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HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 5H LT 40A PERMITNUMBER: AS-BUILT DRAWING PARCEL ID NUMBER: SW0 SW020257 020-112-19 w J CC Q I I1 100' SURFACE U _ WATER _ SETBACK I \ c• ALARM N 1 / IoIHT1 SURFACE N WATER IN / _ _ ROAD DITCH / . I \ ---'" b \ / , V N \ / // % /////////%i•AvA \ \ \\ / / j % \ \ // EXISTING THREE f \ \ / / BEDROOM HOUI E \ \ / / -- - \ I \ I I i � I 1 I \ 1 1 \ � \ \ I / \ v>, .. A B / \ \ HT1 19.74 49.05 2 HT2 25.65 52.01 / C_/ACANT-) \ \\ FCO 6.91 35.30 / \ ALARM 29.44 54.36 / \ , — — _ / DATE: _�0' �00\, 1 4,'LI l ' ia NNN 9/4/02 "7‹ ...1-� �r A L ..f6 i 1G .. DRAWN BY: �! .�S44o ALASKA WATER & WASTEWATER SCALE: B.S.G. ; .• 91 •. *p0 CONSULTANTS, INC. % * • 1" = 30' / �O 6901 DEBARR ROAD,SUITE 28•ANCHORAGE,AK 99504•PHONE(907)337-6179•FAX 19C7,''B-S;9 5 / ` D PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 907 242-9975 2 OF 3 JAMES SOMERVILLE ( ) 000 � '•.J: fr: ar -ss.: LEGAL DESCRIPTION: O 9� 4111 9- `o Q RABBIT CREEK HEIGHTS SUBDIVISION; LOT 40, BLOCK 5 Ossf A`o� iTYP OF WORK: I AS-BUILT OF SEPTIC SYSTEM UPGRADE 44WZ0000a�0 Municipality of Anchorage • • Development Services Department "- .ra _ Building Safety Division On-Site Water&Wastewater Program, 4700 South Bragaw St. :'�" P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW020257 PID Number: 020-112-19 Name: JAMES SOMERVILLE Wastewater System: LINew • Upgrade Address: ABSORPTION FIELD 12971 NORA DRIVE Phone: No. of Bedrooms: (907) 242-9975 3 ❑Deep Trench 0 Shallow Trench ❑Bed ❑Mound ❑Other Soil Rating: Total Depth •m original grade: LEGAL DESCRIPTION GPD/Sq. Ft. Ft Block: Lot: Subdivision: Depth to pipe bottom from original grade: •vel depth beneath pipe: 5 40 RABBIT CREEK HEIGHTS R. Township: Range: Section: — Fill added above original grade: Grovel length: Ft. Ft- Gravel width: Number of lines: Distance between lines: WELL: ❑ New ❑ Upgrade Ft. Ft. Classification (Private, A,B,C): Total De• • Cased To: Toto/ absorptio •rea: Pipe material: Ft. Ft SQ. Ft. Driller. Dote Drilled: Static Water Level: Instal . Dote installed: Ft N L. 1 Yield: Pump Set At: Casing Height Above Ground: GPM Fl. Ft. TANK SEPARATION DISTANCES ❑Septic ■Holding ❑S.T.E.P. ❑Other To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity to gallons: From Tank Field Station Tank Sewer Lines ANCHORAGE TANK 2000 Material: Number of compartments: Well - - - 75'+ 25'+ STEEL 1 Surface Water - - - 100'+ - LIFT STATION Size to gallons: Manufacturer. Lot Line — — — 5'+ - `Pump on* level at: -Pump off` at: High water alarm at Foundation — — — 5'+ — Pump Make odel: Electrical Inspections performed by: Curtain Drain - N,(A i Remarks: II BENCH MARK Location and Description: 0.1_0 1..A/0.--S ,CL;2,��Dc^/E TOP OF HOSE BIB NORTH SIDE OF HOUSE P� vee Assumed Elevation: 100.00 Ft ENGINEER'S SEAL op:, N.N.\. OF , 'N „,..„,,,,,,. .• Joo 4'sT� �' � .. *0 Inspections performed by: AKWWC, INC. Dates: 1st 8/21/02 % i . �� 2nd 8/21/02 / , I VA 8/24/02 D 3rd �QO � '••i-f r•, A. �•arn-ss:' Q � �•. E 795 •' op Development Servic-s Department A•proval 01; °o �, 4 e,-ea •......•• •\hod Reviewed and approved by: 1�� Date: C�' � ` Professioc'o (Rev. 12/01) 4oOQ1 .O�d PERMIT NUMBER: A S - BUILT DRAWING PARCEL IDNUMBER: R: SW020257 020-112-19 TOP OF TANK AT INLET = 90.49— FINAL GRADE = 93.76 - 94.06 —TOP OF TANK AT OUTLET = 90.64 ST 1 ALARM ST2 a a //////////A,A //////////////////l///////J (/// /. i . /) 1-1 NEW 2000 GALLON INSULATION HOLDING TANK INVERT OF BUNG AT INLET = 89.90 DATE: op604',,!