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HomeMy WebLinkAboutRABBIT CREEK BLK 3 LT 6Rabbit Creek Block Lot 6 3 #017-063-17 CI of Anchorage jMunicipality Development Services Department ir•i i �f" T/ Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. �f P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.m (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. PID Number: Name Peter Crimp Wastewater System: 17 New ❑ Upgrade aaa 6743 E. 140th Ave., Anchorage, AK 99516 ABSORPTION FIELD Rmnt 345-7019 N.WCN t000na 4 EIDeepTt*mhl35to11oa TnnN❑Btf ❑Ltounf ❑ot— LEGAL DESCRIPTION 5w It" 0.8 Tial Capin nom onplal Waft GPtVFr` 10.5-11 Ft B 1, Lot suhavaolt 3 6 Rabbit Creek Degan W P" eoaan ". olgral Waoe GavNeep bamartnppa 3.5-4 FI. 7 R Towmny Rare. Seotgn Faafftfaowaollpmi Waft Qrn Ltnpm 0 F, 32+30=60 FL Well: El New [3 Upgrade Gl" adth 3 Nuntar Orblob D -"`I hveananea FL 2 14 Ft CaW.txn(Proalt"A, S. C), Tial Dapel caatfb Tml.t Ptwaaa Pp Maitlal Private 367 FL 1 161 Ft 666 Fr I ASTM 3034 Ditty Alpine Driller Da" pMf 6/10/03 SUM Warr L" 150 lnaaWM. Scotts Services Dar lmaq x 7/7/03 R Y" 2 Pu" Sat a[ gl1 laea CaWV leAim G TANK GP4 �rp R. 2 R SEPARATION DISTANCES El septic ❑Holding ❑S.T.E.P. ❑Other: To Septic Absorption Lift Holding biitJPrlvete • •aW« wur From Tank Field Station Tank SWer Line Greer 1250 Gal vrot 120+' 130+' N/A N/A 70+' %canal Steel N 2 awmP+�vl»na saae.w.el 100+' 100+' N/A N/A LIFT STATION L«Lb 50+' 10+' N/A N/A W, .n . W.l Pumpon.l tat T+u Pty 1 Nqh Waal tam tt Faadtixrl 5+' 15+' N/A N/A h h cufnn Dia- NIA N/A N/A N/A R«'p M.Mb I:NC4GllillptCOJM pNbllllef py R«n'"' BENCH MARK Lecal,un the 1p�en Garage cement slab aun b+awn 100.0 R E�adlcllt`, .a 00 ga 00 Inspections performed by: Fred W. Kenley Dates: 1"7/7/03 of TM •�tk 2ne 717/031.&. 40at: a • -a . Developm t Services Department Approval +,9 = T. • 4 CE 8176 ; Reviewed and approved by ate: `_ (Rt. 1210) .. Permit No. Page Z of 4 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 LOT 6, BLOCK 3, RABBIT CREEK SUBDIVISION PID No.: . . . . . . . . . . ,.+., .:... � . :...... . ,/. I •�. �� i it ...:. . . . . . 1 , . ...—...... a� �.' .' . . . . .. . 'g: 111 . . . . .,. - -_ ----- ,--, _-� ,/A... . .. . �• I s ENGINEER'S SEAL ��P• e <�'kt�I 6/ ¢f 0000 . . . . . . . . . . . . . . . . . . . ll Permit No. Page 3 of 4 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 1 nTC ❑I nnl/ Z 0AMMT nD[*CV CI IDI'11VICIAKI ,,, .. .. .. ., ... ..... _.. nu IVO.; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • • = • • • 'ZJ : • • • • • • Q N I . . . . . . . . . . . . . . . . . . . . . . . . . � r . . . . . . . . . . . . . bi . I . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . Permit No. Page 4 of 4 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: LOT 6, BLOCK 3, RABBIT CREEK SUBDIVISION PID No.: A 1 01 ,S'04 S31 VA • NE . . . . . . . . . . . . . •O O ."L 't, 01 ;S'C S318YA cd �> 6 � • 11 • N ' . . . . . . . mW ..... ..... . y G N N NE . . . . . . . . . . . . . •O O ."L K. . . . . . . . . . . . . . . . . . .g SEAL � v r• �> 6 � • 11 W W . . . . . . . mW y G N N it K. . . . . . . . . . . . . . . . . . I1 Z 01 .g SEAL � v r• �> 6 � 00 / ? / ♦ o : �I W = .0 . . . .g. I1 Z 01 .g SEAL � v r• �> 6 � 00 / ? / ♦ o : �I W = .0 i �' monoay, may w, zuw w: no rm rew, allu mule wlouol f.w v.u4 - • .