HomeMy WebLinkAboutCRABTREE ACRES LT 22B
Municipality of Anchorage Page ! of ~--
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~,.Jq~oz~ I PID Number: O~'l-OclZ- ~'"~
N~: ~ Ct~ + ~ ~ ~5~ Wastewater System: U New ~ Upgrade
Address: Z~ ~~ ~ ABSORPTION FIELD
Phone:~ No. of BeCrooms:~ ~ ~eep Trench ~ Shallow Trench U Bed U Mound ~ Other
LEGAL DESCRIPTIO N so,, Ra~ing: Total Depth from original grade:
GPD/Sq,
Block Subdivision: Derh to pipe bottom from original grade: Gravel depth beneath pipe
Township: J Range: J Section: Fill aaaed above onginat grade: Gravel length:
I
Ft. Ft.
~ Gravel width: Number of lines: Distance be~een lines:
WELL:
New
U
Pg
rede
Ft. Ft.
Classification (Private. A,B.C~: Total Dept~: Cased To: Total absorption area: Pipe material:
Driller: Date Drilled: Static Water Level: Installer: Date installed:
SEPARATION DISTANCES c Septic ~ Holding a S.T.E.P.
To Se¢~c A~sor~bon L#t Holding ~ublic/Pnva[e Manufacturer: Capacity in gallons:
From Tank Fietd Station Tank Sewer Lines
/ Material: Number of Compartments:
Surface LIFT STATION
Water
Lot Size m gallons: ~ Manufacturer:
I
Line
Foundation
Curtain Pump Make & Model ~ Electrical inspections performed by:
I
Drain
Remarks: ~C ~ys~ As- ~u~- BENCH MARK
Location and Description:
O~L~ ~ ~[,
Inspections peflormeO by: Dates: 1st ~~: ~,~
Department of Ho~ ith an u So.ices approval
I'
T2-013 IRev 9/91) MOA 25
Permit No. ,, ~J~OZ.~i Page ~- of L
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Lo...r Zz.D
PID No.:
Permit NO.
~J c~'O~'~ / Page . Z.. of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION ~-0_~- ~
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
el?:
Legal Description:
RCV!)
MA~ 18 1996
Munic' t.~i,~y o~ Ancl~ofage
Dept. Health & Human Services
Municipality of Anchorage Page ! of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
.-ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 5~U c~"OZ~'~ PID Number:
Name: ~L/'~.~ /~//~/~C~ Wastewater System: ~w ~ Upgrade
~Oyd¢ ~~ J~ ~.~ ABSORPTION EIELD
Phone: ~ No. of Bedrooms:
~OO~ ~ Deep Trench ~ Shallow Trench ~ed ~ Mound ~ Other
Subdivision: Depth to pioe bottom from onginal gm,e: Gravel depth beneath pipe
Township: ~ Range: ~ Section: Fill aad~ above original grade: Gravel length:
WELL: ~T /~ ~ New Upgrade . Gravel width: /~ Ft. ~ I Ft.
Classdi~tion (Private, A.B.C): / ~ Total Depth: Cased To: Totat absorption area: Pipe material: ~
SEPARATION DISTANCES ~i~ ~ Ho~Ui~g ~
TO 5eOlic A~taon U~ Holding ~li~Pfivale Manufacturer: Ca~aci~ in gallons:
Sudace I ~ ~ >/~' LIFT STAT~
Water ~ ]~0 1 ~
Lot ~ I c~
Cu~ainDrain ~/~ ~ ~ Pump~Mo~el ~ Electrical Inso~tions pe~o~,~ by:
Remarks: ~~Hffl,;~: >~/~ BENCH MARK
Location ana Description:
I Assum~ Elevation: /~' ~ F~,,
ENGINEER'S S~L
Inspections pe~ormed by: Dates: ls
Department of Heait um es approval . -~.~-~- ...... ·
Reviewed and approved by: : ~Oate:
72-013 (Rev. 9/91) MOA 25
Permi.t No. _. ~l~J q~'~Z..~ I Page Z. of ~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAl. SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit No. '~ ~.~ <~ ~'0,7_ ~" / P~,ge ~ of -~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: PID No.:
.~...~ ................ ~ ....... ....... ~ ........ . ....... "..
