HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 3H LT 9AOnsite File Rabbit Creek View & Heights Block 3H Lot 9A #020-531-31 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 'I of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 251049 PID Number: 020-531-31 Dwelling: N Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name ILNITSKIY ABSORPTION FIELD ❑ Deep Trench E] Wide Trench [ Bed 0 Mound Site Address 16241 DIANE DR [I Other Phone Number of Bedrooms 5oit Rating depth from original grade 4 JTolal 2.7 GPD/SF +4.4 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade +1.9 Ft Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot RABBIT CREEK VIEW & HEIGHTS 133H, L9A Fitl added above original grade 2.0+ Gravel 11 ngth Township Range Section Ft, 45 Ft. Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines SEPARATION DISTANCES To Septic Absorption Holding Sewer Lift Station Total absorption area Number of trenches Ft. Dist. between trenches From Tank Field Tank Line 225 1 Fe Ft. Well 501+ 50r+ TANK ❑ Septic ❑ S.T.E.P. El Holding I@ Other Manufacturer Capacity Surface Water 50'+ Gal. Material Number of compartments Lot Line 10'+ NA Foundation 101+ LIFT STATION Manufacturer Capacity I Remarks Gal. Alarm location Electrical Installed by Installer PIPE MATERIAL House to tank Tank to 3034 drainfield MIKE N ANDERSON Drainfietd 3034! co/MT3034 Inspector MIKE N ANERSON PE. BENCH MARK (Assumed elevation) 100.11 ft ins dates 1" 3/12/25 2"d Location and description 3r° 4 t TOP OF MAN HOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL �� 'F -, Va�r p Q .t= 4 r `� . Conditional Approval: Date ,. •; ; QCitT4 MICHAEL N. ANCiRLGA f Septic Systerri �. - +$��f C Approved . , - Dat �.� • 9 9 ,� ;� . 3�?S;. •'`' `' Note: this approval does not include well permit require ents. .;'. Permit No. OSP251049 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: RABBIT CREEK VIEW & HEIGHTS BILK 3H LT 9A PID No.: 020-531-31 MARK A B \ \ \M T1 32.5 49.8 \ MT2 62.4 48.6 \ \ \ \ STREA \ SMALL STREAM W/ 50' SET BACK �\ LOCATION OF WET LANDS-,.,. <� -- \ T2 \OF\MH BENCH, TCPB \ /LAS � APPROX. LOCATION OF W WELL 1 � I iLT j \ SCALE: "=50' SEPTIC SECTION N.T.S. WATER ® 3.5 MAY 2020 DF Aff 49 TH '• •�� .....::.r....I.....w....,........ r...::.....0 - MICHAEL N. ANDERSON; W: No. CE 9469 °0,3-13-25 � �'•••...........••.• �� .i MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251049 Work Type: Septic Upgrade Effective Date: Expiration Date: Tax Code Number: 02053131000 Site Legal Address: RABBIT CREEK VIEW & HEIGHTS BLK 3H LT9A G:3240 Site Mailing Address: 16241 Diane DR, Anchorage Owner: ILNITSKIY TARAS Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy 3/12/2025 3/12/2026 Lot Size in Sq Ft: 19525 Total Bedrooms: 4 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Reeeived=gy­ _ _ _ _ L !,-�i cic J -fo IYNIq Issued By: Date: Date: ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-531-31 Property owner(s) TARAS ILNITSKIY Mailing address SAME Site address 16241 DIANE DR ANCH AK Day phone Legal description RABBIT CREEK HEIGHTS & VIEW BLK 3H LOT 9A Number of Bedrooms 4 Engineering Firm MIKE ANDERSON Building Permit Number Not Applicable RE APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Absorption Field 0 Initial ❑ Septic Tank 1-1 Upgrade Holding Tank 0 Renewal El Privy El Well R THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: 5 _Z_ Date of Payment:Z-7 ,ZZ�' Permit No. 5/0qq Waiver Fees: Date of Payment: Waiver No. Distance: March 7, 2025 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Septic