantial compliance with municipal code. The Municipality of Anchorage, Kvelopment Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department Phone:907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-154-22 Complete legal description T1 5N, R1 W, Section 8, Lot 179 Location (site address) 19831 Crabtree St., Chugiak Current property owner(s) Calbick Revocable Trust 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone Sarah Baker 907-952-0439 3. TYPE OF WATER SUPPLY: ❑■ Private Well serving # 1 dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 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 22 - See advisory if steel or fiberglass 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 $ 1J7iyo ZCOSADate of Payment 7 - TZ- COSA # 572'tX Waiver Fee $ Date of Payment Waiver # COSA Application_Ap2025.doc COSA Checklist_May2025.docx COSA Checklist Legal Description: Parcel ID: 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 Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. 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) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: T15N, R1W, Section 8, Lot 179 151-154-22 2.1 10/25/2000 82 0 81 0.288 18+ 6/30/2025 Crewdson Engineering 14 6/30/2025 *per 2010 COSA 49" 7/2/2025 8/16/2003 6 3 1600*6/30/2025 NO** 22 Plastic* *pump basin set below grade in insulated wood enclosure 7/1/2025 0 450+ 1 200 0 450+ 24 0 24 *>volume of rock x 0.4 in gallons, **none known ✔ COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/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 Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: 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 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 Phone Engineer’s Printed Name Date ✔88*✔ ✔✔ ✔✔ ✔ ✔ ✔✔ ✔✔ ✔ ✔✔ ✔ ✔ *Septic tank >100', Lift Station 88' with approved waiver Crewdson Engineering, LLC 907-280-9493 James Crewdson 7/14/2025 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 3�r�f s On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC251268 Subdivision: T15N R1W Block:Section 8, Lot: 179 907-343-7904 Fax: 343-7997 The septic tank for this property is 22 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 �, Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ,"5 n, ?r'(- - I-MA6- Lift Station/Pump Vault )% C -7r " 6StiAli AS}�11 4 Maintenance Log ©v+—s o� c�CU'1 n Owner Imo. e cc -J . CIC Street Address f ( Cft"L f e Septic Tank: -Sludge level flinches -Pumping: required es no -Pumping completed Cy no Lift station: -Pump basket cleaned yes no(''' -Effluent filter cleanedey s noLeno -Control floats cleaned e no -Proper float settings confirmed -Operation satisfactory Cyy�e, no Alarm System:�- -Dedicated electrical alarm circuit Q no -Audible and visual alarm inside dwelling no -Alarm system operation atisfactory ) not satisfactory Manhole Riser *Ground water intrusion at riser to tank connection yesn--N *Ground water intrusion around pipe penetrations yes -Weep hole functionalear s no� -Manhole lid: Functional e es' no Insulated no Properly Secured es no Other -All manufacturer required inspections and maintenance completed no Comments: / Q.1\LLI�riL�.' �/ V`c �kL P L OrCi�L \ e ��P 1VC' 0�A2' U NQ �t G r✓, \ �� m Lt, On rt -Shur \ -re't M x,(j- Qualified Maintenance Provider: Technician tv4'`�r,.,tt l ` -- �-x%v`��s'' Date of maintenance CompanySg:�XW;e-w ice, Signature Date Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-154-22 GENERAL INFORMATION Complete legal description Location (site address) T15N, R1W, Section 8, BLM Lot 179 19831 Crabtree Street Chugiak, AK 99567 COSA# L~ (L I C,[2 '~ ~ Expiration Date: ~- ~7~ - /'/ Current Property owner(s) Dianna R. & Jennifer Payne Mailing address P.O. Box 671977 Chugiak, AK 99567 Day phone Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address unless otherwise requested, COSA will be held bY DSD for pickup. 2. NUMBER OF BEDROOMS: Three (3) 3, TYPE OF WATER SUPPLY: Individual WelI [] 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 sample results. (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 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 Anderson Engineering Phone 522-7773 Address P,O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE ~ Approved for ~.