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950251
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:RISNER ALICE E & LACEY
OWI~ER ADDRESS:20939 CRABTREE ST
CHUGIAK, AK 99567
DATE ISSUED: 8/30/95
EXPIRATION DATE: 8/30/96
PARCEL ID:05109264
LEGAL DESCRIPTION:
CRABTREE ACRES LT 22B
LOT SIZE: 49471 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
t. 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 (ISAAC80) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THIS SYSTEM WAS ORIGINALLY DESIGNED, APPROVED BY ADEC, AND
INSTALLED FOR A 4 BEDROOM DUPLEX. DUE TO A ZONING PROBLEM,
THE RESIDENCE WAS CHANGED TO A 4 BEDROOM SINGLE FAMILY
RESIDENCE.
RECEIVED BY: '~~~ ~ ~'-~
ISSUED BY: ~~~/~ X
DATE
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
August 18, 1995
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lots 22B, Crabtree Acres Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The owner of this property originally intended to construct a duplex. The
septic system and well were designed to serve the duplex and submitted
to ADEC for review and approval. Once approval was received the septic
system was installed in accordance with the approved design. The owner
then discovered the zoning in the area would not allow for multifamily
housing. He has now decided to construct a four bedroom home. We hereby
request a permit be issued to construct a well and septic system to serve
a four bedroom home.
The percolation rate of the soils underlying the absorption bed is less than
I minute per inch. A 2' sand filtration layer has been designed to slow the
percolation rate of the septic effluent. An application rate of .7 GPD/SF
was used to size the bed. The lot is fairly flat and the surface drainage
will not be impacted by this construction.
If the system is installed as designed the following statements may be
made:
The system, if constructed 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.
Lot 22B, Crabtree Acres Subdivision
August 18, 1995
Page Two
The system, if constructed as designed, will have no adverse impact
on reserved space, either surface or subsurface, on any lots located
in the area.
on drainage patterns in the area.
be maintained.
The system, if constructed as designed, will have no adverse impact
The current drainage pattern will
Sincerely,
Michael E. Anderson, P.E.
Attachments
JOB
SHEET NO.
CALCULATED
CHECKED BY.
SCALE
OF
DATE
DATE
Z
Ill 'm
mom
C~ "n C3
-'
LOT 22B, CRABTREE ACRES SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home
Perc. Rate: Less Than I Min./Inch
Application Rate: .7 GPD/SF
Shallow Bed
1,250 Gallon Septic Tank
Min. 2' Filter Material
4 Bedrooms X 150 GPD / .7 GPD/SF = 857 SF of Absorption Area
857 SF / 18 LF Wide = 47.6 LF Length
Therefore: Construct a Shallow Bed Absorption System 18' Wide X 50'
Long at the Location Shown on the Site Plan. Distribution Pipe Placed at
3.5' Below the Ground Surface. Two Feet of Approved Filter Material
Must be Placed Below the Distribution Pipe.
///,y,./
' /.,' b' 3'
i$ ! I I I
NOTE:
TYPICAL SHALLOW BED SYSTEM
(NO SCALE)
~'~ ,?.~
Bottom of Bed to be 4' Above GroundwaterS~.~,~-]'/.,.~
Grade Area Over Bed to Drain Away. ~'~:~ ·
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERF(
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
2O
(:,OATLS O/r.../.,cA ~,1
COMMENTS
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? __
s
IF YES, AT WHAT
DEPTH?