Permit Legal: RABBIT CREEK VIEW & HEIGHTS BLK 3H LT 9A To Whom it may concern: This is a request for a septic permit on the above referenced lot. The old 2020 leach field has failed and needs rebuilding. The existing Advantex tank, pod and pump basin will remain, but the field will be re-built and extended slightly for longevity. Only the leach field will be rebuilt per the design. A small stream is located east of the east property line, see the site plan. Class C wet lands cover most of this lot please see the permit in the MOA file. This new system will not impact any of the surrounding neighbors. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251049, Deb Wockenfuss, 03/12/25 DESIGN CRITERIA: 1"=200' PROPERTY LINE PROPOSED DRAINAGE FIELD EXISTING HOUSE-C A R L S T - EXISTING WELL 50' RADIUS SCALE: DJRDRAWN: DATE: RABBIT CREEK VIEW & HEIGHTS, BLOCK 3H, LOT 9A Anchorage, Alaska TARAS ILNITSKIY 3/6/2025 - D I A N E D R - -FRANCESCA DR- -N I C K L E E N S T - LI TT LE R A B B I T C R E E K SEPTIC FIELD SECTION 0.5' EFFECTIVE 4 BDRM X 150 = 600 GPD SOILS = 600/3.0 = 200 GPD 200 GA/5 = 40' 5.0' WIDE 40' LONG (1) MOUND +0.5' DEEP 10 (TH#1) 1.5 GM ORG 5.0' SEED AND 4" TOPSOIL FILTER FABRIC & SEWER ROCK 1.25"Ø PIPE GRADE WATER @ 3.5' MAY 2020 2" INSULATION 2:1 +2.0 -1.5 FILTER SAND 6 ML 0.0 +0.5 INSTALL SOIL MATT TO STABILIZE SLOPE OR USE 3:1 SLOPE MIN. 2' OF COVER REQ. + INSUL. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251049, Deb Wockenfuss, 03/12/25 EXISTING ADVANTEX STEEL TANK AND POD 1"=50' FCO PROPERTY LINE CLASS C WET LANDS, SEE APPROVAL W/ ZONING DRIV E W A Y EXISTING WELL 50' RADIUS, TYP. WELL VACANT RABBIT CREEK VIEW & HEIGHTS BLOCK 3H, LOT 10A SCALE: DJRDRAWN: DATE: RABBIT CREEK VIEW & HEIGHTS, BLOCK 3H, LOT 9A Anchorage, Alaska TARAS ILNITSKIY 3/6/2025 R ABB I T C R EEK V I EW & H E I G H T S BLO CK 3 H , L O T 9 A RABBIT CREEK VIEW & HEIGHTS BLOCK 3H, LOT 8A RABBIT CREEK VIEW & HEIGHTS BLOCK 2H, LOT 5A 5 0.0' CREEK S E T B A CK LI T T L E R A B B I T C R E E K MT MT SLO P E 0 - 5 % SLO P E 0 - 5 % NO SLOPES OR CUTS >25% WITHIN 50' OF THE SITE WELL WELL WELL TH#1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251049, Deb Wockenfuss, 03/12/25 _ OafOQ B`/YG U z Y C I ,. _. . S `. f YY Mark Begich Mayor Pump Installation Log Well Drilling permit Numbal ljw-a 7f 361 bate ®tiaeael b_ parcel Ideatifleation Numberi______ 7Manufsanrerls ou�property 0, NameBt Addt ai CfX- d- �ei�+�A �,,3a�rotion Date: - �i ^ 2Depth Below Top of Weil Casing: C30 feet sanrer's Name: FPS 3 00 Pump Model: /D 5�rn X30 pump Size ila hp pitless Adapter Burial Depth: r(� feet pitless Adapter Manufacturer's Name: C� pitless Adapter Installer: 1/ i 0�"'t'n 4 Well Disinfected Upon Completion? 4 Yes ❑ No Method of Disinfection: CA I•VrAk *Alc� Comments: pump Installer Namo: Johnny luiy Hefty Drilling, Inc. Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. STATE OF ALASKA b413U DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey ®r WATER a e �rMehr of N'�VP* WATER WELL LOG Revised 08/18/2016 Drilling Started: 2 / 17 / 2021 Completed: 2 / 17 / 2021 Pump Install: City/Borough I Subdivision Block Lot Property Owner Name & Address Ta ra s 11 n i is k i y f Municipality of Anchorage RF+BBITCREEK VIEW 8 HEIGHTS 3H 9A Well location: Latitude 61.07366716561128 Longitude -149.7306114435196 Meridian S Township 011N Range 003W Section 01 , NE 1/4 of SE 1/4 of SE 1/4 of NW 1/4 BOREHOLE DATA: (from ground surface) Drilling method: ■ it rotary, able tool❑Other Suggest T.M. Hanna's hydrogeologic classification system* Well use:❑Public