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HomeMy WebLinkAboutCALKINS LT 3Onsite File Calkins Lot 3 #050-211-18 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221127 PID Number: 050-211-18 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑t Upgrade Name Velduis Jerry & Betty Trust ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 10635 Crest View Ln, Eagle River ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-230-1678 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Calkins 3 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ 25'+ TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ Material Number of compartments Lot Line 51+ NA Poly 2 Foundation $,$'* LIFT STATION Manufacturer Capacity Remarks *Not in soil structural prism, see record drawing. Gal. Ornamental column to septic tank separation: 5.9' Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Martin Construction Drainfield CO/MT3034 Inspector Crewdson Engineering LLC BENCH MARK (Assumed elevation)100 ft Inspection 15` 6-1-22 6-3-22 dates:2nd Location and description 3rd 4"' Bottom of siding at "BM" on record drawing ON-SITE WATER AND WASTEWATER SECTION APPROVAL `�.,�t�\��� -ow Conditional Approval: IF A4,1 Date •' ,r& P.� .to. •�yy �, •, mes A. Crewdson •. Septic System Approved Date 011527 i tJ��pROFES510NP� -' Note: this approval not include well permit requirements. trcev uoivu ia) DRIVEWAY 100' WELL RADIUS_ _ BENCHMARK BOS ELEV 100' 8.8' 1� 1 \ IN \ \ GREER POLY 1250 I7 - SWING TIES (feet) LEGEND A B FC 5.4 SCALE: 1 "=5' MH1 12.4 19.1 S1 15.9 20.0 DC 19.5 21.5 C1 23.1 23.4 NOTES 1. Ornamental Column The column supports unroofed ornamental joists/beams. Precipitation is free to fall through the unroofed structure to the uncovered 35 square feet of ground below. The column is greater than 5 -feet from the septic tank and satisfies the AMC 15.65.205B1c Exception. WM I V I JY. / IN -INV 94.1' OUT -INV 93.9' Crewdson Engineering, LLC Calkins Lot 3 OF• A�gsill Record Drawing j* . ' TH 9*+� ,;y 4 Plan and Profile • • •' •"' '...... I am rewdson l�+ FFG C11527 Prepared for. Jerry Veldhuis Date: 8-8-2022,11 T�'Fpp WQ - ... IONP�� W PO Box 671389 Chug iak AK 99567 • cellc.1@outlook.com Permit: OSP221127 Page: 1 of 1 \�A` , Cell/Text:907-280-9493 • Fax:907-688-2295 ALLC #112279 ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWDSON ENGINEERING, LLC AND SHALL NOT BE USED FOR ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING, LLC LEGEND PROFILE BM -bench mark BOS - bottom of siding SCALE: 1 "=5' BR - bedroom C# - cleanout ELEV D# - double cleanout EG 99.4' EG - existing ground MH 1 FG 99.6' ELEV - elevation n S1 FG - finish grade IAW - in accordance with IN - inlet INV - invert MH# - 24"0 manhole OUT - outlet S# - standpipe SFH - single family home TOT - top of tank SEPTIC TANK OUT rr�ier�uc+ I V I JY. / IN -INV 94.1' OUT -INV 93.9' Crewdson Engineering, LLC Calkins Lot 3 OF• A�gsill Record Drawing j* . ' TH 9*+� ,;y 4 Plan and Profile • • •' •"' '...... I am rewdson l�+ FFG C11527 Prepared for. Jerry Veldhuis Date: 8-8-2022,11 T�'Fpp WQ - ... IONP�� W PO Box 671389 Chug iak AK 99567 • cellc.1@outlook.com Permit: OSP221127 Page: 1 of 1 \�A` , Cell/Text:907-280-9493 • Fax:907-688-2295 ALLC #112279 ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWDSON ENGINEERING, LLC AND SHALL NOT BE USED FOR ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING, LLC /S89"42L52'E' 50.0' WELL \ 0 35.0' X GRAVELZ - 55.2' rr1 O v N O Lot 10 125.20' 1 111 8.1'x15.3' SHED a 5.3'x29.2' BALCONY MANHOLE RUANING Wu GRAVEL Lot 3 m 20,663 S.F. 10.2'x14.2' SHED 2.0'x6.5' CANT N C, YCHAIN-LINK PEN 0 L OJ Lot 11 M PC)f AI I I 1 N 89'42'52"W 125.20 } — — — — CHAIN-LINK FENCE) Lot 4 I Lot 12 10' UTILITY EASEMENTS