E
Monitoring? DaI~
Gross Net Depth to I Net
Reading Date Time Time Water Drop
~O:l~,, ! ,.;'/z..."I t'l'z.." i
I0;~7 I (~" i 'i~." ']
PERCOLATION RATE ~' / tmmutes/mch) PERC HOLE DIAMETER
TEST RUN BETWEEN~' FT AND ~5 F'r
T' -~" /5 F,4 5-r.~- ~ ,j I ~ ~ ~ u,r' -c'
ACCO"DANCE W,T. AL~ STAT~AND MUN,C'"A' ~U,DEUNES'N EFFECT ON,.ls DAT~ DATE:
72-008 (Rev. 4/85)
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: Lot 22B, Crabtree Acres Subdivision
GENERAL:
1. The scope of this project includes the installation of a
1,250 gallon septic tank and the construction of an 18' X 50'
shallow absorption bed with 2' of filter sand to be placed
atop the porous GP material underlying the bed.
2. Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all
underground utility locates and for the layout of the septic
system and verification of the location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK INSTALLATION/REPAIR
The existing septic tank shall be exposed and checked for
leaks on all surfaces. If leakage is detected a new septic
tank must be installed.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts
for pumping access.
Lot 22B, Crabtree Acres Subdivision
August 18, 1995
Page Two
3. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of
12 inches above final grade.
5. Septic tanks installed without 4' of cover shall have a
minimum of 2" of direct burial insulation.
6. A foundation cleanout shall be installed one to four feet
from the building foundation. Two cleanouts shall be
installed between the tank and the drainfield. The first
cleanout shall be located on undisturbed soil not more than
10' from the tank. The first cleanout shall be to clean
toward the drainfield. The second cleanout shall be to clean
toward the tank.
7. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown
on the design. The bottom of the bed shall be within 2" of
level. The bed shall not be installed on a slope greater than
10%.
2. Distribution piping must be placed level with perforations
down atop a level bed of drainfield rock. Rock should then
be placed over the pipe to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
Lot 22B, Crabtree Acres Subdivision
August 18, 1995
Page Three
5. Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any community
well.
6. Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to prevent
settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the
drainfield rock. Contractor shall verify this condition prior
to placement of the rock. All pockets of unacceptable
materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated, but
not solid) and ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
Lot 22B, Crabtree Acres Subdivision
August 18, 1995
Page Four
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 seive.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
Contractor shall provide a copy of all field survey layout and
construction notes for use in preparing the certified as-built
of the completed system.
FILTER MATERIAL SPECIFICATION
FILTER MATERIAL MUST BE WITHIN THE FOLLOWING SIZE
LIMITS:
The maximum diameter of the smallest 10%
(effective grain size) of the particles
between .25 (Number 40 seive) and 1.0
(Number 8 seive).
by weight
shall be
millimeters
Bm
The ratio of the maximum diameter of the smallest 60
percent by weight of the filter particles to the
maximum diameter of the smallest 10 percent by
weight (uniformity coefficient) shall be less than 4.0.
Not more than 5 percent by weight of the particles
finer than .074 millimeters (Number 200 seive).
MAR--08--96 FRI 16 :~8 SEWAR~ & A$SOC LAN~ SURV 90? 6940830 P.O1
96-03-11 07:46 RCVD
ASBUILT- ' ... ".__. ' ..... =' S~4AI~D & ~SOCIATES LAND Sb'~V~YING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: ~ ~~_
FOLLOWING DESCRIBED PROPERTY; '/~-:~ ~ ~'~ A ~
~.~ ~ .o ~.~.M~.TS ~x~s~ ~c~ ~s ~~ ~"' ~ '"~".