� _ _ - ....Isis .. �...-..z .. /,.. i7eessaaa.aesnase ar •r� .12198 "C'.7 It St1 'I yyh/41411Y11\ Vl f1V 414! 41fM !!\111141! VVl IIVYJ 'AA. .. •• C1f -1 llf0G1 ` w/ (.V UVA 1JVVJV M111.UVIpye raOJhp JDJ 1yVVJV Rick Mystrom hhnmwnv n »nennnv+ e! 1 Mayor Permit Number: #SW 030095 Date of Issue: 445-03 Parcel Identifeation Number: 017-063-17 Date Started: 6-10-03 Date Completed: 6-10-03- is well located at approved Permit to atior? Yes [1 No Legal Description: Rabbit Creek Sub Blk 3 Lt 6 property Owner Name & Address: Peter Crimp & Paula Cutlenberg 6740 Crestline Road anrhnrnae. Alaska 99516 Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From o Stick-up 0 2 silt 2 5 gravelly silt 5 32 siltygravel 32 56 gravelly silt 56 99 silty gravel wet 99 103 silt 103 122 gravelly silt 122 154 bedrock 154 367 Method of Drillinl; [E air rotcry r] cable tool Casing type: —Steel Wall Thickness: 150 inches Diameter: 6 inches Depth: 161 fact Liner Type: Diameter: ir.chcs Depth: feet Casing stickup above ground: 2 fret Static water level (from ground level): 1Qfeet Pumping level: 367 feet after 2 hours pumping 2 gpm Recovery Rate: 2 gpst, . Method of Testing: gilift Well Intake Opening Type: ❑ Open End X31 Open Hole ❑ Screened Startfact Stopled feet ❑perforations Start.—fact Stopled fat Grout Type: bentMi-le Qranules Volume: Liz ne n• Stnrtof.ct Stopped feet Pump: Intake Depth _ feet Pomo size liplirandNarne Well Disinfected Upon Completion? 9 Yes 0 No Method of Disinfection: chlorine tab'ets Comments: Well Driller. Alpine Drilling & Enterprises PC Bcx 110496 An,;ho-age Aktska 39511 Attention: The lwell ldriller shall provide a well lol.to the property owner within 30 days of completion and the property E /09LIM-. E3MT. zly — of —--------••------------------ « J✓ I O LOT 5 • = SEPTlC S R "S � Z3 v ,'e T1'CK9 SO .� 3. N yz4w w, 4 �1 EwsrirVa �'TRUC7uRE I ® WELL E. /40TH AVENUE r Q 43, 633 S.F kl Sv n rZ 10 ,302 ° —SECT/OnI !JIVE —� all 01 33F77 SECT/GW LINE ESMT. c� j _\ Lot 6 b/ lock /�L /V ° of •A`As�9tl Rob Creek S46at /s;on Anchorage Recording District, Alaska 11:401 sofs of nerd other thew thoof the Nee of record ors het shows :.ere" .«•j otherwise 00144. LOT SURVEY CERTIFICATION LEGEND s:, Risteyl" .i�,e I hereby wnfy that toes sere•yed eke prop«hr shown ad deeateee 0 Brass or Aluminum copped monument %cP�Ito, .•..• r,J� wl UnWe that IN se a44 de pot wwriay or tower"00 M 0aloomf ProWty OW Prop - 0 Iron hub�ekrrecoborvered vemd. l; p40FESS�ON �I,+ so Iwo o,ono, 9 on oalao.nt property owtop or soerosek on the pre•Isos • 5/8" x 90" rebor set this survey %\ In W" otl0n one nwt Mae we 0e roadways, wtnty two, or ether visible 5A IS OF VERT/CAL Z)A7UA1 wes.ew on sole preWY eeeept a Wleeled herew. _ /927 N.G.S. /97Z ADUUST. Scale �i° l Date Prepared by: R. L. BUTTON / ° © krvoyw 05-05 -03 (9,'1279-6200 5IRW. EothA e. We 9X.0/ Ref. F.B. No.Property of: PETER CRIMP - -6O PAULA CULLEN ERG l Municipality of Anchorage MarkBeyich, Mayor =�" .. t a �-/ 511 f.i• Building Safcty Di -s isiorl P.O. Box 19CkW * 4700 Bragaµ• street Anchorage, Alaska 995196650 • (907) 343.8301• Pae (907) 343.8:00 littp://%M�,.mitni.org March 31, 2004 Peter Crimp & Paula Cullenberg 6740 Crestline Road Anchorage, AK 99516 Subject: On -Site Water and/or Wastewater Permit. Permit Number: SW030095 Legal Description: RbifCreek Block 3 Lot 6 Dear Mr. Higgins: An On -Site Water/Wastewater Permit, number SW030095 issued by this office for a single-family system, will expire on April 24, 2004. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well permit. If you have any questions, please call this office at 343-7904. Sincer Ja •s Cross, P.E. Manager On -Site Water and Wastewater Program Enc: Copy of permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW030095 Date Issued: Apr 25, 2003 Expiration Date: Apr 24, 2004 Parcel ID: 017-063-17 Legal Description:4RABBIT CREEK SUBDIVISION BLOCK 3 LOT 6 ' Design Engineer: 0069 Douglas T. Kenley, PE Site Address: 6740 CRESTLINE ROAD Owner Name: PETER CRIMP & PAULA CULLENBERG Lot Size: 45630 SO. FT. Owner Address: 6740 CRESTLINE ROAD Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516 - 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. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify 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). 1 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. Received Issued By: r Date: �lcur Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-06-3-17 Permit Number SW 0306 9S Property owner(s) OEs6,� G',c.vlp Day phone SITE 4aeg4wtaddress (1) 6 740 CRES"7 NF ROAD Mailing address (2) AAlcHog,4r,,E Lfi 5'k/4 Zip Code 757-5-146 Legal description (Lot, Block & Sub'd.) 4v)' Legal description (Section, Township & Range) Lot Size Acres/0 4S 630 THIS APPL16ATION IS FOR: Number of Bedrooms y Sewer Only ❑ Well Only ❑ Sewer and Well Q� Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: �Qxx' Date of Payment: /d o' Receipt Number: �b (Rev. 12100) Waiver Fees: Date of Payment: Receipt Number: Douglas T. Kenley, P.E. 9960 E. Puffin Drive, Palmer, Alaska 99645 (907) 746-1073 April 6, 2003 Municipality of Anchorage On -Site Services 4700 South Bragaw Re: Mr. Peter Crimp, Owner Lot 6, Block 3, Rabbit Creek Subdivision Anchorage, Alaska PERCOLATION TEST RESULTS AND GENERAL SITE INVESTIGATION REPORT On June 15, 2002, an inspection was conducted on the above -referenced property of approximately 45,630 square feet, which site is located at the end of Prator Drive. The lot fronts what is supposed to be E. 140'h Avenue; however, the road is not in at this time. The inspection revealed that the property was average treed with spruce being the predominate fauna present, with some birch, poplar, and cottonwood. The front of the lot closest to the access road is fairly level and the lot is terraced with a drop of 15', then level, then a 15 degree grade to the back of the lot. The immediate area that has been selected for the wastewater disposal system has an average slope of 4 to 6%. Three perc tests were conducted (see site plan). On June 19, 2002, test hole # I was dug to a depth of 18' (see attached soils log). The first perc test revealed a site that was not usable for a standard septic system. The second and third test holes were dug on June 20, 2002. Test hole #2 revealed soils that perc greater than 60 minutes per inch. The third test hole perced at 11 minutes per inch. Each test hole was inspected for ground water on April 6, 2003, and no ground water was detected. It is proposed to use two 3' wide x 7' E.D. x 30' long trenches, and a new 1250 gallon tank will be installed for the future 4 -bedroom house. On-site observation and physical