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HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 2H LT 15AMunicipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211036 PID Number: 020-551-14 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name Kelly N Wozencraft ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8001 Marino Drive, Anchorage, AK 99516 ❑ Other Phone (907) 441-9945 Number of Bedrooms 3 Soil Rating Total depth from original grade N/A GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Rabbit Creek V&H 2H 15A Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well >100' N/A N/A N/A >25 TANK ❑ Septic ❑ S.T.E.P. R Holding ❑ Other Manufacturer Anchorage Tank Capacity 3000 Gal. Surface Water >100' N/A N/A N/A Material Number of compartments Lot Line >5' N/A N/A N/A NA Epoxy coated steel 2 Foundation >1 0, N/A N/A N/A LIFT STATION a rer Capacity Gal. Remarks *No stand pipes were installed. 20" Orenco manway risers were installed on both sides of tank Alarm location installed by High level alarm present and tested by installer, PIPE MATERIAL House to tank D3034 Tank to N/A drainfield Installer JR's Septic Drainfield N/A CO/MT*N/A Inspector L. Tidwell BENCH MARK (Assumed elevation) 100 ft Inspection ection 15' 4/21/22 2 °h Location and description gm 4 m Bottom of siding @ point'A' ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp -e. Conditional Approval: Date ��Q�. • •'9tS,���� o*• TH .,. BenC'592iller � �'sl ' 5/10/22 •'� Septic System Approved Dates �c�— 2 _ ••....••�F�AM'- . 111 pROfESS10N�® Note: this approval does not include well permit requirements. �I \GV VV/VG/ 1 V) NEW 3000 -GALLON EPDXY COATED TWO- COMPARTMENT ADVANTEX TANK w/ 20" �|�l� M��_��1_1� PID " =,-= `^^^ . ._" EXISTING HOLDING TANK REMOVED & DISPOSED | -- | � _-- �u-� ` --- | ' | O 30 60 kE ME kM ON FEE A 8 58.0 54.4 LEGEND C0'CLEANOUT 2CO'DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( F8'FLOW SPLITTER VALVE WH - MANHOLE MT - MONITORING TUBE SV-SEPT|CVENT TH'TEST HOLE PERMIT # OSP211036 PID # 020-551-14 FNGIN EI RING (NO SCALE) 2" INSULATION .......... • ' • . • • • • , Benja 'n Schiller ' CE 52292 1 FQF�••...••'�F�o iha_ PROFESSIDNP � r1 I � 1 I i I � I � i I J I I I / 30.0 R.O.W. —j I OL'60Z 3..YO.O£ .00S 1 bS6L/£2 `L £8 3JHd `E60L >(008 / 1N31N33t/3 3NOHd373L/0/LU0373,OL 0'9Z i I O U N o° Lo N coco L,33.7 OL•6L4 3..96.SZ.00S v 3 O m v 133ZI1 S 7�l d� E � Oa i I P O U- 0 W O Q 00 al U ?mya�ay�c EcE �o>ao N>°°p -Qj LL- j�O aiQ5 WH/ O 2 E 44J 1 M O m acvw❑c PyyV«« 1 R « R Z-Sa._ U N O N N (/� fl. 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O u cuNgo p O Y E_ cr po El b w C7 cn X O L X — — IC /.�A� (ID) QQ MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221036 La t c0 f Dehartrnent Effective Date: 2/15/2022 Work Type: SepticTank Upgrade Expiration Date: 2/15/2023 Tax Code Number: 02055114000 Site Legal Address: RABBIT CREEK VIEW & HEIGHTS BLK 2H LT 15A G:3340 Site Mailing Address: 8001 MARINO DR, Anchorage Owner: WOZENCRAFT KELLY N Lot Size in Sq Ft: 20755 Design Engineer: FORGE ENGINEERING Total Bedrooms: 3 This permit is for the construction of: Disposal Field Septic Tank Q Holding Tank Privy Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date: 2 Z MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-551-14 Property owner(s) Kely N Wozencraft Day phone (907) 441-9945 Mailing address 8001 Marino Drive, Anchorage, AK 99516 Site address Same Legal description (Sub's., Block & Lot) Rabbit Creek V&H B2H Ll 5A Legal description (Township, Range & Section) Lot Size 20,755 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank ❑ Upgrade ❑X (D) Holding Tank RX Renewal ElDuplex Multiple Dwellings Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: a a 5 Date of Payment: Receipt Number: Permit No. 0 3 P a a 10 3 G Permit App_'-'- :-.,:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. IN e February 15, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 2/15/22 Subject: Rabbit Creek V&H B2H L15A – Marino Drive Septic holding tank replacement Dear On-Site Services Engineer: The holding tank at the subject property has reached the end of its life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the well, and new proposed holding tank location. No conflicts exist between this proposed holding tank and any other well or septic system, whether on this lot or adjacent lots. Currently, there is no single compartment holding