HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 4V LT 13ARabbit Creek
View Heights
Block 4V
Lot 13A
#020-541-46
Municipality of Anchorage
Development Services Department mat M0
Building Safety Division
\_
On -Site Water and Wastewater Program, 4700 S. Brogaw SL
P.O. Box 196650 Anchorage, AK 99519-6650 Page I of 2
www.ci.anchorage.alLus (907)343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SLU0107-9r PID Number. 02C7 -032 - 13
H,m. Jon; Sf Ron
Wastewater System: [:]New ® Upgrade
A"ess 16351 Nrc0eei Sf ASF/, +1C 99S/
3 YS- 2 t 39 Numba e3 oom.
D OW rmm 13 OVsnch 0 aw o Lana ou r
LEGAL DESCRIPTION
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TANK
GPM
Ft.
FL
SEPARATION DISTANCES
❑ Septic ® Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
PubrrJPrlval
Sewer Llne
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BENCH MARK
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warm ✓7 ox rhoun1-ea Fnrlcle
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Inspections performed by: Fl&66ZE-rec-4. S'F.D Dates: 1" t9117/01
rF : .9Tyt ta 'yt
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.....................:...
m*e4
Development Services Department Approval
..: r�:... �L.
Reviewed and approved by: Date:$•• OI
. THEODORE F. aLOORE
~: CE-35G�
tan coot
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PERMIT NO: SWO10295 WELL PAGE 2 OF 2
-----------------
IPID
PID NO: 020-032-134 `\ �-='-------
z
--- -Z SWING TIES:
w LOT 13 BLOCK 4
Y
FROM:
COR. "A"
COR. "B"
WELL "C"
6 -INCH
5.0' SOIL
TO:
PUMPOUT
COVER ALARM
Z
DBL. C.O. "D"
37'
16'
88'
n
I
4" C.O. "E"
36'
15'
88.5'
6" C.O. "F"
27.5'
13.5'
91.5'
DRIVE
4" C.O. "G"
24.5'
14.5'
93.5'
w
\
\
3
R75'
\
tzi
DOUBLE Co
�I
WELL"C" \
\
TBM HIGH LEVEL
0 HOLDING TANK ALARM BOX
'E"
� 6" PUMPOUT"F"
I 55' 2 f 13 BDRM
f� pHOU€SE
ALARM ,=t•:,.=,,.�
FLOAT 'G" A"
I \ DRAINAGE DITCH i
NOWATERATTIME
+ OF INSTALLATION
FINAL GRADE
PROFILE VIEW
NOT TO SCALE
PLAN VIEW
SCALE: 1" = 30'
LOT 13, BLOCK 4, RABBIT CREEK VIEW S/D
HOLDING TANK INSTALLATION
AS -BUILT INSPECTION REPORT
FLATTOP TECIINICAL SERVICES SCALE: AS NOTED
14530 ECI TO STREET DRAWN BYTFM
ANCI IORAGE, ALASKA 99516 AUGUST, 2001
6 -INCH
5.0' SOIL
PUMPOUT
COVER ALARM
FLOAT
PROFILE VIEW
NOT TO SCALE
PLAN VIEW
SCALE: 1" = 30'
LOT 13, BLOCK 4, RABBIT CREEK VIEW S/D
HOLDING TANK INSTALLATION
AS -BUILT INSPECTION REPORT
FLATTOP TECIINICAL SERVICES SCALE: AS NOTED
14530 ECI TO STREET DRAWN BYTFM
ANCI IORAGE, ALASKA 99516 AUGUST, 2001
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SWO10295
Legal Description: RABBIT CREEK VIEW BLK 4 LT 13
l c f G 3: oo104`
Date Issued: Aug 02, 2001
Expiration Date: Aug 02, 2002
Parcel ID: 020-032-13
Design Engineer: 0019 Flattop Technical Services Site Address: 016351 NICKLEEN ST
Owner Name: Joni Stephan Lot Size: 217974 SO. FT.
Owner Address: 16351 NICKLEEN STREET Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE , AK 99516-5214
This permit is for the construction of:
❑ Disposal Field ❑ Septic Tank Q 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).
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 By:
Issued By:
Date: a& -/v/
La�ir Date: TJ — 2 —d l
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 SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
ZD
Parcel I.D. O ZO — 03 2 - f ? Permit Number SW 0 /C 2 4r
Property owners) %an ; Sf Gov l,Q n Day phone -
Mailing address (1) 163 S1 !�lrckr• e� -�f
Mailing address (2) A^CA0 / Zip Code 99s %j5�
Legal description (Lot, Block & Sub'd.) i.af % 13/oc k RuS 1 %f✓+e% (/� �ct�
Legal description (Section, Township & Range)
Lot Size 213a?� Acres/ q.Ft.
Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only ❑
Well Only
❑
Sewer and Well ❑
Water Storage
❑
Sewer Upgrade 13
THIS PROPERTY CONTAINS:
Hot Tub 11Jacuzzi
❑
Swimming Pool ❑
Water Softening Unit
❑
Therapy Pool ❑
I 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:
Waiver Fees:
Date of Payment: -7/7-7/01 Date of Payment: 7 / 2.7 /0
Receipt Number: l O 1 —(�� Receipt Number: -7
(Rev. 12100)
i
I
SEPTIC
AREA
DRIVE"""'
I
I
I N LOT 12
(VACANT)
LOT 11
WELL
R 75'
I DRAINAGE DITCH \
I�
_ LOT 13,,\ BLOCK.4'
O I I DRNE ,' -- �'
I o
pI INSTALL VLL
I I
54' DBL C.O.
, �
=�}BDRM
W
W I �-
N I I I DRAINAGE DITCH i
w I I \`(W.SMALLFLOW),��
Z I
INSTALL
TANK SHED
NSTALL 4000 GAL.
ABANDON EXISTING SEPTIC TANK
AND SOIL ABSORPTION TRENCHES
I
I
LOT 15
I (VACANT)
I
I
I
GEORGE COURT
i— — — — — — — — — — — — — —'
I
I
e
.I�
LOT 14
(VACANT)
LOT 16
(1r9Tli�':a ••�.��;'?��p
'•..•.• NH.INIH '
HEODORE F. bOORE�� C
.- CL - 3589
LOT 13A, BLOCK 4, RABBIT CREEK VIEW SID I
WATER AND WASTEWATER SYSTEM
SITE PLAN
FLATTOP TECI EWCAL SERVICES 11INCH=50FEET
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 1 JULY, 2001
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXI?
INSTALL DOUBLE C.O.
TOP OF FILLED AREA
OVER TANK (5' COVER) —
(SLOPE AWAY FROM SHED)
NEW 4000 GALLON
HOLDING TANK
[•=1J�A'l�liill�ill
4" DIA ALARM FLOAT
ACCESS CLEANOUT_
N
O f?
PLAN VIEW
SCALE: 1" = 10'
EXISTING WASTE LINE FROM
GRAVEL DRIVE
ALARM
z1 1 11 11
1 OVER TANK �A CLEPSRSM �� 6" PUMPOUT * DOUBLE C.O.
ORIGINAL GROUND 4" C.O.
.n NEW 4000 GALLON HOLDING TANK
L 4" WASTE LINE
m • •�- -� m. �----------•--.• FROM HOUSE
17.2
PROFILE VIEW
Or A4z,�ti.1 SCALE: 1" = 5'
... , }F�y LOT 13, BLOCK 4 RABBIT CREEK VIEW
HOLDING TANK INSTALLATION
I=' •� ••THEOCORE F. �MOORE � �!¢" PLAN AND CROSS-SECTION
$ n
CL -3589 �: m�` �•
.•�a`' 41 FLATTOP TECIMCAL SERVICES SCALE: AS SIIOWN
(y �, F, • -. ; � 5 � 14530 ECHO STREET DRAWN BY: TFM
ANCI IORAGE, AK, 99516 JULY, 2001
C: SOILS LOG
11 1. -) -1) K
MUNICIPALITY OF ANCHORAGE 1
• r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TERCOLt.TION
TEST
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: i A1`50 -1S<1 DATE PERFORMED: 5L,' 155
n r
LEGAL DESCRIPTION: L,I3 f; a'-171AF3;3 rT �L� k6 15-)'o �'0
1 '
2
4(o
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5 .�
6
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No. 1437-E � e
20
COMh1E
PERFORMED
72.00E 16.791
WAS GROUND WATER k I S
ENCOUNTERED7 0
P 7 c
IF YES, AT WHAT E I I I
DEPTH? I
Reading
Date
Gross
Time
Net
Time
Deoth to
Water
Net
Droo
51
Ir
1 5�3 V
I 3/g
PERCOLATION RATE 670 Im.nuteslincnl
TEST RUN BETWEEN IF FT AND c7 FT
CERTIFIED
DATE. rz., S
rFYattop 7echnicaCScn ices
14530 Echo Street, f7nchorage, flX 99516
(Phone (907) 345-1355
Lot 13, Block 4, Rabbit Creek View SID
16351 Nickleen Street
Holding tank installation
Specifications
1.0 General:
1.1 The scope of the project consists of abandoning an existing 1000 -gallon septic tank and soil
absorption trench and installing a new 4000 -gallon holding tank with a high level alarm system.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections
All construction procedures and material specifications shall conform to Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around
any buried utilities.
