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Home My WebLink AboutRABBIT CREEK VIEW & HEIGHTS BLK 4V LT 4ARabbit Creek View Heights Block 4V Lot 4A #020-541-37 Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT W-37 Permit Number: OSP151232 PID Number: 020 ❑ New ❑✓ Upgrade Name: Jacques Boutet and Donna Gryder-Boutet ABSORPTION FIELD ❑ Deep Trench El Shallow Trench E] Bed ❑Mound Address 9043 Snowy Owl Lane Anchorage, AK 99507 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft, Subdivision Block Lot Rabbit Creek View & Heights 4V 4A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width FL Beds: Number of Lines Distance between lines Ft SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft' Ft. Well >100' >100' >100' >75' >25' TANK O Septic ❑ S.T.E.P. ❑ Holding ❑ other Manufacturer Anchorage Tank Capacity 1,250Ga1. Surface water >100' >100' N/A NIA Material Number of compartments Lot Line >5' >10' N/A N/A Steel Two NA Foundation >5' >10' NIA N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Tank Only Replaced Under This Permit. Pump on level at in, Pump off level at in, High water alarm at in. Existing Tank Decommissioned in Accordance With Municipal Code. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tankD3034 Tank to D3034 drainfeld G&R Excavating Drainfield Co/MT Inspector W Roberts BENCHMARK (Assumed elevation) 100.Oft Inspectionr 1 8/11/15 8/12/15 Location and description dates: 2na 30 8/14/15 4'" Back Upper Deck. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL :n.A0,q► W i OF q 0P'�� `�S`��, Conditional Approval: Date 07, .... ....c — -- MICHAEL E. ANDERSON :a- Av CE-4381=� Approved Date 81 q�/, 14% j""�� Inspection Keport_1-1-12.aeo r Permit Number, OSP151232 I LOT 4A, BLOCK 4)( V RABBIT CREEK V & H I LOT 2A 30,761 SF -I ----------------------- N 89°37'15"E 187.70' I _ I I 10' UTILITY EASEMENTS I C2 j z4 • st QOfZ I S2 p p i CO i Ui FCO i Existing Absorption ,� Four Bed Bedroom Home rn NOTE: Existing Septic Tank Decommisioned in #S256.6' B Accordance with 9' 68.9' Municipal Code. 69.7' I LOT 4A ®Existing I 30,761 s.f. Well I GAS 10'x20'It NATURAL \ WOODEN FENCE � � 6=:1'3iSff.'i&7riE:1 Ai I LOT 6A LEGEND .:, OF q( �� ••...�51�+ S1 — Septic Vent ..�P,* CO — Clean Out M1 — Monitor Tube {z ; •* •`: 0, TH — Test Hole c 49th / FCO — Foundation Cleanout �,j j �j 2CO —Double Cleanout MICHAEL E. ANDERSON : No. CE -4381 ; PLAN AS BUILT ��- t� �� ROrresl�NP�s�� SCALE 1" = 30' W rri rn N J W LLI Ld LLJ Ld Z LLI0 On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151232 Tax Code Number: 02054137000 Work Type: SepticTank Upgrade Permit Effective Dates: August 11, 2015 to August 10, 2016 Design Engineer: ANDERSON ENGINEERING Subdivision: RABBIT CREEK VIEW & HEIGHTS Site Legal Address: RABBIT CREEK VIEW & HEIGHTS BLK 4V LT 4A G:3241 Owner/Address: BOUTET JACQUES M M & GRYDER-BOUTET DONNA E %BOUTET COMPANY 9043 SNOWY OWL LANE ANCHORAGE AK 995072 Site Mailing Address: 16100 GENEVIEVE ST, Anchorage This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 30761 Total Bedrooms: 4 N Private Well N Water Storage 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By 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. 020-541-37 Property owner(s) Jacques & Donna Boutet Day phone 646-1601 Mailing address 9043 Snowy Owl Lane Anchorage, AK 99507 Site address 16100 Genevieve Street Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Rabbit Creek View & Heights, Block 4V, Lot 4A Legal description (Township, Range & Section) Lot Size 30,761 Sq. Ft. Number of Bedrooms Threeol y APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: [M all that apply) Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade 0 Duplex Duplex (D) ❑ Holding Tank El Renewal El Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature property owner or authorized agent) Permit/Rush Fees: AA Waiver Fees: Date of Payment: '1(20)15f% Date of Payment: Receipt Number: 6!5q AA 6) Receipt Number: Permit No. O�ip 1 S �Z�i 2 Waiver No. piieovi., - k�2S'orP1%�o�.-�:��d u`ev�IIe w eow,��,n�-�ed�l^�vr �l-u ve,rnDv?�,n� � p p'upV%,� �. �Ui E��ic1 i ��Q .LOr J`e�inlnd Permit App_9-1-12.doc ` J ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) August 11, 2015 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4A, Block 44, Rabbit Creek View and Heights Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer The septic tank on Lot 4A, Block 4H, Rabbit Creek View and Heights Subdivision has failed and must be replaced. In addition, the outlet of the tank is completely plugged and no efflulent can access the absorption bed. We are therefore requesting a permit be issued for the construction of a new 1,250 gallon steel septic tank to serve the home. The attached Site Plan and backup documentation identify the location and configuration of the existing septic system and the location of the new tank. Also identified on the plans is the existing well on the lot and those on the adjacent properties. No conflicts existing between the well separation distance the septic system on this or the adjacent lots. The existing tank on the lot will be properly disposed in accordance with Municipal Code. The existing absorption system will remain in place for continued service. The monitor tubes and cleanouts in the bed are ineffective and improperly located. They will be replaced with new vents at the correct locations. The ground surface on the lot slopes at a grade of 7% to the west in the area of the septic tank. The tank will be constructed near the location of the old tank and in conformance with Municipal requirements. If the tank is constructed