INDICA~D. IT IS THE RES~NSIBILI~ OF THE ~_
WHI~ ~ NOT ~E~ ~ THE R~ ~BDi-
VISION P~T. UNDER NO CIRCUMSTANCES S~ F~ ~.". LS- ~l e -' ~
~Y DATA H~EON BE US~ FOR ~NS~U~iON ~_~ ~, e~ '.. .."~
~ FENCE LINES~ OR ~R E~LISHING ~ND- ~AWN[ ~s~~
A~Y EINES. ~
MUNICIPALITY OF ANCHORAGE
gfk
Development Services DepartmentPhone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-092-64
1. GENERAL INFORMATION
Expiration Date: i 1 ^ 3 - Z
Complete legal description CRABTREE ACRES LT 22B
Location (site address) 20939 Crabtree St Chugiak AK
Current property owner(s) SEMPSIS MICHAEL & KAREN
Mailing address
Real estate agent
PO Box 672247 Chugiak
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone _
AK 99567
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
El
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ -5-60
Date of Payment ?�14 /Z 1
Receipt Number 01770 D
COSA # 0SC2 I N00
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Eklutna Engineering, LLC
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend, PE
6. DSD SIGNATURE
System #1 Approved for _q_ bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
Phone 907.406.1058
Date
•�tqs��
oaeao T tea•••
Date�
No. CE 11904 . •��``
bedrooms, with the following stipulations:
ON-SITF
WATER AND rr
o ,_
m PRCJQ
� l JF1Ati/1 E
B 1�" Original Certificate Date: S r z �2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
.representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisory
Other -Ttieez�—� � Age JU UiSiUr'y
Legal Description: CRABTREE ACRES LT 22B
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 1995
Total depth 160 ft
Cased to 150 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) ' 24 in.
Date of flow test for COSA 7/1312021
Static water level at beginning of test 54 ft.
Comments
B. TANK DATA
Age of tank(s) 26 years
Tank type/material septic steel
Measured operating fluid level in septic tank 50"
❑ Standpipes/foundation cleanout per record drawing
Date of pumping June 23, 2021
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1995
0 ALL standpipes present per record drawing
Total measured depth from grade 4.0 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
R Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 051-092-64
Structure served by this system
Well production at time of test 5.2 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? R Yes ❑ No
0 Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic 1.77 ug/L ❑ Arsenic less than MRL (ND)
Collected by Curtis Townsend
Date of Sample 711812021
C. LIFT STATION
❑ Required maintenance com
Age of lift station year's
Lift station material
Comment
Adequacy test date 7113/2021
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 601 gal
New depth 0 in
Elapsed time 0 min
Final fluid depth 0 in
Absorption rate � 600 gpd
Any rejuvenation treatment (past 12 months) no
If yes, enter date
- '_C.A• 011k 1 I1
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0✓
Yes
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25'M Yes
if No ft
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' M Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No ft
Water Main > 10'
Animal Containment > 50' Yes
if No ft
M Yes
if No
ft
Q Yes if No ft
Water Service Line > 10'
0✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' 0 Yes
if No
ft
Q Yes
if No ft
From Septic/Molding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0✓
Yes
if No
ft
Surface Water > 100'
M Yes if No ft
Property Line > 5'
0✓
Yes
if No
ft
Wells on Adjacent Lots:
ED
Absorption Field > 5'
0
Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'
Q Yes if No ft
Water Service Line > 10'
0✓
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'
0
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
ED
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
0✓
Yes
if No
ft
Community Wells > 200' P/1 Yes if No ft
Surface Water > 100'✓0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that t 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.
COSA Checklist yellow sheet
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT.� � 907-343-7904
On -Site plater and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC211400
Subdivision: Crabtree Acres lot 22B
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 26 years old. Typical replacement costs range from $8,000 to $11,000
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 20 -year-old steel tank MAY look like.
an,F fi>
��� � � Mailing address P O Box 196650 *�Anc�iorage, Alaska 99519 6650 *www muni org
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
051-09-.-264
GENERAL INFORMATION
Complete legal description
Lot 22B, Crabtree Acres Subdivision
Location (site address or directions)
South on Crabtree Street off Birchwood
Loop Road.