1.4 The contractor shall provide 5 feet of soil cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the
construction.
2.0 Holding Tank:
2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top
and backfilling with soil.
2.2 The new 4000 -gallon Municipally approved holding tank shall be installed in the approximate
location shown on the site plan. The tank shall be set level on undisturbed soil and buried a minimum of
5'feet below final ground surface to prevent flotation. While a large quantity of groundwater is not
anticipated in the area of proposed installation, the contractor should be prepared to de -water the
excavation, if necessary.
2.3 To provide the maximum amount of unsaturated backfill, the top of the holding tank shall be
set approximately 5.5'— 6.0' below the level of the end of the building/driveway pad. Additional fill
material shall be hauled in, as necessary to bring the finish grade over the tank up to create an extension
of the pad outwards at a 55 downwards slope. The fill slope down to original groune on the west side of
the tank shall not exceed 2:1.
2.4 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot. A double
cleanout shall be installed at the point where the new waste line extension ties into the existing waste
line coming from the house.
2.5 The holding tank shall be equipped with a low voltage, high level float that triggers an
approved visible and audible alarm mounted inside the residence. The float shall be positioned to
trigger the alarm when the fluid depth is approximately 57 inches above the bottom of the tank, thereby
leaving 600-800 gallons of capacity remaining in the tank at the time the alarm first sounds.
3.0 Inspections:
3.1 A total of 3 engineering inspections will be required during the course of the project: (1) initial
stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the tank has been set level in the excavation and the
piping connected and alarm installed, but prior to backfill, and (3) after final backfill and grading is
complete.
3.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
Municipality of Anchorage
Development Services Department
� Building Safety Division
On -Site Water and Wastcwater Program `
4700 Bragaw Street s " "'
P.O. Box 196650 Anchorage, AK 99519-6630
www.cl.anchoragc.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: WRO10063 PID#: 02003213 HA#: Permit#: 5w010295
Date Received: 7127101
Legal Description: Rabbit Creek View Block 4 Lot 13
Engineer. Ted Moore, P.E. Flattoo Technical Services
Rit:F "zM,TV1WiTin,=, TV13'FIfL�
r' - - - 3iiiu• � c i ir-
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
...............................................................................
Waiver Is Granted: _ X Waiver Is not Granted:
List Conditions or Reasons for above: SEE EAIG/A/Ef/P iS L E /%E1P 6f 1 u S T/f/C/4 %1vA.1
p/�rFv 7-2t,-0/ mmc/4Ed
Date: 6-2-0/ By : 04AJ
Name of Reviewer
...............................................................................
Reck ZM Amount: $ Date Paid: 7127101
8/2/200I
Municipality of Anchorage
George P. Uruerch, Mayor Department of
Public Works
Building Safety D117sion
P.O. Box 19G050 • 4700 S. Bragatr street
Anchorage, Alaska 99519.6650 • (907) 343.8301
11tt1)://%„w.ci.anchoragc.nk.us
Ted Moore, P.E.
Flattop Technical Services
14530 Echo St.
Anchorage, AK 99516
Subject: Waiver Request for Rabbit Creek View Block 4 Lot 13
Waiver Request #WR010063
Parcel ID 9020-032-13
Permit # SW010295
Dear Mr. Moore:
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
35.0 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 343-7904.
Sincerely, o %1
t /
Daniel J. Rot
Civil Engineer
On -Site Water & Wastewater Program
i
�5- TTOP TECHNICAL .SEIt�I� :
CIVIL& ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS
TItEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345.1355 ANCHORAGE, ALASKA 99516
July 26, 2001
W QA I C� c�Cr,,3
M.O.A. DSD
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to request a waiver allowing installation of a 4000 gallon holding tank as
close as 35 feet from a small drainage ditch carrying water and 54 feet from a roadside ditch, which also
carries a small amount of water throughout the year. The project is necessary to replace an existing
failing septic system located on Lot 13, Block 4, Rabbit Creek View S/D, located at 16351 Nickleen St.
The property is in the process of being sold, and it is necessary to bring the on-site water and wastewater
systems into compliance with code in order to qualify for issuance of a HAA certificate. An upgrade
permit application, site plan, design drawings, specifications and copies of other documents pertaining to
the installation of the existing septic system are enclosed for your review.
The proposed holding tank will be installed in the approximate location shown on the site plan. As
you are no doubt aware, many of the lots in this area are very poorly drained. The 1985 soils log
(enclosed) shows the presence of a layer of nearly impermeable blue clayey gravel located immediately
below the organic layer. Although no groundwater table was reported on the log, it is probable that
runoff water migrates laterally through the shallow organic layer on top of the clayey gravel until it
encounters the soil absorption trenches excavated below that level. Despite the construction of several
drainage ditches intended to divert shallow subsurface water away from the existing soil absorption
trench, the fluid level in the existing trenches is presently at ground level.
While the proposed site for the holding tank is able to achieve the required 75 -foot separation from
the private well serving this residence, there is no site on the property that comes close to achieving the
required 100 -foot separation from the small surface water flows in the drainage ditches. The closest
drainage ditch with flowing surface water is 35 feet from the proposed holding tank location, however
the shortest flow path to surface water is approximately 54 feet.
The waiver can best be justified as a significant improvement over the present situation of a
failing septic system in groundwater, situated less than 30 feet uphill of a drainage ditch with flowing
water. By comparison the proposed holding tank will be a sealed container that is designed to discharge
no wastewater into the local environment. The tank will be fabricated of 3/16" steel with a bituminous
coating, which should provide a much longer life before corroding through than a conventional septic
tank fabricated of 12-guage steel. Of course, watertight Calder couplings will be used on all tank
connections, and an audible and visible high level alarm installed to alert the homeowner when it is time
to pump the tank. The tank is oversized so as to minimize the burden on the homeowner to ensure that
it is regularly pumped. Were wastewater to surface from the holding tank, because it was over -full or
leaking, it would flow downhill to the west (a distance of over 54 feet) before encountering surface
water, rather than horizontally 34 feet towards the southern drainage ditch. Being in the front yard, such
a flow would be readily apparent and provide incentive for the homeowner to take corrective action.
A driller's log for a 1975 deepening of the well on this lot is enclosed. It does not provide useful
information pertaining to the shallow soils since it begins at 40 feet, but it does show that bedrock was
encountered at 65 feet and that the total depth is 125 feet. On July 24, 20011 conducted a yield test of
the well. The initial static water level was 6 inches above ground surface, and steady pumping of 796
gallons of water from the well at an average pump rate of 6.5 gpm caused the water level to be drawn
down only to 14 feet below ground level. Water samples collected that day showed no coliform or other
bacteria. The nitrate sample is still being tested at the lab and I shall provide those test results to your
office when they are available. The coliform test results indicate that the existing failing septic system is
not contaminating the well. This provides a level of confidence that the proposed holding tank will not
contribute to a public health threat.
The topography of the lot slopes downward towards the west at approximately 8%. The house is
constructed on a built up pad which the driveway ascends en -route to the garage. In order to take
advantage of the shielding effect of the house pad and to maximize the available soil cover over the
holding tank to prevent flotation after it is pumped, the proposed tank location is adjacent to the existing
pad, which will be extended out over the holding tank.
The proposed project will have no significant impact on present or future water supply and
wastewater disposal systems serving adjacent properties, nor will it have any significant impact on
reserved space -surface and subsurface, or on drainage.
Based on the above analysis, it is my opinion that the requested waiver can be safely granted without
concern as to adverse impacts on public health. It will also be a significant improvement over the
present failing septic system. Please give me a call at 345-1355 if you have any questions on this
submittal.
Sincerely,
Ted Moore, P.E.