in accordance with our design the following statements apply The tank, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. Lot 4A, Block 414, Rabbit Creek View and Heights August 11, 2015 Page 2 of 2 2. The tank, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The tank, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The tank, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, 7 ✓ e - Michael E. Anderson, P.E. Attachments O O Ga W 6 LOT 4A, BLOCK 4HV LOT 2A RABBIT CREEK V & H 30,761 SF RVE VWELL PROTECTI RgDI=100' US 1 1 � 3 N 89'37'15"E 187.70 30.1 / 3 10' UTILITY EASEMENTS W z �SV i Q Y W 2CO SV 1,250 Gallon Septic Tank �. a. Ljj ------ ,— / O X r—r –f CO // -- O MT • I // U) / FCO Existing Absorption I I / TBM _ OF CONCRE E PL C1 r 7 W Bed ELEV. 100.00 ASSUMED > W •I MT i > CO J W Z I W I /� V I I WELL 10'x20' NATURAL GAS EASEMENT S 89°41'55"W 187.11' SCOPE OF WORK LOT 6A Decommission Existing Septic LEGEND Tank in Accordance with Municipal S1 — Septic Vent Code. Place New 1,250 Gallon CO — Clean Out Septic Tank M1 — Monitor Tube .p��,�1 OF and 2 — Post Tank �� , .44 ....... Clean Outs. Tie In Existing TH — Test Hole . = ��P Absoorption Bed. Place Clean FCO — Foundation Cleanout s Outs and Monitor Tubes in 49th Absorption Bed. 0'j% J r SITE PLAN ..............................�.........+..-.-.5.. '�' """AE` E -4381 °" 4 •� f't IVO. CE -4381 f♦1��f! ,•'•.`: SCALE 1" = 30' 8.11-1 ' - MUNICIPALITY OF ANCHORAGE I DEPARTMENT OF HEALTH & ENVIRONMFNTAL 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 g royj 0w_ 3,+5 1454 3e IPGRADE MAILING ADDRESS 16 1 oa Genevi"e_ LEGAL DESCRIPTION RAb�t'F CfeeK View Loo 4 aloc.kL- eke T1(NIZ LOCATIO NO. OF BEDROOMS �y 4 t° !A�' l 1 _4e i Well Absorption area Dwelling PERMIT NO. U DISTANCE TO: 1 v 8 20 6S 9$ 0L 9506S yi aManufacturer UJ 1)nchora Material SF�� No. of compartments Liq. capacity in gallons Inside length Width Liquid depth 2—,5-C) IF HOMEMADE: 0 DISTANCE TO: Well Dwelling PERMIT NO. =Oz Z F Manufacturer Material Liquid capacity in gallons D DISTANCE TO: Well Foundation �$ Nearest lot line 4 8 PERMgNO. S'616 5 LU ��j'j,, W LL U w 'No. of lines 6 Len th of each I'ne Total length of lines Trench width ' Distance between lines � ? ,;t, t4. 4 200 / inches 4-6 zi H Top of tile to finish grade Material beneath tile Total effective absorption area p Q 4 inches � LL Length Width Depth PERMIT NO. LU C9 Q F Type of crib Crib diameter Crib depth Total effective absorption area as w WWell W Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER 0W Sl 1 ierh PIPE MATERIALS 3034 (81e (ceYw t`t e) a O SOI L TEST RATING 3 g C1'/b 7777 r, 6 INSTALLER Df?- Hr fncUry �il(a�sa`I�"n �'% �S3'� O"•� 2 .t. r REMARKS (nS eci-ecl b L�wrc wroR S•C8J'O Z li �t5 i Them Sol C S; - km W&S tarp /.�' C I l e lk _rjr br (rt,,S @ 1•r� rUc,C t J,c.S '`-r� r,,;..rrlts�i wel W -,5 s",,A to,. t M e IV APPROVED DATE LEGAL - 11: /D �� 7!' ea %G:. /C'f - [ A4.n. 1..t in dJ r ._ 2, fS_ ' ' ~ . � ` � ' �� ` ` DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 ` ` �� PERMIT NO: 850265 DATE ISSUED: 06/06/85 APPLICANT: BYRON WILSON ADDRESS: 16100 GENE0IEVE ' ANCHORAGE. AK 99516 CONTACT PHONE: 345-1454 LEGAL DESCRIP:SUBDIVISION. RABBIT GREEK VIEWLOT. 4 ' BLOCK: 4 � SECTION: I.8 TOWNSHIP: 11N RANGE: 3W LOT SIZE: (SQ.FT. OR ACRES> MAX BEDROOMS Z.[/ Listed below are t.h ti available t i1ri designing you septic system. Choose the � � -_ DEPTH TO PIPE BOTTOM 8RAVEL DEPTH (FT.) .5 1.5 TOTAL DEPTH (FT.) GRAVEL WIDTH (FT.) GRAVEL LENGTH (FT.) _. 0 �� 86.0 ** - �_� GRAVEL V8LUME (CU.Y 31.2 /� ~ 31"9 TANK SIZE (GALS)1,250.0 1,250.0 ** SOIL RATING (SQ.FT. /BR) 138 138 ** DEPTH TO PIPE BOTTOM < 3.5 FT" REQUIRES INSULATION ** DE' TOYPIPE BOTTOM < 4"0 FT" MAY REQUIRE A LIFT STATION **GRAVEL LENE"TH > 75 FT, REQUIRES MULTIPLE RUNS (NOT EXCEEDING ** TANK MUST HAVE AT LEA13'T TWO COMPARTMENTS ..... ..... ��.... �..... �� 75 FT. EACH) I certi�y that: ^ 1" I am f*amiliJir with the requirements f'or on-site sewers and wel1s as set forth by the Municipality o[ Anchorage (MDA) and the State of' Alaska. 2, I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State o[ Alaska requirements for the set back distances f'rom any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4, I understand that this permit is valid for a maximum of* 4 bedrooms and any enlargement will require an additional permit. , IF A LIFT STATION IS INSTALLED IN ANAREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTR IC4L PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRIGAL INSPECTION REPORT; AND (3> THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRITCIAN" SIGNED APPLICANT: BYRON WILSON y0 T�A1|Fn A�Y .�,. .^, _ . /V°-'_~ DATE: DATF: � ~ /m />�,\ PERMIT NO: DATE ISSUED: APPLICANIT: ADDRESSW CONTACTP: IONE: KD Ts!~-- W 1:~V K M M Up EHJTT M EE HAT 1-1 1~� 850265 06/06/85 BYRON WILSON 16100 GENEVIEVE ANCHORAGE, AK 99516 345-1454 LEGAL DESCRIP: SUBDIVISION: RABBIT CREEK VIEW LOT: 41 L/ SECTION: 18 TOWNSXIP: 11N RANGE: ��y LOT SIZE: 43000 (SQ.FT. OR ACRES) 138 138 ' \ MAX BEDROOMS: 3 0[/�^^ @-/ MAX BEDROOM� BLOCK: 4 /- / V !HNK SIZE <WHL3| UT ",0 ** ,�u;.� ** L. RATING (SQ,FT./BR) / \l 138 138 \J \�/' ** DEPTH TO PIPE BOTT < 3`5 FT. REQUIRES INSULATION ** DEPTH TO PIPE i3 crp i OM < 4.0 FT" MAY REQUIRE A LIFT STATIOM , ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS � I certi{y that: / / i ha r, with the requirements � for on-site sewers and wells as s�t Vort 11 13 he Municipality of Anchorage (MOA> and the StatEW oV Alaska. 2, I 04 j. 1 l the system in accordance with all MOA codes and regulations; and i compliance with the design Criteria us this permit. 