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SHACKLETON LT 22A-3
Shackleton Lot 22A-3 #016-141-43 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191193 PID Number: 016-141-43 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: ANICA ROSKAM ABSORPTION FIELD - EXISTING Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 11300 JOHNS ROAD, ANCH., AK 99515 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. SHACKLETON 22A-3 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To'1 Septic Absorption Lift Station Holding Sewer Total absorption area Ft Number of trenches Dist.between trenches From Tank Field Tank Line -- -- Ft. Well 100'+ NA NA NA NA TANK ® Septic El S.T.E.P. 0 Holding ❑ Other Manufacturer Capacity Surface Water 100'+ NA NA NA INFILTRATOR 1094 Gal. Material Number of compartments Lot Line 5'+ NA NA NA PLASTIC 2 NA I LIFT STATION Foundation 10'+ NA NA NA Manufacturer Capacity Gal. Curtain Drain NA NA NA NA Pump on level at Pump off level at High water alarm at Remarks Existing septic tank decommissioned per code, new tank installed 5' from & in. in. in. connected to existing field w/ COs. . Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer NORTHERN EXCAVATION Drainfield CO/MT 3034 Inspector FWCS / MNA BENCH MARK .(Assumed elevation) 100 ft Inspdates: 1,. 6/6/19 2nd 6/7/2019 Location and description 3' 4'" DOOR SILL COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL41110. 04h � i \ Conditional Approval: Date ,��''... .•� 1� Of*49THi� Inikiii,,,,,44 MICHAEL N. ANDERSON. / #1 No. CE. 9469 �� 4i •. 6%I V 19.. •••••('P' A ed L ---4-Al/ -ail Date r- 1�~1 PEssto11�' i Inspection Report_9-1-12.doc Permit No. OSP191193 PID No.: 016-141-43 11.6 0) co C cV 6`.8' O CV O -Z- o Z LOT 22A- 3 - In 11.2 t shed c ciSUMP O '' N = O E o 0 z 0O ' ci A 44.0 LJ O M •_A O ' , : , z = FC0_ 3—BR HOUSE 33.0 D w CO Gravel 0 CO M driveway Z _ . °0 C -10 — B o o 8.0 ^ a y COs \ `° C6 NEW 1094—GAL 8.6 Storage SEPTIC TANK 9.6' Chai • fence '‘ \ \ \ \ \ N ,9°52'30"E 120.00 SCALE: 1' = 20' A—C==26,6' \ FCO r FCO �MH Co i COjj-.CO B—C==12.6' )01.15 \ 5 7- FINAL GRADE A—D==30,3' 97.15 B—D==17.3' 4 i 99.91 1.094 GALLON EXISTING EXISTING FIELD PLASTIC TANK SEPTIC SECTION SCALE: NTS PREPARED FOR: F�N\ ANICA L. ROSKAM _ Ar < , ' 1 SHACKLETON LOT 22A-3 / A. TH!� �7 4i 11300 JOHNS ROAD, ANCHORAGE, AK 99515 / * 49— * / Hi Michael N. Anderson, DATE: 6/11/2019 P.E. �` .t MICHAEL N. ANDERSON pe / 4661 Natrone Ave. 4 \ No. CE 9469 �� DRAWN: FWCS 6/11/19 r, Anchorage, Alaska 99516 1sslolo. .aw' (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 20' \\`_4111. 6/4/19 MUNICIPALITY OF ANCHORAGE f41 •4y� �- .., alis Development Services Department 7 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 016-141-43 Property owner(s) ANICA L ROSKAM Day phone 9072270599 Mailing address 11300 JOHN'S ROAD, ANCHORAGE, AK 99515 Site address 11300 JOHN'S ROAD, ANCHORAGE, AK 99515 Legal description (Sub'd., Block & Lot) SHACKLETON LOT 22A-3 Legal description (Township, Range & Section) Lot Size 13,200 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank ® Upgrade ® Duplex (D) ❑ Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ 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: oZ 15_ Waiver Fees: Date of Payment: 512311111 Date of Payment: Receipt Number: JJ`_q3 44p Receipt Number: Permit No. Qs p i q 41 Q F Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 May 23, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SHACKLETON LOT 22A-3 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3- bedroom house. The lot is served by a private well with other lots in the area served by public & private water. The proposed design will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191193, Rebecca Carroll, 06/04/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191193, Rebecca Carroll, 06/04/19 MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ErNEW y� !' 