survey show that there are no water wells or private wastewater disposal systems within a 100' radius of the proposed system. The proposed system will have no measurable impact on surface or sub -surface drainage, or on drainage from adjacent lots. It appears that there is no potential for contamination of adjacent water wells or streams from known sources. Also, the proposed development will not prohibit future development of any neighboring lots. Attached please find proposed design drawings for the deep trench system. If there should be any questions concerning the percolation rate or characteristics of the site, please call me at (907) 746- 1073 or 243-5372. Sincerely, 011e( ty, Douglas T. KP PE#8176 , All, gz"P�4 1#4 q ® 0 0 0 0 0 0 ©D O N a�P O N WIC LINE OP,CIMINE LOW I 190.00' N0UF37001M t IT i I 111 PEEa CRW DOUGLAS T. KEPLEY, RE i' LOT G. BLOCK 9, RABBIT cams BUBDMSION �`� ••�•• v 4e �sa S ANCHORAGE: ALASKA m n c ED IT (` t PETER CRUP DOIJOLAS T. KENLEY, RE 1F t LOT e. BLOCK s. RABW CREEK SUBDIVISION —`� ••�•• • ANCHOMWL ALA8" U § w ||`|| PETER CROP %KENLEYPIE to LOT 4.BLOCK &RABBr CREEK SUBMISION _a__ \2 ke \ ( � r 2» P � 2 | m . | k k ) m § plk1. k }) LE k� U § w ||`|| PETER CROP %KENLEYPIE to LOT 4.BLOCK &RABBr CREEK SUBMISION _a__ cl) m -v A --i m E D z m n q O z t i d PETER CRIMP DOUGLAS T. KENLEY. P.E. �g LOT S. BLOCK 3, RABBIT CREEK SUBDIVISION `•- i '8 E ANC/IORA(iE, ALASKA • Municipality of Anchorage DEPARTMENT OF HEALTH d HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502.0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR +�6>'6.Gi�0 DATE PERFORMED..�uaE iy ;Lun,L [ter 6 B..oc.kr3 LEGAL DESCRIPTION ,E?.vs9,rGE�G� Svda1 Township. Range. Section JJ SLOPE SITE PLAN %`sem o eco ll. cs ye 4,6� 2 4 5 6 7 8 9 HL ,ov,Ce TG1Y Cc COMMENTS WAS GROUND WATER , P_ —Y.- ERCOLA710r'+RATE.4' tMA,I*w,A,,nI PERC MOLE OIAME T¢N - TEST PVN BET WEEN B/-$- FTAND FT I(/�� CERiIf T 7 SnTEST WAS PERFORMED IN fY L7�/Y1 PERF ORMEO e• ��� ACCORDANCE WIT N ALL STA TE ANO MVNICIPALOVIOELINESINEf 0 EC7ON 7NIS OATS OA7E' OF••A4 �1 Municipality of Anchorage i � •, (NEER' SE •,�,�� Development Services Department GJ: 9TH •:�*R� Building Safety Division {r• 49. e e ti 0 yt On-SileWater and Wastewater Program �••• 4700 South Bra92w St. • • , , , e P.O. pox 196M Anchorage. AK 99519.61156 y : DO • T. KENLEY . w d—OnchMc:e.ak.us / t�`e. 00. "7) 343-7964rE 8176 Soils Log - Percolation Test ,+ill •H.�.=� Performed Far. �6lEG C.ei•'-�� Date Performed: xy, xCOX, e LpY C1•-ctK �a .� r L�,CP6.�' S•��• Township. mange, Section: Legal Description: Slope Site Plan ,/,acE Depth 1LQ.raA)165 2 e be F% 3- 4- s�Er1 T2sr- 5- C C 6- 7- 8- 10- 11 Cf//GC 12- c;:SDRO(FIDWATF-R �o E�C=r PSD? IF YES. AT WHAT DEPTH? Depth to Water After 6lonhoring? Dale: ��Z�oL %s/cam 20- FER"DLAi�CNPATE iG 0 (rixlesSrGq // FERC HOLE DIAI.IETER b T55i FV, E_i'1`-="1 .f� F, PND O/f— FT CO`.1LtEAlTS .tJa 1 I //. PERFORMED BY: �•CGO � >�^-�L6 ) ' Cwt CERTIFY TY.:.T THIS TEST 4�/ 5 yL PERFORMED I. i ACCORO:,DICE 4:9TH ALL STATE AND 1.:UNICIPAL GUIDELI S IN EFFEC 1 THIS DATE. DATE: Z / ZQD�i Reading Date Gross Time I Net Time Depth to Water Net Drop 14- "0 i 15- 18 J. 9 0 S� q l� 6- 16- Z MEN ■■■■■..