PLOT PLAN ___ AS BUILT X_ SCALE _1= 40__ GRID _ NW 0055_— Project No. (907) " Daryl Avenue, Anchorage, Alaska oo9o951�54-43049 Lang & Associates, i n `+ (907) 522-6476 Phone (907) 522-4625 Fax o4 Professional Land Surveyors kenOlongsurvey.com o aFA jonathanOlangsurvey.com �oP •.ls DO I hereby certify that I have surveyed the following described property: LOT 3, CALKINS SUBDIVISION (PLAT No. 72-216) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the LL_1_ Day of __TQ w , '__'L__, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. ................................ KENII'Ht (� LAgq •: o .• "1�g�22 v �a F .......... yJOG AECC963 0 +' i 1- ti SPLIT—LEVEL CONCRETE 18.6' RESIDENCE 4 ^' a' \ mPORCH' 3.0' / C T 0 w - o o m x c O 9.9' A J4 SEPTIC „- - 25.3' PIPES T2 Z _ ORp,VE�' 5.7' CANT MANHOLE RUANING Wu GRAVEL Lot 3 m 20,663 S.F. 10.2'x14.2' SHED 2.0'x6.5' CANT N C, YCHAIN-LINK PEN 0 L OJ Lot 11 M PC)f AI I I 1 N 89'42'52"W 125.20 } — — — — CHAIN-LINK FENCE) Lot 4 I Lot 12 10' UTILITY EASEMENTS PLOT PLAN ___ AS BUILT X_ SCALE _1= 40__ GRID _ NW 0055_— Project No. (907) " Daryl Avenue, Anchorage, Alaska oo9o951�54-43049 Lang & Associates, i n `+ (907) 522-6476 Phone (907) 522-4625 Fax o4 Professional Land Surveyors kenOlongsurvey.com o aFA jonathanOlangsurvey.com �oP •.ls DO I hereby certify that I have surveyed the following described property: LOT 3, CALKINS SUBDIVISION (PLAT No. 72-216) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the LL_1_ Day of __TQ w , '__'L__, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. ................................ KENII'Ht (� LAgq •: o .• "1�g�22 v �a F .......... yJOG AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221127 Work Type: SepticTank Upgrade Tax Code Number: 05021118000 Site Legal Address: CALKINS LT 3 G:0055 Site Mailing Address: 10635 CREST VIEW LN, Eagle River Owner: VELDHUIS JERRY & BETTY TRUST Design Engineer: CREWDSON ENGINEERING, LLC This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: De par tIII ell t 5/20/2022 5/20/2023 20663 ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: 1 Issued By: Z1L Date: Date: S1.2 C40'�.2 0 MUMUp UTV OFHCHOR -/ GEE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-211-18 Property owner(s) Jerry & Betty Velduis Day phone 907-230-1678 Mailing address 10635 Crest View Ln, Eagle River, AK 99577 Site address sante Legal description (Sub'd., Block & Lot) Calkins, Lot 3 Legal description (Township, Range & Section) Lot Size 20,663 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank Q Upgrade (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 2_5 Date of Payment: 10 2-2 Receipt Number: 7 Permit No. 0-5O22 0 2 7 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc James “Jay” Crewdson, P.E. Email: CELLC.1@outlook.com Cell/Text: (907) 280‐9493 Fax: (907) 688‐2295 PO Box 671389 ● 18368 Amonson Road ● Chugiak, Alaska 99567 May 12, 2022 Onsite Reviewer Municipality of Anchorage On‐site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99519‐6650 Reference: Calkins, Lot 3 Septic Tank Upgrade Design Narrative The owner of the 4‐bedroom home would like to replace the existing septic tank. The existing septic tank will be removed in accordance with the code and replaced with a 1250‐gallon or larger new septic tank in accordance with the code.  The existing foundation cleanout will be inspected and reused/repaired/replaced to be in accordance with the code.  