tank approved for use in the MOA. However, we would like to propose utilizing a 2 compartment, 3000-gallon Advantex tank as a holding tank instead. This would meet the 2000-gallon holding tank capacity requirement for a 3-bedroom home in the first compartment, and the second compartment would act as extra volume. Wells on this and adjacent lots are shown. The new tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from property lines. Please refer to the attached test hole logs, soils lab analysis, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221036, Deb Wockenfuss, 02/15/22 OHPOHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHP OHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPBenjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=30' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND RABBIT CREEK V&H, BLOCK 2H LOT 15A FEET 0 30 60 NOTE: ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. 3-BDRM HOME 2/15/2022 EXISTING WELLS w/ 100' RADIICARL STREETMARINO DRIVE DECOMMISSION EXISTING HOLDING TANK PER UPC INSTALL NEW 3000-GALLON EPOXY COATED TWO- COMPARTMENT ADVANTEX TANK w/ 20" MANWAYS & BALLASTS Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221036, Deb Wockenfuss, 02/15/22 Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEER2/15/2022 SEPTIC TANK BALLAST (NO SCALE) GLACIER VIEW HEIGHTS #4, BLOCK 3, LOT 1 BOUYANCY CALCULATIONS: (NEGLECTING WEIGHT OF TANK) BOUYANCY FORCE ON EMPTY TANK: 3,000 GAL CAPACITY x 8.35 LB/GAL = 25,050 LBS WEIGHT OF CONCRETE BALLASTS: 8'x2.5'x2.5' x 150 LB/FT3 x 2 = 15,000 LBS WEIGHT OF SOIL ABOVE TANK: 4'x15'x6' x 130 LB/FT3 = 46,800 LBS SAFETY FACTOR: 2.47 EYE BOLTS 1' IN FROM ENDS 2" NYLON RATCHET STRAPS TIGHTEN OVER TANK 8' L X 2.5' W x 2.5' D CONCRETE BALLAST 4' CONCEPTUAL ONLY. OTHER METHODS TO SECURE TANKS WILL BE PERMITTED AT THE DISCRETION OF THE ENGINEER. NOTE: 3000-GALLON ADVANTEX TANK *NOTE: THE MOA APPROVED 3000-GALLON, EPOXY COATED, TWO- COMPARTMENT, STEEL ADVANTEX TANK FROM ANCHORAGE TANK IS RATED FOR A MAXIMUM BURY DEPTH OF 10' w/ A MAXIMUM OF 2' OF GROUNDWATER ABOVE THE INLET Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221036, Deb Wockenfuss, 02/15/22 Lot 15A, Block 2H Rabbit Creek View & Heights 20,755 Sq. Ft. 8001 Marino Drive 2 Story Wood Frame House L=47.1 2R=30.00 S00° 30' 04"E 209.7014.5 6.320.0 26.021.6 4.627.0 30.614.06.311.5 E G S S S OHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHP OHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHPOHP10 ELECTR,CTELEPHONE EASEMENTBOO. 1043, PAGE 831, 2318410 8T,L,T< EASEMENT T<P. LOT 16A LOT 14A 30.0 R.O.W.30.0 R.O.W.CARL STREETMAR,NO DR,VE G R A V E L W A < D R , V E 38.1 OHPS89° 31' 44"W 69.95 S89° 31' 40"W 99.84 W 33.7PLANTER EDGE OF GRAVEL LOT 23A S00° 28' 18"E 179.701 0 0 WE L L RAD,8S PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. February 2nd, 2022. Legend: Scale 1" = 40' Gas Meter Electric Meter/Outside Power Deck Septic Water Well Telephone Pole Fence Overhead UtilityS G E Lot 15A, Block 2H Rabbit Creek View & Heights General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Daryl Burque 22-049 2/3/2022 2004-91 3340 W Culvert Pierre M. Stragier No. L.S. - 9812 02/03/2022 R E GISTEREDPROFESSIO N A L LA NDSURVEYOR MUNIC DE {TMENT Er 825 "L" Street, ON-SITE SEWAGE DISPOSAL CIPALITY OF ANCHORAGE OF FIEALTH AND HUMAN SER i.S /ironmental Health Division horage, Alaska 99502, Telephone 264--4720 . SYSTEM AND/OR WELL INSPECTION REPORT HOLDTNG DISTANCES _.  ~:~ ABSORPT{0N WELL _ .. TANK FIELD cage,AK 125' to WELL 108 ' ~oom~ 3 .~ba~do~ed field ~ LOT LINE 38 ' 20' to abamdoned field 45' 75' to ts FOUNDATION 55' abandoned field 19' ~S-BUIL'r'~IAGRAM (Show locaL,on ol well. sephc systen~, property hnes, Ioundabon, driveway, wa~er bodies, etc ) 0 ~z ~ ] OTHER ' NA ' __ I ~ / I, ratify) FT ~Lpe ~ ~ ( _ ed. New /l~ ~,~/~) -. . '~ ~., ~ dow~ Inspectibps~rmed by ~ ~?~ , I~ anchors ~~~ ~ ~rm Date Date: .~ [ .': ", ~ Horzzon Const. Address C/O GEOLAB 1131E. 76th Ave. 8101Anchorac ~rm(s) Perm,t No N~[ 344-8042 I 850516 / 15 2 Rabbit Ck Heig] Sec 1TllN R3W TANKS E~ SEPTIC [] HOLDING Greer t[ 2000 Steel ___ 1 TYPE OF SYSTEM TRENCH ~ BE[) O W. DRAIN ~ or,glmd grade NA NA NA 80 FT NA[ NA SO FT] cast ir Earthworks Ex./ __ WELLS ~PRIVATE OTHER I~°~a'D°Pm FTI REMARKS: Existing system aba3____ ~-p~c tank pumped and removed. from house to septic tank remox east iron pi~e install~ from t holding tank. Holding tank tied with 4 concrete filled sonotube and galvanized cable. High water SJ Electro 101HW installed by Electrical Contractor. NlunJcipal a.d State guidelines in died on this date: Health Department Approvak DIEI='AR'I]~4EI'4]' OF I"E~:AI....'f'I"J AND ENVIRONME']~4'I"AL.. F;'F~O'T'EC]-);Olxl El;:".5 I.. !iCFREET, AN[]HDRAGIE, Al< 99,50 1 7,.