■■■ EMEMEM MEME MMMM NEE 20- FER"DLAi�CNPATE iG 0 (rixlesSrGq // FERC HOLE DIAI.IETER b T55i FV, E_i'1`-="1 .f� F, PND O/f— FT CO`.1LtEAlTS .tJa 1 I //. PERFORMED BY: �•CGO � >�^-�L6 ) ' Cwt CERTIFY TY.:.T THIS TEST 4�/ 5 yL PERFORMED I. i ACCORO:,DICE 4:9TH ALL STATE AND 1.:UNICIPAL GUIDELI S IN EFFEC 1 THIS DATE. DATE: Z / ZQD�i Reading Date Gross Time I Net Time Depth to Water Net Drop 14- "0 i 15- 18 J. 9 0 S� q l� 6- 16- Z _ 17- 1 1B- 20- FER"DLAi�CNPATE iG 0 (rixlesSrGq // FERC HOLE DIAI.IETER b T55i FV, E_i'1`-="1 .f� F, PND O/f— FT CO`.1LtEAlTS .tJa 1 I //. PERFORMED BY: �•CGO � >�^-�L6 ) ' Cwt CERTIFY TY.:.T THIS TEST 4�/ 5 yL PERFORMED I. i ACCORO:,DICE 4:9TH ALL STATE AND 1.:UNICIPAL GUIDELI S IN EFFEC 1 THIS DATE. DATE: Z / ZQD�i Municipality of Anchorage • NGIN S AL}, i �b• Development Services Department T}{ {t BUJI &g Safety Division :rt • ' • 1 • •t �1 On -Site Water and Wastewater Program 47CO South Bragaw St. • • t "' "' P.O. Bax 196650 Anchorage, AK 99519•Eb:O / T wwwdanc�0_ak.us .Q�i�. .CE 8176 i —(907) 343-7904 �II ....••'� Soils Log - Percolation Test U. PedcrtnedFer. ,[yG/G.r✓ ���NO Date Perfonned:,�u.eJ6x0 2evx oY d eat f S�ey Township, Range, Section: Legal Description: t L•.�e�E � Stcpe Site Flan 7�rlf Depth 3- 9- 11 1 15- 17 19 - Grf /O.�c.o,vGr'� ll Ge co.0 !1s-,dG 7r�fT y, -AS CaDtNo YIATER �° E\CC=B- ADO S L IF YES. AT YMAT DEPTH'D 0 Depth to Ylger After P tuanitoring? -�, I' E D,r<l,%OtL ,Vo3 Rzzding Date GrossTene Z d/ZC�O Z �z P� I �p� NelTUne I Depth to Water I Net Drop 8.f -J.— ■■■■■■M.■■ elf zrx/ I x /% n ONE-MMMME ��' N ■■■■■■■■■■ I■■■■■.■■■■ MMEMMEMEM y, -AS CaDtNo YIATER �° E\CC=B- ADO S L IF YES. AT YMAT DEPTH'D 0 Depth to Ylger After P tuanitoring? -�, I' E D,r<l,%OtL ,Vo3 Rzzding Date GrossTene Z d/ZC�O Z �z P� I �p� NelTUne I Depth to Water I Net Drop 8.f -J.— VT�FE�:r PATE �� lczxtestcC�) FERC HCLS MAMIETER b TEST RV,"'=T'ME=N � FT P\D FT COMMENTS �eGS�A�EO �4ekluC I CERTI. Y THAT THIS TEST WAS PERFOR?.IED BY: F.e�o �• i� ZtD3 PERFORMED IN ACCORDANCE WITH ALL STATE P\D &'Ut:ICIPAL GUIDc �:ES IDI EFr i OPI TrIS DATE. DATE: elf zrx/ I x /% n _. e , ��' N VT�FE�:r PATE �� lczxtestcC�) FERC HCLS MAMIETER b TEST RV,"'=T'ME=N � FT P\D FT COMMENTS �eGS�A�EO �4ekluC I CERTI. Y THAT THIS TEST WAS PERFOR?.IED BY: F.e�o �• i� ZtD3 PERFORMED IN ACCORDANCE WITH ALL STATE P\D &'Ut:ICIPAL GUIDc �:ES IDI EFr i OPI TrIS DATE. DATE: /`may ti . _ i i 1 � � :. � � I�.l�il r���i���A�l �el�� �rr � �- :� �� f � s •IAG���A� '�'...1 �.�A " is I•�+i„M�° � LL .,Ali -.•:+.f.J r, J. .n• t 3!L�aIF =:�-���;]('Ji►f�iE3i!u`�Iri�iiij:,eill'..�7 -w-..- 1 '4lEl:X"'!iL•li?i (al liT-I='.�1:�eja) � w�1311)Wf.jYj i jell = i •,� '17iilli a :1 CJ��CI�EIMSCal't7a'�+%i�►51�lu�E1?T1i"�', • � `'t'F1C1'�I�a�JC)!i�:X�1t1'1�k — '>=��' �uIIFi'1G 17 i 111F3M-MC— _u –1.2 1 YlilF�3j+Tk li�:Cj Q?U6, Ii'Jt'.tl{I ii IiliNi(.lI lM1 •.:�'::r:lIZTI�)'t7.���p�it:.G7e�iI+':I1.E+Gi •!�!�?C•lixi�i�]ii�'.k �F r ��1J;�r�''�rY;;r ;# I MUNICIPALITY F ANCHORAGE Development Services Department _:_T Phone: 907-343-7904 On -Site Water & Wastewater Section �" Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-063-17 Expiration Date: ��"�� -20p 70 1. GENERAL INFORMATION Complete legal description Rabbit Creek, Block 3, Lot 6 Location (site address) 6743 E 140th Avenue Anchorage, AK Current property owner(s) Peter Crimp & Paula Cullenberg Day phone (907) 440-6709 Mailing address 6743 E 140th Avenue Anchorage, AK 99516 Real estate agent