A new double cleanout will be installed within 10 feet of the septic tank outlet in accordance with the code. There are no anticipated probable adverse impacts to adjacent properties if the septic tank upgrade is constructed as designed. Please feel free to contact me if you have any questions. James “Jay” Crewdson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221127, Rebecca Carroll, 05/20/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221127, Rebecca Carroll, 05/20/22 ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264~t720 ON~ITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE I ~NEW MAILING ADDRESS 7?0 ~, ~)/~ ,' LEGAL DESCRIPTION ~ V ~ ~ LOCATION NO. OF BEDROOMS I owe,,,n= Manufacturer ~ ~e~ r ~Width ~ Liquid depth IF HOUE~DE: Inside length Well Manufacturer DISTANCE TO: No. of lines4 J~,e,, II 9' Length of eoch line 7~'_1~ ,o11,..l~' Dwelling Top of tile to finish grade Length Width Type of crib Crib diameter Well DISTANCE TO: Class Depth Building foundation Foundation/~/ ~ Total length ofllnes , Material beneath tile Depth Material Nearest lot line ~ ~. / Trench widt~_~ inches inches PERMIT NO. Liquid capacity in gallons PERMIT NO'E. ~, Distance between lines I?' Total fectiv a.a~or lion area PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to tot line I PERMIT NO. I DISTANCE TO: Sewer line Septic tank I Absorption area(s) OTHER SOIL TEST RATING REMARKS APPROVED 72~13 (Rev. 3/78) DATE LEGAL Lot7 MUNICIPALITY OF ANCHORAGE_. ~~'0 DepartmentF'~ Health and Environmentar ~rotection 825 ~ Street, Anchor.age, AK. .J501 264-4720 ~ ~,~ * * * HANDWRITTEN PERMIT * * * Permi~ #, I ' WELL AND~ ON-SITE SEWER PERMIT Applic~t: ~'J~/ U3~a_ . Mailing Address: ~O~~ Location: Phone Nu~er: ~ ~ ~ Legal Description: 0 ~ ~ ~/D Lot Size: "' T~e of Soil ~sorption System Is: Trench: ~ Drainfield: ~ Seepage Bed: Holding Tank: Max~ N~er of Bedrooms: .~ Soil mating(sq.ft/br) ~O The Re~red Size of the Soil ~sorption System Is: ' t~m mTN ~ ' GRAVEL D~H S '' WIDTH I ~/~ The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTICS) TANK SIZE = /~EU GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ' * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection.and approval by this departmen. will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements f~r on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the res~ence is remodeled to include more that~ bedroomS. /~pplicant Date: 5--- SW-P/024(1/81) ~-~MUNICIPALITY OF ANCNORAGE~.~ Departmen! If llealth and ' ~ EnvironmentL :Protection Pouch 6-650, Anchorage, AK 99502 264-4720 On-site Sewer/-W~r Permit HANDWRITTEN Permit No: ~-~ o ~--~ Date ssued: 51 Address: ~' Lot Size: ~ ~O (Sq. Ft. or Acres) , · Max Bedrooms: Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. Depth to pipe bottom(ft.) Gravel depth (ft.) Total depth (ft.) Gravel width (ft.) Gravel length (ft.) Tank size (gal.) Soil rating (sq. ft./bt) ID'-o ** Gravel length 75 feet requires multiple runs (not exceeding 75 feet each) ** Tank must have at least two compartments 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. 3. 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 lot. 4. I understand that this permit is valid for the maximum number of bedroo~ stated above, and any enlargement or modification 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 ELE CT RI CAL/~f0'~ . f S IGNED~:---~ , ISSUED BY: / b SWP/024 rev.1/85 4040 "B" STREET, ANCHORAGE, ALASKA 99503 PHONE: 907-279.258! Merkel Construction Box 42 Eagle River, AK 99577 Subject: Gentlemen: October 1, 1976 W.O. %17860 Subsurface Investigation for Suitability of On-Site Sewer, Lot 3, Calkins Subdivision, Eagle River Transmitted herein in accordance with your instructions are the results of the above referenced investigation as perfomed by us on September 27, and 28, 1976. The scope of this project is investigation for suitability of an on-site sewerage system. Included in this transmittal are: Test Hole Location Sketch Test Hole Log Explanatory Information Figure 1 Table A Sheets 1-3 The exploration was conducted