HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 2V LT 1ARabbit Cre k
View & H
ight
Block 2V
Lot lA
#020- 521 - 18
" 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: ~V~/ c~-O~C)~ PID Number:
Name: ~"-~'~[.}~-. ~, ~[T~ Wastewater System: D New ~Upgrade
Address: ~0, ~X ~l~O~ ~?[11 ,~/~ ABSORPTION FIELD
Phone: No. of B~rooms: ~Trench ~ Shallow Trench ~Bed ~Mound~r
LEGAL DESCR,PT,ON SoilRafing:~GPD/Sq. Ft. 'TotalDepth~gmde:
Lot: Subdivision: Deplh to pipe bottom from o ' al grade:
Range: ~ above original grade: Gravel length:
Township: Section: Fill added ~ ~ Ft.
WELL: ~l,~ D Upgrade Graveldept~ Ft, Num~: JDistance~tweenlinej~.
Yield: I Pump Set at: I Casing Height Above Ground:
~ ~. ~. TANK
SEPARATION DISTANCES ~ Septic ~Holding ~ S.T.E.P.
TO Septic Absorption Lift Holding ~u blic/Pdvate Manufacturer: Capacity~:
Material: Number of Compa~ments:
Surface ~/~ L~FT STATION
Water I0~'~
Foundation
Cu~ainDrain ~ ~/ '( ~¢ , ~ Inspections pedormed by: ~
R ~¢~
Location and Description:
60~[0~ OF ~ U~E. ~ Assumed Elevation: ¢6~ Ft.
Ins s & S,NGINEERING
pections pedormed by: _ sss~Nama~m"e ~at~jst ~-~-~
Eagle River, Alaska ~5~ . zno~
Department of Health ~ ~n Servers approval
Reviewed and aPproved by: r~ ~. ~- ~- ~ ate: ~¢~Z./ ¢ ~
permit' No. ~~ Page
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
of
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
72-013 A (2/91) MOA 25
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 WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920206
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:PREVITS STEVE J &
OWNER ADDRESS:P.O. BOX 113203
Anchorage Ak. 99511
PARCEL ID:02003236
DATE ISSUED: 8/03/92
EXPIRATION DATE: 8/03/93
LEGAL DESCRIPTION: RABBIT CREEK VIEW BLK
1
2 LT
LOT SIZE: 37366 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
HOLDING TANK SYSTEM
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENGINEER MUST NOTIFY DHHS AT LEAST TWO HOURS PRIOR TO EACH
INSPECTION>
RECEIVED BY: ~ ~j DATE:
ISSUED BY: dO~4O ~V~,~ DATE:
Ju~y 28, 1922
ROBERT SHAFER, P.E
ROGER SHAFER. P.E.
CIVIL ENGINEERS
(9071694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MA~N EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDtES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519~~650
REFERENCE: Lot I; Block 2; Rabbit Creek View Subdivision
RequeSt you issue a permit for the installation of a 4000 gallon
wast~water holding tank to s~rve the referenced property. The two 1250
galZon holding tan~ installed in 1971 have collapsed. At pr~se~
th~r~ is s~wage exposed, therefore, expedition of the p~rmit would be
appreciated.
Attached please find a site plan depicting the proposed tank location.
If you have any questions or require additional information for your
r~vi~w, please contact us.
Sincerely,
ROGER J. SHAFER, P.E.
RJS/ss
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
PHONE .~"/q (~/7~'
DISTANCE FROM WELl 769/'' MATERIAl ~'~'~ NUMBER OF
COMPARTMENTS
LIQUID CAPACITY ,~,~O~ 7~/~GALLONS. INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
OUTSIDE DIAMETER OR WIDTH
· DISTANCE FROM WELT
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREAI
, LENGTH , DEPTH
BUILDING FOUNDATION
SQ.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
FOUNDATION . NEAREST LOT LINE , OF LINES
DISTANCE BETWEEN LINES
TRENCH WrDTH
IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: TYPE ~"1~4,~.~ , DEPTH ~'~"7! DISTANCE FROM '~' WATER
.BUILDING FOUNDATION. SAMPLE . NEAREST
LOT LINE , SEWER LINE ., TANK , SYSTEM . CESSPOOl , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
G.A.A.B.
GREATEI ANCHORAGE AREA
> ,L~ ~ / HEALTH DEPARTMENT
[~1~.' ~[~ ~e St. Anchor~e, Ak~ 99501
)ROUGH
279-2511
c s, No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME O F APPLICANT ~ ~ //--~1~"~/""')~
MAILING ADDRESS .'~'"/,"~?,~ PHONE NO.