3" I wiI3 adhere toall MOA and State o� Alaska requ0rement1; [or Lhe set back dista:ces from any existing well, wastewater disposal system or public sewerage syste� on this or any adjacent or nearby lot. 4. I understand that this permit is valid For a maximum o� 3 bedrooms and any enlargement will require an additional permit. M -W Drilling, Inc. ♦ P.O. Box 110378 ♦ Anchorc le, A K 99511 •907-345-4000 ♦ 907-3,15-3287 Fax* Job No.: 02-137 Project No.: N/A Permit No. SWO20189 Groundwater Well As -Built & Lot; ♦ Well Owner. Boutet, Donna _ ♦ Use of Well: Domestic ♦ Legal Description. Rabbit Creek View, Block 4, Lot 4 16100 Genevere- Anchorage, Alaska Constructioi t ♦Hole Depth: 205' ♦Casing Size. 6" *Cased To: 37' ♦Materlal: A 53 Steel ♦Drill Method: Air Rotary Perf. ♦ Well Completion- Open end X Screen _ Perforated ! Method: ♦Screen/Perforation description: None ♦Grout Notes: 10" Surface casing installed & pulled while grouting annulus with bentonite. NfR ♦ Notes: -4011C TO S042, ♦ Well Development: Method. Air surge Note e. *Static water level (SWL) 25' (above) (below) top c (casing (TOC). ♦ Well yield test at 2.5 gallons per minute (GPA Iga (Ions per hour (GPH) for 1 hours with 100% of drawdown (DD) from static level (SWL). *Method. Airlift ♦Date of completion: 25 June 2002 0Pump Install: 26 June 2002 Well Log Depth in feet from top of casing. Details of formations nenetrai ed, size of materlal; color and hardness. 0 TO 2 Casing stickup 2 TO 5 Topsoil 5 TO 17 Gravel: sandy, coarse 17 TO 20 Fractured bedrock 20 TO 205 Bedrock: gray/black, siltstone a-gillite, small water leaps in sporadic TO fractures. TO TO TO TO TO TO TOj TO TO TO NwwA Certified ContrPetor TO Certificate No's. 814 &'072 I r w � S M- W Drilling, Inc. MEMO 01 July 2002 To: Whom It May Concern From: Wayne Westberg, President Re: Rabbit Creek View Subdivision, Lot 4, Block 4 Subject: Well Decommissioning This is to verify that the old well (74' total depth, ? foot of casing) was decommissioned in the following manner: 1) Pump pulled, waterline disconnected. 2) Back-filled with coarse bentonite chips to minus 10 feet. 3) Casing cut off at minus 10 feet (ie. Below old pitless unit) and a4"' steel plate welded on top. NWWA Certified Contractor Certificate No's. 814 & 973 uP.O. Box 110378u Anchorage, AK 995111) uPhone:907-345-4000uFax:907-345-3287u 0 'r are our business!!i George P. lhaereh, Mayor May 12, 2003 Jacques Boutet 16100 Genevieve St. Anchorage AK 99516 Mtmicip":ty oiAnchorage Building Safety Division Subject: On -Site Water and/or Wastewater Permit. Permit Number: SW020189 Legal Description: Rabbit Creek View Block 4 Lot 4 Dear Jacques Boutet: Anchorage 2002 An On -Site Water/Wastewater Permit, number SW020189, issued by this office for a single-family system, will expire on June 24, 2003. This permit was valid for365 calendar days. If this was'a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection ` reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, anew permit must be obtained from this office.' A newpermit for a'second year may be issued for a fee of $100.00 if the renewal application is received on or before the expiration date of the original permit. When applying for anew permit, the fees are: $400.00 for a wastewater permit and $150.00 fora well permit. If you have any questions, please call this office at 343-7904. Sincer, J s Cross, P.E. Manager On -Site Water and Wastewater Program Enc: Copy of permit P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: (907) 343-8301 • rax: (907) 343-8200 4700 South Bragaiv Street • Anchorage, Alaska 99507 littp://ihxiv.ci.anchorage.,alc.us h ' MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WATER SUPPLY PERMIT Initial Date Issued: Jun 24, 2002 Expiration Date: Jun 24, 2003 Permit Number: SW020189 Parcel ID: 020-032-21 Legal Description: RABBIT CREEK VIEW BLK 4 LT 4 Design Engineer: 0014 Anderson Engineering Site Address: 016100 GENEVIEVE ST Owner Name: Jacques Boutet Lot Size: 31445 SQ. FT. Owner Address: 16100 GENEVIEVE STREET Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516-5237 This permit is for the construction of: C Disposal Field [] Septic Tank Holding Tank E 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: Date: Issued By: r �,. �—� ' Date: 6 z Municipality of Anchorage • '� Development Services Department"GEB` Building Safety Division ax On -Site Water and Wastewater Program IS '- 4700 South Bragaw St. 5 " 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 Parcel I.D. _ r'y2o —O6a — '-) 1 Permit Number SW Property owner(s) Jacques Boutet and Donna Gryder-Boutet Day phone 345.6314 Mailing address (1) 9043 Snowy Owl Circle Anchorage AK 99507 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 4, Block 4 Rabbit Creek View Subdivision Legal description (Section, Township & Range) Lot Size__j,1 LIL/ S Acres q.Ft: THIS APPLICATION IS FOR: Sewer Only ❑ Sewer and Well ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Number of Bedrooms Four (4) Well Only Water Storage Jacuzzi ❑ Water Softening Unit ❑ 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: i ` �� Waiver Fees: Date of Payment: G a b Receipt Number: (Rev. 12/00) Date of Payment: Receipt Number: June 18, 2002 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4, Block 4, Rabbit Creek View Subdivision Well Placement and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer The owners of Lot 4, Block 4, Rabbit Creek View Subdivision intends to place a new well on the property in an attempt to increase the water production available to the four bedroom home on the lot. The location of the well and the 100' protective radius are shown on the attached site plan. No conflicts exist between the location of the new well and septic systems on adjacent properties. We hereby apply for a permit to construct the new well. Please let me know if you have additional questions. �Sincerely, Michael E. Anderson, P.E. Attachments PROPOSED BUILDING CORNER EE T O Z 5-89`42' W_-_^ ISO. 00 10'1,171117-Y <J EASEN/EA/T Ne � i RUN .