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HomeMy WebLinkAboutLITTLE RABBIT CREEK LT 1Onsite File PjawLabs" - t Formerly Rabbit Creek View & Heights BIk IH Lt IA Wockenfuss, Deborah M. From: Ben Schiller <ben@forgecivil.com> Sent: Tuesday, October 18, 2022 11:26 AM To: Wockenfuss, Deborah M. Cc: Kate Sauve Subject: Re: doc21727320220819162804.pdf Attachments: septic Rabbit Creek.pdf Follow Up Flag: Follow up Flag Status: Flagged We had Precision Excavating expose the bed on Lot 1A and repair the monitoring tubes on that system. We confirmed the location, and the surveyors added the pipes in to this survey. We can confirm that the system is entirely on the lot. Let me know if you have any questions - Benjamin Schiller, PE 907-310-9090 N On Fri, Aug 19, 2022 at 4:20 PM Wockenfuss, Deborah M.<deborah.wockenfuss@anchorageak.gov> wrote: 1 LOT 1A, BLOCK 1H,RABBIT CREEK VIEW &RABBIT CREEK HEIGHTSSUBDIVISION REPLAT,PLAT 2004-91As-built124 E 7th AvenueAnchorage, Alaska 99501(907) 306-8104mail@S4AK.comLand SurveyingLand Development ConsultantsSubdivision SpecialistsConstruction SurveyingAKCAN 173042S4Group LTJ am t'9 1.: I 4 Ild �4225: O ------------ use O Y I F I7--� y� a��y F ii k� � g4 s�-�3 QFFFoRhg9 i f Ild �4225: R c B NF •4� 4 NM � � .� P 9 3�� jJ±j� px pi � 1� eo °�pppppppp�Qs .Q f MUNICIPALITY OF ANCHORAGE -� \\ DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTECTION 1' ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT mT PHONE EW NAME �� -�l`11 UPGRADE MAILING ADDRESS LEGAL DESCRIPTION Liter. �1/�=t'.31"� �Q �c:,'C+tfs l•c1-� NO. OF BEDROOMS LOCATION L+y . (lam t 1•.- - - /yiJi'1� !" ••�-�'�} f Dwelling PERMIT NO. - Well 1 Absorpti n area DISTANCE TO: 2-G 1S ��� \ — Material No. of compartments .y F_Z Manufacturer ,r ���lJ tb Q C� Liquid depth in W I— — Inside length Width ILiq. capacity in gallons IF HOMEMADE:-� —� G;j - - PERMIT NO. Well welling C. DISTANCE TO: - fP --- — — — Liquid capacity in gallons Material 0 Q Manufacturer !' 7: F- PERMI-1 N0. Well � y Oundation Nearest lot line — DISTANCE TO: __ Pa/ !" w _ Distance between lines uJ,i PJo. of lines Length of each line al length of lines Trench width inches in _ - - — Total effective absorption area F� d Cr.ToP of rile to finish grade aterial beneath rile y_ inches PERMIT NO. in Depth 1 _ ..��_ ^ Length at Lt Width t } i- � . PD MOO t-- t --J- -�_ ea an ••7 _ > l� Type ofm�rih meter Crib diameter Crib depth _l Total effective absorption -. �•-�- __. w — Well r Buildii1g foundatiionn Nearest lot line ' N DISTANCE TO'. \,J r��� Distance to lot line PERMIT NO. Clas =i �w�'I De th Driller Absorption area(s) - w Building foundation — Sewer line Septic tank DISTANCETO: OTHER r PIPE MATERIALS ►JJt /�\ UA 0;) ��1✓� i — SOILTEST RATING ' t 3/S`1 I2 I ------ INSTALLER REMARKS C SCO �.>0 1104tlp0 •t V96evtl ¢t,� °e' y � A4If. t'. L•� r . N'iC�•. P•St 1 �J. Is�iJid Yt �. afhN , yt .JjED I UEPARTMENT UF HEA|TH AND E.� 825 L STR^��T AN�'�yIRON�ENT�L` PROlECT�lON MURAGL�, AK 99501 264-4720 Of 9 ",H~_���`��� �ERMIT NO: DATE ISSUED: 8�0371 ENGINEERED DE�IGN o//U1/85 APPLlCANT: ADDRESS: LUPJN WOODWORKS 11480 BROWDER Al NHOR ONEGEAK qq516pH6171 LEG�L DES2RIP: LOT SIZE: �U1­ilDIVISION: R48B�T ��CTI 0VI«EEK "5AUWNS (SQ FT O|H�P: F� A�REB> certi�y that: 1. I am familiar with the uhe MAI !B �or on�sit� will install the �ystry o� Anchorage (MOA) andGe�e'� a�d 3 and in complianc� Nith em in a�cordancg with all t�e State ^ I will adhere to all MO�he design �riteri� o� this codes �jst�nces �r�m any �Xi � and StAte o{ Ala5ka s stjn� w�l� ...~^ '�qui'O0enf� [ITS. " LOT 1 11N RANG�: 3W �ells �s set o� Alask�. �nd r�g�lations, f . .. or`a/-.