APPLICATION T0 I~STALL: SEPTIC TANK //. SEEPAGE PIT /. D RAIN FIELD . OTHER
TO SERVE THE FOLLOWING FACILITY ~ ~ ~ ~
TICIPATEB BATE 0F COMPLETION~
BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ~
DIAGRAM OF SYSTEM
I certify that I am of Greater Ancl/orage 28-68 and that the
above described system is i with said code.
DATE .~///~//~::) AP PLICANTSSIONATURE-/d':~'""-"'-'"'"' 7-~
0
~GREATER ANCHORAGE AREA BOROOG~
IiUALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA'99501
CASE
Legal Descz,~p~on: ~ot ! Block ~ ~ubd~v~s~on
Thas Fcrm Reports a: Sozls Log
Depth
Fee~ Soil Characteristics Location Sketch
Net Time
Depth To H20
Net Drop
Froposed Instal~Seepage Pi~ Drain Field
Depth" Of inlet Depth To Bottom Of P-----i~: Or T~en¢!~"
/
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-032-36
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 1, Block 2 Rabbit Creek View S/D
Location (site address or directions) 15601 Nickleen
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Elizabeth Baker
P.O. Box 63627 EAFB, AK 99506
Day phone 229-3253
Day phone
Real Estate Agent
Mailing Address
Day phone
Unlessothe~isemqueste~ HAAwNbeheNbyDHHS~rpick~.HAAp~ked ~by:
2. NUMBEROFBEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health
Authority Approval (HAA) based only upon the represe~tations given in paragraph 5 by an independent professional
civil engineer registered in the State of Aiaska, Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DHHS also issues HAAs upon request to home owners, Certificates of Health Authority Approval are
valid for 90 days from the date of issue for propertie:; served by a private or Class C well and may be reissued with
new water sample results less than 30 days old, CorJffcates are valid for one year for properties served by Class A
or B wells or a public water system, The Municipalit.~ of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
(Rev. 11/99)
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 Health Authority Approval Guidelines for 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 based on the
information obtained from the Munic pality of Anchorage files and from my investigation and inspection the Oh-
s te water supply and/or wastewater disposal system is in compliance w th all applicable Municipal a~d State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ..Pannone En.q. Svc. Phone. 272-8218
Address P.O. Box 102954~ Anch~ AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date_. '10/5/2003
Eng. inee. rs Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious
engineering analysis of the system in accordance with MOA DHHS Guidelines & Re"ulations The
reported results describe the performance of the s,,stem under t~ .... ~: ..... ~ ~ .' ~,.'~.*~ [J~ A~ "%~
..... ~, mia separauon alstances measured to readdy identifiable features The onerati--~ e~ ~r~
. · Idseptmsystemsdepend°nthet°cals°flc°n&t~on, ground water levels that mav fluctuate
uur~ng the year, and the water usage of the family be n~ served bv the system Th,~ .... ,,'a;,;^~
o. uts~de the control of the evaluator of this system. All systems eventually fail and satisfactory test regnltq
au not guarantee f~ture performance of/he system, nor do the,, ouar ...... ,,~ .,-- -. ~, · -X-5--~,,--4-vv~i;~i~..~.......~...
· : s ....... m u,~e are no nmnen ae~ect
or..enc:oae.ment.s. PE.S cat, therefore not prov,de any warranty for future performance nor give any
eanmare o[ now long the systan] will continue to meet the o-er~,:~--, .... ' ........
p,,,. ~ u~c ut ires repor~ oy any other person or party is not authorized nor will it confer an,, 1~o; -:~K.
5. DHHS SIGNATURE
F"'" Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Expiration Date:
(Rev 11~J9)
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Reissue Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 1, Block 2 Rabbit Creek View
A. WELL DATA
Parcer I.D.: 020-032-36
Well type Private
Date completed
Total depth. 57 ft
If A, B, or C provide PWSID # __
Sanitary seal YES
Cased to 40+ ft
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ,-~J~-- colonies/100 mi
Date of sample: 10/612003
B. S=B~I~;IHOLDING TANK DATA
UNKOWN ft
g.p.m
Well Log NO
Wires properly protected Y
Casing height (above ground) 8* in.