�' a, rWel J � NOTE: Abandon Existing Well In Accor ance _ With AD Requirements. 4Z'WT- _ f 90.00 NOTE: No Conflicts With Septic Systems on Adjacent Lots. ... UNDER NO CIRCUMSTANCES SHOULD AN AS—WILT BE USM FOR. . THE SURWY.OR TAKES RESPCNSIBUrr FOR 7HE RHITIAI. TRANSACRCN OR „vec.............._ __.. .ONLY AND ASSII _ rn LOT SURVEY SURVEY ramE AS—MMT ... NO CORNERS SET RECIERWICATON AS—BUILT . - - NO CORNERS SET Lar SURVEY A5 -OMT PLOT PLAN REcaTnr•TrwAa, AS—BIACT dWy� � flat T lot dy*d the ram and descried hereon and that L have found or es-LabUshed all of the lot Comers. AS sham w Vw Plm WA is Vw bestww of Ry Imo.l.dpr be- mowed met Eosenents of record, other tlrs +lase slime m the eerna.d Plat. ore not shown hereon T,= =70-4 Wens AND �T 'azzlw m a wa pa. .. L� ASPHALT CONCRETE ONLY THOSE IMPROVEMENTS ABOVE GROUND AND' NSIBLE WILL BE SHOWN. FENCES WELLS SEPTIC CLEANOUT,' SIDEWALKS DRIVEWAYS. ETC:, ARE SHOWN IN THEIR APPROMMATE LOCATION. ONLY.' EN MAY PREVENT SOME IMPROVEMTS SNOW FROM BF]NG SEEN AND LOCATED Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 40' REC. LOT S.F. 1" 3241 92-056 LOT 4, BLOCK, 4, RABBIT CREEK VIEW.SUBD. CO,b Q CA - .30g 23� I ; 2 DANT o l i ZG3 2 STa.v.v FR/4*ff :YD u3G WfOtlYU6/-/T ! w � :In i RUN .�' a, rWel J � NOTE: Abandon Existing Well In Accor ance _ With AD Requirements. 4Z'WT- _ f 90.00 NOTE: No Conflicts With Septic Systems on Adjacent Lots. ... UNDER NO CIRCUMSTANCES SHOULD AN AS—WILT BE USM FOR. . THE SURWY.OR TAKES RESPCNSIBUrr FOR 7HE RHITIAI. TRANSACRCN OR „vec.............._ __.. .ONLY AND ASSII _ rn LOT SURVEY SURVEY ramE AS—MMT ... NO CORNERS SET RECIERWICATON AS—BUILT . - - NO CORNERS SET Lar SURVEY A5 -OMT PLOT PLAN REcaTnr•TrwAa, AS—BIACT dWy� � flat T lot dy*d the ram and descried hereon and that L have found or es-LabUshed all of the lot Comers. AS sham w Vw Plm WA is Vw bestww of Ry Imo.l.dpr be- mowed met Eosenents of record, other tlrs +lase slime m the eerna.d Plat. ore not shown hereon T,= =70-4 Wens AND �T 'azzlw m a wa pa. .. L� ASPHALT CONCRETE ONLY THOSE IMPROVEMENTS ABOVE GROUND AND' NSIBLE WILL BE SHOWN. FENCES WELLS SEPTIC CLEANOUT,' SIDEWALKS DRIVEWAYS. ETC:, ARE SHOWN IN THEIR APPROMMATE LOCATION. ONLY.' EN MAY PREVENT SOME IMPROVEMTS SNOW FROM BF]NG SEEN AND LOCATED Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 40' REC. LOT S.F. 1" 3241 92-056 LOT 4, BLOCK, 4, RABBIT CREEK VIEW.SUBD. ueveioprT sn e. e4/o reef.. eP6e i 5.A MY' N S"HE T rr nt well on the lot. , D e: 6/20/0 y information and m -sub ri# your request. , DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORA8Ev AK 99501 264~4720 ERMIT NO: 850265 ENGINEERED DESIGN ATE ISSUED:06/06/85 CANT BYRON WILSON DDRESS: ' 16100 GENEVIEVE ANCHORAGE� Al-::' 99516 ONTACT PHONE: 345-1454 * EGAL DESCRIP: SUBDIVISION: RABBIT CREEK VIEW '4ECTION: 18 TOWNSHIP:11N OT �IZE: ^ 43^00 (SQ"FT" OR ACRES) LOT: A. RANGE: ZW BLOCK: 4 certify that: 1. I am familiar with therequirements {or onsite sewers and wells as set (orth by the Municipality o[ Anchorage (MOA) and the Staten of Alaska" 2. I will install the system in accordancewith all MOA codes,and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State Alaska requirements for the set back distances From any existing well, wastewater, disposal system or public ' sewerage system on this or any adjacent or nearby lot. F A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, HEN (1) AN ELECTRICAL PERMIT AND INSPECTIO MUST BE OBTAINED(2) AS�BUILTS ILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3> THE LECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. lGNED DATE: ~~~~^..... .... _.... .... ..... .... ~~��~�_�_��_~��__��~�_ ...... PPLICANT: BYRON WILSON SSUED BY DATE: F;��&m_ �_«� �� ... ........ � n ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ' ERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: al��'14�. !! A-jA/� DATE PERFORMED: V — LEGAL DESCRIPTION:t,,.,+�_ `�iJ� � 1cTil�� 1"C 2° ll �1P- _! �16 :/ , e -3w Se -j 1 SLOPE SITE PLAN 3 C�— 6- 7 8 10- 11 12 � 13 c14L� 14- 15- 16- 17- 18- 19- 20 4151617181920 COMMENTS WAS GROUND WATER S ENCOUNTERED?Vp--) � L O P IF YES, AT WHAT E DEPTH? 1 `1 In N., k Reading Date Gross im�.e.�/ Net Time Depth to Net Drop �il_ pT, �f 9^��^' � j 0 ff'(/ ''Water Y I r r1� ice; c�� '" +'! � _ � r�� —� j � 4 y N,zo Ll �{? arra S?w v.ii� .�r-- PERCOLATION RATE S`A� (minus inch) TEST RUN BETWEEN - AL FT AND FT a4- <1 r r2 /y PERFORMED BY:ICt>i?\ CERTIFIED BY: , v DA A !7_ ova ALASKA ENVIROtMENTAL SHEET NO. OF 'Z - CONTROL 1 19 to -1 - SERVI( !� INC. CALCULATED BY DATE 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 CHECKED BY DATE (907) 561-5040 2041 IN. 13 W' Mm 01471. JVO ALASKA ENVIRONMENTAL SHEET No. 2- of CONTROL SERVICE )INC. 1200 West 33rd Avenue, Suite B CALCULATED BY 1 DATE ANCHORAGE, ALASKA 99503 CHECKED Sr DATE (907) 561.5040 SCALE 1y7 S I136 n'/4 PMM 2"1®In, Groton, Mm rAn .M -W DRILLING INC. P.O. BOX 110378 ANCHORAGE, ALASKA 99511 PHONE 349-8535 NAME ADDRE55 CITY 2 Zs -/.9 LEGAL DESCRIPTION/, 4/ �¢� /�ar�(i�• LEGAL OWNERS BANK OR LENDING INSTITUTIONS CURRENTLY HOLDING DEED OF TRUST 4s-- /¢S4- HOMEPHONE WORKPHONE Fnl INVOICE N0- 2748 DATE A/?