using a Nodwell mounted Mobile Drill Model B-50 drill rig with a continuous flight solid stem auger. The rig is owned and operated by Denali Drilling, Inc. Drilling was supervised, the test holes logged and percolation test performed by Mr. O.M. Hatch, Geologist with Alaska Testlab. The test hole was placed at the approximate location shown on Figure 1. The log of this test hole is included as Table A of this report. ' In interpreting the log it would be helpful to utilize the explanatory information contained in Sheets 1 to 3 of this report. When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the free water level. For the percolation test, the test hole was filled with water and left overnight to saturate. On returning the next day, the hole was refilled with water and the drop in the water level carefully monitored over the next 70 minutes. This procedure is not a standardized percolation test, however, we understand that the Municipality of Anchorage, Department of Public Health and Environmental Protection prefers tests performed in this manner to evaluate a site for a proposed on-site sewerage system. Merkel Construct~--~ October 1, 1976 'Page 2 Using the above test, the observed minimum percolation rate was 13.3 minutes per inch. No water table was observed during drilling, but it should be noted that the free water level nozmally fluctuates seasonally and with precipitation. We hope this report meets your present needs. If we can be of further service, please feel free to contact us. Sincerely, MRN:rb Enclosures ALASKA TESTLAB Melvin R. Nichols, P.~. Laboratory Manager %O L6t 3, Calkins Subdivision W.O. #17860 Date: September 27, 1976 Logged By: O.M. Hatch Depth in Feet From To 0.0' - 1.0' 1.0' - 16.0' Soil Description Brown peat, Pt, damp, soft to stiff. F-l, brown silty sandy gravel, GM, damp,' medium to high ~ensity, occasional cobbles to 12". Bottom of Test Hole: Frost Line: Free Water Level: 16.0' None Observed None Observed DOC Co. DBa SULLIVAN WATER W LLS P, O. BC~ 272, CHUGIAK, ALASKA 99567 · TELEPHON :~ C2 !-2759 OWNEROF LAND /Y~I~'.~I~. f (,.ltC~,~ y ADDRESS ', I LEGAL DESCRIPTION ~-- 7' ~.- A,~.'~,,,~' 3','~0 PE~iT NUMBER : ~' DEPTH OF '¢ ELL ~ q ~ STATIC LEV£L OF WATER FT. DRAW DO;: N t.'f, GALS, PEP, H~ KIND OF CASING KIND OF FORMATION: From ~ Ft. tr. ~ Ft, From -~ 'Ft. to ~ Ft. From. Ft, to.~,Ft. Ft. to__Ft. From , From '~/~" Ft. to /~ Ft. From It. to Ft. From. Ft. to Ft. [~ From ~:~/~Ft. to ~;~ Ft. From. ~'.~ Ft, to.-,~..~Ft,. From_ ?~' '¥'~Ft. tO F_~'O Ft. From_ Ft. t~Ft.. From_ Ft. to .. Ft. From _Ft. to Ft. Ft. Ft.. Fi, Ft Ft. Ft. Ft. Ft. Ft. ~:t.- It, -Ft, .Fi Ft. Ft. _Ft MISCL, INFORMATION: From Ft. to From __ Ft. to From Ft. to From __ Ft. to From Ft. to From It. to From--Ft. to From__~Ft. to From Ft. to Fromm, Ft. to From -i Ft. to From" ' Ft.' to · ~.r~ - 'From ~FI, I~ ~ From FL t~ From -,, ' Ft. to From ~ Ft. to. -'"' '. From '" ~ Ft. to_ _ · .~ ...... ~T DRILLER'S NAME / 7'. ��1�UHMPA UTY ©F HCH0PRAGE Development Services Department j Phone: 907-343-7904 On -Site Water & Wastewater Section -- Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 0500211-18 1. GENERAL INFORMATION Complete legal description Calkins, Lot 3 Expiration Date:�� ZZ Location (site address) 10635 Crest View Ln, Eagle River, AK 99577 Current property owner(s) Jerry & Betty Veldhuis Mailing address same Real estate agent 2. TYPE OF DWELLING: Fx_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 907-230-1678 Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment i0la yTo o �a Receipt Number (1 50 50 6 COSA# OSCa�2 130 �o Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Crewdson Engineering Phone 907-280-9493 Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name James Crewdson Date 6/23/2022 By: Original Certificate Date: e // ZZ The Municipality of Anchorage velopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet .p may.TH 6. DSD SIGNATURE System #1 Approved for y bedrooms �,'. James A. Crewason : v t System #2 Approved for 011527_ bedrooms ��1�`FOp90 ..