AT INSPECTION
II212002
9 ft
5.4 g.p.m
Nitrate ~_~.~ ~fr~g/I Other bacteri~
Collected by: Laura Pannone Arsenic
colonies/100 mi
~ mg/I
Tank Type/Material STEEL
Date installed 915/1992 Tank size
Cleanouts _Y Foundation cleanout _Y
Date of pumping I O I J I 0 ~ Pumper A* HOME SVC
C, ABSORPTION FIELD DATA
Date installed__ Soil rating (g,p.d./~ or ft2/bdrm) N/A
4000 gal Number of Compa~tments'l
Depression over tank N High water alarm Y__
System type
Length N/A ft Width ~/, Gravel below pipe ft
Total depth ft Effective absorption area ~'t~ Monitoring tube Depression over field
Date of adequacy test __ R~/Fail) ~ For__ -- bedrooms
Fluid depth in absorption field bef.~t in Water added gal. New depth
Elapsed Time: min / Final fluid depth in Absorption rate >=
Any rejuvenation treatmerft (past 12 mo.) (Y/N & type) If yes, give date
(Rev. 11/99)
in.
g.p.d.
D, LIFT STATION
Date installed
"Pump on" level at.
Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot _ 84
Absorption field on lot NIA
Public sewer main N/A
Sewer/septic service line 25+
in"Pump ~<~1 at
cles tes"~d
Manhole/Access
High water alarm level at in
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent Pots 100+
Public sewer manhole/cleanout N/A
Holding tank 84
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5
Water main N/A
Drainage 23'**
Property line. 5+
Water service line 10+
Wells on adjacent lots 100+
Absorption field N/A
Surface water 23' Waiver ranted
*We Located in Garage. Casinq surrounded by concrete.~eparation Waiver qranted 10/13/00.
G. ENGINEER'S CERTIFICATION ...~.~"~,,..
· , ..........
/ c~Rify t~ff / ~ve determined through fie/d inspections and ~ ~;'"' ~'~**,
rewew or Mun/c~al reco~s that the above systems a~ in ~ ~ ~_ ~ ~ ~ ~
Receipt Number ' ~ '
' ~%bq~ S~ Receipt Number
(Rev. 11/99) -~
Water Service line
Curtain drain
F. COMMENTS
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line n/a Building foundation Water main
Surface water Driveway, parking/vehicle storage
Wells on adjacent lots
Municipality of Anchorage
Development Se~ices Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519~650
www ci.anchorage.aKus
~907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL ''
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-032-36
E×piration Date: 4/2.,'1/0Z
GENERAL INFORMATION
Complete legal description ~ot 14 Block 2 Rabbit Creek View SID
Location (site address or directions) 15601 Nickleen
Current Property owner(s) _Sam Kito Day phone
Mailing address 15601 Nickleen, 99518
Lending agency
Day phone
Mailing address
Real Estate Agent
Bela Bodnar
Day phone 2444415
Mailing Address
Unless otherwise requested, HAA will be held by DHH$ for pickup. HAA picked up by:
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
TYPE OF WASTEWATER DISPOSAL: ' '
Individual On-site [] '
Well
[] Individual Holding tank
[] Community On-site
[] Public Sewer
aht of Anchora e Department of Health and Human Serv ces (DHHS) Issues Certificates of Health ,.
The Municip ' y g ' ' ' h 5 b an independent
' AoDroval (HAA) based only upon the representations given in paragrap y . .
Authority _:..., .. - ...... ~,,~ ~t~tR r~f Alaska Certificates of Health Authority Approval are requ~reu
professional CIVIL engineer regls[ereu .~ ~,,~ ........
for the transfer of title (excep[ between spouses) on eroperties serveo by a single family on-site wastewater ,
disposal and/or water supply system. DHHS also issues HAAs uoon reaues[ to home owners. Certifcates of
Health Authority 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 -esults less Than 30 days old Certificates are valid for one year
for properties served by Class A or B wells or a public water s~stem. The Municipality of Anchorage is not
resaonsible for errors or omissions in the professional engineer's work.
4. ' STATEMENT OF INSPECTION BY ENGINEER
As
Name
Engineer's Pdnted Name
eng/ne/ering analys
soil condition, gro~d water levels that ma3' fluctnate din/rig the year,
and the water usage of the fam/lv being se/wed by the system. Thes~ conditions ~a 0~i R/de the controI of
the e~)aluator of this system. Ali system~ evantually fail and ~a~i~fa'ctory Jest res~its do not gaarantee
futttre performance of the syste~ nor do they guarantee that there are no hidden defects or encroachments.