�� UNIT CITY. MATERIALS PRICE AMOUNT / Ob XDAT S r / l/JL�� /240 S L�-l�8 vr9'!o - LUa/ar. E✓ 3 D - T a /z4s /3 /4-v All charges shall be paid in full within ten WORKMAN LI Fi DATE IN OUT Jv;oreOTAL MATERIALS HOUR Z RATE S G g VyE / MATERIALS (FROM ABOVE) GPM DRAWDOWN AA / S PUMP MAKE HP S OTTfN ` �af/ rdSP HAJ7 00 AV PRATE f� SERIAL NUMBER MODEL SCREEN LENGTH SLOT SIZE LINER//SCREEN DESCRIPTION OF WORK CUSTOMER SIGNATURE XDAT S r / l/JL�� /240 S L�-l�8 vr9'!o - LUa/ar. E✓ 3 D - T a /z4s /3 /4-v All charges shall be paid in full within ten WORKMAN LI Fi DATE IN OUT LABOR HOUR Z RATE S G g / MATERIALS (FROM ABOVE) days unless other arrangements are made prior to drilling. The customer shall pay in-,C'd terest at the rate of 1!12 % per month on any amount not paid within ten days. Failure to AA / S C�"�j OTHER CHARGES pad may result in a lien against the property. /'r`a�UNV 0 CUSTOMER SIGNATURE PAY THIS AMOUNT —► ALASKA NUIROUBTAL COnTROL HHUIUS, 6ngineerinq & 6nuironmental Studies SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM — LOT 4 BLOCK 4 RABBIT CREEK VIEW 1.0 GENERAL 1.1 THE DRAWINGS, SHEETS 1 THRU 2, SHALL BE PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, DEPARTMENT OF HEALTH & HUMAN SERVICES (DHHS), THE CONDITIONS OF THE PERMIT, AND ALL APPLICABLE RULES AND REGULATIONS CURRENTLY IN EFFECT. I[LICIPAIITY OF ANCHORAGE' f NVIR001gNTAlEPROTECTIpN i995, RECEIVED 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY, AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY A DHHS APPROVED INSPECTOR. 1.4 IT IS THE RESPONSIBILITY OF THE INSTALLER TO ADHERE TO APPROVED DESIGNS FOR INSTALLATION, TO MAINTAIN THE SPECIFIED SEPARATION DISTANCES, AND TO HAVE THE APPROPRIATE INSPECTIONS. 1.5 IF THE INSTALLATION IS NOT INSPECTED BY AN AECS ENGINEER, AECS WILL NOT BE RESPONSIBLE FOR THE DESIGN. AN ENGINEER AT AECS SHOULD BE CONSULTED PRIOR TO CONSTRUCTION, TO DETERMINE THE NUMBER OF INSPECTIONS THAT WILL BE REQUIRED AND TO EXPLAIN WHAT THESE INSPECTIONS WILL INVOLVE. 2.0 SEPTIC SYSTEM 2.1 THE SEPTIC TANK SHALL BE A UPC—APPROVED TWO—COMPARTMENT TANK, CONSTRUCTED OF 12—GAUGE STEEL WITH BITUMASTIC COATING, SET LEVEL ON UNDISTURBED SOIL, AND INSULATED WITH AN OVERLYING LAYER OF 2 INCH BURIAL TYPE POLYSTYRENE. 2.2 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM THE HOUSE FOUNDATION, AND A MINIMUM OF 5 FEET FROM THE ABSORPTION AREA. 2.3 THE SEPTIC TANK AND BED'SHALL'BE A MINIMUM OF 100 FT. FROM ANY PRIVATE WELL OR BODY OF WATER, 150 FEET FROM CLASS C WELLS, AND 200 FEET FROM CLASS A OR B WELLS, UNLESS OTHERWISE SPECIFIED. LESS THAN THE REQUIRED SEPARATION DISTANCE MUST HAVE PRIOR,APPROVAL OR WAIVER BY ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION (ADEC). »nn I11rst 33rd Auenue Suite B • Anchorage. Alaska 99503+(907) 561-5040 2.4 PIPING SHALL BE FITTED WITH A MECHANICAL WATERTIGHT CALDER COUPLING ON THE OUTLET AND INLET OF THE SEPTIC TANK. PIPING SHALL BE 4 -INCH SOLID PVC ASTM D3034 OR CAST IRON, SLOPED A MINIMUM OF 1/4 INCH PER FOOT WITH A MINIMUM OF 4 FEET OF COVER. 2.5 CLEANOUTS SHALL BE INSTALLED AS DESIGNATED AND CAPPED WITH AIR -TIGHT RAIN CAPS (JIM CAPS OR EQUIVALENT), AND EXTEND A MINIMUM OF 2 FEET ABOVE GROUND LEVEL. 3.0 SEEPAGE BED 3.1 THE GRAVEL FOR THE BED SHALL BE 0.5 TO 2.5 INCH, SCREENED ROCK WITH LESS THAN 3% PASSING #200 SIEVE RESIDUAL. ALL SUBSTITUTES MUST HAVE PRIOR DHEP APPROVAL. 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE LEVEL AND RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. 3.3 THE DISTRIBUTION PIPE SHALL BE 4 -INCH RIGID PVC WITH A MINIMUM CRUSH STRENGTH OF 1500 LBS. ALL PIPES SHALL BE LAID LEVEL, AND SPACED ACCORDING TO THE DRAWINGS. 3.4 MONITOR STANDPIPES SHALL BE PLACED AS SHOWN IN THE DRAWINGS. THEY SHALL BE RIGID PVC ASTM D-3034, OR OR 4 INCH DIAMETER CAST IRON. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5 INCH HOLES ON THE 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE, OR A SECTION OF REGULAR PERFORATED SEWER PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO -HUB COUPLING OR SOLVENT JOINT. A RUBBER RAINCAP (JIM CAP OR EQUIVALENT) SHALL BE PLACED OVER THE TOP OF THE PIPE. 3.5 IF THE FINAL GRADE OVER THE BED IS LESS THAN 4 FEET ABOVE THE GRAVEL, INSULATION IS REQUIRED, USING DOW EXTRUDED BLUE STYROFOAM BOARD. THERE SHALL BE 1 INCH OF INSULATION FOR EVERY FOOT OF SOIL LESS THAN THE REQUIRED 4 FEET OF COVER, BUT THERE MUST BE AT LEAST 18 INCHES OF SOIL EVEN THOUGH INSULATION IS USED. THE SOLID PIPE EXTENDING FROM THE SEPTIC TANK TO THE DRAINFIELD SHALL ALSO HAVE 4 FEET OF COVER OR AN EQUIVALENT LAYER OF INSULATION COMBINED WITH SOIL TO PREVENT FREEZING OF THE LINE. 3.6 IF INSULATION IS NOT NECESSARY, THEN THE GRAVEL MUST BE COVERED WITH A LAYER OF A NONWOVEN FABRIC (SUCH AS MIRAFAI, FIBRETEX 200 GRADE, POLY -FILTER X, OR EQUIVALENT). 3.7 THE TOP AND SIDES OF THE BEDS SHALL BE PLANTED WITH A WHITE CLOVER AND RED<FESCUE MIX OR BLUE GRASS. 4.0 INSPECTIONS 4.1 THIS BED WILL REQUIRE THREE INSPECTIONS. THE FIRST INSPECTION WILL BE OF THE OPEN EXCAVATION, TO ASSURE THAT THE SYSTEM IS INSTALLED IN PROPER STRATA AND DEPTH. 4.2 THE SECOND INSPECTION WILL BE OF THE NFS SAND. 4.3 THE THIRD INSPECTION WILL BE AFTER PLACEMENT OF THE GRAVEL, MONITOR STANDPIPES) AND DISTRIBUTION PIPE TO VERIFY PROPER INSTALLATION AND MATERIALS PRIOR TO BACKFILL. ro w 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' 1 15:5 — 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, s tion, township, range 13tOr3�. y ®� 1�b i i- �',P �e O ico - -r I N R3LAD Location (address or directions) io Genay I g- VE qS (b) Applicant Name lA.!