\ ./ 9/4/02 _o OF A� �1Q� DRAWN BY: if ' - • S t)r, WATER & WASTEWATER B.S.G. ;��. T ` ! ALASKA o CONSULTANTS, INC. SCALE: `� • D 6901 DEBARR ROAD.SUITE 2B •ANCHORAGE.AK 99504 ' PHONE (907)337-6179•FAX(907)338-3246 N.T.S. r D PREPAREDFOR: RSOMERVILLE PHONE (907)NUMBER: 242-9975 PAGE 3NUMBER: OF 3 O L� O -ff. ' �a ness • 0 LEGAL DESCRIPTION: 9� • 7953 • o Q RABBIT CREEK HEIGHTS SUBDIVISION; LOT 40, BLOCK 5 �p�m cS1 ITYPEPROFILE AS-BUILT DRAWING OF SEPTIC UPGRADE 4���O000��oo 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 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 31, 2002 Expiration Date: Jul 31, 2003 Permit Number: SW020257 Parcel ID: 020-112-19 Legal Description: RABBIT CREEK HEIGHTS BLK 5 LT 40 Design Engineer: 0041 AK Water&Wastewater Consultan Site Address: 016545 CARL ST Owner Name: James Somerville Lot Size: 28126 SQ. FT. Owner Address: 16545 CARL STREET Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE , AK 99516-5504 This permit is for the construction of: Disposal Field Septic Tank .11 Holding Tank I 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: -7g ����� Date: VI ('O2_ I Issued By: (f. Date: +f?I/cz • Municipality of Anchorage . :: ;:v,, • t Development Services Department Building Safety Division a.i 5 T r On-Site Water&Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage,AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-1 12-19 Permit Number Property owner(s) JAMES SOMERVILLE C/0 PAM REYNOLDS Day phone 242-9975 Mailing address(1) PRUDENTIAL VISTA 4241 "B" STREET ATTN: PAM REYNOLDS Mailing address(2) ANCHORAGE. ALASKA Zip Code 99503 Legal description (Lot, Block& Sub'd.) RABBIT CREEK HEIGHTS S/D; LOT 40, BLOCK 5 Legal description (Section, Township & Range) N/A Lot Size a62 Acre Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS, INC. Permit Fees: 14OO Waiver Fees: Date of Payment: //46v2. Date of Payment: Receipt Number: 02 303 Receipt Number: ALASIZA WATER & WASTEWATER ...,:x.„7,,,,z ......., CONSULTANTS, INC. July 26, 2002 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water& Wastewater Program 4700 South Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Holding Tank Upgrade for Lot 40, Block 5, Rabbit Creek Heights Subdivision To whom it may concern: An undocumented 2000-gallon holding tank currently serves the existing 3-bedroom house. We exposed the tank to verify the integrity, and confirmed it had holes. We proceeded to dig test holes for a septic system design, and found the soil to be unsuitable for an on-site septic system. In short, we are proposing that the existing 2000-gallon holding tank be abandoned, and a new 2000-gallon holding tank be installed in accordance with the Municipal standards. 1. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 2. TOPOGRAPHY: There are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. 11 ly, e fr; ' . 1.rues P.t . M.S. ' Pres len' r NOTE: Attached is a site plan drawing, a design drawing„ and a 3 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road,Suite 2B * Anchorage,AK 99504 Ph:(907)337-6179 * Fax: (907)338-3246* Website:akwwc.com _—_— —_—_—_ _—__--__ _._____.______._ ____ MARINA.._.DR,IVE_—__._-_____.—--- .._--_..._.____-__—.-— E --- \ / ` I , / \ j • / f I CA- 71 1 \ WACANN-, / \ J I WACA-0-,T-, \ / � jl \ / W / ` I W�ACANT3 I ��--�� \\ ,/ UJ l l `-VACANNNT cc �\ i NI I EXISTING 2000 GALLON I �.I J `~ 0_1 HOLDING TANK TO BE I _,j L--�.------- --_.