PES can therefore not provide an3' warranty for future performance nor give any estimate of how long the
system will cenfinue to meet the operational requiremenis of the ADEC or MOA DHHS. The content of
this report is for the sole benefit of the owner listed above. Any re]ianee upon or use of tlus report by any
other person or party ~s not authorized nor will it confer any legal figh~t whatsc~ver.
5. DHHS SIGNATURE
~ Approved for :_ 4 bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the folJowJng stipulat ons
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
WeII Flow Advisory
X
By:.
Expiration Date:_Z~/~ v~/O~.
(Rev. 11~S~.
Original Certificate
Reissue Date:
Legal Description:
A. WELL DATA
Well type Private
Date completed __
Totai depth 57 ft
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
w,,wv.ci.anohorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 1, Block 2 Rabbit Creek View
If A, B, or C provide PWSID #__
Sanitary seal YES
Cased to 40+ ft
FROM WELL LOG
UNKOWN ft
g.p.m
Nitrate 1.2 mgll
Collected by: ERIC
Parcel I,D.: 020-032-36
Well Log NO
Wires properly protected _Y
Casing height (above ground) 8*
AT INSPECTION
1/2/2002
9 ft
5.4 gpm
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi
Date of sample: 1/3/2002
B, SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Date installed .91511992 Tank size
Cleanouts _ Foundation cleanout Y_
Date of pumping 113/2002
C. ABSORPTION FIELD DATA
in,
Other bacteria 0 colonies/100 mi
Arsenic .002u mgll
Date installed
Length NIA ft
Total depth ft
Date of adequacy test __
4000
__ gal Number of Compartments 1
Depression over tank N High water alarm Y_._
Pumper A+ HOME SVC
Soil rating (g.p.d./ft2 or ft2/bdrm) NIA
Width ft
Effective absorption area ft2
Results (Pass/Fail)
Fluid depth in absorption field before test __ in
Elapsed Time: __ min Final fluid depth __
Any rejuvenation treatment (past i2 mo.) (Y/N & type)
(Rev. 11/99)
Monitoring tube __
Water added
in
System type
Gravel below pipe ft
Depression over field __
For bedrooms
__ gal. New depth
Absorption rate >= __
If yes, give date
in.
g.p.d.
D. LiFT STATION
Date installed
"Pump on" level at __
Datum
Size in gallons N/A
in"Pump offf level at
Cycles tested
Manhole/Access
High water alarm level at __ in
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots 100+
Public sewer manhole/cleanout
Holding tank 84
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/tilt station on lot 84 100+
Absorption field on lot NIA
Public sewer main N/A
Sewer/septic service line 25+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 Property line 5+
Water service line 10+
Water main N/A
Drainage 23'** Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line n/a
Water Service line
Curtain drain
F. COMMENTS
Building foundation
Surface water
Wells on adjacent lots
N/A
Absorption field NIA
Surface water 23' Waiver qranted
Water main
Driveway, parking/vehicle storage
*Well Located in Garaqe. Casinq surrounded by concrete. Separation Waiver ,qranted 10/13/00.
G. ENGINEER'S CERTIFICATION
I certify that I have determined:through field inspectiops and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone, P.E.
Date 1-12-02
Date of Payment
Receipt Number
(Rev. 11/99)
Waiver Fee $
Date of Payment
Receipt Number
Parcel I.D, #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P,O, Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE Of HEALTH AUTHORITY
APPROVAL FOR a SINGLE FAMILLY DWELLING
020-032-56
1, GENERAL INFORMATION
Complete legal description RABBIT CREEK VIEW SUBDIVISION: LOT 1. BLOCK
Location (site address or directions) 15601 NICKLEEN ST. ANCHORAGE. AK
Property owner PAULINE PREVITS Dayphone
Mailing address 15601 NICKLEEN ST. ANCHORAGE. AK
Lending agency Day phone
Mailing address
(907) 545-1427
Agent CHRIS WINKLER w/ TOTEM REALTY Dayphone (907') 551-1142
Address 724 E. 15th AVE. ANCHORAGE. AK 99501 ,
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: ff community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4, TYPE OF WASTEVVATER DISPOSAL:
Individual on-site
Holding Tank xxx
Community on-site
Public sewer
NOTE: ff community wastewater system, provide written confirmation from State ADEC
ing to the legality and status of system.