~'. 6 4 '.,', 4, 7 2 () F'ERM!'I' NO; :[) A 'f' IE .I.,:~,:~ U 1:::. L): APF:'L :1: []ANT'.' A D D R Ii!i: S S: CONTACT I:::'HDNE, CIO GEOL.AB HOF~IZOI',I CONSTF;~ 11:]; 1 ANC, HORAGE, Al< 995 :[0 344 SUBDIVISION: RABBIT CREEK HEI(3HTS LOT~ 15 BLOCI<: SE:C"f' I ON ~ 1 'TOWNSH I P ,", 1 I Iq RANGE;: i~ 3W 2 1C~()() (,'.3Q., F'T, OR MAF;~ I I',.I0 ANJ(} CARl... ]2 (:::~::m't'.. :i. ~"~,' tl'h:~.L :i :1.,,I am {am'il:i. aP w:i. tl", t~.1"1(:.;~ r'equ:i.,*emer'rLs t'l::m (:.~n-s:i. te sewer's, ar'id wml].!.::'~. F(:m'Lh by tho;, H;..u"l:i.c:i.l:~alit:.y of' Anr.:l"lor'ac...je (IfiL]A) and 't'..hB Bl'.a'Le ,::)t' Alasl.::a. 2. I ~.*,~:i.:t.]. :i. rls-I.:.all t. he syste:m :i.n a,:::cor, dance t,~.i.'t'..h a:l. 1 MOA c:odes'~ and ,'.,~rld :i.n cc)fi'~l:::.].ianc:e w:i. th 'Lh,~ (::les:i. gr"~ ¢::r':J. te~-:i.a o'f' tl"i:i.:; per'm.'i.t. 3:1, t wilt a(:'ll'ie~r'e to all MOA ar'id S'Late (:~,f (../la~.-.d-::a r'(.z.:,(::luip6):mer'rt'..s ToP.the set back s(-:{:t,~¢:H'ag(:.~ ;:,y!!st,~:~.:.,1 Ol] 'L['li!~:i o[' al"ly ad.ja(:;:.~:.:.tnt ,f::)i" r'le,~:Ir'by TI'.'!Elxi (1) AN tEI..ECTRICAL. PERMI'I" AND INSF:'ECT]:ON I"IUEF'F BIE OBTAINEDJ AF:'I::;'L }: CAI',I]": ]: SSUI!i:I} BY O[OLAB I l ~ 31 E~ST 76TH ~vr~oe go7- 344-8042 SUITE ~ ~ Ol h~CHORhG[, hLhSKh 99S02 August 19, 1985 Iqunioiapality of Anohor`age Department of Health and Envi~'onmantal Pr`otection 82G "L" 8treat Anch~'oaoe, AlasKa Reference'. Rabbit C~'eak Heights Lot 115 Block 2 ~entlemen: Recent inspection of the subject lot indicates that the water table is within two to three feet of the ground surface at this time. In light of this infor`mation and the past problems that have bean experiencod with this m/stem, we recommend tIlat DHEP i~ue a pea'mit fop a holding tank for- this property. There is suffioient room on the lot for the holding tank to be installed Il'lOPe than 100' from the well, and in a position where it might be easily servioed f~'om Carl ab'ret. If conditions r-equi~'e it, wa sea no Pea,son why the tank could not bo installed olosar' to the well, if nece~,~ary within the I O0 foot pr-otective radius, since the well is Iooated on the uphill side of the lot. Ther-e will be little risk of contam ination. Should you h~ve any questions, please de not hesitate to contact ua at 344-8042. Sincerely, David A. Stanley, P.O. President O__eo__iogicai Consulting · T~,.;tin~_L_aborator_y__o.Quali~§.._Control , Septic System Dgsign~& Insp~_ecti~)__n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMEN'rAL 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 ~;~'~/0~ I_ [] UPGRADE VIAl LING ADDRESS LEGAL DESCRIPTION LOOATION J .... - Well . - Absorption ~rea !/ DISTANCE TO: J / /O I ~ ~[ ~anufacturer e JL~. c IF HOMEMADE: Inside length Dwelling DISTANCE TO: ~ inufacturer DISTANCE TO: J ~ I J T~al length of lines ~op of tile ,o finish ~rade Zi~ ¢ '~ ~neath ,ile - Length Type of crib DISTANCE TO: Class DISTANCE TO: Width Crib diameter Well Depth Building foundation Depth Crib depth Building foundation Driller SewerlJne Material Nearest Jot line_~)~t ¢ NO. OF BEDROOMS PERMIT NO. No. of compartments Liquid clept ~ PERMIT NO. Liquid capacity in gallons PERMIT [x~. "~ L~'.~) ~.~ ) ~. Trencl] width inches J Distance b~nes '~ ~/~¢ J Total effec'tlc"~o_rption area  PERMITNO. Total effective absorption area Nearest lot line Distance to lot line Septic tank iPERMITNO. Absorption area(s) OTHER APPROVED DATE LEGAL 72-013 (Rev, 3~78) PEI¥11 'i' ~-~0. [.,EF'FIF.:THENT ~ HEFIL. TH FIN[:, EN',,,' I RCIhlMEI',II"F:IL DTECT I ........ . ...... , ......... ':'":'~' .... 1... STF.:EET., H1,t ...H ~ [,'. P :~E.., F:IK. /z,, ;::: :~; .4 - 4 C, ]"~., .... '_'E; Z "'IF" IE 5~; IE 11..]t ~ IF%" F:;:~ ~:_..':~ E." P", Z T' ,:: 82:~)2:i..;~: ::, FIF'F'I.. I CFIFJ"I" L. OCI::IT I CIN L..EGiFIL F'ORF.:EST I','IETSKER,::RL'¢E~¢.'.R '?'::L25 OL[:, SEI.,.tFIF.:[:, li.[,.l'-r'. LOT t5 BLK 2 RFIBBIT CREEl<: HTS. LOf SIZE 999:)99 SI:.:!L..II:IRI::Z I:EET T'¢F:'E elf ::.] iTJ ]: [.. FIE:SOF.::PTIOI'q 5YS;"I"EH IS: TRENCFI I'"IFtXIHLIH t'.,tL.II','IE',[EI:;$: i]F BE[:,RI]II]HS ::= :~: SOIL. RFITINCi (SI.T! FT,."E:I:~:;,= ±]:Et '/'tiE: IE:EC!IJ I EEl::, S I ZE OF "FHE SO ]: L. RBSC¢.F'I" I Ot'.,! S"r'STEH t S: it;i::, EE F" 'T II"."