--' COMPLETELY ABANDONED �j tI I ' „ "" Y V PER UPC 1 1 - -t-_ i SURFACE ) / ~ WATER IN �► -- t PROPOSED K. ... \\ / 7 Iy ROAD DITCH (• r r -I SEPTIC " -\ ( �' y r'r __-1 I UPGRADE SEE r r r \\J \\ r I \\PAGE 2 OF 2,,••••• _- / Aii/ \\ \ i r r- I \1_1\ \ rCANV� / /( \ \\ / I WACANT / ' I / 1 \ \ \ I I \ \ i I ; i ��` '; ; I c CANS \\ \ \ \ 1 I\\ \ , 1\ 1 // /I WACANT� \\ \ \\\ \\ i \ \ / / - li �f / \~�—_ -fir / \ t �' \�� € 1 r / 100' SURFACE � ?a�=--'r WATER ( ,may t � SETBACK `` , ,�� `` \ CANT "`\..,yam`2\ ` / j/I ..../"... I � 1 I i WACANT3 i 1 4 // ' WAC ANNj W�ACAN� I • I 1 ( CANT-, s-\\ \ •\ DATE: >: EXISTING 2000 GALLON COMPLETELY _A�D�pP� U� _ _ _ _ __ _ _ _ . APPROXIMATE CATION OF TEST /'\ idi HOLE �� -- -- -- -- �_ EXISTING- 7\ m 8� /\ �� UNDOCUMENTED < T /oo' SURFACE DRAINFIELD? | u | |r� WATER - _ _ _ - ~1 SETBACK / ` ~~ ~~ � ~` �^ . ~ PROPOSED 2000 � �, GALLON HOLDING N-, TANK | / � / SURFACE WATER /w / / N«»»» -/ / ' ~~ -~ -- sa�uy' -- -- -���' \ ..,•-• | � ' \ ' '` | ^^ ��*x' ��' `\ / ' � / \/ | `\ ` / ~ ` // `\ \ A\ / \ \ (- / 1 ` ` ` 1 / | ~ \ \ / ' ' ' , cxSnwc rxnsc ` ` ' / •. � ^'� �^ >���� ocononu HOUSE \ \ / / ^ ~-- | ` ` . � ' /P\/ \ / ~ ` - � / | ` / | /�, ' ' �� ' ---- / ` � � / ._^___�- . \ / | �d�� ` / ' 1 | \ | --_-__/ ` I | | / | � ' / RA w \ w«� / / ` / / \ / � / / \ / / � \ | / � ' � \ , ` \ / // \ | / \ \ `A ,�}� � ��u�� / ` ' ' 'OP ^�� �� |m+& .--- �r'� \ ~~ .~ �` �u «o�u� ,A- � \ ~ ^ . _/�-� ` /� \ g�. ��SE=�/ Fo�- L_A��°, /^\ \ i ^/ VACANT / \ `� -___ �___��' / �=_/ /, ` / `` / ^^ ' // // \` | `~ ~^ _~ ~~ `� . � ~_ _-- ~- / DATE: 7/24/2002 OF ~"�| • , � onmvw e� �.[.VV ALASKA �v��`����� w�. WASTEWATERscx�. CONSULTANTS, =~=�'~^^~�^'~�~=�� ., , INC. 1 = 3O mm/usowmROAD,SUITE m`ANCHORAGE,xx"mo ^ PHONE wmmr-6/79` FAX nwnm-324o PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JAMES SOMERVILLE (907) 243-9975 2 OF 2 ' LEGAL DESCRIPTION: VA , ^ -'"5^ : RABBIT CREEK HEIGHTS SUBDIVISION; LOT 40. BLOCK 5 «0 TYPE OF WORK: ~ -~ SITE PLAN ‘Omoau*~- 9 �:F�jjl'p t' _. F,••• •• -. 1..svp0 ALASKA WATER & WASTEWATER '-/`'.••. `� . o CONSULTANTS, INC. --..._ :. Q 9 I P. 6901 DEBARR ROAD, SUITE 28 • ANCHORAGE, AK. 99504 • PHONE: (907)337-6179 • FAX: (907)338-3246 • WEBSITE: okwwc.com ' D SOIL LOG - PERCOLATION TEST i RABBIT CREEK HEIGHTS SUBDIVISION; LOT 40. BLOCK 5 J1 fr• 1 ss. Q LEGAL DESCRIPTION: �O 0 iE 7953 ,zQ� PERFORMED FOR: JAMES SOMERVILLE DATE: 7/9/2002 0O� • *• ' I c"),6:1 cA'0 ‘%,PrOfe55+° °oma ((feet) TEST HOLE #1 �� .6 = 1 -- ORGANICS SOIL CLASSIFICATIONS 3- Mel GP 1 ( ML , 1J11511 GM / CL 4—I 7 GCOL 00000' SW MH BLUE WET ML 5— SP d CH IIlIIIUit SM ' 7',' OH SEE SITE PLAN FOR 6— ` M SC TEST HOLE LOCATION 7— B.O.H. DEPTH TO DATE GROUNDWATER 8- 9— SITE PLAN ___ 1'=100' 10— NET T IME NET OP TER 11 - DATE READING CLOCK (MINUTES) W READING EL ( NCHDES) 7/11/2002 6 30 6 13— — __.. 14— --.---------- ----- _______ 16— —.--- — 17— -----------------------• 18 18— PERCOLATION RATE N/A (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19— TEST RUN BETWEEN N/A FT. AND N/A FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: • YES E NO SOILS LOGGED BY: JEFFREY A. GARNESS PERCOLATION TEST PERFORMED BY: ZACH GALL COMMENTS: PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WpS PgRFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 7 J z&2 Ol (-;r1LLIE4 HiEri l F� NEHL 1 TF JC') E"i r�'I.RCiPJMN7 iL rF"ofi'Enfi a (L C� 2510 E. TUDOR RD. , ANCHORAGE, AK. 99587 ' 2?r-2221 WELL IPEF:ri I 1-- PERMIT PERMIT NO. C 74173 1i'3 7 APPLICANT RUDI HELBIG SPA BOX 438H 344-1076 _OCATION CARL BEET _EGAL L40 B5 RABBIT CREEK HOTS LOT SIZE 46800 SQUARE FEET •IINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 00 FET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. EPEC:IFtCATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='E F hr1 I T ' . F I L I C• . F=CI R or-.1 E ',' F I FF F=R:O t•1 I L_I I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. z6:6 44"-�=66 _.I GNED SIE.APPLICANT L APPI CANT RUD I HELBIG 12I :15:-gAv"1-C,'I-.