MUNICIPALITy4�%ANCHORAGE
'"e I MEMORANDUM
Date
To: -19 E6
From:_ ltioi�, �
Re: d '7's
S lk� let .,t-4s,.0�¢mak! ta,x
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sem.-.-{'.ter e•_ l..�c>.{�M p� .�..�
91-015(Rev.1/811
r.
' I
MUNICIPALITY OF ANCHORAGE
'�
\1 DEPARTMENT OF
HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING
DIVISION
/ 825 L Street• Anchorage, Alaska 99501
Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR
WELL INSPECTION REPORT
NAME
PHONE
❑ NEW
7—'A6(L
S• 30
VUPGRADE
MAILING ADDRESS
0.
LEGAL DESCRIPTION
S
vl
1
tu.�
LOCATION
NO. OF BEDROOMS
Well f
Absorption area
Dwelling f
PERMIT NO.
caY
DISTANCE TO:
ss
ZZ
_
n 2Q
ManufacturerMaterial
No. of compartments--
V
S
L
rn
Li t, capacity in gallons
dao
IF HOMEMADE:
Inside length
Width
Liquid depth
6 Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
.+D2
SF
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
WrJlbOt
F.un anon f
Nearest lot inlf
PERMIT NO.
=
2Z 19
U
of
Na. lines
Leingth of lie s
Total len iM1 f li
Trench witl_141
Distance betw�ee1n fines
Inches
%1✓
I..
Top of the to finish grade /I __s
Material beneath tile
(00
Total effecsive absorp ion area
�o
inches
17)%}t7
Length
Width
epth
PERMIT NO.
W
t7
i f
Type of crib
Crib tliameter
r' depth
Total effective absorption area
W 1
In
DISTANCE TO:
Well
Building foundation
Nearest lot line
1class.
Depth
Driller
Distance to lot line
PEH MIT NO.
W
DISTANCE TO:
fdation
ildBuingoun
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
ew-s Lt1 'so F' t
SOIL TEST R
^I_N`G
'44 I
2/
IN)T LLER
REMARKS
N
Y
•�'
AOL—
• • • •'C
!� lebetf A.•3Sofe.
+% .,� No. .• vS f
aA r
APPROVED �' '• OAT LEGAL
C,,ZLE RIVER ALASKA 'S'M
/
PH. 604-2979
U
72013 IRev. 3/78)
i
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
r'"'
r1Ua.s _ a_ _ r v ter- fkT.A t_1a DT;C3 EI—
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
025 L STREET, ANCHORAGE, nK 99101
264-4720
05/28/II5C/o
S °< S ENG'G ZABRISKIE
SRI? 196X
EAGLE RIVER, AK 99.x-,77
694-2979
LEGAL DESCRIP: SUBDIVISION: RABBIT CREEK VIEW LOT: 13 BLOCK'.: 4
SECTION: 1 TOWNSHIP: 11N RANGE: 3W
LOT SIZE: 27360 (SQ.FT. OR ACRES)
LOT LOCATION: NICKLEEN STREET OFF.JAMIE
MAX DEDROOMS:
Listed below are the options available to you in deigning your septic
e_ystom. Choose the option that bent fits your site.
- -
-
-��f�C"(--[-, )
- -
�r.r"=j}
DEPTH TO PIPE BOTTOM (FT.)
6.0 ✓/
6,5
6.0
GRAVEL DEPTH (FT.)
5,0 ✓
0.5
0
TOTAL DEPTH (FT.)
11.0 ✓
7.0
S.0
GRAVEL WIDTH (FT.)
2,5
28,0
5.0
GRAVEL LENGTH (FT.)
134.0 �t
5[), 0
1II7, 0 x
CRAVEL VOLUME (CU.YDC.)
60.3
56.0
C6.6
TANK SIZE (GALS)
1,000.0*`�
1,000.0 �y
1,0011,0 a�
SOIL RATING (SQ.FT./DR)
445
330
445
* GRAVEL LENGTH : 75 FT" REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** TANK MUST HAVE AT LEAST. TWO COMPARTMENTS
I certify that:
1. I art; familiar with the requirements for on-site s.nwers.and wells as seat
forth by the Municipality of Anchorage (MOA) and the State of Ala_ka.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this parmit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
dis=tances from any existing well, wastewater'dicposal system cr public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and,
any enlargement will require an additional pormit.
IF A LIFT STATION IS INSTALLED IN AN AREA*COVERED BY HOA DUILDING CODES,
THEN (1) AN ELECTRPa9YFrRMIT AND INSPECTION MUST P7 OSTAINED; (2) AC -GUILTS
WILL NOT DE APPROVE WI HOOT AN ELECTRICAL_ INSPECTION REPORT; AND (3) THE
ELECTRICAL LIORV4 MUST B yW BY A LICENSED ELECTRICIAN,
i
SIGNED LATE -
APPLICANT:
ISSUED BY
DATE:
---- V "
❑ SOILS SLOG
MUNICIPALITY OF ANCHORAGE S !) ? Z
\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TESTOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 2 6 F /
0-\52 7 1 — n 31T DA-• C<4TEE PPERFO1R/MEDD:' lS—tlo� BSS
LEGAL DESCRIPTION:L, 15 R= -K• 4' -P1Aa—Fc
1 �Ir
2 �o
gLrJ� Gt-7Lyr:•�
3-
4-
O 4 O O
5
u
6 �
7'
wi u'wr n -1-y
SLOPE
Reading
4
Gross
Time
Net
Time
,o
Net -
Drop
X1:006.
.o
2
I : 30 A
WAS GROUND WATER
ENCOUNTERED?
12
b
�o
1f�.00�
IF YES, AT WHAT
��IgY
,
5
DEPTH?
13
0
SLOPE
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net -
Drop
X1:006.
2
I : 30 A
41
1f�.00�
15 �
��IgY
tlt-iy
5
10:IJA
20 ^
PERCOLATION RATE 610 (minutes/inch)
TEST RUN BETWEEN FT AND 2 FT
72.008 (6/79)
MUNICIPALITY OF ANCHORAGE
• v DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
❑ SOILS LOG J
t�v.r �5 07 3. DV
K1 PERCOLATION
TEST
PERFORMED FOR: �FS2-ISiIC. DATE PERFORMED:
LEGAL DESCRIPTION: L, 13 R LK • 4- 41 F53 IT E+,J s
F1PT(M SLOPE
14
Date
Gross
Time
WAS GROUND WATER
11
�r)J
.�� Of 4 1
�P��• •,Cgsa't
., •r-
ENCOUNTERED?
16
0sa,-
12
or�
�•
17
.....:i...di
IF YES. AT WHAT
/,
fs
18
DEPTH?
13
C;'
O
`0\��Y►s�l• �F.
14
Date
Gross
Time
Net -
Time
15
� � �
.�� Of 4 1
�P��• •,Cgsa't
., •r-
16
0sa,-
" g +�
or�
�•
17
.....:i...di
/,
..t• bbert•A. Sh•bt �..P
i
18
(i
sJ,�•. No. 1457-E
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19
`0\��Y►s�l• �F.
MEN
Roadin9
Date
Gross
Time
Net -
Time
Depth to
Water
Net
Drop
2-
IS ; 301
'720 0110
3
:ti A
0: 155A
t
I
20 est c.T d_�. -�•'_r
PCRFORMCU OY
/:' 008 (6179)
No. 1/57-i nr
nf....F ..... .
CERTIFIED
6,0 (minutes/inch)
FT AND 2 FT
DATE: u 4'7
5 & S Engineering
SRS 196x '
Eagle River, Alaslia "S"
SUBJECT: Z /3
�,
MPUTATION SHEET DATE:
SHEET / OF Z
p // ,DC7 C,e. U/EGcJ S�Ij' BY
CKD
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_ . ^ ub•n A. Sh•1.w w
s No. I451-6
S & S Engineering
SIP 196x . C NIPUTATION SHEET
-_..� o;ver, Alaska 99577 /
SUBJECT: L /3 81 l- 4 /1`�gg8l 7- 6'e
DATE:
SHEET •ZOF Z
BY
CKD
CtHyEy
o — 7� 74 t�,a_r 1-ewo✓e � ave,,- Xiie
the a 6so �o ,//on a re a der,-//�� . �✓><4'4'la 7(/L7 ill .
ov cuii/�i ���/ti �.t �eee✓fury
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+iP�Q• No. 1457.6
F9 .