~ == :E: L.. E:_E hll Eli T' Hi .... ]- ~, C~ B?. Fb "..." EEL £:, E']: F:" -T Ii4 ...... THE LEI'.,IGTH [::,IP1Ei'-,ISIIZII*,I IS THE: LENGTH ,::I1,',t FEET) OF THE TRENC:H I]R [:,F.:I::IIt'.,!FIELE:,. THE E:,EPI'H OF FI TF.:EI'.,ICH OI;.: P1.T I5 THE [)I'_=;"rFII'.,ICE BETI.qEE1,.4 THE SUF.:FFtCE OF THE FiI:EIU1,.~[:, Ihl'.,l[:, THE E',OTTOi'"I OF 1"HE EXE:Ft',,,'FF[':[OI'.,! ,::Ii'.,t FEEl"). THERE IS 1,40 SET I-,.II[:,TH FOR TREt'.,ICHES. THE GRR',,,'EL I::,EPTH Z5 THE I"Ilt'.,tIMLIM [)EPTH OF GRFI',,,'EL. BETI.,.IliE1,.,I THE OUTFFIL. L PIPE F:I1,.,I[) THE BOTTOM OF THE EXC:FI',,,'FII"ION (: I I'..t FEET). iF;:4'.' E..E.- C., LIi % IR: EE [:, 5~F, E F:" '-IF" Z C.': ]"" FII F,l IF=::: ftC; .'[_ ;~: EC =-= d._ IEI~ ('?.ii ~;~ Eii FII I~_ Ii._ C~ Ii'-,ft ::.TEl; F:'EI:;.:H i '1" FIF'PL. I C:R1,qT HI::tS THE RESPONS I B I L. I T'¢ TO I I'.,IFORM '1"I'..11S [:,EF'FIR'FHENT [:,t. JR I NCi THE I NSI"FILLF'IT 1. O1,.,I Z NSF'ECT I OI',IS OF FII'.,t',' I.,.IEL. L.:E;, FI[)._TF1CENT TO TH I S F'RECERT"r' Fli"4[:' THE i'qUHE:EI:~'. OF RE51.[:'ENE:ES I"HFtT THE t.,.IELL I.,IILL SER',,,'E. ..................... T' 1t.4 C" ":::; ;.Z?.:.'.: Z:, Z li'".~ .~.; F" EE C: -If'" Z C~ INii ~; FI~ F:-:-" E F;:2 It.:...~ C.~ IUt ][ Ii:;;.: lie Iii::', ........................ [ii;FICl<:l:' 1. LL Z l'.,li] OF FIi'.,I'T' S'¢STEH 1.41 THOI_IT F 1. 1,.,11:II.... 1. Iq:'~;PECT 1. O1,',1 FI1,{:, I::IPF'ft]',,,'RL E','¢ TH I S DEPRf;.':'I"HEi",IT ~,.tZLL. BE 5L.tBJ'ECT TO F'It]SECLITI01,.,I. HII",IIHLJM £:,ISTFti'.,ICE BETI.,.IEEI'-.! FI t4EI....L R1,'4E:, FI1,',1"¢ I_-I1,.,t-.-SITIE SE!.,.!RGE [.',ISPI]SRL 5'.?:STEM IS ::JOEl F'EET FOR FI F:'R]:',,,'R"FE [,.IELL OR :1.50 TO ;;K,.Z~ FEET FF..'OH R PLIBLIC !,-!ELL E:,EPEI'.,I[)I1,.4L-~ LIF'O1,.,I "fi. II:F; T"r'F'E OF F'LISL. ZC t.,.IELL.. HIi",t1.1iUH E:,1. STFIt'iC:E FROH I::1 PF.'.'I',,,'FITE I.,]ELL TO FI F'F.':I',,,'FITE SE[qER L..Z1,.,!E IS 25 FEET FI1,.,IE:, TO Fi L-:OHHU1,'.t1.T'T' SEI,.IEF.". LI1,qE 1.S 75 FEET. CFH-.IEt-;: EEOU 1. I:;?.EMEI'.,ITS HFI'¢ I:¥'PL'T'. SPEC 1. F T C:l::l'l- 1.' ON'.E:; RI",IE:, C:O1,',lL=;'FF.:IJCT 1 O1"4 I) 1. FI',,,'FI I IJ::IBLE i]] 1. t",ISUF::E F'RCII:'EIE: 1' I",15 TI::ILLff['1' O1'-.I. 1. C:EI";,:"[' I F'T' TFIFtT l: I l::lh'l FFII'"IILtlaR I.,IITFI THE I;':EQUlREHEI",tI'S [:'OR OI",I-SI"['E SEt,.IE:RS I::INE:, I.,-!EL. LS FE; SET POI:;.'.TFi ES" THE I'iLIb,I 1. C: I F'FIL I "F'T' OF F:I1,,ICHOF.:FICE. ;?;:: T t.,.IIL. L 1.1"4SI"FILL THE S"r'STEM 1'1'',1 IaE:COF.:E:'FSE:E I.,-!ITH TFIE OOE:'ES. 2i:: 1. UN[:,EF.:SI"RI'C:, THFIT THE OI",I-S1.TIE SEI.,.IEI';: 5'T'STEM HFI'T' REC!LIIRE EI",IL.FIRGEHE1,'4T IF THE EESIE:'ENCE 1.S F.:EMO[:'ELEC' TI] 1.1,'~CI.&IE:'E HOF.'.E THRi",I ]: BE[:'F.:OOMS. ~ ,<~ ,.,/? 5,19 - 6.561 $ 6 ? 9 lo ~2 I? WATER WELl_ RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol 8. Geophysicol Surveys LOCATION OF WELL (Pleose complete either Io~ lb or lc.) I~.IOISTANCE DHtECT~ON FROM ROAD INTERSECTIONS AND Street Address end Areo of Well Locofion 2. WELL [-OG Feet Below Surfoce M~teriol Type Top Bottom Drilling Pormft No. A.DL. NO. OWNER OF WEL. L: ] Address: 4, WELL DEPTH: (finol) i~--- ff. 5. DATE OF COMPLETION 6, L-'~ co hie fool ~.~ ROt(3 r y [~] Driven [~ Auger [~Jefted E~ Gored r~']Other: 7, USE: [~ Domestic [~ P*lblic SuppLy E~ Industry [] Irrigation [] Recharge [] Commerical [] Te~t Well [] Other: B. CASING: [] Threaded ~} Welded diem. :i in. to , fl. Depth Weighl __lbs./ft. diom.__in fo___ fi, Depth StJckup ft. 9. FINISH OF WELL: Type: __ Diameter: Slot/Mesh Size: Lengtb: Sol between fl end Backfilling Grovel pock -- ft. [] Above or [] Below land surface Date II, PUMPING LEVEL below lend surfoce end YIELD , ' ft. (~fter :' 71 hrs. pumping , g,p.m. 12.GROUTING Well Grouted: L~ Yes [] No M(~teriol: ~] Neet Cement [] Other: 13. PUMP: (if ovoHobie) HP Lertgth of Drop Pipe ft. capucity g.p.m. 14. REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Wafer Temperature This well was drilled under my jurisdiction and lhis report is Irue fo fha besl of my knowledge (]nd belief; Registered Business Nome Co~fracl License Number ° []F E]c Signed: Authorized Represenlefive Form 02-WWR (11/81) Copy Distribution; WHITE-Stole DGGS~ PINK-Driller, CANARY-Cuslohler MUNICIPALITY OF ANCHORAGE Development Services Department P