^'dispos�l—�^~ � zne set back IF A LIFTASTATION IS INgTALLED INnyN�dj�cent oP by lot,�yst�� o' Public WILL, w.nTH~'" `�/ B� ELECTRICALIPERMIT AND HNSA�EAICDV�R�D By M�) BUILDING CODE� ELECT�ICA� W`'`"'�o w [HOUT AN EL5�—�~' v/v nub[ BE OBTAINED ` URKDOI /KICAL IK/SPECTION REpORT ; (2) AS~BUILTS GIGNED ELECT|ICIAN, ��__�_�_�� ISSUED �Y ~ DA��: ��=~�^ . ------ ------- M I 47 C ol V;2e - - - - - - - - - - - -47 on Mal a r °Ocoo �• + t:',aoaucu o0.0°4•ooe.oyy erald V.Rand oll Jr. s•'°o NO. 4053-S <C,' o°e a°•cJ� sr+ �o%'080FESSI0NA1- N 89 0 40 S .. F SiOKRGE 12m ql°' z4 r,•, - P2or'a�E© /Q (\j hiOUSL' i.o�RTrdrJ c 25I(° H A; E 1_ Or EXCLUSION NOTE: It is the owners' responsibility to determine the existence of any easements, covenants, or restrictions which do not appear • on the recorded subdivision plat. l 29Q. 9P LSN)= --GHqmNP-Y �oURT 30l t=NC31NEEFIS •PLANNERS • StJFtVEYO1�S SURVEY CERTIFICATION: I hereby certify that I have surveyed the property shown and described hereon and that the Improvements situated thereon are within the property lines and P P Y no encroachments exist other than noted. LEGAL DESCRIPTION: PLOT P� O� t I o 7 ' 13 L D / rl ' j,_ lJ IJ f:... r ` LEGEND: SET FOUND 5/8" REB! R (� HUB & TACK ❑to MONUMENT ® ® AL -CAP ® e W.O.•. g,5-L—Z39 BOOK/PG: i7—Z� DVrnV s1A�E.",3dI PLEASE NOTE: It is the contractor's responsibility to check top of foundation in relation to finish grade and building setbacks in relation to lot lines and easements. CHECKED BY: DATE: 440 WEST BENSON 272-9231 ANCHORAGE, ALASKA 99503 562 5291 Q �X '(' I p ' `+✓ �+• i 1'F—m �� . PK NAIL X IRON PIPE @ �= ELE VS. • DATUM ASSUMED SOILS LOG MUNICIPALITY OF ANCHORAGE o DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 _= SOILS LOG — PERCOLATION TEST PERFORMED FOR:ti r= 1 I F'�� i'> t.. r c-` c�-�L_- �. DATE PERFORMED: LEGAL DESCRIPTION:_.-�j[=� �'L-'��` ( ��`hi'> r'i-CL,i— I-�^� SLOPE SITE PLAN 1 2 3 ' / / 0..' til L_ �■ 4 OF A `��C r ■ ■ fag Q °• °eoe 0i� 15 0I■■ ■■■■■ 16 6 17 a• qa °• o •+.+ �q tr + Mobart A. Shsrtar °° No. IA457-E d 6�°� 18 ■(i■_�■_■_■_■_■_ '°o�nESSVZ`� �a 19 9 10 11 12 13 Date ■ �■ I OF 14 ■ ■ fag Q °• °eoe 0i� 15 0I■■ ■■■■■ 16 17 a• qa °• o •+.+ �q tr + Mobart A. Shsrtar °° No. IA457-E d 6�°� 18 ■(i■_�■_■_■_■_■_ '°o�nESSVZ`� �a 19 WAS GROUND WATER L ENCOUNTERED? y O d 0------ _ IF YES, AT WHAT t E DEPTH? -1 Reading Date ■ �■ I ■ 111 000000—M ■ ■ '�■M■ ■■EMNE MIDI■ 0I■■ ■■■■■ ■(i■_�■_■_■_■_■_ WAS GROUND WATER L ENCOUNTERED? y O d 0------ _ IF YES, AT WHAT t E DEPTH? -1 Reading Date Gross Time Net Time Depth to Water Net Drop 20 PERCOLATION RATE IJ 11A (minutes/inch) TEST RUN BETWEEN — FT AND FT COMMENTS— �tt~ to,cL�)rJ� PERFORMED BY: _CERTIFIED BY: DATE: 72-008 (6/79) ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE `� PERCOLATION o DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION / TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: C.�"-.7=J DATE PERFORMED:,�� is � 1Z-'{��"� LEGAL DESCRIPTION:_ 4 /��/ L'l—,/-<---L— " i7 SLOPE SITE PLAN 14 15 16 17 18 19 /„'vb \Y•• k., rare ! �.`ti4t F� } X(rrWbart A. 5hafw 1 Q n No. I -w -E WAS GROUND WATERrr S i A I - _ l.._ 1 GI 0''I 2 3 �— - 4 CAL- ENCOUNTERED? L _. f— � \ti�hyfY.1L: �-�C=-1�/�•���.> 6 7 14 15 16 17 18 19 /„'vb \Y•• k., rare ! �.`ti4t F� } X(rrWbart A. 5hafw 1 Q n No. I -w -E WAS GROUND WATERrr S ENCOUNTERED? L P + E IF YES, AT WHAT G DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop p h — I� lUt5��'l `„ 2 :4c) Z 20 lay r t__]PERCOLATION RATE (r///��/inutes/inch) TEST RUN BETWEEN �I I 2_ FT AND I -t- FT COMMENTS\K/,N. —t!:A L. J+ r- t/ - CERTIFIED BY: DATE: J��� S_ PERFORMED BY: .a a . -+� )� -- 7 2-00 8 (6/79) _.-...__ __... ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION � PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 -'' SOILS LOG - PERCOLATION TEST , PERFORMED FOR: - C C -f !iC DATE PERFORMED: � '� 6y LEGAL DESCRIPTION:117, _ L_� ✓1Ci/� ` �5 — SLOPE SITE PLAN REP 9) �-ry 1 -- 2 wz 3 �- 11 %o-0 7 c � °« Z. 5 7 M 9 L 10 11 19 WAS GROUND WATER a S ENCOUNTERED?