RABBIT f.REEK VIEW SUBD.VISION
LOT 13 /': BLOCK 4
LOCATED IN SEC. 1. T11N, R3W. S.M.. AK
T/LN 13AV5 OF' 59AZIAI& N B9'4/�So`EGQ) ZG43.9/(M) 36 3/
T /1N FLAT W. JO -/33 GSED AS ,CCCORD G
M SEG. /, FNP, A,C.MON, 5EC• CoIz.,FND. 0. e. MON.
Al /S °3B X 33 `W L 551, 8/ (M) m
_ ? O T //�" � Qc lY FNp. %L" RCOAP FNP. Az REE3AP-
� N 89' 4G X44" E /90, LBS (M)
v . �• f3.9' -moi I Gz.S' •� co
(� 1 ® TEST QI Ix
Q
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tu
,� I h Q Imo— SEPfrG 5TA►1� PIPE AA N LoT /4
GOT /5 h
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RUA
111 4• . p.1 I?.s
V M Q ° t,` v to Q ,Z'hM •� Z ` , : PW.t. POLE —`
N0u9¢ j L
'. Z •) r 40.5' -� � �-- BG. 5' I N
r `T
�, M1 FNa. IZ REBAR � `
5 69'4z'W /9a.00
10 UTILITY 66MT. A5 PCP *70-/33 II
��FND. �L"REBAR 1
14/`C 0
I�EQG{I�PE�' WA/vim►' TV CA.S4411UMT NO CORNERS SET THIS DATE
TO pei0vs0o NO. + WF_S
P420PE2T7 L/NES J /} WAft)Ee
TO s' O N E X l S71AJG SO. P2goEZTy
L -I NE.
PRELIMINARY
I bereby certify that I have performed a Mortgagee's in.
spection of the following described property'
LOT /3 B L OC K 4•
RAI351T C,CCCIC VICW 50BD.
Anchorage Recording Precinct. Alaska, and that the improve-
ments situated thereon are within the property lines and do
not overlap or encroach on the property lying adjacent there -
t0. that no improvementsin
on property lying adjacent thereto
enewch on the }remnes in question and that there are no
roadways, teaaamiasion lines or other visible easements on
said property except u indicated hereon.
Dated at Anchorage, Alaska
tht. day Of 19_
EASEMENTS OF RECORD. OTHER THAN
THOSE SHOWN ON THE RECORDED ROBERT T. KEAN & ASSOCIATES
PLAT+ARE NOT SHOWN HEREON. Surveyors
"RE
.L 4 bets 6..;A
r _
M -W DRILLING, Inc.
P. O. Box 4.1224 • 1310C International Airport Road
ANCHORAGE. ALASKA 99509
!7 .
DRILLING LOG
Well Owner Use of Well n^'^
Location (address of: Township, Range, Section, if known; or distance main road
R 4, Lot 13 R,hhit Creek Vi( -.w r1't,+te�.
Size of casing 6- nepth of Hole 125 feet Cased to 59.4 feet
Static water level 10 ft. (above) . (below) land surface. Finish of well (check one) open end ( x );
Screen ( ); Perforated ( ).
Describe screen or perforation
Well pumping test at 10 gallons per (hour)
of drawdown from static level.
Date of completion 2e 107
(minute) for--I-----hours with I nom- ft.
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
Tp 40
^ �i F.xiRtin� ter-11
TO Sn Gr ;el._v £,ter henrinr _•.•.oulr! not r l -:,n un
n TO Lr
TO
TO Qc f:�t^r� Rnrirn^t
L-- TO 11[1 T'rnrtn rr+r! Pn^4
L' n TO 1 ffS - Grny; Rn -1, 4 Fr—t—c-1 Rork w4 th 11-- c.. ..
—TO-
-TO-
-TO-
To
OTO
TOTO
—TO-
O
-TO-
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-TO-
TO
NW%VA Certified Contraetor
Ccrtificatc Nos. 814 & 073
2
2 — STATE
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 020-541-46 Expiration Date:
1. GENERAL INFORMATION
Complete legal description Rabbit Creek View & Heights Block 4V Lot 13A
Location (site address) 16351 Nickleen St
Current Property ownd (s) Farthing Day phone 240-1930
Mailing address Same
Real Estate -.Agent, Cindy Wilson, Partners RE Day phone 240-1930
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class C Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Received by: Date: 711C
COSA to be released to the engineer, unless otherwis . quested by the engineer.
COSA Fee $ SZto-OO
Date of Payment 8 1 1.'
Receipt Number !/ t0p
COSA# QSCIU19955
Date:
Date of Payment
Receipt Number
Waiver #
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date8/9/2016
ro
6. DSD SIGNATURE
System #1 Approved for
bedrooms. 1,.•`. •• l _
System #2 Approved for
.rvq
bedrooms. <.'•
PE 6M
''
Disapproved.
- •_�`�,���
Conditional approval for
bedrooms, with the following stipulaf;ns�
Bv: lnnn c Original Certificate Date:
The Municipality of Anchorage Devlopment 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 blue sheet 9-1-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # _of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: ABs f T C R my- pfrs 8 LIy L1311PameI ID: 020 S 4 / V`
A. WELL DATA
Well type If A, B, or C provide PWSID # Well Log (Y/N)
Date completed l/ Z _75 Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth /25 ft. Cased to S - Casing height (above ground) Z1V in.
FROM. WELL LOG AT 105PECTION �
Date,of test.
Static water level 3 ft. 2 ft.
Well production 0 Q.p.m. 7 7L- g.p.m.
WATER SAMPLE RESULTS:
Coliform <0 colonies/100 mL Nitrate 0. 4P54mq/L t
Arsenic /N/16 ug/L Date of sample: /6 Collected by: Abe,& F- J
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material 41//gS'Date installed 4/
Tank size 006 gal Number of compartments Cleanouts (YIN)
Foundation cleanout (Y/N) : Depression over tank (Y/N))//� High water alarm (Y/N)
Date of pumping Z % 6 Pumper 006✓7�^
C. ABSORPTION FIELD DATA AIA
Date installed Soil rating (g.p.d./ftz or ftz/bdrm) System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption area ft Monitoring tube Depression over field —
Date of adeyu�cy test Results (Pass/Fail) For bedrooms
Fluid depth in'absorption felbefore test in. Water added gala. . New depth in.
Elapsed Tim4V 2: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION A/A
Date installed Size in gallons Manhole/Access (Y/N)
"'Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES >l
WELL ON LOT TO:
Septic tank/lift station on lot AIA On adjacent lots Jf j C1 '4 -
Ab sorption
fAbsorption field on lot 4 A On adjacent lots foo "f
Public sewer main �/J Q ra" Public sewer manhole/cleanout r ` 16O r7' -
Sewer
' -Sewer /septic service line Z.5 r'f' Holding tank 75 rf
Animal containment areas Q f Manure/animal excrete storage areas �% d t
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation S f Property line /D + Absorption field it/A
Water main .113 rt' Water service line i d 'r Surface water
Wells onadjacentlots
ABSORPTION FIELD ON LOT TO: AIA s
Property line Building foundation Water main
Water Service line- Surface water Driveway, parkingLvehicle storage
Curtain Ora in Wells on adjacent lots
F. 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.
Engineer's Printed
oName
Date
COSA yellow sheet 2-6-15.doc
1 M1
M
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-541-46 COSA# 1 l I U t
1. GENERAL INFORMATION Expiration Date: A— 1
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
!:71:3:3��N3��I.i�4X4R� 3[iZ�7:i���[7iKL•1
16351 NICKLEEN STREET *ANCHORAGE, AK 99516
CRAIG & REBECCA WILSON Day phone
16351 NICKLEEN STREET *ANCHORAGE, AK 99516
Day phone
Day phone
110 W. 38TH SUITE 100 *ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
350-4530
808-298-8861
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
0
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEI'i';ENT. OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown, below, 1 verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that tha on Sita wator supply and:::," wastewater disposal system iS (aro' safe fun--tio nal and an`enLiate
for the number of bedrooms and type of structure indicated herein. i further verify that based on the
intormation obtained fro - tha Municipality of Ancho, age files and from, my investigation and inspeClio ra, the
on-site water supply and/or wastewater disposal system is(are) in compliance with alt applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough, OF F AF A i4O4�4p4
conscientious engineering analysis of the system in accordance with ADEC and MOA X00 I
DSD Guidelines & Regulations. The reported results described the performance of the Op pOQ
system under the conditions encountered at the time of the test, and separation _
distances measured to readily identifiable features. The opera6onal life of a!1 wells and fir?* g T.
septic systems depend on the local soils condition, groundwater levels that may • • • r • {
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test , '...i'� [ i.
t i �.................t
results do not guarantee future performance of the system, nor do they guarantee that Q - Jef re /A. Gorness; G
there are no hidden defects or encroachments. GEG, LTD. can therefore not provideP� 9p. E 7953/ v 0
any warranty or future estimate of how long the system will continue to meet the q01 rle
'e 3l Z i' it Eo�O
operational requirements of the ADEC or MOA DSD. The content of this report is for d p �&
the sole benefit of the owner listed above. Any reliance upon or use of this report by any �0� r°f essi� o
04000 0
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for I bedrooms.