1 ®Ay/u'r�'/tk', ❑ UPGRADE MAILING ADDRESS skh , X 19 P als /9'vel-1 LEGAL DESCRIPTION 1 dT 9 3 _55IAC1 T no SIP LOCATIONkJA r A) NO. OF BEDROOMS v7 Well Absorption area / Dwellin PERMIT NO. '1k1111 Uy DISTANCE T0: � ��' a Q Manufacturer Materials r69r No, of compartments wF N Liq. a acity in gallons 50 IF HOMEMADE: Inside length Width Liquid depth a z DISTANCE TO: Well Dwelling PERMIT NO. = z Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: Well y- ,` a�d! NI Foundati n V Nearest lot line 7+ PERMIT N J LL z No. of lines Length of each line Total length of vines Trench width_ •f— Distance betweery Imes WA. p- z / ,.S -3;j� �3:r inches ;� b cc Top of tile to finish grade / Material beneath tile � 1 Total effective abysonrption area O a V Length Width Depth PERMIT NO. w C7 Q F Type of crib Crib diameter Crib depth Total effective absorption area as w U.1 in Well Building foundation Nearest lot line DISTANCE TO: J JMe ClaJAI,ss Depth Driller Distance to lot line PERMIT NO. I LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER Pi 44 C7 REMARKS s , � 1 t APPROVED DATE �LEGAL 72-013 (Rev. 3/78) LEN8T� DIMENSION IS THE LENGTH (IN �EET) OF THE T�ENCH OR DRH1NFIrLC! TO THE �r p �� ���P'����� OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF �EPHRTMENT HEHLTH RND ENVIRONMENTHL /�OTECTION THE—_ B'OTTOM OF THE EXCHVHTION , w 825 'L' "TREET/ HNCHORHGE/ Alf".99501 SET WIDTH /1 9�/dD`D I,�/ ' . � 264 4720 -- —� THE GRHVEL � / � ��u/] MINIMUM DEPTH ���q�E— BETWEEN THE OUTFHLL PIPE HND —1� PERMIT NO ( 811114 > FEET) HPPLICH�T MYRON KNETTER SRH BOX 190B HNCH ]44~8]64 � LOCHTION LEE L. A' LEGFK LOT 22~H] SHHCKLTON SUB LOT SIZE 4]560 SQUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM IS� TRENCH MHXIMUM NUMBER OF BEDRO8MS � ] SOIL RHTING (SQ FT/BR)� J. THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS� THE LEN8T� DIMENSION IS THE LENGTH (IN �EET) OF THE T�ENCH OR DRH1NFIrLC! TO THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GRQUND HND THE—_ B'OTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE (IN FEET) ��1' �r-Ill� PER�IT HPPLICHNT HHS THE RE5PO�SIBILITY TO INFQRM THIS DEPHRTMENT 1. UFR THE INSTHLLHTION INSPECT�ONS OF HNY WELLS ADJACENT TO THIS PROP�RTY HND THE NUMBER OF RESIDENCES 'THAT THE WELL WILL SERVE T 1..����������� � �LI 21 "fl��� BHCKFILLING QF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TQ PROSECUTION. MINIMUM DISTHNCE BETNEEN H WELL HND WAY ON�SITE SEWHGE �ISPOSHL SY�TEy1 IS 100 FEET FOR H PRIVHTE WELL OR 1�0 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVRTE WELL TO H PRIVHTE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE I 75 FEET WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPARTMENT WITHRN I0 DHYS OF THE WELL COMPLETION. OTHER REOUIR�MENT� MHY HPPLYSP�CIFICRTIONS 8ND CONSTRUCTI8� [)IHGRHMS 9RE HYHILHBLEl. TO INSURE PROPER INSTHLLHTI,jN. T ���E" Pl EE� I CERTIFY THHT 1: I HM FGMILIH� W�TH THE RE��IREM�NTS FOR ON�SITE 5EWER5 �ND WELLS H� SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WlTH THE CODES ]� I UNDERSTHND THAITHE ONSITE SENER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE SIGNED� ~�--�~ Conti . ng Engineers & Associates 212 East International Airport Rd. Suite 204 -. -� ANCHORAGE, ALASKA 99502 • (907) 278.3773 SOILS LOG — PERCOLATION TEST % SOILS LOG ❑ PERCOLATION TEST PERFORMED FOR: Al - y /f ti /(.) /< 4 N C // C/I' DATE PERFORMED: 17— LEGAL O / LEGAL DESCRIPTION: 2 2"''`'} 3 514A C L 7"/V DEPTH r SLOPE—� SITE PLAN (FEET) G3 P—P I I I 1 ' 1 I I 2 3 4 . -5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS c c,it� s c S'A c UV Ci 2 S SQ Fr/ r 0 P6,�9 WAS GROUND WATERS`V L ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? or ' Rai B. Jokelo v cJj�e NO. 1995-E =<,° L' JrI" Reading Date Gross Time - Net Time Depth to Water Net Drop 1 PERCOLATION RATE (minutes/inch) TEST HYN PgTYYEEN FT AND FT PERFORMED BY: GAILY J L %L L Al%" CERTIFIED BY: ANCHOR DRILLING 3940 E 112th St Anchorage,.AK 99507 Phone 344-3433 Date: WATER WE LL L G G N A M E: \4\— - � ADDRESS: LottIg BlockSubd.v"�,��\� ,� (Off John's Rd) 0 - 18 Ft Sand & Gravel 18 - 4.2 Ft Clay & Gravel 42 - 79 Ft Gravel 79 - 102 Ft Brawn Clay 102 - 129 Ft Gravel 129 -,155 rpt Clay & Gravel 155 - 168 Ft Sand & small gravel 168 - 171 Ft Course gravel w/water at 15 GPM. Well Cased to 171 Ft Static Water Level - 131 Ft Yield - 15 gpm c EpLmJS 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 C ' Parcel I.D. 016-141-43 Expiration Date: (7t ( 2.7- 1 ` 1. GENERAL INFORMATION Complete legal description SHACKLETON LOT 22A-3 Location (site address) 11300 JOHNS ROAD,ANCHORAGE,AK 99515 Current property owner(s) ANICA L.ROSKAM Day phone Mailing address 11300 JOHNS ROAD,ANCHORAGE,AK 99515 Real estate agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex E Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 820 Waiver Fee $ Date of Payment 60 f Io21I9 Date of Payment Receipt Number 0117-1 a 0 Receipt Number COSA# 0509 /AZ1 