>� L Depth to Water 0 P IF YES, AT WHAT E DEPTH? - Reading Date Gross Time Net Time Depth to Water Net Drop p A04 -Lzr !/ �J r 20 PERCOLATION RATE , (minutes/inch) �l TEST RUN BETWEEN �.��. FT AND —� - - FT ls' COMMENTS /!'_/i//��/%2✓�i,G�.�✓�� 4-41_/- DATE: - v r r 1'31111 It/l JE Al PERFORMED BY: � 2•'l ii.r�Cil�'�n, < <` rt , - CERTIFIED B f. s 72-008 (6/79)' +�-'' /A e � �-, /(- � k:..✓fu3�'r'�n 7 ( l ..•......-_ -.-_-, �ar>i �r�---'--� � i LAJ Z��vwtjtiL J!rs) � ���.:fUk,',.�:Yi_'� %"9 F r�t' ldbb'-nJ �..t MwQ pll:i4GF�g4 �1t4ar6� - Icy C'J['.4-1N- �`'� Gyi;, f�ikre f�..Yrt^s (1C 4f AU1` �+'�/•�5.� 4!'t lss�9d'6CN J' U.p r.��e.e,.�vj-,� ���. •. �y1pQ' fsi�,fir� _ JNA L'�3 :.� [t. /�?G EY �. , _�. 1` ..�._ .,--- V�R,t�.,irsi.rt !�C yrr�/ s-���rl�!!t� F✓�. `-.. `"•+-r- rlr*.IH.t.• f�e.7(a . _ <kJt�u,l ._ --•• `/1�' 7� .�"% 9i Tom, ��l_= __. v`c� �ccar- [,/aJ -� ,.'d.l �,� f L{ � F! rC-a:•� �c:J �,Y, � v %J /c�[- r✓J Fj Yn/�'LbJ . .D!"- ��l.r L; �°� �-z•��h+>wa J �fs�a, �" �:'�FI!.1a�) (.1I•.�r.�.a �t�J:J2. �J, Lj`i�<�.•G+1..�1_� .8�,'141� ova,• ,e;�£3�_ �°.;a „R`'�,�,ol��.,,��„•"S:s�'� �<..:� ._.....-.., . _._ «. 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Hefty Drilling E K IIS, U-jS - S.R.A. Box 1553 H Anchorage,Alaska 99507 PNCNO?Ar's �NIVICDIE? ON�AL pROTE TION W?,O W ti �10 t-4 I C." I`��I -Ir a-ir" CH F" ������s F -a Fi i --:i F -7 - DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE., HK. 99501 264-4720 PERMIT NO ( 821020 ) APPLICANT HJ CHRLSQN PO BOX 10048 LOCATION NOT VALID WITHOUT SEPTIC: SYSTEM PERMIT LEGAL L1BI RABBIT CREEK HEIGHTS 99511 ]45-0870 LOT SIZE 999999 SQUARE FEET MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM F9 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO 8 PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DHY5 OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ����I 'I- I �EE C�l F:Drel 0 F—:"F-' :3i::lL , ��G-=, ;2 I CERTIFY THAT 1: I HM 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. SIGNED:�_�_��_�_~ APPLICANT HJ CHRLSON . � l'` MUNICIPALITY OF ANCHORAGE DEPARTMENT Or HEALTH AND ENVIRONMENTAL PRO t LCTION DIVISION OF ENVIRONMENTAI- HEALTH CERTIFICATE Of- INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON -SI'T'E SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot block subdivision section, towns i prange) J Location (address or directro,ns) % f 2. i ,t1 b cant Name I F %�� J"�l __ Business _� () A pp;: 1 Telephone. Home """ / Applicant Address -�%L 2'— �r/ f 2 v ./ 1! �l �- (c) Applicant is (check one). Lending Institution EJ Owner/builder�Buyer C_I ; Other ❑ (explain); -- (d) Lending Institution yj_`_- l?(-f"Telephone Address (e) Real Estate Company and Agent _ Lam— �n�_< �'y-7Z-�U Address Telephone -- ---_.----. 'ow (f) PJlaia the HAA to the following address: TYPE OF RESIDENCE Single -Family Multi -Family C1 Number of Bedrooms Other 3. WATER SUPPLY Individual WeII Community 0 Public El 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)? Public L Community El Holding Tank L7 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 5. ENGINLEnING FIRM PROVIDINt. iSPE C-noNs, Ti--sys, FILE SE=ARCH, DA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation oethis 1 --len, Ith 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 - Address .---- Date - — - ---- --- — - ----- Telephone 6. DHEP APPROVAL 1 .�.� -/�w�, �r - Approved for � E<=��L..- bedrooms by -'` - Date Approved --<` —___ Disapproved Terms of Conditional Approval Conditional 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. E=mployees 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 P. of 2 MUNICIPALITY OF ANYMRI+C'PLITY OF ANCHORAGE (MOA) DEPT OF HEtki1i+14rTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTEgJ1q?