=.1 IED BY _ DATEL1 1 _.74 !,k)(- 4 ,C -bti;�k.--\s ‘4.-e_),--k l.05 (0/ 476) vim . LAy.Q1.17 . - ot.t., ot...,,,4.4.4.4,A.A.,: 6b C-ev, « a.. . Lt w 14-`64"'til a O(Aa.t..v.) , cca..4.4.-,: 5 w:,u G, a.Uo-U-c. q\''' • ' lite" km-el Ill ter"... eatter L i 70.Ur'd M 3 try�. r..O*. .. ci h,.o tits ol., 4 ct olAor 1-kr Llitel frs il . -II 15 76 l - tdsez.n,tio w 6'0 W cj2u c` e'li iArt. nC, 611 6e_(& %Ca/4Q_, — C.‘ 64- (j --- 1 , e a 1,81/, C?9 (Vs( ?r14- 64-/-.‘)L /' , 0 1 .f y109 Th 14ELL L D 6 9R2L1.)4c ('O4'7k2 C7 / )Re—r)( PA)21 ) 4 ('o. A PPf )-:-55 /3 9), 3- 4.066 /9/Uci-WRA c Al .9skA q15-0 plio77)?77 can/121A — ,qPD/ 2& 7 '4 of )4 FLL 4 aT i o ,3Lk c- A/91131T CR2-Z-- )7),i)6,'r3 /21=p7-g ak J_=L L /Og f=T )z lihtA's D1/9/1M-74-,Z o /AM 1/PG Lai; �._ / itAr- 5-0)/- 1/- SOILy- 3o (1Iy 6AAm-L 3,0- /e 6).3A;ri ()imp) 112 - /o7 C1/)y e ,aAZF (5 40 7, "70 /07- /08 613AyFL, 6/)/PD, 1.1e2 57/P71( 42-1/2:4 - Coif, (r T o ,91c 7 if /Ziy )</wivi P 6,E MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-551-58 Expiration Date: 10-21-2/ O^21-2/ 1. GENERAL INFORMATION Complete legal description Rabbit Creek V&H Sub, B5H L40A Location (site address) 16545 Carl St, Anchorage, AK 99516 Current property owner(s) James & Margaret N ea n S Day phone (254) 702-3073 Mailing address 16545 Carl St, Anchorage, AK 99516 Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well FE -1 Private Septic ❑ Water Storage ❑ Holding Tank ❑■ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ SSv Waiver Fee $j. _ Date of Payment y l Date of Payment Receipt Number. 0`1 rJ ��� Receipt Number COSH # 113 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 7/12/2021 .�,� of •�q�li C TH �P�,�� 6. DSD SIGNATURE System #1 Approved for 3 bedrooms • • �1�� �� . ' BenjamJrAchiller % System #2 Approved for bedrooms ¢¢�j��slF . , c 7/12/521..' Disapproved �tl\�ROOFFEE0Q0 � Conditional approval for bedrooms, with the following stipulations: % R PND z p,S CO � G �� ErVT SERA. ;� •, �0 B VA, �0--CA4 Original Certificate Date: —7-2-1-2 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 Checklist blue sheet COSA Checklist Legal Description: Rabbit Creek V&H Sub, B5H L40A Parcel ID: 020-551-58 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 6/25/1976 Total depth 108 ft Cased to 40* ft Fin -1 Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 6/30/2021 Static water level at beginning of test Artesian ft. Comments *Casing depth taken from 2002 COSA B. TANK DATA Age of tank(s) 18 years Tank type/material Holding/Steel Measured operating fluid level in septic tank 24 Fm] Standpipes/foundation cleanout per record drawing --�--.---- Date.-of_pump;ng.-4/22/202,1._No.rthland.wPumpinc Well production at time of test 4.8 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes IN No ® Coliform bacteria is Negative Nitrate mg/L ❑® Nitrate less than MRL (ND) Arsenic ug/L Q Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 6/23/2021 LIFT STATION ❑ Requl aintenance completed Age of lift station years Lift station material Comments: BSORPTION FIELD DATA Z ich sys tested (date installed) Adequacy test date ❑ ALL standpipes p nt per record drawing Results ❑ Pass For bedrooms Total measured depth from gr ft (max) Fluid depth prior to test in Measured depth to pipe invert from gra ft (min) Water added gal ❑ N/A - pressurized field New depth in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time min ❑ Code -required soil cover over field Fina depth in ❑ System presoaked Absorption rat gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatm ast 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies COSA Checklist yellow sheet 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 >75* Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' ft Private Wells > 100' Animal Containment > 50' ✓❑ Yes if No ❑✓ Yes if No ft ft Community Wells > 200' Yes if No ft Manure/Animal Excreta Storage > 100' ✓❑ Yes Community Sewer Main > 75' ❑✓ Yes if No ft 7 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) ft ft ft ft ft Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5'✓❑ Yes if No ft Wells on Adjacent Lots.- ots:Absorption AbsorptionField > 5' ❑✓ Yes if No ft Private Wells > 100' ❑✓ 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 n/a ft If absorption field is under driveway comment below n/a Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: _ro_ ._..a_.�later_Main> 10_ . ❑ Yesa. if Ll_o n/a.ft� ,F.. bPr..ivate Wells.�_1..OD'e ❑ Yese. if�_No na-a.ft. �.-_ , Water Service Line > 10' ❑ Yes if No n/a ft Community Wells > 200' ❑ Yes if No n/a ft n/a Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS *Holding tank installed >75' from well per 2002 permit G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 49 TH .. :- Benjar6chiller PF' ` CE 12592 ••`�®� 7/12/2021 pROFESSIOO:�AM- MUNICIPALITY OF AN ; t ya.p E Development Services Department SEP 1 12018 one: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site System /t.o.rova '� ss > g5 (y Parcel 1.D. 020-551-58 Expiration Date: j 2- -( - 1. GENERAL INFORMATION Complete legal description Rabbit Creek View & Heights Block 5H Lot 40A Location (site address) 16545 Carl Sreet Current property owner(s) Loren Dixon Day phone Mailing address 16545 Carl Street, Anchorage, AK 99516 Real estate agent Cody Keim Day phone 907-250-9558 2. TYPE OF DWELLING: J 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 0 Private Septic Water Storage ❑ Holding Tank n Community Well [ Community n Public Water System ❑ Public Sewer n Waiver request for: Distance: Received by: (/a 4/)//0 Date: `%//37/ COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5Z6 Waiver Fee $ Date of Payment 19//2.W Date of Payment Receipt Number Q g7-3. Receipt Number COSA# Irj JL/71(19- Waiver# 6. 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. f 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 Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 203, Anchorage AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. 6. DSD SIGNATURE System #1 Approved for -3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 9/10/18 0-�����Q *: 4.9 TH 0 .�7........ ............. Benjarri�n�Schiller 9 1 2 0118 (1 ���FDpROfESSlO��N'..� bedrooms, with the following stipulations: -„t ER AND c WASTEWA7L—K PAc v • r By: Original Certificate Date: 3 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Rabbit Creek View & Heights Block 5H Lot 40A Parcel ID: 020-551-58 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 6/25/1976 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 108 ft. Cased to *40+ ft. Casing height (above ground) 1 6 in. FROM WELL LOG AT INSPECTION Date of test 6/25/76 8/16/18 Static water level Artesian ft Artesian ft Well production 4 g.p.m. 2.2 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 8/29/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Holding/Steel Date installed 8/21/2002 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 Date of pumping (1'12-(g 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 Results (Pass/Fail) For 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. 