p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-551-14 Expiration Date: g- 2 2- 1. GENERAL INFORMATION Complete legal description Rabbit Creek View & Heights Block 2H Lot 15A Location (site address) 8001 Marino Drive, Anchorage, AK 99516 Current property owner(s) Kelly N Wozencraft Day phone Mailing address 8001 Marino Drive, Anchorage, AK 99516 Boston- Ho man (907)441-9945 Real estate agent pI� Day phone 2. TYPE OF DWELLING: 0 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: Private Well Private Septic ❑ Water Storage ❑ Holding Tank ❑■ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 550 Waiver Fee $ Date of PaymentLl �2 - 2-1Date of Payment Receipt Number -7 -2--D Receipt Number COSA # 0 ­�- G 2 2. 116 9 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering (M -J-) Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 4/27/2022 6. DSD SIGNATURE System #1 Approved for 3 System. #2 Approved for Disapproved Conditional approval for ;101j*:49TH •*�/ r bedrooms % BenjaAgmSchiller bedroomskctrF •,ca//2i/z22,.����``,��,�/ bedrooms, with the following stipulations: l�lllxnA ll(( I 1/!III 11 Original Certificate Date: The Municipality of Anchorage Development Services Division(DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory 7 = Other COSA Checklist blue sheet Legal Description: Rabbit Creek View & Heights Block 2H Lot 15A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ®❑ Well log is filed with Onsite (or attached) Date drilled 7/15/1983* Total depth 160 ft Cased to 157 ft ®❑ Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 2/8/22 Parcel ID: 020-551-14 Structure served by this system Well production at time of test 0.4 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No OR Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 02/03/22 Static water level at beginning of test 32.7 ft. Comments Well log illegible; information taken from COSA paperwork B. TANK DATA Age of tank(s) NEW years Tank type/material. Holding/Steel Measured operating. fluid level in septic tank N/A W Standpipes/foundation cleanout per record drawing Date of pumping New construction 4/21/22 High level alarm present and tested by installer SORPTION FIELD DATA Which sys tested (date installed) ALL standpipes ent per record drawing Total measured depth from g ft (max) Measured depth to pipe invert from gra ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet STATION ❑ Require intenance completed Age of lift station ears Lift station. material Comments: Adequacy test date Results 0 Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Findepth in Absorption rate gpd Any rejuvenation treatme ast 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' U Yes if No ft Property Line > 5 ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ✓Q Yes if No ft Private Wells > 100' ✓0 Yes if No ft Water. Main >. 10'. _- .✓❑ Yes if No ft Community Wells > 200' ✓❑ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if. No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet TH BenjarrtSchiller Fc • CE 125924/27/22 • �`� �' PROFESStQNa� Municipality of Anchorage � ..:::... . Development Services Department Building Safety Division .:A F .,.Y. On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC221169 During a recent COSA on-site inspection and test of the potable water supply well on Block 2H, Lot 15A of Rabbit Creels V&H subdivision, the well's productivity was determined to be .4 gallons per minute. The minimum well productivity required by this Department (AMC 1.5.55) for a 3 -bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. • • oPT„C pc, C f •2ce” Municipality of Anchorage _ �- On-Site Water and Wastewater Program 9' • '''' `j' l (907) 343-7904 7� 0 .2: [.0 IL 3 4:4 Certificate of On-Site Systems Approval \ � 4ti 020-551-14 �/ Parcel I.D. Expiration Date: E/S ^/g .1 6 8 1 cl'> 1. GENERAL INFORMATION Complete legal description Rabbit Creek View & Heights Block 2H Lot 15A Location (site address) 8001 Marino Dr. Current Property owner(s) Katherine & David Callaway Day phone Mailing address 8001 Marino Dr. Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: lit � h Date: COSA to be released to the engineer,unless otherwise requested y t engineer. COSA Fee $ 6-at. Waiver Fee $ Date of Payment ,'7 f 7-1 a Date of Payment Receipt Number 0.22,$563 Receipt Number COSA# aJ $ �'g�' Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe 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 soil condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 5/4/2018 i77€OFA qk �i k� _ l 6. DSD SIGNATURE ""= ""' 94 System#1 Approved for bedrooms .Steven 1 H. Pannone 6Is% CE-8149 0„,,of System #2 Approved for bedrooms • Disapproved ‘A.N. Conditional approval for bedrooms, with the following stipulations: c, 1S Z3 /l1P�..