Disapproved.
�OIy OF A&0,
Conditional approval for bedrooms, with the following sti�fsr' Q
2: nN.SITE
Attachnneri is,
COSA Checklist 4/ Arcanip ^piyignry
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineers Report
f:itra I_ Advisory Other
i'
By; / j'14 ( � Original Certificate Date: s
(Rev. 11/05)
Municipality of Anchorage
a�
• '� Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: RABBIT CREEK VIEW; BLOCK 4V, LOT 13A Parcel ID: 020-541-46
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 11 /24/1975 Sanitary seal (YIN) YES
Total depth 125 ft. Cased to 59.4 ft.
FROM WELL LOG
Date of test 11/24/1975
Static water level 30 ft.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
3/21/11
3 ft.
Well production 10 g.p.m. 7.60 9.p -m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 0.639 mg./L. Collected by: GEG, Ltd.
Arsenic: ND ug./L. Date of sample: 3/18/11
B. SEPTIC/HOLDING TANK DATA *DOUBLE CLEANOUTS INSTALLED BEFORE THE TANK
Tank Type/Material HOLDING TANK/STEEL Date installed 8/17/2001
Tank size 4000 gal. Number of Compartments 1 Cleanouts (Y/N)
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping Pumper NORTHLAND PUMPING SERVICE
C. ABSORPTION FIELD DATA
Date installed
Length ft.
Soil rating (g.p.d./ft2or /bdr _
Width ft.
Total depth ft. Eff. absorption area_ ft2 Monitoring
Date of adequacy test
Results
Fluid depth in absorption field before test m. Water added
Elapsed Time: _ mi Final fluid depth_ in.
HOLDING TANK
System type _
Gravel below
ibeepres
gal.
Absorption rate >=-
ion over field
For bedrooms
New depth _in.
g.p.d.
treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' level High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots 100'+
Absorption field on lot NSA On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank link ,7 S : f
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field N/A
Water main N/A Water service line 10'+ Surface water *35'+
Wells on adjacent lots 75'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water service line
Curtain drain
F. COMMENTS
*WR#010063
Building foundation Water
Surface water
on adjacent lots
storage
G. ENGINEER'S CERTIFICATION o OF
i certify that I have determined through field inspections and �e —
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date. (70 '•J f Ga ness;•
Engineer's Printed Name JEFFREY A. GARNESS ��9s A J 79 `foo
Date
/'r. see Anf%d\o
COSA Fee $ ) I Waiver Fee $
Date of Payment I I Date of Payment
Receipt Number b, 4� Receipt Number
(Rev. 11105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE
OF ON-SITE SYSTEMS APPROVAL
,+�
FOR A SINGLE FAMILY DWELLING
Parcel l.D.O_W--;`gt-g6 COSA# q,46jqQ0,,?C1 q
1. GENERAL INFORMATION Expiration Date: .6__— 2 ` 0 1
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
RABBIT CREEK VIEW: BLOCK 4V, LOT 13A
16351 NICKLEEN STREET 'ANCHORAGE. AK 99516
BENJAMIN WILLIAMS Day phone 644-2715
16351 NICKLEEN STREET *ANCHORAGE. AK 99516
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
0
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage tiles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG, VD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiablo features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lost
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed 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.
5. DSD SIGNATURE
Approved for -3 bedrooms.
Disapproved.
337-6179
Date -2/5-/0,7
KL
.....
.J fs.-
CE -7 53
O�tl.°._ •��.lr. ���•ec•Qv�
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
V
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
By: r
,Q
(Rm. 11N5)
ON-SITE
WATER AND
WASTEWATER
PROGRAM
Original Certificate Date: 2 — C/ ` D 9
Municipality of Anchorage
• � Development Services Department
Building Safety Division
On -Site Water & Wastewater Program "
4700 Bragaw Street
P.O. Box 196650
Anchorage. AK 99519-6650
www.muni.org/onsits
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: RABBIT CREEK VIEW, BLOCK 4V, LOT 13A Parcel ID: 02 O
A. WELL DATA
Well type PRNATE If A. B, or C provide PWSID# N/A
Date completed 11 /24/1975 Sanitary seal (YIN) YES
Total depth 125 ft. Cased to 59.4 ft,
FROM WELL LOG
Date of test 11/24/1975
Static water levet 30 ft.
Well production 10 g.p.m.
WATER SAMPLE RESULTS:
Coliform n colonies/100 ml.
Arsenic: NDug./L.
Well Log (YIN) YES
Wires properly protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
1/16/09
3
6.61 g.p.m.
Nitrate 0.796 mg./L. Other bacteria 0 colonies/100 ml.
172-970-9
Date of sample: 1/16/09 Collected by: GEL' I td
B. SEPTICIHOLDING TANK DATA "DOUBLE CLEANOUTS INSTALLED BEFORE THE TANK
Tank Type/Material HOLDING TANK/STEEL Date installed 8/17/2001
r
Tank size 4000 gal. Number of Compartments t Cleanouts (YIN) YES
Foundation cleanout (YIN) ' Depression over tank (YIN) NO High water alarm (YIN) N/A
Date of pumping 10/14/2008 Pumper AROUND THE CLOCK
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./Wor felbdrm)_ System type
Length ft. Width ft. Gravel below i ft.
Total depth ft. Eff. absorption area_ ft' Monitoring tube Depression over field
Date of adequacy test Results P ail) For bedrooms
Fluid depth in absorption field before _ in. Water added _gal. New depth _in.
Elapsed Timeyairrt. Final fluid depth _ in. Absorption rate >= g.p.d.
treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
i
"Pump on" level at in. 'Pump off" leve High water alarm level at
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots 100'+
Absorption field on lot N/A On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank 75'+'
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field N/A
Water main N/A Water service line 10'+ Surface water •35'
Wells on adjacent lots 75'+
HOLDING TANK
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
Water service line Surface waterparking/vehicle storage
Curtain Wells on adjacent lots
F. COMMENTS
•JWR010063i
G. ENGINEER'S CERTIFICATION co� O . • �q4p�
1 certify that if have determined through field inspections andOp° . 9 T 1.17 o
v P
review of Municipal records that the above systems are in """' .0
conformance with MOA COSA guidelines in effect on this
date. Q f A. arness.Q
Engineer's Printed Name JEFFREY A. GARNESS QO C /53 ! Cpm
Date dPro
essl
ressi°^Oo�
�0400'i_
COSA Fee S I q U Waiver Fee $
Date of Payment � 5 Date of Payment
Receipt Number X73 Receipt Number
(Rev. 11105)
SGS WEN
1090174001
Client Name
Garncss Engineering Group, Ltd.
Project Mme/x
Rabbit Creek View B4V L13A
Client Sample ID
Rabbit Creck View B4V L13A
Matrix
Drinking Water
PWSID
0
Sample Remarks
Printed Date/Time
Collected Date/Fime
Recehed Date?ime
Technical Director
01/23/2009 14:26
01/162009 11:30
01/162009 13:30
Stephen C. Ede
Allowable Prep Analysis
Paranncta Results PQL Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug(L EP200.9 C (<10) 01/19/09 0120/09 NRB
Waters Department
Total Nitratc/Nitritc-N 0.796 0.100
Microbiology Laboratory
Colony Count 15
Total Coliform 0
Fecal Colifurm 0
mg/L SP1204500NO3-F B (q0)
coVl00mL SM209222B
coU100ml. SM209222B
coVl00mL SA1209222B
A (<200)
A (<I)
A (<I)
01/20/09 1DZ
01/16/09 DLC
01/16/09 DLC
01/16/09 DLC
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Professional Land Surveyors
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ITIS THE RESPONSBIUTY OF THE BUILDER OR OWNCR, PRIOR TO
ONLY THOSC IMPROVEMENTS ABOVE GROUND AND VISIBLE PALL BE
CONSTRUCTION. TO VERIFY
PROPOSED BNLDNO GRADE RELATIVE
SHOWN. FENCES. MEAL SEPTIC CILANOUTL MOEMALKZ. OMVEwAYL
TO FINISHED GRADE AND LTMITY CONNECTIONS AND TO DETERMINE
ETC, AMC SHOWN N THCIR APPROXIMATE LOCATION. ONLY. SNOW
THC EXISTENCE OF ANY EASEMENTS, COVENANTS OR RCSTMCMONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEW AND LOCATED.
WRM 00 MOT APPEAR ON TNF RFCIRtOFO S1lRMV16117IN Pt AT._^
t. MSTAN ►. APP PPr• I .. r
UNDER NO CtRMNSTMMS SHOULD AN AS -BUILT BE USED FOR CCNSTRUCnON OR FOR ESTABUSISNO BOUNDARY OR rENM LNCS.
THE SURVEYOR TAKES KV0NSIB:UTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABDJTY ONLY FOR THE COST OF THC SURVEY.
LISTED DISTANCES PREVAI OVER SCALING, REPR000CTIOH MAY CAUSE ERRORS N SCALE.
//,; �.5/�%�
Around The Clock Pumping
5700 Whispering Spruce
` Anchorage, AK 99516
345-9126
,�,eqqvo, 4%wrxzC;5-
Sold
.;
W7 04:50 600Z -LZ -N7. 1
JAN -20-2009 04:14P FROM: TO:3383246 P:3/3
NORTHLAND PUMPING SERVICE, INC.
Your Professional Septic Pumping Service Company
7501 E. 140th Avenue
ANCHORAGE. ALASKA 93516
(907)344-7146 - FAX (907) 868-6770
TO gm Williams
16351 Nick -leen
Anchorage, AK 99516
IIHMS.
Pump Holding Tank \
Less Charge Card Payment
every 6-9 weds �3 L7 ---r-9 y,
. . Gallons ... Holding Tank
Septic . Standpipes
Leach Area _Time
2.!5 19269
DAP -7--'
POA
n 05
$75.00
-75.00
n PROBLEM AREA - CALL FOR MORE INFORMATION
Li NEEDS TO BE DONE AGAIN IN 6 MONTHS
❑ Gwd Shape ❑ Sluthtk txrildup nn honom ❑ Floater on top
❑ Jim cap missing or ❑ Cut standpipe to V a0ove ground ❑ Needs Septictrine
nnrd:: replacing
■z AN -20-2009 04:13P FROM:
i■
■ NORTHLAND PUMPING SERVICE, INC.
■
■: Your Professional Septic Pumping Service Company
7501 E. 140th Avenue
ANCHORAGE, ALASKA 99516
(907) 344-7146 - FAX (907) 868-6770
TO Bea Williams
16351 Nckleen
Anchorage, AK 99516
Holding Tank
Surcharge
70:3383246 P:1/3
6_1 19697
April -29, 2009
�e95 Cred:'r C.cr-a Yc rr+-
i $75.P0
/6.00
One full lalad
every 6-8 weeks
/
Gallons Holding Tank
n
PROBLEM AREA -CALL FOR MORE INFORMATION
❑
NEEDSTO BE DONE AGAIN IN 6 MONTHS
_ Septic —Standpipes
n
Good Ships I I Sludgo buddup on ho::om ❑ Floalar on top
❑
Jim cap missing or F -j Cut standpipe to 1' above ground ❑ Needs Septictrine
_ Leach Area _Time
need: replacing
JAN -20-2009 04:13P FR011: T0:3323246 P:2/3
NORTHLAND PUMPING SERVICE, INC.tl\`\VL�JLi7�■
your Professional Septic Pumping Service Company
7501 E. 1401h Avenue 19 618
ANCHORAGE, ALASKA 99516
(907)344-7146 • FAX (907)868-6770
TO Ben Williams
16351 Nckleen I \ A
Anchorage, AK 99516 'P
TMMS:
•••
w
Pump Holding Tank $75.00
Less Charge Card Payment -75.00
Auto —every 6-8 weeks
Gallons ... .- Holding Tank [l PROBLEM AREA, CALL FOR MORE INFORMATION
❑ NEEDSTO BE DONE AGAIN IN 6 MONTHS
Scptic Standpipes 5. Gwd Shapr ❑ Sludgc buildup on bottom ❑ Floalo, on lop
J Jim cap missing or j Cut standpipe to V above ground I .I Needs Septictrine
Leach Area —Time needs replacing
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/0nsito
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
020-541-46
1. GENERAL INFORMATION
COSA #
Expiration Date: — -2-
Complete
Complete legal description Rabbit Creek View Block 4V Lot 13A
Location (site address) . 16351 Nickleen Street
Current Property owner(s) Scott Thomas & Rebecca Downey Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent .
Mailing Address
Sam Daniel
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well .❑
Individuat Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ❑
Individuat Holding Tank ❑✓
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval -'
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information
obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water
supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Watkins Engineering, INC.
Address 2520 Laird Cir. Anchorage, PJaska. 99516
Phone (907) 349-1851
Engineer's Printed Name Cindy W. Ellis Date March 17, 2006
5. DSD SIGNATURE
✓ Approved for 3
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following
Wy W. Ellis
CE.105n
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: ��, / Gl� Original Certificate Date: 3 — 6
(PW 11M
Municipality of Anchorage.
• Development Services Department
Building Safety Division
On-SRe Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196850
Anchorage, AK 995196650
www.munl.org/onsite
.(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Rabbit Creek View Blk 4V Lot 13A Parcel ID: 020.641-46
A. WELL DATA
Weil we Pri If A. B, or C provide PWSID # _ Well Log (YM) Yea
Date completed 1184/75 Sanitary seal (YIN) Yes Wires property protected (YM) Yes
Total depth 125 ft. Cased to 39A ft.
FROM WELL LOG
Data of test 1184/1975
Static water Wid 10 ft.
Well production 10 9.p -m.
WATER SAMPLE RESULTS:
Cdironn 0 colonies/100 mL Nitrate 0.603 mg/L
Arsenic: <0=005 mgA Date of sample: 3/9106
B. SEPTIC/HOLDING TANK DATA
Tank Type/Materlal Steel Holding Tank
Casing height (above ground) 35 in.
AT INSPECTION
319/2006
surface ft.
7.7 9 -
p.m -
Other bacteria 0 colonies/100 mL
Collected by: Cindy Ellis
Date Installed 8/178001
Tank size 4000 gal. Number of Compartments Cleanouts (YM) Yes
Foundation cleanout (Y" DOO Depression over tank (YM) No High water alarm (YM) Yes
Date of pumping Febuary 2$ 2008 Pumper Northland Pumping Service, INC.
C. ABSORPTION FIELD DATA
Date installed WA Soil rating (g.p dJft or fe/bdnn) System type
Length R Width ft. Gravel below pipe R
Total depth ft. Eff. absorption area _Me Monitoring tube --Depression over Meld
Date of adequacy test Results (Pass/Fall) For _ bedrooms
Fluid depth in absorption Maid before test in. Water added gal. New depth kr.
Elapsed Time: min. Final fluid depth In. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 112 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed N/A Size in gallons
'Pump on' level at _ In. 'Pump ofr level at _ In.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/Oft station on kit WA
Absorption Heid on lot WA
Public sewer main WA
Manhole/Access (YIN)
High water alarm level at in.
Meats alarm ti dreuti requirements?
On adjacent lots 109+
On adjacent lots 100'+
Public sewer manhole/cleanout WA
Sewer /septic service One 58AY Holding tank 85.9
Animal containmentareas 100'+ Menure/antmal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTICIHOLOING TANK ON LOT TO:
Building foundation 11.0' Property One _0' Absorption fleld WA
Water main WA Water service line 30'+ Surface water IW+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One N/A Building foundation Water main
Water Service One
Curtain drain
Surface water
Wells on adjacent kits
F. COMMENTS: No water in ditch along Mckleen street
G. ENGINEER'S CERTIFICATION
I car* that I have determined thtmgh tleld Mspectlons and
review of Uwddpal reswds that the above systems are in
conformance wlfb MOA COSH guldellnes in effect on this date.