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 >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line >5 Absorption field >5 >10' >10' >100' Water main Water service line Surface water 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 *Casing depth taken from 2002 COSA. G. ENGINEER'S CERTIFICATION - - (r_\k I certify that I have determined through field inspections and Q, . review of Municipal records that the above systems are in Al, Co..' ,,j.4.- -v conformance with MOA COSA guidelines in effect on this date. , *; 49 Ti-I f *y Engineer's Printed Name Benjamin Schiller, PE ��. .. ;i.`".• . , Date 9/10/18 �i '.4 Benja ' chiller I1 7('-' •. CE 12592 •'`11 �1 '.. 9/10/18 .• ,' ll> ...PROFESS1O ' -46-41". COSA brown sheet 10-10-12.doc • Municipality of Anchorage >;E• 4'-� Development Services Department � - -- "� Building Safety Division On-Site Water&Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage,AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Sdi%/ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-1 12-19 HAA# /i0 `/57 j 1. GENERAL INFORMATION Expiration Date: / . — 4 - d Complete legal description RABBIT CREEK HEIGHTS SUBDIVISION; LOT 40, BLOCK 5; Location (site address or directions) 16545 CARL ST. Current Property owner(s) JAMES & JOYCE SOMERVILLE Day phone 242-9975 Mailing address 12971 NORA DR. ANCH. AK. 99515 Lending agency Day phone Mailing address Real Estate Agent PAM REYNOLDS W/ PRUDENTIAL VISTA Day phone 242-9975 4241 "B" ST. ANCHORAGE, AK. 99503 Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well U Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank U Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses)for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note:Alaska Water and Wastewater Consultants, Inc. shall be paid$2i 9q 4.zsat, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 . Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date `f /5/C 2- Engineer's Engineer's Comments: In conducting this evaluation,AKWWC, Inc. attempted to provide a thorough, aoo�OOp�4 conscientious engineering analysis of the system in accordance with ADEC and MOA o� O A 4/6.i)i.% DSD Guidelines&Regulations. The reported results described the performance of the . �' • '..... system under the conditions encountered at the time of the test, and separation Qpi`� .• t , �O distances measured to readily identifiable features. The operational life of all wells and Q •• ,,H '' Q septic systems depend on the local soils condition, groundwater levels that may '�••••• •••�•••�� * Q� fluctuate during the year, and the water usage of the family being served by the system. aThese conditions are outside the control of the evaluator of the system. Satisfactory test /•.results do not guarantee future performance of the system,nor do they guarantee that fo 13 •.J ff 1-yti . Garne . ithere are no hidden defects or encroachments.AKWWC, Inc. can therefore not provide 1 o C: 7953 •. \<P0'oQ any warranty or future estimate of how long the system will continue to meet the p"f • ._ .•. p operational requirements of the ADEC or MOA DSD. The content of this report is for Q4'e0'pro •f essio�o�hoc the sole benefit of the owner listed above.Any reliance upon or use of this report by any ��pOoo� .o other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE SI Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ``��E''•Iy OFme,(r . • ' • - • G� WATONCR SITE AND ; m. : WASTEWATER _ PROGRAM Attachments: • : , HAA Checklist I . Manitenance Agreements .i .9,,91.