(7, did e, G\QP�� c ON-SITE WATER AND %11' WASTEWATER z PROGRAM ni By: � li.�. � ' Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Adviso Septic System Advisory senic A dviso,ry Well Flow Advisory OtherlC COSA blue sheet_f - , c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Rabbit Creek View & Heights Block 2H Lot 15A Parcel ID: A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 7/15/1983 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 160 ft. Cased to 157 ft. Casing height(above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 7/15/1983 4/20/2018 Static water level 27 ft. 70 ft. Well production 1.1 g.p.m. 3.8 g.p.m. WATER SAMPLE RESULTS: Coliform NEC' colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 4/20&24/18 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Holding/Steel Date installed 8/28/1985 Tank size 2000 gal. Number of Compartments 1 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y 4/A61 Date of pumping 3/30/2018 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 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 4/20/2018 Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. N Any rejuvenation 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 at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS 'TAN wits cl -tit'rt7C, q. 2 A' A t Corel -T0 6 t C5voitni i 4(4-: T-- 7- p (, MA. A4-0 V 1-40 7'AnD,c,A—rro 6) O- -A et/ L (-_ lt.Lt AJ c G. ENGINEER'S CERTIFICATION �� OF ,Q�q0� I certify that I have determined through field inspections and /A0103..Awki-• `) y��A review of Municipal records that the above systems are in 0*: , • a /\ %l , conformance with MOA COSA guidelines in effect on this date. %•••• •• •• ••• 0 Engineer's Printed Name Steven Pannone i••:Sveri k. Pannone• 1 5/4/2018 h-0:-.. CE-8149 41 Date 94`) , COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT I• ', 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite / Septic Tank Advisory Certificate of On-Site Systems Approval # osc181187 Subdivision: Rabbit Creek View & Heights Block:2H, Lot: 15A The septic tank for this property is 33 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. • • 7L,. . 11110. � a.� . w 6,�„ • i , ... , 4 1}1 . ky i. w 4*•' /y t,{,ir . 1 Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650 * www.muni.org • oC. FLEMfNG SURVEYING SERVtc;� r( 8221 DEL STREET --- Z.' Y.: \ ANCKORAGE, ALASKASE 99502 NPHONE 243-4890 _. /4 in �QIn , (' Itri L `r�oz_� S.D 4 „, L. `� OS Z/019/ AS—3 ii r r E, 2/0.00 DATE ���sa;% FLDAL QI° 3o,ON �6:2__- 111 r ;'49THL�1 =9*fit xZell ta" -;..Z).=....". ..- a co kfl � + � rlt1sdo a5taee+o 3 ysf1.a JCN arir-I 7115,s - 7sj /.6 i, CA C —i Q t I^ Q r f a: 1 C I o0 -8 .T '&1 ! `�'� Zr� Q �5— 1*---. \ NOTES Eoaamants not o Ppaariep m record aubdsiae 0 ill t N �t plot aro not shown unleee description of asessocasss P ti/1�,t�LL 1 / ��^ I provided by client- It is the respoesibitify or the oz, O t.} �1l CJ orbuilder, priortoconstruction to usrifyproposal4 ( ! K:- PAQ�1 NG bul Idinp grade relotive to finial grade oad .stilirlea t Ll(�� �Q�A J \N f connectioaa,and I determine s1w eaiste, a of any ' I easements,covenants,or restrictions �rbicbdo not T �; i�, a J"' oppwr on the recorded subdivision plot, ti S, Q /9'Os"E� /eOr 00 r• L' ors am Elevations based as disdistant)t., unless othervi. I O I iedicateds and be ;ags and distances ate record darn. .}-r m CLIENTS s EtilGil`/EE2/A16-- C - LII (Y C-d .E" L 7—.€ EE T LEGAL DESCRIPTION 6 0.,0., LOT /S BL0CK Z 2ABBIT`>�' -l< HEtG TS - • PLAT it0, SCALE 'KO-g87 ' /" GR10 �o 33ao MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # (~'~,~L~ \ '~ ~. - ~ ~). NAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 15; Block 2; Rabbit Creek Heiqhts Location (address or directions) 8001 Marine Driue~ Anchorage, A~aska (bl Property owner H.U.D. #035324 Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) RealEstateCompanyandAgent ASSOCIATED BROKERS attn: Sandq Address 640 West 36th Avenue, Anchorage, A~aska 99503 Telephone 563-3333 (e) Mail the HAA to the following address: (or check here.