�KLIST - FEBRUARY 1984 264-4720 E:C111995j� Legal Description: A. WELL DATA R K E I V E LJ Well Classification If A, B, C, D.E.C. Approved (Y/N) — N o _ Well Log Present ON) _ Date Completed 1 EJ -3 -'SZ Yield 1-2C-nFk'A _ t + Total Depth LO _ Cased to LP -1 Depth of Grouting Static Water Level + Pump Set At K . Casing Height Above Ground —. ���� Sanitary Seal on CasingaN) Electrical Wiring in Conduit (2�1\1) Separation Distances from Well: To Septic/Fk4di fg "Tank on Lot Depression Around Wellhead (Y/Q On Adjoining Lots L C.— -I- To Nearest Edge of Absorption Field on I of �'�✓�� + ; On Adjoining Lots To Nearest Public Sewer Line N J& _ To Nearest Public Sewer Cleanout/Manhole _ 1-5)4 __ To Nearest Sewer Service Line on Lot + t Water Sample Collected by _---A �P��La6w 1+�G ; Dat Water Sample Test Results Comments B. SEPTICLHA=)1" TANK DATA !✓ e a Date Installed -• t � Size l eters _ No. of Compartments r2--- Standpipes¢?/N) _ Air -tight Caps ON) Foundation Cleanout(MN) Depression over Tank (Y& _ Date Last Pumped t rl el y1 Pumping/Maintenance Contract on File (Y/N) IN _ ; for — tz d Holding Tank High -Water Alarm (Y/N) _ Temporary Holding Tank Permit (Y/N) 0 Separation Distances from Septic/P,&1 +6 J Tank: � 1 To Water -Supply Well — leo To Building Foundation _ To Property Line �a'd' To Disposal Field ,45;; To Water Main/Service Line 4- To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) 6 MUNICIPALI-IV OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEG ZION DIVISION OF ENVIRONMENTAL SdUALTH ( IAMFICATE, OF INSPECT ION FOH HIHALTI I AUTI-1O1-11TY APPROVAL OF ON SITC SEWER AND WATER FACILITY 2,64-4720 Application Date 1. GENE -RAI. INFORMATION (a) Legal Description (include lot, block, s_ bdw,siun, section, township, range)1.y Location (address or directions) (b) (e) Applicant Name,-_,c� <_ ` y.-'•yf3+_: - _ Telephone. Horne �e` f r�r ✓ Business __---- -- - Applicant Address t'= � i Applicant is (check one). Lending Institution [a Oviner,ouildor3ff Buyer (1 Other (explain); (d) Lending IFSLItUtlon Address (e) Real Estate Company and Agent Address _ Telephone - (f) Mail the HAA to the following address: -.-.- _ -- Telephone 2. TYPE OF RESIDENCE Single-( amilylMinti-Family`. Other ______�� ✓"=___%_!_( �j� �C Number of Bedrooms 3. WATER SUPPLY Individual Well Community LJ 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 ❑ Public El El ElHolding Tank CI Aj 0_/Cjr ( Ails / I-vl t7 Note: If community well systern, must have written confirmation from the State Department of Environmental Conservation attesting to file legality and status. Page I of 2 ,r ops ;i 1 ear ft fd ITiLEnING FIRM PROVIDING INSPECTIONS, T.Es-l-S, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate forthe number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained ,l 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 i+ r,. �111�i=1�'l pp Name of Firm— -GAU MJ3,a --- --_� _ Telephone _ Address /----------------- ----------------------------------- Date Ptoh`3,Yl A. JI:Cfo- 3`�y ao„�ca<� ��v Psi'• 6. DHt, A P P 1 -10 YA L/I Approved forte' ''rJ s-� —-bedroorns by,/r-- Approved Disapproved'--___ ______ Conditional Perms of Conditional Approval._- CAUTION The Muncipafity of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representation: given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHFP does this as a courtesy to purchasers of horses and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHFP do riot conduct inspections or analyze data before a certificate is issued. Tyre, Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: �•T'�� J A. WELL DATA r- ��A Well Classification