-",V1_ Disapproved \\0FES0 Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: e // ZZ The Municipality of Anchorage velopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of 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 of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION 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 Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Calkins, Lot 3 050-211-18 3+ 5-23-83 0 348 348 12+ Crewdson Engineering 5-2-22 256 7-26-2022 0 Septic/Poly na na 5-2-22 4 9.3 2 6.3 650 4 250 2.8 ft 2 600+ ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ 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 From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ 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 septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft 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 If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ✔✔ ✔ ✔ ✔ ✔ ✔ ✔✔ *✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ * House Foundation:8.8', Ornamental Post: 5.9'. Approved by permit OSP221127 ✔ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O, Box 196650 Anchorage, Alaska. 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING {'~'~ --~ ~ - \ ~ NAA# ~ [::~c~ ~/'Y'%c~ Ir) GENERAL INFORMATION Complete legal description Lot 5; Location (site address or directions) 10635 Cr~stvicw Property owner Mailing address Lending agency Mailing address V~:c/~ Harwood Day phone Day phone Agent ~)arlen~ Nicolayaen RE/MAX OF bAGLE RIVER Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 694-4200 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holdi .ng tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 121 · ~po~ s~eeu!§ua leUO!SSej0Jd eq~ u! suo!ss!Luo ~o s~o~Je ~o~ elq!suodsm lou s! e§eJoqouv ,to/q!l~d!o!unl~ eq/ 'panss! s! eleOU!lJaO e e~ojaq el~p eZXl~Ue ~o suo!~oadsu! ~onpuoo lou op SHHa,~o seeXolduJ~ 'SlUa~UaJ!nba~ el~ls pu~ ledepeJ u!eiJeo ~Js!l~s oi ~ep~o u! suo!lnl!lsu! 5u!pual ~!eql pu~ satuoq ,to sJaseqoJnd ol ~se~Jno3 e se S!ql saop SHHQ eq.L 'e>lSel¥ ~o el~lS eql u! paJels!§aJ Jaau!§ ua leUO!SSajo~d luapuadapu! ue ,{q e^oqe g .qde~§eJed ul ua^!§ suo!3eluesa~deJ eq1 uodn Xluo paseq sa1~OU!lJaO I~^oJdd¥ /qpoqlnv qlleaH sanss! (SHHQ) sao!~uas umunH pue tl~l~aH ,to luatup~dao e§~oqouv ,to/q!l~d!o!unl~l eq.L slueuJtuoo leUO!l!ppv :suop, elnd!ls I~U!MOIIOJ eLI1 LII!M 'SLUOOJpeq 'SLUOOJpeq JoJ leAoJdde leUOp4puoo 'pa^oJddes!o JoJ paAoJddv ,~ gl~n.LVNOlS SHHQ euoqd · uop, oedsu) s)ql jo e)ep eql uo lOeWe uj suo!ielnl~aJ pue 'seoueu!pJo '9 EI:I:INIDN:I Ag NOLL:D:IdSNI dO .LN31N:::IJ.VJ.S . . ~--~.~'~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: ~r~'''''~ ~"~l~'~z-!~-3S"'~l~ ParcelI.D. A. WELL DATA Well type'~'~ ~/~'~ Log present(~/N) Total depth Sanitary seal. N) If A, B, or C, attach ADEC letter. ADEC water system number Oatecompleted ~ -'Z-"/'~- ~5"~ Driller ~L~t--t---~,V/'~ \-~'t4. Date of test Static water level Well flow Pump level Cased to "~ ~"~" Casing height Wires properly protected ~N) y FROM WELL LOG ! SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ C:)'dC Nitrate g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Absorption field on lot Public seWer main Sewer service line WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~, ~), Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~ --~:); ~'~ Tank size \ "~-"~' ~:) Compartments Cleanouts~TN) ~f ' 'Foundation cleanout(~h'q) .