~ if hold for pick up.) List contact person and day phone number below: $ & S F. NGiNEERING 17fl34 En~le River L~r~n Eagle i~iver, Alaska 995~ 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms_ 2 3. WATER SUPPLY Individual Well E~x Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] 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. 72-025 (Rev. 7/88) Page 1 of 2 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, lverifythat 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 obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 17034 F. aCe River Loop Road No. 20_4 Address Eagle River, AI~,':~: Telephone Date THIS IS A RECERTIFICATION OF THE HEALTH CERTIFICATE ISSUED JULY 3, 1990. THIS RECERTIFICATION DENOTES THE TYPE OF SEWAGE DISPOSAL SYSTEM AS BEING A HOLDING.TANK ETRH~RI~NACH~p~EvDiouTs© AH~AOL~S~;~T~;~cT~TMEAS SHOWN IN Approved for _~-'~---bedrooms by ate Approved /,,.___ Disapproved Conditional Terms of Conditional Approval TheMunicipalityofAnchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdonotconductinspections or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 72~02S IRev. 7/88)Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE Department of Health & Human Sen/ices DIVISION OF ENVIRONMENTAL SERVICES 343-4?'44 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWEFt AND WATER FACILITY FOR SINGLE FAMILY r)WEL. LING Parcel I.D.# ~"~J,O- \\~-~L-.~I. HAA# ~'ll~'~Ol~'~2~,~'~(~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 15; Block 2~ Rabbit Cree~ H~hts Location (address or directions) 8001 Marine Drive, Anchoraqe, Alaska (b) Property owner H,U.D. //033324 Telephone'(home) Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent ASSOCIATED BROKERS Attn: Sandy Address 640 W~t 36th Avenu&, Anchorage_; Alaska 99503 Telephone 563-3333 (e) Mail the HAA to the following address: (or check here.~:, if hold for pick up.) List contact person and day phone number below: S & S ENGINI"ERING 17034 Eagle Ri,vet Loop Road No, 294 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family []z Number of bedrooms_ 2 - 3. WATER SUPPLY Individual Well E~z Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site (~ Public [] Community E3 Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72 025 {Rev 7/881 Page 1 of 2 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 verify 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 obtained from [he Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone ~ S & $ ENGINEF-.RING Address 17034 5.=g!~Riv~4' Loop Road N,-,. 204 Em3'~ River, Alaska ,9577 ~,',~-"/"/~.~f'// Date ~'D / Approved for ~ bedrooms by Approved ~'~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DFIHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph .5 above by ~,n 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 MunicipalityofAnchorage is not responsible for errors or omissions in the professional engineer's work. U(~ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) v OF ANCH(~CclE~KLIST - FEBRUARY 1984 ,~NviRONMENTAL SERVICES D~VISION 343-4744 Legal Description: A. WELL DATA Well Classification RECEIVE[) Well Log Present (Y/N) ~ Total Depth I(¢ O ' Cased to Static Water Level ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) If A, B, C, D.E.C. Approved (Y/N) ~ Date Completed '-"¢ - ! &--- ¢ % Yield t¢'"~'Depth of Grouting Pump Set At ~ 'f- Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot __ / COO To Nearest Edge of Absorption Field on Lot ~/~ To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by _-% '~ ~, ~/~'td~'/'k) ~-f'i tJ~ ; Date Water Sample Test Results Comments B. ~/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) No. of Compartments Air-tight Caps (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ( (PO To Property Line ~'~ ~ To Water Main/Service Line [ To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Foundation Cleanout (Y/N) Date Last Pumped (_,¢ - ..2. '~' - ~ O <~/~ ,') ;for Yemporary Holding Tank Permit (Y/N) A)//~ To Building Foundation '~0 7.~ To Disposal Field Page 1 of 2 C. ABSORPTION FIELD DATA / Soils Rating in Absorption Strata Date Installed ~ - 2 ¢ ~ ~'-'~-- Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test Square Feet of Absortion Area"~ Depression over Field (Y/N) ~ Results of Last Adequacy Test ~'~ SEPARATION DISTANCE FROM ABSORPTI'~FIELD: f.~ To Water-Supply Well /~ %-, ¢/T~.