r If A, B, C, D.E.C. Approved (Y/N) Well Log Present(6)N) _— Date Completed — 92- — Yield Total DepthX0-1 I Cased to — Depth of Grouting -- Static Water Level 2_C> — Pump Set At Casing Height Above Ground �(-�" Sanitary Seal on Casingf(Yk Electrical Wiring in Conduit (Y/N) �Sv 11 '� Depression Around Wellhead (YA0-- Separation Distances from Well: To Septic/Folding Tank on Lot _ 1� �PEy t -r�sf ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot On Adjoining Lots _�_ _ To Nearest Public Sewer To Nearest Public Sewer Line hS /A Cleanout/Manhole —, � — To Nearest Sewer Service Line on Lot Water Sample Collected by 1--�AAe— ; Date Water Sample Test Results Comments �1L�=J—�—�1 — ��5�; Ij2•=�teoy B. SEPTIC/HOLDING TANK DATA Date Installed Size Y/N Air -tight Caps (Y/N) Foundation Cleanout (Y/N) No. of Compartments Depression`avarTank -(Y/N) — -- Pumping/Maintenance Contrast-Qq�e (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 — n11111,AA1 Date Last Pumped Temporary o Building Fo To Disposal Field ng Tank Permit (Y/N) To Stream, Pond, Lake, orlo,, jQr Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ,— Square Feet of Absorption Ar�� Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Mai To Stream/>nd/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments _ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/Ni-- Type of System Design — Length of Field Depth of Field Gravel Bed Thickness - Standpipes Present )$ — Date of Last ASOequacy Test _ Line To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) — Dimensions Manhole/Access (Y/N) — "Pump Off' Level at nt (Y/N) during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date S� Comp CA t�lAvKt� 'v57� MOA No, S C� Receipt No. Date of Payment. _ 4 Amount: $ (` C Raix:rt R. 6hafar !. No. 1457•E Page 2 of 2 y <� �i,N go 72-026 (11/84)�''®.*Q�,KAr.:4. 177ormerly Rabbit Creek View & Heights Blk I H Lt 2A MUNICIPALS u V OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT' On -Site Water and Wastewater Section www.muni.org/onsite Well Dec Legal Address: M{�� / (t Fr K Vol P,� a.. W pry Subdivision �VI�' C' Gf� V��j W I H Lot 907-343-7rj4 Earl: 343-7997 T R Section Lot On-site Water & Wastewater Section certified contractor performing the well decommissioning: _ N " jv Y' V/3i�t �F ��/l� Signature: I Well decommissioning date Method of decommissioning: AMC 15.55.0601-1 a. ❑ b. ❑ C.41 II Location: Use the space below to provide a drawing of the propertyshowing the following items: • North arrow • Decommissioned well locationt • Location of other water wells on the property Two separate swing -tie distances for each well shown o the drawing N Note: The swing -tie distances shall be measured from either permanent structures or the property comers. ~ MUNICIPALITY OF ANCHORAGE DE~ITMENT OF HEALTH AND HUMAN SER~S ~ ....... Environmental Health Division · 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 I' ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES SEPTIC ABSORPTION Phone(s) Pefm,~ No. NO. of B~rooms WELL L Township, Range, Section AS-BUILT DIAGRAM (Show location oi wel~, septic system, prope~y hnes, [oundahon, ) TANKS ~ SEPTIC ~ HOLDING ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ ~ ,~, ~ , WELLS IVAT ~ OTHER (Identify) ~ FT ~ . 72-013 (3/85) Date Drilled ~ 9- ~'.$~ Static Water Level 1~ feet Dr~w Down t~.,jL feet /Hefty Drilling $.R.A. Box 1553 H Anchorage ,Alaska 99507 ~-~+ 2 S,k. ~ Rstbit Creek Gallons Per Minute Total Feet of Casing ' ~ ' DEP~RTM~NT~DF HEALTH AND 'ENVIRONM~TAk~ROTECTION ':~ ' 8~5.L STREET~ ANOHORAGE~ AK . PERMIT,NO: 850570' ENSI~EERE.D'DESISN ~J ~D~TE ISSUED~ 07/¢,1/85 ' ' :,~ QONTACT PHONE: ; .LESAL DESCRIP: .:APPLiCaNT: LU~INi"~OODWORK~ · ADDRESS: 11480~B~O~DER AN~HORA~E~ AK ~51~ 546-1171 SUBDIVISION: ~ SECTION: I TOWNSHIP: llN RANGE: ~L~T,., 8IZE~ .SA (SQ.