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Jerry Scheib
P.O. 'Box 670701 Chugiak,
Day phone
AK 99567
688 4820
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Four
TYPE OF WATER SUPPLY:
Individual well xxxxx
Community well
Public water
NOTE:
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
Holding tank
Community on-site
Public sewer
NOTE:
XXXXX
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 #21
STATEMENT OF INSPECTION BY ENGINEER '
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that base~t on the information obtained from
the 'Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm Anderson Engineering Phone 563-7155
Address P .O. Box 240773 Anchorage , AK 99524
Engineer's signature /1'/~'~/t4~-~ ~ ~'~¢-?'--"' Date 3/16/96
DHHS SIGNATURE
~ Approved for (~>
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The ~l~nicipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued, The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA i~21
Legal Description:
Municipality of Anchorage ~
DEPARTMENT Of HEALTH & HUMANSERViC ECE IVED
Environmental Services Division
825"L" Street, room 502 ® Anchorage, Alaska 99501· (907) $45-4744
MAR ]8 7996
Muz}iC]pality of An
Oept. Health & ~,,"-_c_h..°rage
Health Authority Approval Checklist .... ,,=. ,.~erv/ce8
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary. seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to i ~ O. Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG
i
/i7
AT INSPECTION
g.p.m, g.p.m.
WATER SAMPLE RESULTS:
Coliform 0
Date of sample:
Nitrate ,, i /n ,~ IL Other bacteria
-'Z/Zq/qb Collected by: /4. /'~.
SEPTIC/HOLDING TANK DATA
Date installed O/¢/qe~'
Foundation cleanout (Y/N)
Date of Pumping
Tank size /ZOO Number of Compartments ~ Cleanouts (Y/N).__
Depression (Y/N) /X] High water alarm (Y/N)
Pumper ~ P/$ HLW
Co
ABSORPTION FIELD DATA
Date installed
Length ~ P ~ Width
absorption area ¢/ggg/'~4V/-~Monitoring Tube present(Y/N)
Effective
Date of adequacy test de'w~ ~ ~o.~ ;Results (Pass/Fail) P/}-~;
Soil rating (g.p.d./fl: or ft2/bdrIB) o 7 System type
/ b Gravel thickness below pipeo ~ i Total depth
'x(/ Depression over field (Y/N)
For /~)thC_. bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth ~Y ,(ins.) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Immediately after
Absorption rate =
If yes, give date
__ gal. water added (in.):
~' ~ 0/) g.p.d.
Date mstallcd -~~-~_~ Size in gallons
Manhole/Access (Y/N) ~ "Pump off' level at*
High water alarm level at* *Datum ~-~~~
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
!
Septic/holding tank on lot ~ / 0 ~?
!
; On adjacent lots ~'/PO
Absorption field on lot
> /(,2 0~ · On adjacent lots >/00 t
Public sewer main
Public sewer manhole/cleanout
Sewer/septic service line
) b~ ' Lift station /'d]~'Mc~ r~M ~or
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~> ~- Property line ~ I Absorption field
Water main/service line ~>~'-0 Surface water/drainage >/00 Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Buildiug foundation > Z~5 ~ Water main/service line ~3 S.~D
Surface water ;> ? 0 0 ~ Driveway, parking/vehicle storage area
Curtain drain A]0M e' O,,J [~ r' Wells on adjacent lots '~jO0
Property line
ENGINEER'S CERTIFICATION
I certi~ that I have determined thrufield inspections and review of Municipal recor~t O~ above s2~$~,~s are
in confortnance with MOA H~ guidelines in effect on this date. e*~:.~ ,,:,~, v ~(' '~' "' .... ~ ..... ,.~ .~."'" '"
Signature
Engineer's Name
Date
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
Rev. 8/95 DSS: haa.wk.doc
q
66'lrgt · · ....
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06'6~ ~,..~,0.00.
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A
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~g'6~9
DANIEL SUBDIVISION
LOT 2
LOT l0
1.DIRECT VEHICbI_A~ ACCESS FROM LOT 22B ONTO
· 8IRCH~IX)D LOOP ROAD IS PROf~BiTED.
LOT 23
LEGEND
~ F .g~Ii~) 21/z" D)A~I. ALbld, CAP WONE~iEi,,[T, ON A
2~' O.DI.P. ~' ABOVE GR(KA~. )~RKEO AS SHOWN.