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 ANDERSON CONSTRUCTION &ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 6/11/2019 Comments:This investigation was completed in compliance with MOA guidelines,regulations, �_� ok and best industry practices/methods. The assessment of the condition of the well and septic ='g �r \ applies only to the conditions as of the day tested.The flow and absorption rates may change • 'A�_>�r due to subsurface conditions that may not be observed from the surface,changes in land use, r local soil characteristics,groundwater levels that may fluctuate during the year,quality of ' I •' construction(workmanship&materials),the water usage of the family being served by the *.A (� %\ *+/ system and maintenance. The operational life of all well and septic systems are subject to `� �I�`� these various and dynamic characteristics and are outside the control of the evaluator of the / well and septic system. Therefore,any estimate of how long a system will function satisfactory 44 for current or future occupants or guarantee that no unseen encroachments,deficiencies or %MICS N. ANDERSON' No. CE 9te9 � discrepancies exist can be given by FucS and Anderson Construction&Engineering. '• / 6/11/19 6. DSD SIGNATURE \�_� System #1 Approved for -i bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the followin kktiiblikifillw 114.1TY OF L(ff%r ED ha ERT ! E AND m= rr wp ST ATER O RD�;RAM •�,� fig\`-. j.SERVICEs�� ")))))»0"' _— By: By: -"alai" 1' — • ia Original Certificate Date: G- 12--19 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: SHACKLETON LOT 22A-3 Parcel ID: 016-141-43 If more than 1 septic system on lot: COSA Checklist#_of_ Structure served by this system_ A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 1/9/1983 Well disinfected for coliform test? ❑ Yes ® No Total depth 171 ft ® Coliform bacteria is Negative Cased to 171 ft Nitrate mg/L ® Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic 17.9 ug/L ❑ Arsenic less than MRL (ND) ® Wires are properly protected FLS Casing height (above ground) 12+ in. Collected by `. Date of flow test for COSA 5/17/2019 Date of Sample 5/17/2019 Static water level at beginning of test 37 ft. Well production at time of test 4.5+ gpm Comments B. TANK DATA—6/6/2019 - NEW 1094-gal C. LIFT STATION - NA Age of tank(s) 0 years ❑ Required maintenance completed Tank type/material SEPTIC / PLASTIC Age of lift station years Measured operating fluid level in septic tank Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping NA— NEW TANK D. ABSORPTION FIELD DATA—35'L x 3'W x 6'ED — 0.8 GPD/SF = 570 SF Which system tested (date installed) 10/27/1981 Adequacy test date 5/17/2019 ® *ALL standpipes present per record drawing Results I2 Pass For 3 bedrooms Total measured depth from grade 9_9 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.5 ft (min) Water added 550 gal ❑ N/A— pressurized field New depth 32 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 1040 min depth into effective 5_4 • Code-required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: FWiLS COSA Checklist.docx E. SEPARATION DISTANCES— Per MOA record docs observations 5/17/19. • From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout> 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Z Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Absorption Field > 5' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' Z Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below Surface Water> 100' ® Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 7'_ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water> 100' ® Yes if No ft F. ENGINEER'S COMMENTS �Asw�. .... ��' G. ENGINEER'S CERTIFICATION ,A7.. . .4 1 !certify that I have determined through field inspections and review * :49TH * V of Municipal records that the above systems are in conformance �/M411,14 I with MOA COSA guidelines in effect on this date. I MICHAEL No. CE N. ANDERS9469 ON. � 1 � � COSA Checklist.docx 0‘.••..611 1 i 19. 0 Ar \ ' ssio0s' MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • ''� 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Arsenic Advisory' Certificate of On-Site Systems Approval #OSC191228 Subdivision: Shackleton, Lot 22A-3 A water sample revealed an arsenic concentration of 17.9 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org 8386T Lot 21A N89°52'30"E 120.00 - - - 30 1 Well o 11.6 I (0 13 co O N CO W Q LOT 22A-4 22A-3 0oop O0 T'''' < I 0 c fY .5 0H Co 0 O E %Septic vent(typ) Q o a I 44.0 1 O = I o UJ ° Z i Tz CO, N1 1/2 Story Frame ' 33.0 z Manhole House N o / / 'Gravel (DJ N— 0 28. o o 8.0 " deck ;driveway °a' 8.o _ ._ Wire fence(typ) 1 I 30 l — — — N89°52'30"E 120.00 f Lot 22A-5 Lot 22A-2 ...... 44..` OF \1 RECERTIFIED 6-10-1961'0-) P_� • • •AC;gS�+ AS REVBIUILDT 9-2 NO CORNERS SET THIS DATE air49th ' ' ••• 5 ,r I hereby certify that I have performed a Mortgagee's inspection f �� '. ` of the following described property: LOT 22A-3, / ... / SHACKLETON SUBDIVISION / S. / lizabeth •L. Walatka:2 f Anchorage Recording District,Alaska,and that the / .• • j', sr improvements situated thereon are within the property lines i ,•,,F• 8036 — LS •••yJe- „w and do not overlap or encroach on the property lying o • • • . o '� adjacent thereto,that no improvements on the property lying SCALE: 1 30' pRO�ssioNA-•'�` adjacent thereto encroach on the premises in question and \\,"�% that there are no roadways,transmission lines or other l d 1 l -- 1.9 visible easements on said property except as indicated hereon. Dated at Anchorage,Alaska EASEMENTS OF RECORD,OTHER THAN this 28th day of August 2013. THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES,L.L.C. PLAT ARE NOT SHOWN HEREON FB 19-5, pg 9 Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 13-6, pg 58-59 BE 907-248-1666 • • B6. cP? t � Municipality of Anchorage iC On-Site Water and Wastewater Program LII 1 i (907) 343-7904 Certificate of On-Site Systems Approval Parcel I.D. 016-141-43 Expiration Date: ) J ` l c H 7 1. GENERAL INFORMATION: Complete legal description SHACKLETON; LOT 22A-3 Location (site address) 11300 Johns Road*Anchorage 99515 Current Property owner(s) Wells Fargo Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (wlwo ADU) El Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: 2 �� Date: )/5 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52 Waiver Fee $ Date of Payment 2b0P7' Date of Payment Receipt Number 05 L l0( Receipt Number COSA# 0,50 x-13(.b Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage, Alaska 99507 • Engineer's Printed Name: Jeffrey A. Garness Date: QQQ�oagq In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o QF X04 in accordance with the guidelines and regulations established by the Municipality of Anchorage ando��,'• 1 16\Q industry practices. The reported results describe the condition of the system/s on the date/s of the v Q' ! -• 4a evaluation. Separation distances were measured to readily identifiable features. Hidden defects or ,f:f t 4 T �V encroachments may exist that were not identified during the evaluation. The operational life of all wells . , I p and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and jvA VA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the (� • J- f Gam ss," • system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of .Q • CE-79 •" ap5 the well or septic system. GEG makes no representation whether an alternative well or septic system ( 4),s, • c�4 can be installed on the property in the event either of the current systems fail to perform adequately in �cc°p the future. The content of this report is for the sole benefit of the person/party that retained GEG to �04professoOoo perform the evaluation. Reliance upon the information provided in this report by any other person or ,„�gOOOQo party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms rte Disapproved ' ON-SITE G: Conditional approval for bedrooms, with the followitlgyst natJr-lcionV r 11/tAS FEWATER PRnr,R.A.m y: v�.` �- Original Certificate Date: '/ S---( 7 The Municipality of Anchorage Development Services Divisi. 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 _ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10.12.dac .ri S t=D 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: SHACKLETON: LOT 22A-3 Parcel ID: 016-141-43 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 1/9/83 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 171 ft. Cased to 171 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 1/9/83 7/28/17 Static water level 131 ft. 33.9 ft. Well production 15 g.p.m. 9.7+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd. Arsenic: 15-1 ug./L. Date of sample: 7/28/17 35 YEAR OLD STEEL SEPTIC TANK IS B. SEPTIC/HOLDING TANK DATA APPROACHING THE END OF IT'S USEFUL LIFE Tank Type/Material SEPTIC/STEEL Date installed 10/27/81 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/18117 