~T. OR ACRES) I. I am Familiap ~ih ~'he requirements for F~oeth by ~he Municipality of Anchorage (MOA) a~d ~he 8~a~e.o i ',~.~I ~.ill ins~al] the system in acc~pdan~e ~i~h all MOA codes and in ~ompliance ~i%h ~he design c~i~epia c~r .'.' '5. I .~il! adhere ~o all MOA ~d $~a~e of Alaska ~; dis~an~e~ f~om any existing ~ell, ~as~e~a~ep disposal ~e~epag~ ~y~tem'on ~hts ~p any ad.jacen~ ~'p neaPby !~ I~ A LI~T STATION IS INSTALLED IN AN AREA COVERED BY MOA BU ~::TH~N (1)~ AN' ELECTRICAL PERMIT AND INSPECTION HU~T BE OBTAINED; !~ ~ILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORTiAND' ,-~'~-~C~CTR'ICAL ~ORK MIJST BE DONE BY A LICENSED ELECTRICIAN. ,,APPLI. CANT~ ~OODWORKS ~'~ ISSUED BY , ~_ DATE: DA~: SHEET BY CKD OF · ' fl '"' 'q' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: I 2 3 4 5 6 7 8 SLOPE SITE PLAN 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- WAS GROUND WATER ~ [ ENCOUNTERED? ~ IF YES, AT WHAT ~ E DEPTH? ~' Gross Net Depth to Net Reading Date Time Time Water Drop ,o PERCOLATION RATE (minutes/inch) COMMENTS'~J~C~¢~- PERFORMED BY: 72-008 (6/79) TEST RUN BETWEEN CERTIFIED BY: PH, 69~2~79 FT AND -- FT DATE: PERFORMED FOR: ~ LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST 8 10- 11 SLOPE 13- 14- 15- 16- 17 18 19 20 [] SOILS LOG PERCOLATrON TEST DATE PERFORMED: /~ SITE PLAN ENCOUNTERED? ~ IF YES, AT WHAT / / P DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop / /~->~ 2:/o( . 7~" . PERCOLATION RATE ,~ Z~ (minutes/inch) 2-~ ~f~'~ TEST RUN BETWEEN / FT AND ¢2, FT Municipality of Anchorage Development Services Del artment Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.a k.ds (907} 34~-7g04 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Complete legal description Lo t 2; Location (site address or directions} 1 5 9 0 0 C a r I HAA# H .....~ Expiration Date: 1i7 Block 1; Rabbit Creek Heights Street, Anchorage Current Propertyowner(s) Joe Carlson Day phone 345-0870 Mailing address 15900 Carl Street, Anchorage, AK Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless oli~erwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class__ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Servlces Department (DSD) Issues Certificates of Health Authorify Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for propedies 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 lhe date of issue for properties served by a private or Class C weir and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Cerfific'~(es are valid for one year for properties served by Class A or B welts or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in tile professional engineer's work. STATEMENT OF INSPECTION BY E~Gi~EER As certified by my seal affixed hereto and as of the validation dale shown below, I verify that my invesJigation, based orr 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 ~',Jrtber Verify the{ based on [he information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewa[er disposal system is(are) in compliance Wilb all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm S&S Engineering Address 17034 N. Eagle River Loop~ Engineer's Printed Name Robert C. Cowan~ DSD SIGNATURE Approved for Disapproved. X bedrooms. Phone 694-2979 Ste.204¢ Eagle River 99577 P.E. Date ~/-02 ~ cE,~ ............... 