~ Property Line To Building Foundation To Existing or Abandoned System on Lot ; On Adjo~g Lots To Water Main/Service Line To %ack (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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. Eagle River~Alaska~5~ ¢/_ "/ ,'~ ...... Date ~ ~: P:? Waiver Fee:$ / ~' (~¢2 Date of Payment Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7~88) Back Page 2 of 2 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township range) Location (address or directions) (b) Applicant Name ,~ Telephone: Flome Business Applicant Address (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); _ (d) Lending Institution Telephone Address (e) Real Estate Company and Agent _ // Address Telephone __~._-/ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms i,'% Other 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. SEWAGE DISPOSAL Onsite [] 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 72°025 (11/84) 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 verify that rny investigation of this Health Authority Approval shows tl~at 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 Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection, Name of Firm _ /I'/~- ~ J-/~-. Telephone ~/-~ Date ~-,~0-- ~ DHEP APPROVAL Approved for ~_~'z~-~-(/~_ bed rooms by ,.A~ApPI:~ ~ Disapproved_ Terms of Conditional Approval Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority 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 lending institutions Jn 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 engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 WELL DATA Well Classification ~L~//"?c/~ Well Log Presenti~N) ~ Total Depth ~_~--) _ Cased to Static Water Level Casing Height Above Ground ___ Electrical Wiring in Conduit(~/Jxl) Separation Distances from Well: To.Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line __ Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments MUNICIPALITY OF ANCHORAGr. DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 2 1986 If A, B, C, D.E.C. Approved (Y/N) Date Completed '~ / 5~' ~'.~ Yield ! /(~'7 __ Depth of Grouting ( ; On Adjoining Lots _ . ; On Adjoining Lots To Nearest Public Sewer Pump Set At ~¢~¢~d ~, Sanitary Seal on Casing (~) Depression Around Wellhead (YQ_ /¢~ ~ To Nearest Sewer Service Line on Lot ¢/¢ f'& /~.~-~<~ ..L~/~- ; Date ~ ~ / ~-~¢* Date Installed Si,e Standpipes Oki) Air4ight Cap (~N) Depression over Tank (/'~ Pumping/Maintenance Con[tact on File (Y/N) Holding Tank High-Water Alarm~N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well / To Property Line To Water Main/Service Line Course No. of Compartments / Foundation Cleanout~) Date Last Pumped __,//~ ~O ~,~ ~' Comments ; for Temporary Holding Tank Permit (Y/Ni ~4 To Building Foundation TO Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Lil To Stream/Pond/Lak~ Major Drainage Course To Driveway.~,~ing Area. or Vehicle Storage Area Comm~ Type of System Desi{ Length of Field __ Depth of Fiel( Gravel Bed :)es Present (Y/N) of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed D mensions~.-- Size in Gallons ~, Manhole..CA- cc~ess (Y/N) "Pump On" Level at ~ I~ jr "'~Pump Off" Level at High Water Ala'rm Level at l~.J,.-%'~. Vent (Y/N) Tested for J Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) jJ Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that.t, have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed f,.~,.~-.--, /~/.. ~_~;/.-~ Date ~ %~.~_~ - ?~; Company ~'~'- ~ Receipt No. Date of Payment Amount: $ MOA No. Page 2 of 2 72-026 (11/84) Pzopsrty Owner Mailing Address APPLIf NT FILLS OUT UPPER HA' ' ONLY i,' .. Zip Code Phone Buyer Address Zip Code Lending Institulion Phone Address Zip Code Realty Co. & Agent Phone Address Zip Code Legal Description Street Location Type of Residence [7 Single Family [] Multiple Family No. of Bedrooms .... ~] Other Water Supply [] Individual ATTACH WELL I..OG. A well Icg is required for all wells drilled since June 1975. [] Community For wells drilled prior to that date, give well depth (attach Icg if available). C~ Public Utility Sewer Disposal [] Individual [3 Public Utility (3 Holding Tank Year Individual Installed: When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector lespeclor Inspector Inspector Field Notes: APPROVED BEDROOMS DISAPPROVED CONDITIONAL APPROVAL' *CONDITIONS OF APPROVAL Soils Rating -- ~. Date Sewer'lnstalled Well To Absorption Area Well to Tank _/ 7 (~ Well Log Received I,.,-. Septic Tank Size