supply,❑Domestic,❑Reinjection,❑Hydrofracking https://my.ngwa.org/NC Product?id=a185000000l3Yu1b3AAD ❑ Commercial, ❑Obserrvatttti_ion/Monitoring,❑Test/Exploratory,❑Cooling, ❑Irrigation/Agriculture,F�rounding,❑Recharge/Aquifer Storage, ❑Heating,❑Geothermal Exploration,❑Other Fluids used: Depth From To overburden 0 2 silty gravel 2 6 Depth of hole: 78 ft Casing stickup: 2 ft Casing type: steel Casing thickness: •25 inches Casing diameter: 6 inches Casing depth: 78 ft Liner type: Depth: ft Diameter: inches Note: silty clay 6 13 silt and gravel 13 23 wet silt and gravel 23 33 little water and gravel 33 43 Well intake opening type: E Open end, pen hole, Other open end Screen type: , Screen mesh size: Screen start: ft, Screen stop: ft, Perforated❑YesElNo Perforation description: Perffrom: ft, Perf to: ft. Perf from: ft, Perf to: ft dry silt and gravel 43 68 wet gravel 68 73 coarse gravel with water 73 78 Gravel packed❑Yes E]No Gravel start: ft, Gravel stop: ft Note: Static water (from top of casing): 3 ft on / / Artesian well ❑ Pumping level & yield: feet after hours at gpm Method of testing: airlift Development method: Duration: Recovery rate: 15 gpm Grout type: bentonite Volume 1 bag Depth: From 0 ft, To 20 ft Include description or sketch of well location (include road names, buildings, etc.): Final pump intake depth: ft Model: Pump size: hp Brand name: Was well disinfected upon completion? L!j Yes No Method of disinfection: tabs Was water quality tested?❑Yes F-1 No Water quality parameters tested: Well driller name: .................................................................................. Company name: .HEFTY.DRILLING.... .................................................. Mailingaddress: .................................................................................... N h City: State: AK Zip: Phone number: ( ) - AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Driller's signature: Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: Date: / ! Anchorage Municipal Code 15.55.060(1) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City https://dnr.alaska.gov/welts/ within 30 days of well completion. OR email electronic well logs to City Permit Number: Date of Issue: —/—/ dnr.water.reports(,)alaska.gov Parcel Identification Number: 'Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press MUNICIPALITY OF ANCHORAGE s Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Well Log Permit Number: # OSP201361 Date of Issue: 2/16/2021 Parcel Identification Number: Date Started: 2/17/2021 Date Completed: 2/17/2021 Is well located at approved permit location? Yes 0 No ❑ Legal Description: Rabbit Creek View & Heights BLK 3H LT 9A G:3240 Property Owner Name & Address: Taras Ilnitskiy 16241 Diane Dr, Anchorage AK Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Casing Stick Up 0 2 Overburden 2 4 Silty Gravel 4 8 Silty Clay 8 15 Silt & Gravel 15 25 Wet Silt & Gravel 25 35 Little H2O & Gravel 35 45 Dry Silt & Gravel 45 70 Wet Gravel 70 175 Coarse Gravel w/ H2O 75 80 Water Sample Results: Arsenic: ug/L Nitrates: mg/L Total Coliform Bacteria: colonies/100mL Method of Drilling R air rotary ❑ cable tool Casing type: Steel Wall Thickness: -250 inches Diameter: 6 inches Depth: 80 feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 3 feet Pumping level: feet after hours pumping wpm Recovery Rate: 15 gpm Method of Testing: Airlift Well Intake Opening Type: Q Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet 20' Start _0 feet Stonued 20 Well Disinfected Upon Completion? Yes No Method of Disinfection: Tabs Comments: Well Driller: Johnny Kay ❑ Company: Hefty Drilling Inc Mailing Address: P.O. Box 112130 Anch, AK 99511 Attention: The well driller shall provide a well log to the On-site Water and Wastewater Section within 30 days of completion. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:/Iwww.muni.org/onsite On -Site Water & Wastewater System Permit Permit Number: OSP201361 Effective Date: Work Type: WellSeptic Initial Expiration Date: Tax Code Number: 02053131000 Site Legal Address: RABBIT CREEK VIEW & HEIGHTS BLK 3H LT 9A G:3240 Site Mailing Address: 16241 DIANE DR, Anchorage Owner: ILNITSKIY TARAS Lot Size in Sq Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedroom This permit is for the construction of: 0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Z Private Well All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC60) 3. The wastewater code requires inspections during the installation. The engineer shall notify tl Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 2/16/2021 2/16/2022 19525 ❑ Water Storage of Alaska Development weather Received By: Date: Z I u Z Issued By: f Date: 6 ao2 4 MUNICIPALITY F ANCHORAGE Development Services Department'' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION e Parcel I.D. 020-531-31 Property owner(s) TARAS ILNITSKIY Day phone Mailing address 6421 ANDOVER CIR, ANCH AK Site address SAME Legal description (Sub'd., Block & Lot) RABBIT CREEK VIEW & HEIGHTS BLK 3H LT 9A Legal description (Township, Range & Section) Lot Size 19,525 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) - Absorption Field 0 Initial 7 Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade El Duplex (D) ElHolding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well FX_1 Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: t� 9 8 `I W V I ®_ 1 Date of Payment: 7/3/2-02-0 Receipt Number: 00 3 �7 i Permit No. 0 5 Po'01 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Feb. 10, 2021 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Septic & Well Permit Legal: RABBIT CREEK VIEW & HEIGHTS BLK 3H LT 9A To Whom it may concern: This is a request for a septic and well permit on the above referenced lot. A test hole was excavated and found 1.5 feet of organics then Silty Gravel (GM) down to 6 feet then changed to silty sands (ML) in the bottom. Water was observed at 6 feet but raised to 3.5 feet after the 7-day monitoring period. The perc rate was 30 minutes. Due to the lot size and soils a Advantex system has been designed for the lot with a pump basin. Ballast will be used to keep the tank and pump basin from moving, see site plan. A small stream is located on the east side of the property, see the site plan. Class C wet lands cover most of this lot please see the permit in the MOA file. This new system will not impact any of the surrounding neighbors. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201361, Rebecca Carroll, 02/16/21 DESIGN CRITERIA: 1"=200' PROPERTY LINE PROPOSED DRAINAGE FIELD PROPOSED HOUSE-CARL ST-PROPOSED WELL 50' RADIUS SCALE: DJRDRAWN: DATE: RABBIT CREEK VIEW & HEIGHTS, BLOCK 3H, LOT 9A Anchorage, Alaska TARAS ILNITSKIY 2/10/2021 -D IANE DR - -FRANCESCA DR--NICKLEEN ST-LI T T L E RABBIT CREEKSEPTIC FIELD SECTION 0.5' EFFECTIVE 4 BDRM X 150 = 600 GPD SOILS = 600/4.0 = 200 GPD 150 GA/5 = 30' 5.0' WIDE 30' LONG (1) MOUND +0.5' DEEP 10 (TH#1) 1.5 GM ORG 5.0' SEED AND 4" TOPSOIL FILTER FABRIC & SEWER ROCK ‘3,3( GRADE WATER @ 3.5' MAY 2020 2" INSULATION 2:1 +2.0 -1.5 FILTER SAND 6 ML 0.0 +0.5 INSTALL SOIL MATT TO STABILIZE SLOPE OR USE 3:1 SLOPE MIN. 2' OF COVER REQ. + INSUL. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201361, Rebecca Carroll, 02/16/21 1500 GALLON ADVANTEX W/ POD AND PUMP BASN, 5' SEPARATION MIN. 4,000 LBS TANK & 1000 LBS BASIN BALLAST REQ. 1"=50' FCO PROPERTY LINE CLASS C WET LANDS, SEE APPROVAL W/ ZONING DRIV E W A Y PROPOSED WELL 50' RADIUS WELL RABBIT CREEK VIEW & HEIGHTS BLOCK 3H, LOT 10A SCALE: DJRDRAWN: DATE: RABBIT CREEK VIEW & HEIGHTS, BLOCK 3H, LOT 9A Anchorage, Alaska TARAS ILNITSKIY 2/10/2021 RAB BI T C R E E K VI E W & H EI G H T S BLO C K 3 H, L O T 9 A RABBIT CREEK VIEW & HEIGHTS BLOCK 3H, LOT 8A RABBIT CREEK VIEW & HEIGHTS BLOCK 2H, LOT 5A 100.0' CREEK SETBACKLI T T L E R A B B I T C R E E K MT MT DCO PRIMARY ABSORPTION FIELD SLOPE 0-5 %SLOPE 0-5 % NO SLOPES OR CUTS >25% WITHIN 50' OF THE SITE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201361, Rebecca Carroll, 02/16/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201361, Rebecca Carroll, 02/16/21 Y' OPINION OF COMPLIANCE -ANCHORAGE GENERAL PERMIT 93 -10 -M4/11 -M4/12 -M4 File Number: POA -2020-407, Little Rabbit Creek [GP 93-10-M4 Residential Fill] Municipal Reference Number: Little Rabbit Creek 20-B Permittee (LANDOWNER): Taras llnitsky Expiration Date: October 31, 2020 Project Location: Rabbit Creek View & Heights Subdivision, Lot 9A, Block B3H, Anchorage Anchorage Wetland 108 T Management Plan Map #: SuBm' TAL QEF' 0 2, 2020 Wetland Unit #: 84 t3rat&an ftullw Wetland Fill Amounts: 0.04 acre; -200 cyds gravel fill 9RO Work Description: Minor excavation and backfill for placement of gravel for new residential development and driveway. All work will be performed in accordance with the attached plans submitted with application dated: August 21, 2020 The permittee will perform work in waters of the U.S. (wetlands) in accordance with the terms and conditions of the Anchorage General Permit, as specified below: Anchorage General Permit Conditions: -GF-NERAL =N12IT,l2NS OF THEsr; GENERAL PF.13MITS All activities identified and authorized by these GPs shall be consistent with the special conditions listed above, as well as the general conditions listed below. The Corps can also add site-specific special conditions to a GP verification, as applicable. Obtain GP verification or to activity: No work shall be done under these GPs without first obtaining an Opinion of Compliance (OC) from the MOA Planning Division or General Permit Verification from the Corps. A copy of the Municipal building permit application and grade/fill permit application or Land Use permit application must be included with the GP application. Compensatory mitigation, if required, must be acquired before proceeding with authorized jurisdictional activities. Time -limit: Verification under these GPs is valid until October 31, 2020, unless the GPs are modified, reissued or revoked. It is incumbent upon the applicant to remain informed of Rabbit Creek Heights Subdivision POA -2020-407; Little Rabbit Creek 20-B 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 OSC251083 Parcel ID 020 -531-31 Expiration Date: 2/7/2026 Legal description RABBIT CREEK VIEW HEIGHTS BILK 3H LT9A Site address 16241 DIANE DR Current property owner(s) ILNITSKIY TARAS X The On-site system(s) is/are approved for 4 bedrooms By.vIiyniai �ILIIi�aLc vaLc. Conditional approval for bedrooms, with the following stipulations: Comments or conditions: This C&rtificafe of On -Site Systems Approval (COSA) is intended to demonstrate the subject sy;tem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, D