3 bedrooms, with the following stipulations: Conditional approval for House has not been constructed at this time. Water line, pump, well wires ect. are required for final NAA. Completion and testing of: lift station will be required for final HAA. Final grading of mound and septic area is required before final approval of HAA. This Conditional HAA is for sale of property as is. Septic Additional Comments is not to be put in use prior to final HAA. By: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements SUpplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage 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 HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type ~ll~/~''' If A, B. or C provide PWSID # '"- Well Log (Y/N) Date completed~_~/~''' Sanitary sea, (Y/N)Y/ Wires propedyprotected (Y/N) Totaldepth '~. ft. Casing height (above ground) ,/~) ~ in. Cased to z~ ~'~ff. FROM WELL LOG AT INSPECTION Static water level ft. t t~O ' ~ fl. Well production '~ g.p.m. ~ g.p.m. WATER SAMPLE RESULTS: Coliform . (~ colonies/100 mi. Nitrate ~--~mg./I. Other bacteria (~ colonies/lO0 mi. Collected by: ~f ~) ~-'"~C'-'/'~-/'L~'"~---~ ~"(~"'~ B. SEPTIC/HOLDING TANK DATA ~ Tank Type/Material ~1'7(_,~ Date installed If/tO~ - / / -- Tank size f/"~¢2 gal. Number of Comp_,adments ~ Cleanouts (Y/N) · / Foundation cleanout (Y/N) ~ Depression over tank (Y/N) /~/ High water alarm (Y/N) '"%/ Date of pumping '"'¢//~ Pumper ,/~'/?---l.,~ ~'V ,~ ¢'~"-~,~ ( N,'t,,/~.,,L /°j C, ABSORPTION FIELD DATA Date installed//.~_~Sf Soil rating (g.p.d./f¢ or~.~4~ Length ~ ,~ ft. Width '~rj.~ ft. Total depth ~ ~"'ft. Eft. absorption area )')"~(~ ftz Monitoring tube ___ Date of adequacy test /~¢'-~ Results (Pass/Fail) Fluid depth in absorption field before test ~ in. Water added '- ga[. Elapsed Time: __min. Final fluid depth ~ in. Absorption rate >= Any rejuvenation treatment (past 12 me.) (Y/N & type) ,/4~OAJ E-- System type Mo~l/~l.~ Gravel below pipe ~::), ~ ft. ~/ Depression over field For .~ bedrooms New depth ~ in. D. LIFT STATION ~.Z~ /Vol- Date installed / / "Pump on" level at__~, in. / Datum / E. SEPARATION DISTANCES L Pn- //Y t Size in gallons Manhole/Access (Y/N) "Pump o~ level at ___ in. High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1~1 Absorption field on lot Public sewer main S~,we~eptic service line On adjacent lots On adjacent lots PubliCHoldingSeWertank manh°le/clean°ut SEPARATION DISTANCES FROM SEPTIC/H~'~G TANK ON LOT TO: Building foundation /(,/~)^/~ Property line ~ '~ Water main /~////~- Water service line / Wells on adjacent lots //OO ~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field ~ 'P Surface water ]~)~) ~'~'- Property line / o ~ Build ng foundation ¢~)J~-~'~ Water main /~ Water Service line /C~ ~ Surface water /OO I~L Driveway, parking/vehicle storage Curtain drain NO^'~: ..~-t/~f,.,'~NeJls on adjacent lots [ ~ ~ F. COMMENTS ENGINEER'S CERTIFICATION HAA Fee $ Date of Payment Receipt Number (Rev, 12/00) I ceflify that I have determined through field inspe~ions and review of Municipal reco~s that the above systems are in Engineer's Printed Name ~OO~r C_ C0~ · ,a~,.. ,,,," ],'~ Waiver Fee $ Date of Payment Receipt Number Pv',/ P-_ : ......... :SUEZ2. ,OAT, rt. ~r-I~'Z. LP A~EA_~UA~A~AX7-~ k .FLEMING SURVEYING SERVI(._ 8221 DEL STREET ANCHORAGE, ALASKA 99502 PHONE 24.~- 4890 ....... ~ ~.- ~ ~' .. ~ · ~OTES : Easements not appear ng on record subdivision, plat are not shown unless description of easement is ~rovided by client. If is the responsibility of the owner or builder~ prior to constructJon~ to verity proposed building grade relative to finish grade and utilities connectione~ end to determine the existence of any easements, covenantst or restrictions whichdonot appear on the recorded subdivision plot. Eldvdtions based on a$%um~d da~t~fft unless otherwise i~dicated, end hearin~son,d dislnnqe~,are record data. / ,~EGAL DESCRIPTION LOT '~ , BLOCK ~'A E~'I 7- C~EE~ ~/EI~t-/~.~ 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 GENERAL INFORMATION (a) (b) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name TelepHone: Home ~'~6~05-~0 Business Applicant Address (c) Applicant is (check one): L~nding Institution []; Owner/builde,~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address / Address Telephone (f) .