Engineer's Printed Name Cindy W E0I3
107"b=.7il JFICe:;
COSA Fee $ L433 jb o U
Date of Payment i1 rI1-q�u��,
Receipt Number 7 7 Tcar
(Rev. I IMM
Driveway, parkin Mhide storage
Walver Fee $
Date of Payment _
Receipt Number _
0
IM0 W. Ellis
E• tam
SCS ReEtt
1061168001
Client Name
Watkins Engineering
Project Name/#
Rabbit Creek View B4V L13A
Client Sample ID
Rabbit Creek View B4V L13A
Matra
Drinking Water
PWSID
0
Sample Remarks:
AR Dates/Times are Alaska Standard Time
Printed Date/Time 03/15/2006 17:01
Collected Datdrime 03/092006 11:55
Received Date/Time 03/092006 14:00
Technical Director Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Method Comaimr ID Limes Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (c 10) 03/13/06 03/13/06 TK
Waters Department
Nitrate -N 0.603
Microbiology Laboratory
Total Coliform 0
0.100 mg/L EPA 3532 B (o-10) 03/09/06 JC
col/100mL SM209222B A ("1) 03/09/06 TLF
PAID
Thank you -
200 W POTTER DR}VE
ANCHORAGE. ALASKA 89518
SGS/qEENVIRONMENTALSERVICES Tek 907.682-2343`t.: :,.'•"
• fart 907-68153Ui. •."
Lab.,
.Drinking WaterAnalysis`Repc
. READ w.4TRUCTKINS oN R vow.IiiOHalFOI :oOt
W.
foI Total Coliform Dactena
MUST BE COMPLETED BY WATERSUPPLIER
PUBLIC WATER SYBTM We
XPRNA WATER SYSTEM
Sed Ramie Bed Mnaloa'
SAMPLE COLLECTION:
Dain
trr . W.
�Z
®I!J
Q Swd RaaJM
106. 1168 '} -"
NINE J
SAMPLE TYPE:
Roudes 0 Trabd.Waw
0 Repeat Sample Untreated Wabr .
(rderto lob no.
❑ Special Purpose :
Tmmpo.re .P -
ta Lab or. as Collector OIMr. t,.;,
. .
TO BE COMPLETED BY LABORATORY
tamo)e RecelYlna:
Dale: : ❑ Saepie aw 30 hr eW. ❑ RUSH SAMPLE: •.4
:T rr-- •. RrW MW Mwalla
Temp /�v+8itat Ls— ` ❑ u Hmw V%M r Phone 0:
Delivery Method' �OrL lel >--` ✓ Fax is
Received By T�
ccmn•nta: ...
. .. t ......................... '........................................ u ••Nuu••o••u•uouooHONUYuu•u Y•• ...........
Bacteriological Water Anatole Record: s.nt b Mw.MMtTaa16 (wAJ REatILTS: AMC PSK JUN
Analysts Bapanr' 3/9/06 /s-y� Taal coff m al./nn.•
Ohre Tr •Scat • .
- • Set b czent
,uu"cw Showa: MEMBRANE NUMPt RESUL�TSr:� Mond 0 Faxed 0
modCpa* oamt.
Membrane FIHer Varnc aa.c s �,
ffMMO-MUG (P/A) LTe
�' Q Satisfactory
...�.:. { Ec ❑ Unsatisfactory
ReportedBY:' ✓ Data/Time:�/7iG fir co. nrrc•T..w.•..wruw
1w, a .tx.a....l•
w•e+a,r••. Pb /10 443
SAMPLE COLLECTION:
Dain
trr . W.
�Z
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Q Swd RaaJM
106. 1168 '} -"
NINE J
SAMPLE TYPE:
Roudes 0 Trabd.Waw
0 Repeat Sample Untreated Wabr .
(rderto lob no.
❑ Special Purpose :
Tmmpo.re .P -
ta Lab or. as Collector OIMr. t,.;,
. .
TO BE COMPLETED BY LABORATORY
tamo)e RecelYlna:
Dale: : ❑ Saepie aw 30 hr eW. ❑ RUSH SAMPLE: •.4
:T rr-- •. RrW MW Mwalla
Temp /�v+8itat Ls— ` ❑ u Hmw V%M r Phone 0:
Delivery Method' �OrL lel >--` ✓ Fax is
Received By T�
ccmn•nta: ...
. .. t ......................... '........................................ u ••Nuu••o••u•uouooHONUYuu•u Y•• ...........
Bacteriological Water Anatole Record: s.nt b Mw.MMtTaa16 (wAJ REatILTS: AMC PSK JUN
Analysts Bapanr' 3/9/06 /s-y� Taal coff m al./nn.•
Ohre Tr •Scat • .
- • Set b czent
,uu"cw Showa: MEMBRANE NUMPt RESUL�TSr:� Mond 0 Faxed 0
modCpa* oamt.
Membrane FIHer Varnc aa.c s �,
ffMMO-MUG (P/A) LTe
�' Q Satisfactory
...�.:. { Ec ❑ Unsatisfactory
ReportedBY:' ✓ Data/Time:�/7iG fir co. nrrc•T..w.•..wruw
1w, a .tx.a....l•
~DKV IW „ao,
aay. NUAn)
m+war
•ever •.b,e rtn.a,
//A
SB9'33, /4"W
30'
•'
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1
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WELL Z^O
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20
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$IB' /b'/S"'I•Y
SurtvEY CE7tT*7CATI0N
Prepared by
PLOT PLAN
•••�o�u�11
.••-\E
Robert E. Johns, Jr. & Assoc.
« a ae� w.r e..•.e r,..r. ,.r M 1
. � ................ ,...1111
�.
Professional Land Surveyors
1700 BRINK DR.
�� r„e,•,,. e.. r..All{(
.J •
ANCHORAGE, ALASKA 99501
SCole: 1N — 30'
Rea Lot S.F.
Rea. Plot Flo No.
r....
'� • t•.
FOUNDATION AS-BUILT
'/ ••r• •••• •••• , ...;
Date Surveyed
3-5-OG
Drowt oY}i.T
Checked byY.CS'7
L n•.n L aA,� a. e...r eenr wr f
..•. r.•..r Ar-M,
... ...... /
SJR.••
e...r r wrrwr,r rr wrr
T•.••.;
R ERi NS f
Date Oman:
3-6-06
Grid:
3241
W.O.
638
i � % / •• u
11:•, 121—S
FINAL STRUCTURE AS-BULLI
I erw L aa,. A.rr
. ;°�e��
/•^ •...,•
�
Legal Deeaiptian:
a. aMr wr 1
Iw f+r•..e ., rwu a...r r w
..,.e.. w N
• •............ . ...•.• yJA.M►
♦ P
I.OT 13A E3I,iC 4V
., .r wr r ..
r�.e:'.`: a.�w.�r.rr ,..,�
♦t.
1 Off aebnd pP� ��
,1\\�����♦•
Rabbit CTCek View
❑ lar aMKT SURVEY TYPE
C3 FOUNDATION
SYMBOLS
AS-BUILT
❑ FINAL STRUCTURE AS-MAT
• SET REBAR °�° ;w DRNNACE ASPHALT
❑ PWT PIAN ... AS-RIKT ... LOT &MKT ... iWf14AAPMY
O FOUND REBAR .r.�p WOOD FENCE l CONCRETE
AT-MILT NO C0Q-4E"-_IIET00
ASSUMED ELEV.METAL FENCE
PLOT PLANS ! LOT SURVEYS
'NOTE:
IT 15 THE RESPONSIBIUTY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS. SIDEWALKS. DRIVEWAYS,
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECOROFD SORDIVISION PLAT.
ALL OISTANCFS ARE PFCORn JJNLF¢S n
UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSIVNG BOUNDARY OR FENCE LINES.
THE SURVEYOR TAXES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES RNANGAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
Municipality of Anchorage
�- Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROV
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-032-13
1. GENERAL INFORMATION
HAA #
Expiration Date:
Complete legal description
lof 13.
1310ck N� Ra&6;1 Creek l/.ew
Location (site address or directions)
1635/ NrcC�
leen Sf.
Current Propertyowner(s)
To^%
Sfcpi,a^
Day phone 3y3= 2239
Mailing address
Nrc4/eel) Sf..
fig 44c.995-te
Lending agency
%ioCvant,#
rtc r jpt
Day phone 28 "? - 0 r'>s
Mailing address
2,<00
Car�vua Sf�
f}^Gti. �k 99503
VIJ/✓\
Real Estate AgentP�u�[nf.0/n Day phone 229-ID97
Mailing Address H2i'/ ,Qt S.f�"� Ak 9950.3
Unless otherwise requested, HAA will be held by DSD for pickup. C kar .to r R.a lia ;L, i ti k eN
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑
Individual Holding tank
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates 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 results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm F(a 6Lc4 % ccAP; cu / Phone SYS --
Address 11S30 Ec do S7 /}n c_ o 2�. htc 99S"16'
Engineer's Printed Name —1-A¢o ,-lo -e F. /-racvIe Date iiv 2/, Zoo/
5. DSD SIGNATURE
!/ Approved for 3 bedrooms.
Disapproved.
F'.`�•,�'� '•.;u'yc*ENGINEEF
�.�' 4 3 STAMP
..................... �
�:•cr
Conditional approval for bedrooms, with the following stipulations:
". WATER AND --fn
Additional Comments 1ILnT 1,LTr•n
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: L� G*/. / Original Certificate Date:
(Re'.)2to)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program S
4700 South Bragaw St.
P.O. Box 190650 Anchorage, AK 995196650
www.d.andwrage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 4of /3, BI vck Y, Rcc S h;/ Cr.[ 4 Ur 2cp Parcel ID: O ZO -O 32 - 13
A. WELL DATA
Well 4444eeyyyy Pmt If A, B, or C provide PWSID # _
DalepletZ II/ 2t// 7S Sanitary seal (Y/N) Y
Total depth t Z, -ft. Cased to
FROM WELL LOG
Date of test f I / 2y /7S
Static water level ID ft.
Well production to 9—
p.m-WATER SAMPLE RESULTS:
Coliform _Q_colonies/100 ml. Nitrate al2r mg.A.
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 3r In.
AT INSPECTION
7/2y/o/
O.S ft. =6 a ra /cmc l
6 S t 9 -
p.m -
Other bacteria _0 colonies/100 mi.
Date of sample: 7 / 2V / 200 / Geed by: F/ph6� 7"e SA Sf-c
B. SEPTIC/HOLDING TANK DATA
TankType/Material IS*hel Date installed R//7/0/
Tank size I oc<) gal. Number of Compartments f Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping N-.4- (New) Pumper
C. ABSORPTION FIELD DATA n/, 14.
Date installed Soil rating (g.p.d.1W or ft2/bdrm) _ System type
Length
ft. Width
ft. Gravel below pipe ft.
Total depth _ ft. Eff. absorption area ft2 Monitoring tube _ Depression over field
Date of adequacy test Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption Haid before test _ In. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in.
Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) If yes, give date
D. LIFT STATION N -A.
Date installed Size in gallons
"Pump on" level at _ In. 'Pump ofr level at _ In.
Datum
E. SEPARATION DISTANCES
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line > ?-S'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots > 10 v '
On adjacent lots 7 r ao '
Public sewer manhde/deanout
Holding tank a
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
In.
Building foundation io Property line IV Absorption field W.A.
Water main �> ZS' Water service line 2S Surface water 37' Av a, &A [dryj
Wells on adjacent lots 7S rS' to 46" w wo
fel-See &,ower'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: N, ,'y.
Property line Building foundation Water main
Water Service line
Curtain drain
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface water
Wells on adjacent lots
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance wAh MOA HAA guidelines in effect on fhis date.
Engineer's Printed Name -0 fWdOfE F &4c'Ore
Date Aufti-tt 2/ 2600!
HAA Fee $ 3W -9—�
Date of Payment 49/27-/200(
Receipt Number 907/
(Rev. 12/00)
Driveway, parking/vehids storage
Waiver Fee $
Date of Payment
Receipt Number
3::, . • - "
...... .......'�........
r�'• . THEODO': F. 1:00C[ j• 1
Ef PANPERFS- - as-? a
ec CTBE Environmental Services Inc.
CTRE ReLN 1014624001 Client PON Pre -Paid Colis/NO3
Client Name Flattop Technical Srv. Printed Daterrime 07/29/2001 14:12
Project Name/N N/A Collected Date/Time 0724/2001 14:30
Client Sample ID Lot 13, Blk 4, Rabbit Ck View Received Date/rime 07242001 15:45
Mauls Drinking Water Technical Direct phen C. Ed�
Ordered By
PWSID 0 Released
Sample Remarks
Parameter Results PQL
Units Method
Allowable
Limits
Prep Analysis
Date Date Init
Waters Department
Nitrate -N 0.621 0.500
mg/L EPA 300.0
(<10)
0724/01 SCL
Microbiology Laboratory
Total Coliform 0 0 col/I00mL SM189222B (<I) 0724/01 KAP
0
LL
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date l� Z3- es
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range) S
or directions)
(b) Applicant Name Telephone: Home ms's' Z-3U4F Business
Applicant Address I In f_�5!7 — &� e_kA. 1 jt�"Z^ A9 S1
(c) Applicant is (check one): Lending Institution ❑ ; Owner/buildero*. Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and AgentA�
Address es "f" '-or or'
Telephone
(f) the HAA to the following address:
4ro'_%e&,J ' \P-1I1yL_ Plc
87
•c:ALE
1S5n
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well % Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite iE� Public ❑ Community ❑ Holding Tank ❑
Note: If community well system• must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
T2-025(11154)
f^
n
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health
Authority Approval 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 otu:ned
from the Municipality of Anchorage files and from my investigation and inspection• the on-site water supply anC'or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances• and regulations in effect on
the date of this inspection.
Name of Firm
IS•I•o
Date
Telephone
A`It\�
L Q4S1 !
bv6od A. Vmfw
No- 1457.1
6. DHEP APPROVAL
4r
Approved for bedrooms by Date ,
Approved ��' Disapproved Conditional
Terms of Conditional Approval /1�Dti
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues HeaN•h AUhority
Approval certificates based solely upon the representations given In paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their Ilending
Institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 engineers work.
Page 2 of 2
n-0251»/841
hNGNOa�f>f
pEP1• Ib
A. WELL DATA
5W
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1684
284-4720
Well Classification SIS If A, B, C. D.E.C. Approved (Y/N) t-1 /,A
Well Log Present4YW) Date Completed 11-2A-15 Yield • MS CqF N&& j)'
Total Depth IZS Cased to S`i + Depth of Grouting
Static Water Level 1 e • 1Z 0 r-'1 Pump Set At U.K.
Casing Height Above Ground 30N Sanitary Seal on Casing ON)
Electrical Wiring in ConduittVN)
Separation Distances from Well:
Depression Around Wellhead (Y40
To Septic/Melding Tank on Lot ler�r ; On Adjoining Lots 1 001-11
To Nearest Edge of Absorption Field on Lot 1 �r ; On Adjoining Lots 1 uo 1 1
To Nearest Public Sewer Line a �P To Nearest Public Sewer
1
Cleanout/Manhole N 1A To Nearest Sewer Service Line on Lot
Water Sample Collected by Sys _ g �..R —;Date I -24 -$S
Water Sample Test Results ��KFJ
Comments A (6..+_ 1_G-ra -r4m r&r 4yk-n 'b' \'_%O L- 'Cd
B. SEPTIC/MetO" TANK DATA
Date Installed rl- 19- 86Size No. of Compartments _Z1 -
Standpipes LI)N) Air -tight Caps tVN) Foundation Cleanout ($N)
Depression over Tank (YLQ Date Last Pumped �W
Pumping/Maintenance Contract on File (Y/N) lA ;for
Holding Tank High -Water Alarm (Y/N) , Temporary Holding Tank Permit (Y/N) P
Separation Distances from Septic/iieldir Tank
1 r
To Water -Supply Well A cm:;) To Building Foundation
r r
To Property Line r To Disposal Field S
To Water Main/Service Line .
Course P
Comments
Page 1 of 2
72-02601164)
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata AA5 fo 6'11( Type of System Design ��hi
Date Installed — 1 C% — t 5S Length of Field �y
Width of Field 30` Depth of Field �� r
ti
Gravel Bed Thickness lep
Square Feet of Absorption Area 134'0'`P Standpipes Present®N)
Depression over Field (YO Date of Last Adequacy Test LL4"
Results of Last Adequacy Test 4
Separation Distance from Absorption Field:
To Water -Supply Well 1a'o r To Property Line 5 r
To Building Foundation 30� To Existing or Abandoned System on
r
Lot Z_o ; On Adjoining Lots
To Water Main/Service Line 1 r 4" �ToCutbank (if present) N A
To Stream/Pond/Lake/or Major Drainage Course a lA
To Driveway, Parking Area, or Vehicle Storage Area c> Ith1SJr
Comments
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons Manhole /Access (Y/N)
"Pump On" Level at ` "Pump Off" Level at
High Water Alarm Level at 74 Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
Check Permitted Bedroom Rating Against HAA Request ••
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed—$_3PEAt I!Pmla Date S
Compargr.�1LE�$11fR8RB f T MOA No. 3
Receipt No. A0s3 \
Date of Payment 'r\ -7S A5
Amount: $ AS FO
Page 2 of 2
72-026 (11,84)