•®�� Telephone: Home Business 3-' ySLA Applicant Address (c) Applicant is (check one): Lending Institution 0 ; Owner/builder CK; Buyer ❑ ; Other ❑ (explain); (d) Lenaing Institution ' WE SA 1&0� • �Q ETelephone Address — (e) Real Estate CpmOar , and Agent Address' Telephone-' " (f) Mail e HAA to the ollowing address: 2. TYPE OF RESIDENCE Single-FamilylA Multi -Family ® Other Number of Bedrooms 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)f Public ❑ Community ❑ Holding Tank O Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. -Pace 1 of 2 72-025 (11/84) 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 Irwi% 446Ws Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional ana for the number of bedrooms and type of structure indicated herein. I further verify that based on the information ots mfu,rt from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply arw,rr 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 ryS Address ` G— r ' '�i4itU7, �.r< .. ■ ti, I' t / 1 • ?, it l 29 6. DHEP APPROVAL { . , ... /pate l�i�°� 1 �'1� Approved for �� bedrooms by d,, f Approved Disapproved Conditional Terms of Conditional Approval 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 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 engineer's work. Pana 9 of 9 X1 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE. (MOA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) y CHECKLIST - FEBRUARY 1984 AUG 0 8G7' 264-4720 Legal Description: _4071V A. WELL DATA Well Classification P, If A, B, C, D.E.C. Approved (Y/N) 'VZ9– Well Log Present (Y)I Date Completed Yield Total Depth? Cased to 22 s Depth of Grouting Static Water Level :30/ 30/ Pump Set At Casing Height Above Ground Sanitary Seal on Casing) Electrical Wiring in Conduit ) Depression Around Wellhead (Y6 Separation Distances from Well: 1W / To Septic/Holding Tank on Lot `, _'4 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot $S7 ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by _ Water Sample Test Results _ Comments To Nearest Public Sewer To Nearest Sewer Service Line on Lot 6 Date B. SEPTIC/HOLDING TANK DATA 0/j/ y Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Size Air -tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well — To Property Line To Water Main/Service Line Course Comments Page 1 of 2 No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �aType of System Design _/2 Date Installed u Ztso_& r Length of Field 4L"X ^- -- Width of Field LA�XDepth of Field�1 Gravel Bed Thickness Square Feet of Absorption Area bc_7�+0_- Standpipes Present (Y&}I Depression over Field (Y& — Results of Last Adequacy Test AN 114 Date of Last Adequacy Test A./0 A -,6 - Separation Distance from Absorption Field: To Water -Supply Well $3 / To Property Line To Building Foundation - To Existing or Abandoned System on Lot __ &444`. ; On Adjoining Lots 7`30 ' '�! To Water Main/Service Line�'2 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course fi /DO To Driveway, Parking Area, or Vehicle Storage Area Comments _�� SGo�i'c nA�— ®zr/x�2o �.�r-411* 947 �++JK /1u/ / G!t /tEiJ ..` j��yrt ho S><a�ncYpiuC htFaetvt2 r7 own Cr/LF�c./ G�dtrar�a� LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes tY/DLY� Dimensions Manhole/ ** Check Permitted Bedroom Rating Against HAA Request ** Off' Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed � Date ��`.� Company / LLfLL - MOA No. ST 9S tiaK Receipt No. '�� c:5 a�0 D Date of Payment Amount: $ .GiG YLG Qt�v'lc�� Page 2 of 72-026 (11iea) h CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER t.swrt.,urx.. 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: F" see h on back I.D. NO. water System Name Phone No. Mailing Address City State SAMPLE DATE: 111J_a—t F-776 EaD- Mo. Day Year Zip Code SAMPLE TYPE: Routine ❑ Check Sample (for routine sample t ❑Treated Water ❑ Special Purposea with lab ref. Untreated Water SAMPLE Time Collected NO LOCATION,( j Collected r 3 I 4 5 READ INSTRUCTIONS BEFORE TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received r� Time Received i2 r' Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No..� Result" Analyst I I ED �m Fr -1 .No, of colonies/ 100 ml. or No. of Posrove portions 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1963 Membrane Filter. Direct Count Verification: LTB Final Membrane Filter esults Reported By L BGB ✓ �.` i Date S COLLECTING SAMPLE TNTC = Too Numerous To Count Coilforml100ml Collform/100ml Time: Dy a.m. p.m. MUNICIPALITY OF ANCHORAGE 11 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 . --- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4 Block 4 Rabbit Creek View Subdivision Location (address or directions) Genevieve Drive (b) Applicant Name B. Wilson Telephone: Home __— Business _ Applicant Address 16100 Genevieve Drive —_—_ (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder EF; Buyer ❑ ; Other ❑ (explain); 345-1-454 (d) Lending institution Westland Mortgage % Colleen Mq. 563-5150— — Address 400 West Tudor Road, Anchorage, Alaska 99503 (e) Real Estate Company and Agent - -- -- Address — -- --- Telephone-------- (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-FamilyUx Multi -Family ❑ Other — --- — - Number of Bedrooms four (4) 3. WATER SUPPLY Individual Well Ek 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 Ek 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 (11/84) Page 1 of 2 5. NGINEERING FIRM PROVIDIN . INSPECTIONS, TESTS, FILE SEARCH, Da A 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 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 Telephone - A`IA,r Date -- 6. DHEP APPROVAL Approved foredrooms by � "--2.