Pumper MCDONALD'S PUMPING SERVICE C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE Date Installed 10,27,81 Soil rating (g.p.d./ft`or /bdr ) 125 System type TRENCH Length 35 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth '9.8+ ft. Eff. absorption area 420 ft' Monitoring tube YES Depression over field NO Date of adequacy test 4/28/17 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 743 gal. New depth 33 in. Elapsed Time: 140 min. Final fluid depth 7 in. Absorption rate >= 4504 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes. give date - -2000 GALLON PRE-SOAK WAS PERFORMED ON 7/27/17 -MT EXTENDS 65" BELOW THE INVERT OF THE CLEANOUT -LIQUID DEPTH REMAINED AT 33" DURING THE LAST 438 GALLONS INTRODUCED -SEPTIC TANK PUMPER RECOMMENDED THAT DRAINFIELD LINE BE JET CLEANED D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) • "Pump on" level at in. "Pump off" level at • wa er alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank lift station on lot 100'+ On adjacent lots '1004 (WITH CAVEAT) Absorption field on lot 100'+ On adjacent lots •1004 (WITH CAVEAT) Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'i Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas too'4- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5't Water main 10'4 Water service line 10'+ Surface water 100'+ Wells on adjacent lots '100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line "7 Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway. parking/vehicle storage 104 Curtain drain NONE KNOWN Wells on adjacent lots '100'+ F. COMMENTS "WELL AND SEPTIC ON LOT TO NORTH ARE UNDOCUMENTED.SEE ATTACHED EMAIL FROM JODY MAUS(GEG TECH) REGARDING WELL LOCATION BASED UPON CONVERSATION WITH OCCUPANT AT 11240 JOHNS ROAD. (SEE ATTACHED AERIAL PHOTO WITH COMENTS). `"WR#131338 svoisultik oil 4 444. G. ENGINEER'S CERTIFICATION P,•.•• 4.• • _ • %1 j •..••'• *•• i certify that I have determined through field inspections and •I 49 I. t OP review of Municipal records that the above systems are in i •• conformance with MOA COSHguidelines in effect on this '1••• ••� • w date. : e'r:y A. mess; Engineer's Printed Name JEFFREY A. GARNESS �lk�,s+ lr CE-17913.J/ .40F••• , e „ 5::•�• • Date is ii T LICENSER+tM��t�SSk�4•• #AECCB84 (Hey 10/12/12) • • Municipality of Anchorage II i_ Development Services Department =}:::- :. :‘<::::_ Building Safety Division < On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # OSC 171346 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 22A-3 of Shackleton Subdivision. This inspection revealed an arsenic concentration of 15.1 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Municipality of Anchorage - a° On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel LD. 016-141-43 Expiration Date: - �7 1. GENERAL INFORMATION Complete legal description SHACKLETON S/D LOT 22A-3 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 11300 JOHNS ROAD, ANCHORAGE, AK, 99515 JOHN KNETTER Day phone 343-9799 11300 JOHNS ROAD, ANCHORAGE, AK, 99515 Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) F] Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site ■ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: - �� Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Y [.y Waiver Fee $ Off6 Date of Payment loji5 o Date of Payment W15113 Receipt Number 09';t9&6 Receipt Number1 a9�C� COSA # '5c 131538 Waiver # _ CID- a( — 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, U0. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator ofthe system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate ofhow long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE t System #1 Approved for 12) bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following Phone 337-6179 Date 10 114 k tOFt(t��i�/i RVVATERAND ON-SITE =o WASTEWATER oz= non(_RAM 65 Original Certificate Date: 16" " Z a % 3 The Mbnrcipalify YAnnchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Well Flow Advisory (Rev. 11105) Arsenic Advisory Other 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: SHACKLETON S/D; LOT 22A-3 ParcellD: 016-141-43 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 1/9/1983 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 171 ft. Cased to 171 ft. Casing height (above ground) 12+ in. Date of test Static water level FROM WELL LOG 1/9/1983 131 ft. Well production WATER SAMPLE RESULTS: 15 g.p.m. AT INSPECTION 9/10/2013 32 ft. 6.47+ —9-P M. Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd. Arsenic: 6.47 ug./L. Date of sample: 9/6-9/9/2013 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 10/27/1981 Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 10/7/13 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GRAD Date installed 10/27/1981 Soil rating (g.p.d./ft'or Ibdrm 125 System type TRENCH Length 35 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth *10.6 ft. Eff. absorption area 420 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/10/2013 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 23.5 in. Water added 8100 gal. New depth 45.5 in. Elapsed Time: 1289 min. Final fluid depth 23.5 in. Absorption rate >= 450+ g.p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off E. SEPARATION DISTANCES Manhole/Access level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lot: Absorption field on lot 100'+ On adjacent lots *100'+ *100'+ Public sewer main N/A Public sewer manhole/cleanout Sewer /septic service line 25'+ Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots *100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line **7' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots * 100'+ F. COMMENTS *WELL AND SEPTIC ON LOT TO NORTH IS UNDOCUMENTED. WELL NOT ABLE TO BE LOCATED DURING FIELD INSPECTIONS BUT NOT OBSERVED WITHIN 100'+ OF SUBJECT SEPTIC SYSTEM. SEPTIC TANK FOR LOT TO NORTH LOCATED, DRAINFIELD CONFIGURATION & LOCATION UNKNOWN BUT ASSUMED TO BE 125'+ FROM WELL ON SUBJECT PROPERTY. **SEE ATTACHED WAIVER REQUEST. 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. Engineer's Printed Name JEFFREY A. GARNESS Date 1 0'r 4 10 (Rev. 11105) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS October 11, 2013 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref Lot Line Waiver Request for Shackleton; Lot 22A-3, To whom it may concern: We request that your department issue a 7 -foot lot line waiver from the west property line to the existing drainfield. The existing drainfield on Lot 22A-3 has a separation distance of approximately 7 feet to the lot line, and the neighboring property (Schackleton; Lot 22A-4) has a minimum separation distance of 10 feet per moa records. In short, the drainfield on the subject lot has a separation distance of at least 15 feet to the drainfield on the neighboring property. We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any quAstions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 hftp://www.muni.orm/Onsite Development Services Division On -Site Water and Wastewater Program oellt .s N0 P F' L J Department **** VARIANCE/WAIVER REVIEW **** Waiver#: 131338 PID#:016-141-43 COSA#:131538 Permit#: Legal Description: Shackleton L -22A-3 Engineer: Garness Engineering Group Applicant: John Knetter Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 7.0 feet. This waiver approval applies to the existing absorption field only. Any fixture upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ® The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ....................................................................... 0....... Waiver is Granted: X Waiver is not Granted: Date: 7 p ,�� Approved by: ame viewer .............................................. ... .. ............0020....... Rec#: 09296G Amount: $200.00 Date Paid: 10/15/13 **** VARIANCEMAIVER REVIEW **** Lot 22A-4 O 0 O O 0 o) 0 0 O no Lot 21 A N89052'30"E 120.00 i 1 � I I geQUo e ire fence 8386T 30 Well O I LOT 22A-3 --T-11 r-- N11 1/2 Story Frame House � r w 28.0 0 ,-, s n a — — i N89052'30"E 120.00 Lot 22A-5 Lot 22A-2 OF • A4 -.1I, v,•49th yI 00 00 ol.i7.. qIpn�.Fred Wolatka 10 �1+fro • . a SCALE: 1"= 30' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 13-6, pg 58-59 Gravel driveway Conc. ret. wall 30 � link fent REVISED 9-25.13(f/r AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 22A-3. SHACKLETON SUBDIVISION Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not ovedap or encroach on the property lying adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 28th day of August ,2013. FRED WALATKA 8 ASSOCIATES BE(907-248-1666) Engineers and Surveyors Ab October 8, 2013 Jeanine Lockett 11300 Johns Road Anchorage, AK 99518 Grid: A2630 Re: Letter of Non -Objection To whom it may concern: ENSTAR Natural Gas Company A DIVISION OF SEMCO ENERGY Engineering Department Right of Way Section 401 E. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907)334-7753 FAX (907) 334-7798 ENSTAR Natural Gas Company has no objection to the septic leach field encroachment into west utility easement situated adjacent to and coincident with the west boundary line of Shackleton Subdivision Lot 22A-3, Section 19, Township 12 North, Range 3 West, Seward Meridian, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. Acceptance and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: • Landowner/Contractor working near ENSTAR gas facilities shall contact the Alaska Digline, Inc., (907) 278-3121 or 811 for line locating two (2) business days prior to any related excavation. • ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. • Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. • Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the land owner. • All applicable safety code regulations will be observed and maintained. • This letter of non -objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, Jennifer Diederich Right of Way & Permitting Agent ENSTAR Natural Gas Company cc: File Anchorage Water & Wastewater Utility Engineering Division Mayor Dan Sullivan October 8th, 2013 Jeanine Lockett 11300 Johns Road Anchorage, AK 99515 Board Chair Timothy M. Sullivan, Sr. Re: Shackleton Subdivision Lot 22A-3 (Grid SW2630) Request for Letter of Non -objection to Encroachment (Tax ID# 016-141-43) The Anchorage Water and Wastewater Utility received a request from you on October 8th, 2013 in regards to gravel for a leach field encroaching into the utility easement along the west property line of Shackleton Lot 22A-3. AWWU is currently not using this utility easement and has no objection to the encroachment. AWWU hereby issues this letter with stipulations to allow the encroachment of gravel for a leach field into the utility easement, the property owner(s) agrees to the following: 1. AWWU will be held harmless, now and forever, for any damages or injury to any person as a result of the encroachment; 2. The property owner(s) shall call for utility locates before excavation in the easement; 3. All applicable codes and regulations will be observed and maintained within the easement; 4. This letter will in no way preclude AWWU from full use and enjoyment of its rights within any portion of the easement; 5. The property owner(s) shall pay any additional and/or extraordinary costs incurred to accommodate the encroachment during any future required construction or reconstruction of AWWU facilities; 6. AWWU's non -objection does not imply other approvals that may be required for this encroachment; and, 7. AWWU does not provide a position for any other parcel or utility impacted by the encroachment. Should you have any questions, please call the AWWU Planning Section at 564-2739. Respectfully, , Tim ross4 Engineering Tec nician 4mv�. Anchorage Water & Wastewater Utility tlM+A Clearly 3000 Arctic Boulevard • Anchorage.Alwka 99503 Phone 907-564-2774 • Fax 907-562-0624 • »im aimti biz October 8, 2013 Jeanine Lockett 11300 Johns Road Anchorage, Alaska 99518 Dear Jeanine Lockett: Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the leach field encroaching into the utility easement at Lot 22A-3, Shackleton subdivision, also known as 11130 Johns Road, city grid 2630. This letter of non -objection in no way precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of-way, including unlimited access for servicing its facilities. Also any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GCI's facilities to accommodate any or all of the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. Sincerely, Markus Kofoid OSP Design Engineer GCI Communication Corp 5151 Fairbanks St. Anchorage, AK 99503 907-868-6168 Office 907-868-8580 Fax Accet nee 1 \4X Date October 8, 2013 Jeanine Lockett 11300 Johns Road Anchorage, Alaska 99518 Alaska Communications received a request from Jeanine Lockett in regards to a septic leach field encroaching into 10' Utility easement at Shacklton Subdivision, Lot 22A-3. Please see referenced "Sign Location Plan" attached. Alaska Communications is currently using most of these right-of-ways and some utility easements and has no objection to the encroachment. Alaska Communications hereby issues this letter with stipulations to allow the encroachment of the signs into the right-of-ways and utility easements. Acceptance, (your signature below), and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: 1. Alaska Communications will be held harmless, now and forever, for any damages or injury to any person or property as a result of this encroachment. 