Rona Florio 2. TYPE OF DWELLING: ❑° Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone (907) 279-8877 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 00-1 Private Septic 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 $ . so 6 LVJ b ` Waiver Fee $ Date of Payment % r !,! Z Date of Payment Receipt Number [�2�2C%,� Receipt Number COSA # 0 S c- a j a y ri 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 Forge Engineering Phone (907) 522-7773 Address 1399 W 34th Ave, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/16/2020 . OF .. .r. 49th .... . �4 6. DSD SIGNATURE e ' ,.. System #1 Approved for bedrooms m�, : hdICHAELE. ANDERSON: ju No. CE -4381 _® System #2 Approved for bedrooms ©sem% F 7/16/20 Disapproved ®� ®a0RO�FESS13 M o®®® %a Conditional approval for bedrooms, with the following stipulations: By: �•_ \ �C Original Certificate Date: 20 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Rabbit Creek, Block 3, Lot 6 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Parcel ID: 017-063-17 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 1 gpm Date drilled 6/10/03 Water storage tank volume None gallons Total depth 367 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 161 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) '24 in. Collected by FORGE ENGINEERING Date of flow test for COSA 4/29/20 Date of Sample 6/29/20 Static water level at beginning of test 151 ft. Comments B. TANK DATA Age of tank(s) 16 years Tank type/material Steel Measured operating fluid level in septic tank 50 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/5/20 Northland - Pumping Service D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 7/7/03 IN ALL standpipes present per record drawing Total measured depth from grade 13.25 ft (max) Measured depth to pipe invert from grade 6 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 Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station N/A years Lift station material N/A Comments: Adequacy test date 4/29/20 Results ✓❑Pass For 4 bedrooms Fluid depth prior to test 26 in Water added 1147 gal New depth 31 in Elapsed time 1411 min Final fluid depth 27 in Absorption rate >600 gpd Any rejuvenation treatment (past 12 months) If yes, enter date N/A N/A 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' F,71 Yes Community Sewer Manhole/Cleanout > 100' r/7 Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' 7 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Fv� Yes if No ft r-,71 Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ED Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' F,71 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' E✓ Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Main > 10'✓Q Yes if No ft Community Wells > 200' ✓1 Yes if No ft Water Service Line > 10' ✓� 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 If absorption field is under driveway comment below Property Line > 10' Q✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Q✓ Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' ✓� Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATIONOF 1 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. 0 -9th =� �0 m.0u, »nn.uumuna.. nun.�:�V �n MICHAEL E. ANDERSON Ar No CE -4381 7/20/20 � ,.>•'' COSA Checklist yellow sheet ®�� F� p5��� """' .. 4,a%ja»�®� ft ft