~ ... Depression (Y/~) High water alarm (Y/N) '"Alarm te~t~d.~ (y/N)~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot . ~t .' ~. Onadjacentlots [ ~I Jr' Foundation [ ~:~ To propertyline I ~.~Jr- Absorption field ~z~ ~ ...... Water main/service line Surface water/drainage [ {;;~:~>1~' ~";i:'? :, ".'"'' ' 72-026 (Rev. 7/9 t) Front ,CONT'iNUED ON BACK PAGE C. LIFT TS~TION ..- Date installe~d----. Size in gallons ~~. · ~ "" Manufacturer Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on level at "Pump off" level at Cycles'tested To building foundation On adjacent lots -~t j~ Surface water Soil rating ~ ~ ~'~:'~-- ~ystem type _ w Gravel thickness '~ Total depth "" cleanout~s Present4~HN) ,/ Del~'ress!~n over field {~"~ 'Pe'roxide treatment (past 12 months) (Y~') SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent 10tS ~ ~t~ property line To existing or abandoned system on lot Cutban'k ~ ~~Water main/se~ice line Curtain drain t'-~ 1~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA Date of adequacy test ~' ~ I~--'~"~ for -- z~~ bedrooms ~~ If yes, give date -- Driveway, parking/vehicle storage area ~ IA-~' iuidelines in effect on the date of th~s inspection, Signature Engineer's Name Date 'S & S ENGINEERING Eagle River', Alaska HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number Surface water D. ABSORPTION FIELD DATA Date installed (u~- ~- (~'~ '' Length '"~,~:~ ' Width Total· absorption'area Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot · '~ On adjacent lots " CHEMICAL'& GEOLOGICAL LABORATORY A DIVISION OF COMMERCIALTESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 J)~J-l.l-qI3 l~.~lJl. T$ t~o'r I)~I/0ICF. It 50732 Che.~lab EeL! 92,0385 ~ample ! 3 liatzlx: ~!~EP, FAX: (907) 561-5301 Client 3aaple PW$1D : Collected : Jl~ 30 92 I 17:15 tme. [ecetved = Jl~ 31 92 ! 14:15 h~e. Client ~ame Client lcct ~eqt : O~de~e~ Send Repozte to: 1)3 & $ E#~I~ERI~ Pa~amete~ ~eeults Units Method Allowable Limits I~ITIU[T[-ll lID(O.lO) ~j/1 [Pi 3S3.2 Ee~atks: I Teltl ~e:fo~met ' ~ee ~peclal lrmtzuctiona Above UA-Unavailable ~- ~ono ~etectefl "~ee ~nple Red,ks lbove NA- Not l~l~e~ L~-Less ~n. Member of the SGS Group (Soci~t~ G~n~rale de Sur~e[llance) _. APPLIC"NT FILLS OUT UPPER HAL~'~ONLY Lending Institutlo~ ~/~fi ~ ~/~J(~ ~ ~ Phone Address Zip Code Realty ~. & A~nt Phone Address Zip Code Type of ~ Single Family Multiple Family No. of Bedroo~ D Other Water Supply ~ Indlvid~l A~ACH ~LL LOG. A w~l log Is ;~ulred for all wells drilled since June 1975. ~ ~mmunity . For wells ~illed prior to that date. give well depth (attach I~ if available). ~ Public Utility ~ Public ~llity When Connected to Public Utility:t, D Holding Tank NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: .RECE.I.V. ED ( L,/L) APPROVED BE°ROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED , ,CONO,T,ONA. APP,OVA" . DATE _1 "5. -'~ '-* ~ -~ Soils Rating Date Sewer Installed Well To Absorption Area // ,,~ Well Log Received · ALASKA I I uI Oi ITI I TAL COFITI OL S P, uIC[ S, II'lC. (~nqin~erinq ~, (~nuironm~nlaJ SlucJies December 5, 1983 Munlcipal{ty of Anchorage Department of Health & Environmental Protection 825 L. Street Anchorage, Ak. 99501 Re: Health Authority On December 2, 1983 our company collected a water sample from the house located on Lot 3 Block 0 Calk{ns Subdivision. The property owner Vickle Woods. The water analysis was satisfactory. A copy of the report is attached. The well is located 100 feet from the septic tank and 100 feet from the leach field. The ef-ectrical wires are encased in con~-ult. *All the st_a~Lp~-a. ~ed. The well-cas,n~ stands Z feet-above ground and has a sanitary seaL. 1200 UJcst 33rc~/~ucnue, Suite [~ · ~nc~oraqe,/~las~,a 99503 · {907/ 276-1361