- _ _y--` � �^h _ Date Conditional approval for four 4 bedroom Engineer's Seal August 9, 1985 Approved Disapproved Terms of Conditional Approval Monies to be escrowed to upgrade on-site sewer system as per permit #850265 to meet MOA Requirements. Work to be completed no later than September 9, 1985 ;'��T➢-fl * Z 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 in order to satisfy certain federal and state requirements. Employees of DHEP do riot 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 72-025 (11/D4) 1 2. 3. 4. 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 2.644720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) �® !// erg s A/ ,c% . 3Ga� ✓ Location (address or directions) (b) Applicant Name ice— Telephone: Home -- Business Applicant Address _____--- (c) Applicant is (check one): Lending Institution C1 ; Owner/buildey ; Buyer ®; Other ® (explain); EE (e) (f) Lending Institution =fir Address ---- Real Estate Company and Agent Address — —.- Telephone — ----- Mail the HAA toAheJollowing,ad TYPE OF RESIDENCE Single -Family, Multi -Family ❑ Other Number of Bedrooms --3-- WATER 3— WATER SUPPLY Individual Well VCommunity 0 Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. f' SEWAGE DISPOSAL Onsite Public Cl Community C] Holding Tank Note: f community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 Y4 ci 72-025 111184] i 5. ENGINEERING FIRM PROVIDIN, INSPECTIONS, TESTS, FILE SEARCH, DA.A 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 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. s Name of Firm�s - Yr'�e�r tom_ Telephone _.__/✓t, Address w® Id _-3 I Date 1 i. Sr`°7`>t�>a� c� " Ire- G�"'""�' �•c � � �� .� lie 4 eal Y. n,evN"cHWN'O an Y0904 e9 090 A. 2251-E '9b0evm0me• �, �ROFESS 6. DHEP APPROVAL Approved for —bedrooms by _ — — 4e ---62 -- Approved Disapproved _.__ Conditional w� Terms of Conditional Approval _( A. Cit �s`d 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 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 engineer's work. Page 2 of 2 72-025 111: 84) 6 M -W Drilling, Inc. *P.O. Box 110378*Anchorale, AK 99511♦ ♦ 907-345-4000 ♦ 907-315-3287 Fax • Job No.: 02-137 Project No.: N/A Permit No. SW020189 Groundwater Well As -Built & Loz ♦ Well Owner. Boutet, Donna _ ♦ Use of Well: Domestic ♦Legal Description: Rabbit Creek View, Block 4, Lot 4 16100 Genevere- Anchorage, Alaska Construction ♦Hole Depth: 205' ♦Casing Size: 6" *Cased To 37' #Material: A53Steel ♦ Dri11 Method. Air Rotary Perf. ♦ Well Completion- Open end X Screen _ P srforated , Method. *Screen/Perforation description: None *GroutNotes. 10" Surface casing installed & pulled while grouting annulus with bentonite../4 • Notes: -40110 re S442, ♦ Well Development. Method: Air surge Note v. #Static water level (SWL) 25' (ebove) (below) top t jcasing (TOC). ♦ Well yield test at 2.5 gallons per minute (GPM)/gallons per hour (GPH) for 1 hours With 100% of drawdown (DD) from static level (SWL). *Method: Air lift #Date of completion: 25 June 2002 ►Pump Install. 26 June 2002 Well Log Depth in feet from top of casing. I Details of formations oenetrai ed, size of material; color and ! ardn=s. 0 TO 2 Casing stickup 2 TO 5 Topsoil 5 TO 17 Gravel: sandy, coarse 17 TO 20 Fractured bedrock 20 TO 205 Bedrock: gray/black, siltstone a-gillite, small water seaps in sporadic TO fractures. TO TO TO TO TO TO TO TO Gam/ TO TO NWWA Cart9rteti Contractor TO Certificate No's. 814 & "073 B9 io7 c 7� 2 Vi ' S� N�� A ,,,,/ i sig r '. • G£• & •ht Municipality of Ancho gee :. 7 2.017 ` On-Site Water and Wastewater Pro_ - ,;;,� a , ;' . (907)343-7904 / 5 s� c"^' s A F E T Y 6 ii Certificate of On-Site Systems Appro o� 6 e L Parcel I.D. 020-541-37 Expiration Date: . I -I 1 1. GENERAL INFORMATION Complete legal description Rabbit Creek View and Heights, Block 4V, Lot 4A Location (site address) 16100 Genevieve Street Anchorage, AK 99516 Current Property owner(s) Skye & Hilary Cooley Day phone 360-3875 Mailing address 16100 Genevieve Street Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: [X] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual ID Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: S---h i4} Date: _WWIL. COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Szro — Waiver Fee $ Date of Payment "I I?- 1 11 Date of Payment Receipt Number 0332JiC Receipt Number COSA# �0...11 1329 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. Name of Firm Anderson Engineering Phone 522-7773 Address 1399 West 34th Avenue No. 203 Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/27/2017 • 6. DSD SIGNATURE 1i e:;:t. }C System #1 Approved for 1"( bedrooms MICHAEL E. ANDERSON •• CE-4381 ••• J $.? System #2 Approved for bedrooms 46��••;j-Z-7— � i7.•�� Disapproved q4 pROFESSIO\sus Conditional approval for bedrooms, with the following stipulations: -�'0 UN-SITE 1-G, WATFR AND c---;, WASTEWATER c PROGKAI`tiil rc. By: 4L Original Certificate Date: �-' 1 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet S .. c 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 Rabbit Creek View & Heights, Block 4V, Lot 4A 020-541-37 Legal Description: Parcel ID: A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 6/25/02 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 205 ft. Cased to 37 ft. Casing height (above ground) X18 in. FROM WELL LOG AT INSPECTION Date of test 6/25/02 7/20/17 Static water level 25 ft. 38 ft Well production 2'S g.p.m. 3'9 g p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 2.50 mg/L Arsenic ND ug/L Date of sample: 7/10/17 0/17 Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/11/15 Tank size 1 '250 gal, Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 8/2/17 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 8/85 Soil rating (g p d./ft2 or ft2/bdrm) 138 SF/BDRM System type Shallow Bed Length 47 ft. Width 18 ft. Gravel below pipe 5 ft. Total depth 2.5 ft. Eff. absorption area 846 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/20/17 Results (Pass/Fail) Pass For 4 bedrooms 2* Fluid depth in absorption field before test in. Water added 600 gal. New depth 5* in. 2* Elapsed Time: 1 ,440 min. Final fluid depth in Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes. give date *There are 3 monitor tubes in the absorption bed. No water was noted in the distribution pipe during the test. The highest depth of fluid is recorded above. The system absorbs more than 600 gallons of water per 24 hour period. 