-Mail*the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms L~ Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If corem unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~. Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-025 (11/84} As certified by my seal affixed hereto and as of the validation date shown below, t 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 S & S ~nolneeri_~n¢~ SR~ 1~6x Address Ea~ie ~.iver, '"iasi~J ¢,,9S7~ Date Telephone 6. DHEP APPROVAL ~ for ~{'"U~edrooms by Approved Disapproved Date :~onditional · CAUTION The Muncipality of Ar)chorage 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 ?egistered 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 (11/84) MUNICIPALITY OF ANCHORAGE (MO/fir HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: /~4UNf¢IPALITy OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENT/,/. PRO~ TECTION MAR J 8 ~ WELL DATA Well Classification /.)~¢;'/~'~ ~ If A, B, C, D.E.C. Approved (Y/N) /~ Total Depth "~'.-~-/ Cased to .-2~-/ ' Deptt~ of G"routing ~ ~ Static Water Level //~ z Casing Height Above Ground / 2. /f'-/- Electrical Wiring in Conduit (Y/N) /¢/~) 7' /(/~/= 7;- Separation Distances from Well: To Septic/H-~d,~in~ Tank on Lot /¢O ~ ; On Adjoining Lots ,~¢~ /- To Nearest Edge of Absorption Field on Lot /~20 ~ ¢. ; On Adjoining Lots /¢O · f- To Nearest Public Sewer Line /t) //4. To Nearest Public Sewer ! Cleanout/Manhole /-),,/ ¢ To Nearest Sewer Service Line on Lot ZO'~ ¢ Water Sample Collected by '~'~ ~? ~'z-¢'~/~'~7"*~¢¢' ;Date ¥~///~//~ Water Sample Test Results ~ ~? ..¢-/,2--~ 7-0 ~ Comments ~:~.¢.¢'/¢~ ~/' ,?..¢¢ ¢.¢./~/~ /,~///¢/~) ~ /~'/'J Y'.,/~'/~/'2 ~-~'?~' ~ " Pump Set At ¢.~ .¢-¢. :AJO -'~ Sanitary Seal on Casing(~N) Depression Around Wellhead (YN~ B. SEPTIC/I-KCL2:~-~G TANK DATA Date Installed Standpipes ~N) Depression over Tank (Y/I~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /k J//3- Size ,/~O O No. of Compartments "~ Air-tight Caps~N) Foundation Cleanou~)N) Date Last Pumped Separation Distances from Septic/Holding Tank: To Water-Supply Well /~ (-/- To Property Line /d~) ~,-/-- To Water Main/Service Line Course ; for Temporary Holding Tank Permit (Y/N) To Building Foundation TO Disposal Field /~2 ~ ~ / ~ , ('~_/0 -/-~ ~) To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~,~/¢~/Z¢',,"~ Type of System Design /¢¢~(-/'/"/ Date Installed ,//~//~-,/'~- Length of Field ~,~-~ Width of Field '~O ! Depth of Field ~ ~ ,,-~ ~. Gravel Bed Thickness ~' "~' ~' Square Feet of Absorption Area /,,.~¢ O Standpipes Present(~N) Depression over Field (Y/~ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /¢O "/- To Property Line /~ To Building Foundation /f/,'g2 ~ /,<..J To Existing or Abandoned System on Lot ~ / ~ ' On Adjoining Lots '-~ ·/- To Water Main/Service Line /.2D "7- / ~ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ~ ~ ~ ~ To Driveway, Parking Area, or Vehicle Storage Area ~ -~' / ~ - Comments ,/jO~? ¢.~f (/¢ (~-_~¢ /~. //,j / .¢ /¢. ~_~.~%~ .,¢ / ,¢,.¢, ~ /¢)/~ 7-~-¢-~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level Dimensions ..~ ~ Manhole/Access~) "Pump Off" Level at /(~ High Water Alarm Level at Tested for /CD 'T Electrical Code~) Comments ~, / f~ '-,','~ .~ 7',,~ ** Check Permitted Bedroom Rating Against HAA Request ** I ce~ify that I have ch~cked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed SRB l~6X Company E -*~"' Receipt No. Date of Payment Amount: $ /,,t~.~-,~',4/_.~, Vent (Y(~ /t,J(~ . /:~' '~' ,~/'f'/J ~/¢4-/~ Pumping Cycles during Adequacy Test. Meets MOA Page 2 of 2 72-026 (11/84) Date ,~//'b/'~~'' ~ MOA No. ,~'3-~ ~