~ bedrooms. Disapproved. Date 11/01/201o Conditional approval for bedrooms, with the following stipulations: By: Attachments: COSA Checklist X Septic System AdVisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev, 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: BLM Lot 179, T15N, RIW, Section 8 Parcel ID: 051-154-22 A. WELL DATA Well type Private IfA, B, or C provide PWSID # Well Log (Y/N) Date completed 10/25/2000 Sanitary'seal (Y/N) Y Wires properly protected (Y/N) Total depth 82 ft. Cased to 81 ft. Casing height (above ground) __ FROM WELL LOG AT INSPECTION Date of test 8/29/2000 10/17/2010 Static water level 52 ft. 24 ft. Well production 5 g.p.m. 4.2 g.p.m. WATER SAMPLE RESULTS: Nitrate N/D mg/L Other bacteria 0 Date of sample: 10/17 & 26/10 Collected by: A. Harala Coliform 0 colonies/100 mL Arsenic: N/D mg/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments Two Depression over tank (Y/N) N Pumper Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF Width 5 ff. Eft. absorption area 378.6 ft2 Monitoring tube Foundation cleanout (Y/N) ~ Date of pumping No Sludge C. ABSORPTION FIELD DATA Date installed 8/16/03 Length 52 ft. Total depth 5-6 ft. Date of adequacy test 10/17/2010 Results (Pass/Fail) Pass Fluid depth in absorption field before test 17 in. Elapsed Time: 1,440 min. Final fluid depth 17 Any rejuvenation treatment (past 12 mo.) (YiN & type) Y >18 in. Y colonies/100 mL For 3 bedrooms Water added 502 gal. New depth 21.5 in. in. Absorption rate >= 450 g.p.d. If yes, give date System type 5' Wide Trench Gravel below pipe 2 ft. Y Depression over field N Date installed 8/16/03 Cleanouts (Y/N) Y High water alarm (Y/N) N D. LIFT STATION Date installed 8/2003 '~Pump on" level at in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM VVELL ON LOT TO: Size in gallons' 6 (+ or -) "Pump off" level at Cycles tested Septic tank/lift station on lot >~00' ONe,) 88' (ES) Manhole/Access (Y/N) Y**** High water alarm level at in. Meets elam,R'& circuit requirements? Y N/A >100' Absorption field on lot >100' Public sewer main N/A seWer/septic service line >25' Animal containment areas >50' in. On adjacent lots >1oo' On adjacent lots >1oo' Public sewer manhole/cleanout Holding.tank N/A Manure/animal excrete storage areas Property line lO' Water main >1o' Water Service line >1o' ' Driveway, parking/vehicle storage >25' Curtain drain None Noted SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main N/A Water service line >10' Surface water >100' Wells on adjacent lots . >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation >10' Surface water. >10o' Wells on adjacent lots >lOO' F, COMMENTS: Existing Quonset on Lot Temporarily Connected to Septic Tank with Grinder Pump and 2" ABS Pipe. New Three Bedroom Home to be Constructed on Lot. See Waiver Allowing Lift Station to be 88' From Well, Lift Station is a Totally Enclosed Grinder Pump in a 6 Gallon ( or -) Basin. Basin Enclosed in Wooden Insulated Enclosure. review of Municipal m~s that the above systems am in ~n~an~ w~h MOA COSA guidelines in e~ on this date. Engineers Pri~ Name Michael E. Andemon, P.E. 1 ~/01/2~1~ COSA Fee $ /'~ q/~ Waiver Fee $ Date of Payment '~, i ~' I ~ O Date of Payment Receipt Number ~ Ciq ~ ~'~'-('/ Receipt Number (Rev. 11/05) I /I Lot '158 ~ S 89'56'55"E 330.10' GARAG[ 147.8' X 18.5' CONTAINER x 13.5' SHED WITH 4.0' LEAN-TO ENCLOSURES .., : .... ... "-:.:' ...:,......,..'.~..- .. '. . WOODEN~SETnc FENCE 8.6' x 10.2' SHED~. CLEANOUTS Lot 179 2.50 ACRES BLM RIGHT-OF-WAY RESERVATION S 89'35'54"W 329.90' TENADA AVENUE Lot A Lot 180 PUT PLAN AS BUILT X SCALE 1" = 30' GRID ~¥q VZ.5-J Project No. 10-204 Lo n g (907) 522-6476 Registered Land Surveyors (907) 522-4625 kglanglsOalaska.nef / JclanglsOalaska.net & Associates, inc. 1~500 Oaryl Avenue, Anchorage, Alaska 99515-3049 Phone Fax I hereby certify that I have surveyed the following described properly: BLM Lot 17g, Sec. 8, T15N, RlW, SEWARD MERIDIAN, ALASKA Anchorage Recording District, Alaska, and that the improvements slfuafed thereon are wlfhin the properly lines and do not encroach onto the properly adjacent thereto, fhaf no Improvements on the properly lying adjacent thereto encroach on the surveyed premises and fhaf there are no roadways, transmission lines or other visible easements on said properly except aa Indicated hereon. Dated thls the ?.,C~ Day of 4-~c.-rc~ff>~,~-. ,'~..g~ lc~, at Anchorage, Alaska If Is the responsibility of the owner fo determine the exlsfence of any easements, covenants, or resfrlcflons which do not appear on the recorded subdivision plat. ~_~,~.. ............ .~. -,~ %;%,", LS-~o~ .."~