SET 3V4" AI.Ulvt CAP IdoNUI~ENT ON 2"x50" ALUk[
PiPE SET Z ABOVE GRt~J~, )4~RKED AS SHOWN.
o , FOUNO ~' IRON REBAR
· SET ~'~30' IRON REBAFLW[TH SUR CAP, I l/2"
N V2 LOT 26
TYPICA~ SUR CAP
I
~YEY~'S CERTIFI~TE
~ ~y ~b~n, profe~$i~l/~nd ~uyv~yor do hertbZ c~ify
lh~ th~ ~ aY ~r~Wee Subdivision ~ o true ~nd correcl repre~lol/on
c~r~ly ~d t~ ~11 permanent ~x/~rior control monumen/x oil other ~ OF ~-~
CCo
oO
i ' LoT 22B
49.471 SF
49,470 SF
~:-.. LOT 27~
DOLAN SUBDIVISION
ACCEPTANCE OF DEDICATION
The Municipality of ~nchora~e hereby accept~ for public u~e$ an~
for publ/~ purposes /he real property dedicated on thi~
including, but no/ I/mite~ lo /he easements, rights-of-way, alleys,
roadways, thoroughfares and par~$, shown hereon.
Dated ct Anchorage, ~lo~c this ~_~~, day of ~_~ ~ · 199~.
A/ted~
12
LE"~J, MARKED NVZ.
REPLACED WITH -~'x~" F~B~
LOT ~l
LOT 28A
TAX CERTIFICATION
~/I real properly/oxe~ -levied by/he ~4#nl~/~o//ly of
Anchorage on /he urea shown on thy~ plat hove been
paid.
CERTIFICATE OF OWNERSHIP and DEDICATION
I (~v~ hereby cerlify/ha/I [we/hold /he herez~ ~pecified property interest
in the property described hereon. I (wel hereby dedicate 1o /he Municipality
of Anchorage cfi ereos depicted for use as pub/lc ulill?y easemenl$, s/reels,
alleys, thorough/ares, porks, and other public areas shown hereon. There
~holl be reserved adjacent to the dedicated slreet~ shown hereon, a s/ope
reservation easement sufficient to contain cut and f/il s/opes of I.~ feet
horizon/al for each I foot vertical (I. 5 lo I) of c~d ar fill far the purpose of
providing and molntainin9 /he lateral suppod of the constructed
There ~ reserved to the 9ranlors, /heir hells, succes$or~ and ossy~ns, the righl
1o u~e such areas at any lime upon pravidin9 and maintaimhg other adequate
lateral ~upport, os approved by/he Munlcipahty.
1 (we) hereby agree to /hy~ pla/, and lo u~y re$lric/ion or covenant
hereon and any such reslrlclion or covenonl shall be b/~ding and enforceable
o~a/~s/ present and successive ~wners of/his subdivided prop~y.
Buell ~ Tatum Hose Tatum
20925Crob~eeS/. 20925Crab~eeSl.
Chugia~ ~k. 99567 Chu~ia~ ~k. ~95~7
NOTARY ACKNOWLEDGEMENT for BUELL omi ROSE TATUM
L 0 T 22B and ~' '
AI/~e E. f~i~ner Lace~Risner '
15295 Wood Rood 152.95 Wood Road
Riverside. Co.
NOTARf ACKNOWLEDGE~NT for ALICE and LACEY RISNER
VICINITY M.4P 5~£E: f' = 1 MILE
?
PLAT OF
CRABTREE ACRES, LOTS 22A & 22B
A SUBDIVISION OF
BLU LOT 22, WITHIN NE 1/4, SEC. 8, T.15 N, R.1 W, S.~., AK.
WITH VACATI~ RESOLUTION NO, 93-48
ANCHORAGE RECORD]NG DISTRICT CONIAINING ~.~T ACRES
NORTHERN SURVEYS
P,O, Box 111132
Anchorage, Alaska 99511
~r,d NW 1357 [sc=/~ 1": lO0' j Da/e ~,~)V. 12, 93
Dro.,~ ~LC - ~F/?eI No. S-942~_.~'0/ No.
Eoox- 92 Page 6
"DTIO00021-'