72-025 (Rev, 1191 ) Front MOA/t:21 Computer Version
Note: Alaska. Water. and Wastewater Consultants, Inc.. shall be paid $1,925.00 at,
or prior to, closing for the engineering services provideo.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verif~ that my
investigation of this Health Authority Approval application shows that the on-site water supply and/or
wastawater disposal system is safe, functional and adequate for the number of bedrooms and type of
structure indicated herein. I further vedfy 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 in compliance with all Municipal. e/3d State codes, ordinances, and regulations in effect
on the date of this inspection.
Name of Firm ALASKA WA-TE'E & ~ ~ST, Et~ATER~/~/t CONSULTANTS, INC. Phone (907) 337-6179
Address 6901 DEBARR~/OAD,ISt~ V2B~/NCI-IORAGE, ALASKA 99504 · /
Engineer's Signature ~'~ .~.r/ ~/.C---~) Date /
In conducting this evaluation, AWWC, In//a~ter~ ~ted to"~-~'de a thorough, conscientious engineering ~na~ysis of the
system in accordance with ADEC and MOA DH ~ Guidelines & Regulations. The reported results deacdbed the
performance of the system under the conditions encountered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground water levels that may fluctuata during the year, and the water
usage of the fami~ being serwd by the system. 'These conditions are outside the control of
the eveluator of the system. Satisfac~ry test results do not guarantee future performance
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not pro~4de any warran!y for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner tisted above. Any
reliance upon or use of this report by any other person or party is not authorized,
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
X Approved for 4
Disapproved
Conditional approval for
bedrooms
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality 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. 1191 ) Back MOA #21 Computer Vemion
Municipality of Anchorage R E C E IV
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division OCT 0
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
MUNICIPALITY OF ~CH~;:
Health Authority Approval Checklist aWIRON~NTAL SERVICES
Legal Description: RABBIT CREEK VIEW S/D; LOT 1, BLOCK 2 Parcel I.D.: 020-032-36
**WELL LOCATED IN GARAGE. CASING
A. WELLDATA [*PER 1971 GAAB INSPECTION REPORTI SURROUNDED N CONCRETE.
Well Type PRIVATE
Log present (Y/N)
Total depth *57,
IfA, B, or C, attach ADEC letter. ADEC water system number
NO Date completed PRIOR TO 8/18/71
Cased to UNKNOWN Casing height (above ground)
**8"
Sanitary seal (Y/N)
YES
Wires properly protected (Y/N)
YES
Date of test
Static water level
Well production
FROM WELL LOG
~ g.p.m,
AT INSPECTION
8/22/2000
ARTESIAN WELL
4.2 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0
Nitrate 1.22 mq/L Other bacteria. 0
Date of sample:
8/22/2000
Collected by:
A.W.W.C., INC.
B. SEPTIC/HOLDING TANK DATA
Date installed 9/5/92 Tank size. 4000 Number of Compartments 1 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N). YES
Dateof Pumping 9/18/2000 Pumper A+ HOME SERVICES
C.'ABSORPTION FIELD DATA
Date installed , Soil rating (g.p.d./fl2 or ft2/bdrm)
Length Width Gravel thickness below pipe ,~-O~epth
Effective absorption area Monitoring Tub~ssion over field (Y/N)
Date of adequacy test Resu?u~u~sJe~ss/Fail) For.
Fluid depth in absorpti~.); Immediately after gal. water added (in.): __
Fluid depth / (ins) Minutes later:. Absorption rote =
~ent (past 12 months) (Y/N) If yes, give data
72-026 (Rev. 3~96)* Compater Version
System type
Bedrooms
D. LIFT STATION * ~
Date installed . ~ ........ ,,
Manhole/ACCess (Y/N) ~...~p~" level at* "Pump off"level at*
I-figh wa~ *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sower main
Sewer/septic sorvice line
84' On adjacent lots 100'+
N/A On adjacent Iota. 100'+
N/A Public sewer manhole/cleanout N/A
25'+ Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+
Water main/service line 10'+ Sur[ace water/drainage *25'
[*SEE WAIVER LETTERI
Absorption field N/A
Wells on adjacent Iota 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Properly line.
Building foundation
Water mai ' '
Surface water
Curtain drain
NONE KNOWN
Driveway, pa~ing/vehicle ~omgearaa
100'+
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and rev/ew
of Municipal records that the above systems are in conformance
with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name.