••I•• 6Sllh Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By: A / Original Certificate Date: ' - 1r � � CO - 0 Z ..7 (Rev.12101) Municipality of Anchorage • Cri Development Services Department ,.,.......- Building Safety Division %ae ' On-Site Water&Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage,AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: RABBIT CREEK HEIGHTS S/D; LOT 40, BLOCK 5; Parcel ID: 020-112-19 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) Y Date completed 6/25/76 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 108 ft. Cased to 40'+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/25/76 8/27/02 Static water level ARTESIAN ft. ARTESIAN ft. Well production 4 g.p.m. 3.5 _g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate .224 mg./L. Other bacteria 2 colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 7/19/02 Collected by: AWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material HOLDING TANK / STEEL Date installed 8/21/02 Tank size 2000 gal. Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) _ YES Date of pumping NEW Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft or fe/bdrm) System type Length ft. Width ft. - . el below pipe ft. Total depth ft. Eff. absorption area ft2 M•.' • ing tube Depression over field Date of adequacy test '- ults (Pass/Fail) For bedrooms Fluid depth in absorption fie'. - - ore test in. Water added gal. New depth in. Elapsed Tim-• min. Final fluid depth in. Absorption rate >= g.p.d. y rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Ac - "Pump on" level at in. "Pump off - - . in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots 100'+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Holding tank 75'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field N/A Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 75'4- SEPARATION 5'+SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS •F i 1'p G. ENGINEER'S CERTIFICATION v if •.. kl I certify that I have determined through field inspections and ;• 4• T iT •.,37 0aO review of Municipal records that the above systems are in vA conformance with MOA HAA guidelines in effect on this date. "QOM ' -ff.-y A . •••• es.s. $ Engineer's Printed Na e JEFFREY A. GARNESS 01 ;-7953 ..••••\comp • Dated rofession°o� ��OO000�� � .5+ I5°'525 - 1 HAA Fee $ .?J Waiver Fee $ Date of Payment 1/516c9- Date of Payment Receipt Number 25 t(O( 5-,- . Receipt Number (Rev. 12/01) 09/09/02 MON 11:02 FAX 6896499 VISTA REAL ESTATE ER LJ 002 • w • � o t Li • U -•....\\:\z‘z\r‘.., `!' \ I. j 'l . I 11., f I fir. Nig t\ I �oUJdi" iti •/9 4 .. _ 1 1,k,\I . ,•:0 291, „ 12 2 \ f// •„" ._ .,e,„_ T,. .<,���;iz ASBUILT SEWARD & ASSOCIATES LAND SURVE:ING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: /,/ y0/ eM��~�k1 FOLLOWING DESCRIBED PROPERTY: �� OF A ( I .QcSt'rc.PE ,. ep-ii: i'.T''.rl/.�' '•r' DATE: Q�A •' .'�ts'�0 AND THAT NO ENCROACHMENTS EXST EXCEPT AS s�8�z ;�,�, .••. • A• ••y!► INDICATED. IT IS; THE RESPONSIBILITY OF THE i OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: a i EASEMENTS, COVENANTS, OR RESTRICTIONS 3,y �. -«-< 11 WHICH DO NOT API'.BAR ON THE RECORDED SUBDI- . ou.n. Mark S«.r4 . bj•0 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' f3/4.,° LS-6911 •• i ANY DATA HEREON BE USED FOR CONSTRUCTION 9...7-z,_7i �'.• • •• `P• ! OF FENCE LINES, OR FOR ESTABLISHING FOUND- DRAWN:r ���a w"� ARY LINES. - +