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 >1 00' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout 100' Sewer/septic service line X25' Holding tank X75' Animal containment areas >50' Manure/animal excrete storage areas 100' SEPTIC/HOLDING TANK ON LOT TO: >5' >5' >5' Building foundation Property line Absorption field 10' 1 >100' Water main Water service line Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line 10 Building foundation 1 Water main Water Service line 1 Surface water 100Driveway, parking/vehicle storage 1 Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION �' Or ACIU iir4 1 certify that I have determined through field inspections and d�`%1' " *9.1'4�review of Municipal records that the above systems are in ,s Cl: c, ; conformance with MOA COSA guidelines in effect on this date. �` • Engineer's Printed Name Benjamin Schiller, P.E. ea �.... ... .-..moo. Date 8/7/2017 si,p'•, CE-1i5,92 t`' #!4. 5. �er COSA brown sheet 10-10-12.doc Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 'tt�, 5ry41 Certificate of On -Site Systems Approval p— Parcel I.D. 020- '-37 Expiration Date: 1. GENERAL INFORMATION UV 4� Complete legal description Rabbit Creek View and Heights, Block 4A, Lot Location (site address) 16100 Genevieve Street Anchorage, AK 99516 Current Property owner(s) Jacque & Donna BOutet Mailing address Real Estate Agent Day phone 270-6761 9043 Snowy Owl Circle Anchorage, AK 99507 2. TYPE OF DWELLING: R Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well it Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request COSA Fee $ �� A Waiver Fee $ Date of Payment ? 1l'1 � l5 t _ Date of Payment Receipt Number N620(G1 Receipt Number COSA# 05U51H3*� 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. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for —4 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, 522-7773 Rale. 8/17/2015 ♦SOF 'f' 1 9 *' *_* I?,-- MICHAEL .E ANDERSON . o CE -4381 ;\ a with the following stipulationg. By: � Original Certificate Date: R _ / q' /_ The. icipy orage 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 COSA b,ue snee,S .. Other If more than I septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist syr Legal Description: Rabbit Creek View & Heights, Block 4V, Lot 4A Parcel ID: 020-6.51-37 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 6/25/02 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 205 ft. Cased to 37 ft. Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 6/25/02 8/12/15 Static water level 25 ft. 70.3 Well production 2.5 g.p,m, 4.4 WATER SAMPLE RESULTS: WE 9 - p.m - Coliform 0 colonies/100 mL Nitrate L-) lSmg/L Arsenic AID ug/L -Dateofsample: 8/5/15 Collected by: And. Engineering B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Numberof Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping New Const. Pumper C. ABSORPTION FIELD DATA Date installed 8/11/15 Cleanouts (YIN) Y High water alarm (Y/N) N Date installed 8/85 Soil rating (g.p.d./f:2 or ftz/bdrm) 138 sr/BDRM System type Shallow Bed Length 47 ft. Width 18 ft. Gravel below pipe .5 ft. Total depth 2.5 ft. Eff. absorption area 846 ftZ Monitoring tube Y Depression over field N Date of adouaG'y test 8/12/1:5 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 921 gal. New depth 5 in. Elapsed Time: '1;440min. Final fluid depth 0 in. Absorption rate >= 600 g P d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N 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 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 >1 00' Public sewer main >75 Public sewer manhole/cleanout >100 Sewer/septic service line >25 Holding tank >75 Animal containment areas >50' Manure/animal excrete storage areas >100, SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >51 , Water main >10' water service Zine >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100, F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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 Name Michael E. Anderson, P.E. Date 8/17/2015 COSA brown sheet_1010-12.doc Absorption field >51 Surface water >100' Water main N/A Driveway, parking/vehiclestorage >10, 0 c:t-asst A.� -17- � �pR4FE5510�AA: 1 LOT 1 A k k EAT 2A tit k i k LOT 3A k k 6 k k LOT 5A 1 k I 10' UTILITY EASEMENTS a :c -779'x11.7' i SHED ZO Ve'T1 >Ikk{'7. DECK PES 330 Qs.5, 8.3' DECK : { k5.5'x16.3' BALCONY- i k LOT 4A 6t k30,761 8.t. ,-2 � STORY ,r ...LLL�� €° FULL BSMT. RESIDENCE—J kWOODEN FENCE � I S \3'41557 187.16` LOO l 6A I { PLOT PLAN ____ AS BUILT X SCALE 1" - 40' GRID SW 3241 Project No.15-201jA3 t • � ♦ t E.- aft r. ,r. - :.x f r i ��. La- LLJ� a � � 22.3' .., V Y \i W m 2.0' u tad z CANT LU ca [ �,-6'I41--GAS 10'x20` NATURAL EMENT { PLOT PLAN ____ AS BUILT X SCALE 1" - 40' GRID SW 3241 Project No.15-201jA3 t • � ♦ t E.- aft r. ,r. - :.x f r i ��.