JEFFREY A. GARNESS
Date
Wells on adjacent Iota
HAA Fee $ ,.~, c~r_.%
Date of Payment /b ~/Q-
Receipt Number
72-026 (Rev. 3/96)* Computer Version
Waiver Fee $
Date of Payment
Receipt Number
Rick Mystrom.
Mayor
? [unicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http:,/www.ci anchorage.ak.us
October 13, 2000
Jeffrey Garness
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2-B
Anchorage, AK 99504
Subject:
Waiver Request for Rabbit Creek View, Lot 1, Block 2
Waiver Request #WR000085
Parcel ID #020-032-36
HA00499
Dear Mr. Gamess:
Your request for a waiver of the required 100 feet horizontal separation from the holding
tank to surface water has been approved. The approved separation distance is 23.0 feet.
This waiver approval applies to the existing holding tank to surface water 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.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Daniel J. Roth
Civil Engineer
On-Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On-Site Services
Waiver Review Worksheet
WR#: WR000085 PID#: 020-032-36 HA#: HA000499
Date Received: October 6, 2000
Legal Description: Rabbit Creek View, Lot 1, Block 2
Engineer: Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2-B, Anchorage, AK 99504
Appricant: Pauline Previts
Waiver Requested: Waiver between holding tank and standin~l surface water.
Permit:
Criteria: 1. Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
2. Special Conditions:
3. Other:
Total:
Waiver is Granted:
List Conditions or Reasons for above: ~'E
Waiver is not Granted:
Date: /~--I~ --~
Rec#: 06375 Amount: $625,00
By: P~/'
Name of Reviewer
Date Paid: 1016100
ALASKA WATER & WASTEWATER
October 4, 2000
Municipality of Anchorage
Depamnent of Health & Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Attn: Dan Roth
Subject: Rabbit Creek View, Lots 1 & 2, Bk 2
Dear Mr. Roth,
Recently our firm tested the well and evaluated the holding tank on the subject property for
purposes of obtaining a Health Authority Approval. During our site visit it was noted that the
holding tank only about 23 feet from standing surface water in the road ditch and about 75 feet
from standing surface water in a low lying swamp area. We performed a field survey using a
Topcon GPT-1003 total station and have plotted the surface water location/s on the attached site
plan. Upon reviewing the site plan you will see that there is no place on the property to locate
the holding tank and achieve a 100 foot separation distance from the surface water/s, without
extensive culverting and placement of fill. Therefore, we are requesting a waiver of the
separation distance. Justification for the waiver is summarized as follows:
1. The holding tank is in a very visible location such that overflowing sewage would be
noticed by pedestrians.
2. The holding tank is equipped with an alarm that will notify the property owner when it is
full. Ideally, the holding tank will get pumped prior to an overflow event occurring.
3. It is believed that this situation has existed since 1992 with no adverse impact.
If you have any questions, please contact us at 337-6179.
regarding this matter.
h~l~e~ s, P.E., M.S.
Thank you for your consideration
6901 Debarr Road, Suite 2-B, Anchorage, Alaska 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
) m
/ PRESE~ ON 9/16/00,
J ~ i / HOLDINg T~K t J
1~5
~ ~ I, ~ ~C ~9 /
~l 91.41' 96.1~~/
DEC" STAR~ HERE. /
PRESE~ ON 9/16/00. /
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AI ~AS~ WA~I'ER & W~TEWAI'ER ~, ~j. ~[ "
PREPPED FOR: PHONE NUMBER: PAge NUMBER:
PAULINE PREVITS (907) 545-1427 2 Of 2
RABBIT CREEK VIEW SUBDIVISION; LOT 1, BLOCK 2,
DESIGN OF WAIVER REQUEST
ALASI WATER & WASTEWATER
CONSULTANTS, INC.
October 6, 2000
Municipality of Anchorage
Department of Health and Human Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Rabbit Creek View, Lot 1 & 2, Block 2
To whom it may concern:
The well on the subject property was drilled in 1971. Although the owner states that she
previously had some information on the well, at this time she is unable to locate it. We have
consulted Dave Harper with Alpine Drilling; in his opinion this well is undoubtedly not drilled
into bedrock and most likely is cased to the bottom of the hole.
We have noted that the well is artesian; the seal on the well is adequate to prevent any type of
overflow from the casing. It should also be noted that the well is located in the garage. Access
for future repair/maintenance may be difficult.
If you have any questions, please contact us at 337-6179. Thank you for your assistance.
· e ~ , i?~' )
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 33%6179 * Fax: (907) 338-3246 * Website: akwwc.com