2. Any Alaska Communications facility damaged or destroyed as a result of this encroachment will be repaired at no cost to Alaska Communications. 3. Any costs incurred by Alaska Communications for special construction necessitated by this encroachment will be bome by the property owner. 4. All applicable safety code regulations will be observed and maintained. 5. This letter of non -objection will in no way preclude Alaska Communications from full use and enjoyment of its rights within any portion of this easement 6. Alaska Communications is under no obligation to restore any structure damaged as a result of Alaska Communications full use and enjoyment of its rights within any portion of easements or right-of-ways. Please sign both copies, retain one copy for your tree and return tits odw to Alaska Communications. Sincerely, Foreman Outside Plant Engineering, MS#14 600 Telephone Ave. Anchorage, AK 99503 ACCEPTANCE SIGNATURE: DATE: G 2630 FOR ENCROACHMENT PERMIT OR LETTER OF NON -OBJECTION Date: /ff - (�:-- 13 Requestor: Property Owner/s: <� r P f Contact Phone Number/s:� g Requestor/Owner Address: � e ioa- t AtiC�t 4_4 Property Address: f°Bla_o 49- Subdivision Name:. 5h4,.,- w as Lot c� ,;[` Block/Tract Type of Request. Encroachment Permit Letter of Non -objection: (i.e. shed, garage, deck, anyt mgiT— permanent) (i.e. standard fencing, lanscapmg Describe: Rda An Encroachment Permit request requires a copy of the certified as -built or plot plan be submitted with this request. The as-built/plot plan must clearly show the encroachment, and include all dimensions of the encroachment within the easement area, to include distance from the property line or easement line. In accordance with Chugach Tariff TA252-8, a non-refundable processing fee must be submitted with this request, as follows: Encroachment Permit - $280.00 /Cc_,_ � Letter of Non -objection - $-70:00 The Encroachment Permit will be recorded. State recording fees, typically $35.00, are additional and must be submitted after all owners have signed the Encroachment Permit. Submit Request Form, additional information and non-refundable fees to the Land Services Department located in the Chugach Electric Headquarters' Building `A' at 5601 Electron Drive. Call 762-4781 with questions. ererrrrerrrr• ueeeee a ere reeeru ererererr••reerre errererre eer •ereerrrerrrereeeee• For Chugach Land Services Department — Form Modified 8/2/11 DATEAMOUNT PAID --$ LS#f _ FJ 1� GRID E >: y MAP BOOK PAGE PLAT# - V-- L MOA PROPERTY ID# C`>) C4 ( — L,( Chugach Electric Association, Inc. 5601 Election Drive, FO. Box 196300, Anchorage, Alaska 995196300 s 1907) 563-7494 Fax (907( 562-0027 (800) 478-7494 wwv✓chugacheleclric-corn E in(o@chugocheleclriccom &��PPLK AT FILLS OUT UPPER HAL 'ONLY Property OWr. rc_ ...;._C. \ .- . ��.=>L---' Phone Mailing Address ,, --:. a ,�:., ;i .,,.. :---:.,_. Zip Code Time (p Date Buyer .�, : .. r-_�_ Address - -_-. _ _ Zip Code Date Phone Lending Institution ��.�\ •: �;\_ �, . _., - Inspector Address->. ,... ( :-.., Zip Code Inspec or — Phone Realty Co. & Agent Address Zip Code Field Notes: Legal Description_,; Street Location �- Type of Residence Single Family 19 Multiple Family No. of Bedrooms -� ❑ Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. �C!7 ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal�- g Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time (p Date Date Date Date Inspector Inspector Inspector Inspec or ml�2n�S Field Notes: 1)iJGI°L �/ ©ale W 45 L L � d;? ( ) APPROVED BEDROOMS ( ) DISAPPROVED 'CONDITIONS OF APPROVAL ( jcl COpNDIT NAL 4PPROVAL' DATE Soils Rating Date Sewer Installed Well To Absorption Area j �.'� Well Log Received Septic Tank Size S Well to Tank ]2023(31M) Cil -1� / k 5 POU, ri 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWI. F S. MA Y01? DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION November 14, 1984 TO: Whom It May Concern Subject: Lot 22A3 Shackleton Subdivision Inspection on the well casing on the subject lot has shown that construction items listed in the Conditional Ilealth Approval of January 18, 1984 have been completed. Ground around the casing needs to be graded such that water cannot pond around it... If there are any further questions, please call this office at 264-4720. Sincerely, Susan Oswalt Sanitarian SO/ljw