velopment Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory 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 Application 1. GENERAL INFORMATION Parcel I.D. 020-531-31 Complete legal description RABBIT CREEK HEIGHTS & VIEW BILK 3H LOT 9A Location (site address) 16241 DIANE DR Current property owner(s) TARAS ILNITSKIY 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 5 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ■❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑■ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ 9 W3 Date of Payment COSA # OS C_ 2- 1 Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: RABBIT CREEK VIEW & HEIGHTS BLK 3H, LOT 9A Parcel ID: 020-531-31 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA N Well log is filed with Onsite (or attached) Date drilled 2/27/21 Total depth 80 ft Cased to 80 ft X Sanitary seal is functioning correctly N Wires are properly protected Casing height (above ground) 24"+ in. Date of flow test for COSA 2/7/25 Static water level at beginning of test 3.6 ft. Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping ADVANTEX Z Required maintenance completed, if AWWTS Comments: `ADVANTEX SYSTEM D. ABSORPTION FIELD DATA Which system tested (date installed) 3/12/25 0 ALL standpipes present per record drawing Total measured depth from grade 2.5 ft (max) Measured depth to pipe invert from grade ft (min) ffil N/A — pressurized field. K Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes V No N Coliform bacteria is Negative Nitrate 0.454 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/LArsenic less than MRL (ND) Collected by Date 2/7/25 MNA C. LIFT STATION FN Required maintenance completed Age of lift station 5 years Lift station material PLASTIC Comments: Adequacy test date NEW Results 0 Pass Fluid depth prior to test _ in Water added _ gal New fluid depth _ in Elapsed time _ min Final fluid depth _ in Absorption rate _ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Yes if No *>50 ft Neighboring Tank > 100' 0 Yes if No _ ft Absorption Field on Lot > 100' ❑ Yes if No *>50 ft Neighboring Absorption Fields > 100' rml Yes if No _ ft Community Sewer Manhole/Cleanout > 100' Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Holding Tank > 100' Animal Containment > 50' Q Yes if No _ ft Q Yes if No _ ft Manure/Animal Excreta Storage �> 100' Community Sewer Main > 75' DYes f No _ ft LJ Yes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' F2] Yes if No _ ft Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' 0 Yes if No _ ft ❑Yes ifNo_ft ❑� Yes if No _ ft 9 Yes if No ft F. ENGINEER'S COMMENTS * ADVANTEX SYSTEM Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' Efl Yes if No ft E Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm /(/([kcr-- /'tA(C C_Jar✓f PGL Engineer's Printed Name Say.. e COSA Checklist -June 2022 Phone 727-8864 Date �tvarirrexe Field Maintenance Report Unscheduled AnchorageTank 907-272-3543 Property rerfrmckingN T00@6608 Outputs Ope2tor Power (Green LED) SheAEEress Sery s Contact Phorro AX She IDN county 10N POEN RTU VULN Data or Last Inapeclfon ulspatcher Comments ) ,� Date:/ 3 /' IQr_Time: Notification of site condition ❑ Made by VeriComma Monitoring System ❑ Made by �Hom�eowner /• r Y Other . l i e Site condition at time of call ❑ Alarm ❑ Tank Overflow ❑ Odor ❑ Sewage Backup ❑ Other Field Sampling/Observations ❑Necessary Not necessary NTU (15 x NTUs) pH (6-9) DO (2-6) Odor of Sample. Typical Ll Musty El Earthy Ll Moldy Non -typical ❑ Sulfide ❑ Cabbage ❑ Decay Conditions at site Alarm On ❑ Yes A No (If yes, alarm type Tank Liquid Level A Normal ❑ High ❑ Low Pump Operational?x Yes ❑ No Circuit Breakers LcccLyyyyyllIII Recirc........ ❑ Tripped On ❑ Off Discharge..... ❑ Tripped On ❑ On Controls ...... ❑ Tripped)J%1 On ❑ Off VCOMa ATRTU Board: (if applicable) Document the panel status by shading the appropriate inputs and outputs as indicated by the yellow and red LEDs. Inputs T00@6608 Outputs O O 0a)® Power (Green LED) / L1On ❑ Off rel Flashing Cause of Malfunction: ❑ Mechanical ❑ Process -Related Services Rendered: &-0- -rank _ 1 • V / Parts Used: W = Warranty, B = Billable (✓ appropriate selection) hem Notes/Final Recommendations: ❑ System performing; no further action needed ❑ Additional service needed Final/Safety Inspection: Lids bolted on? r Yes ❑ No (If damaged, comment Control Panel reactivated? 71 Yes ❑ No Circuit Breakers: �/ Recirc: On ❑ Off Discharge: VTOn ❑ Off Controls: 7[� On ❑ Off Time at Site I Travel Time I Total Time IDate/_3 Mar (C ✓ Time Fax completed form to 1-866-384-7404 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAIN'T'ENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this (9'-Y' Day of M 0.r Q\ of 20Z5 , by and between herein the "OWNER,,' and the Municipalityof Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the partes to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate anAdvanced WastewaterTreatment System (AWIWTS), described as aIIDDIs1glvlLil�a�i�t,i A Avoytie.X A912 0 located at (legal description) `1 &-)D i+ CMPOL Vity) Q -A6 AC15 s Lark-cwk ar%d Rlorir 3N 2. Mainttnance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AW WTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs.li This includes an annual maintenance fee (typically 5400 to $600). Owner agrees that only maintenance and repair personnel approved by the Mr nicipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AW WTS reduces the poitential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05118/2018) I Page 1 of 3 �S Owner acknowledges that the Municipality may request records of maintenances and repairs from the manufacturer's representative or maintenance provider. �S Owner acknowledges that the fine for failing to maintain and repair an AW WT$ may be assessed in accordance with AMC 14.60.030. S Owner agrees to grant the Municipality reasonable access to test and inspect the AW WTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AW WTS installation and maintenance requirements as provided by the AW WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AW WT$. Owner agrees to maintain remote monitoring of the AW WTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall'pontinue while the AW WTS is operational or until title is transferred. 4. Nouwalver. The failure of the Municipality at any time to enforce a provision,of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. Page 2 of 3 (rev. 05118/2018) OWNER - By: —4 _(signature) (print name) STATE OF ALASKA )ss. THIRD JUDICIAL DISTRICT Date: 4 The foregoin instrument was acknowledged before me this p day of 20.,25by NOT Y—Ptg�LIC FOR ALA KA My ommission expires: (rev. 05 18:2018) (signature) ;print name) Date: Title: ....... ... .... Page 3 of 3 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: RABBIT CREEK VIEW &HEIGHTS REPEAT LOT 9A BLOCK 3H PLAT 2004A1 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoull any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE. E-MAIL: MAR 12, 2025 1 "=30' schullerakogmail.com 25-009-2 DRAWN BY: CHECKED BY GRID NUMBER: BOOK AGE: JLS SW3240 250124 © = FND 5/8" REBAR 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax