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Home My WebLink AboutSHACKLETON LT 23A-2Onsite File Shackleton Lot 23A-2 #016-141-50 Jul 15 22 08:02p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section * ' / Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Date of Issue: -_- Parcel Identification Number: 016 141 50 Legal Description Block Lot Property Owner Name & Address: BROWN, DAWN SHACKELTON 23A 2 121 JOAN COURT ANCHORAGE, AK 99515 Pump Installation Date: os - 27 - 2022 Pump Intake Depth Below Top of Well Casing: 1055 Pump Manufacturer's Name: BERKELEY Pump Model: BYP4JP07221-02 IPump Size: .75 feet Pitless Adapter Burial Depth: 121 feet Pitless Adapter Manufacturer's Name: MARTINSON I Pitless Adapter Installer: Well Disinfected Upon Completion? >(Yes ❑ No Method of Disinfection: PELLETS Comments: Pump Installer Name: _ Company: Mailing Address: City: ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE, AK 99518 907-243-0740 State: Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211089 PID Number: 016-141-50 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name CHARLES & LAVONNE SCOTT ABSORPTION FIELD -ADVANTEX ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 121 JOAN COURT, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 2.5 GPD/SF 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.7 Ft. Gravel depth beneath pipe 7.3 Ft. Subdivision Block Lot SHACKLETON 23A-2 Fill added above original grade VARIES -0.8 TO -1.04 +/- Ft. Gravel length 20 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 292 Ft2 1 Ft. Well 50'+ 50'+ 25'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ® Other ADVANTEX Manufacturer ORENCO / GREER Capacity 1500 Gal. Surface Water 50'+ 50'+ Material HDPE Number of compartments 2 Lot Line 5'+ 10'+ NA Foundation 101+ 10'+ LIFT STATION Manufacturer ORENCO Capacity 1500 Gal. Remarks Original system decommissioned per code. Alarm location BASEMENT Electrical installed by RISING SON Tank to PIPE MATERIAL House to tank 3034 3034 Installer MIKE N. ANDERSON dra of eld Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection ection V 4/14/2021 4/15/2021 Location and description 2rd 3rd 4/15/2021 4" 4/16/2021 TOP OF MH#2 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Of A Conditional Approval: Date Septic pdstem • . R Curtis Huffman APProve 1 ,:� �' �s� • ,��wAge Date 7 a?.3 y2C�� •C4 �1�28991 /2 1.Asw Note: this approval does not include well permit requirements. ��,��•�' tnev uo/UZi i 0) PERMIT: OSP211089 PID: 016-141-50 VACANT LOT 23A-1 A -C=15.9' B -C=18.1' A -D=20.3' B -D=19.7' A -E=28.0' B -E=22.3' A -F=34.6' B -F=30.0' A -G=46.6' B -G=34.1' A -H=49.2' 50' WELL RADII LOT WE: 23A-2 / / 3BR HOUSE 50' WELL RADIUS ELEC.- DFCO MH C MH • QG D DECOMMISSIONED E EXISTING S.T. C( & INSTALLED NEW 1500 -GAL F HDPE TANK W/ AX20 POD. EDGE OF PAVEMENT 50' WELL DCO i-DFCO % 99.21 MH AX20 POD MM 99.16 93.49 4.37 92.94 1500 -GAL HDPE TANK W/ ADVANTEX AX20 POD RETAINING WALL :-11 H MT STAKED 10' PROPERTY LINE PRIOR TO CONST. LOT 23A-3 PAVED PUBLICDRIVE WATER B -H=35.5' SHACKLETON LOT 23A-2 PREPARED FOR: LAVONNE SCOTT 121 JOAN COURT ANCHORAGE, AK 99515 FIRST WATER CONSULTING 13030 SUES WAY DATE: ANCHORAGE, AK 99516 SURVEY: DRAWN: 907-350-9566 SCALE: FirstWaterAK®gmail.com SUPPORT$SERVICES: OFAL,4' 1� Caw.. c s �* 9TH* *� 0 4/22/21 , rtis Huffman FRONTIER 1 s CE 128991 �`� FWCS ' 4/22/21 e � 1 " = 30' \ P*0FESSIO'0' CO MT CO MT D998.63 8.03 FINAL GRADE 97.59 ORIGINAL GRADE TH21-1 ORG/OL FILTER FABRIC 4.5' 3.94 93.94 SEWER ROCK SW 86.63 86.63 NO GRND.WTR. 4/14/21 19' SEPTIC SECTION 7163 BOH SCALE1 NTS B -H=35.5' SHACKLETON LOT 23A-2 PREPARED FOR: LAVONNE SCOTT 121 JOAN COURT ANCHORAGE, AK 99515 FIRST WATER CONSULTING 13030 SUES WAY DATE: ANCHORAGE, AK 99516 SURVEY: DRAWN: 907-350-9566 SCALE: FirstWaterAK®gmail.com SUPPORT$SERVICES: OFAL,4' 1� Caw.. c s �* 9TH* *� 0 4/22/21 , rtis Huffman FRONTIER 1 s CE 128991 �`� FWCS ' 4/22/21 e � 1 " = 30' \ P*0FESSIO'0' LOT 23A-1 LOT 23A-3 LOT 22A-1LOT 22A ;;;;;;;;;;;;;;;;;;;;;;;;;50.0R.O.W.S89° 52' 30"W 100.00 S00° 09' 00"E 140.17N89° 52' 30"E 100.00 N00° 09' 00"W 140.17OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU JOAN COURT EDGE OF PAVEMENT 10' UTIL. ESMT.PAVED DRIVEWAYMBLot 23A-2 Shackleton Subdivision 14,017 Sq. Ft. +/- 121 Joan Court 1 Story Wood Frame House With Attached 2 Car Garage RETAIN. WALL (TYP.) 1 0 0 ' W E L L R A D I U S 12.3 44.36.8 GEOHUOHUOHUOHUOHUOHUOHU 51.8 2 7 . 2 16.0 1 0 . 4 10.910 . 4 24.9 8 . 7 22.4 2 9 . 2 22.4 6 . 8 D.B.W. SS S S S SS E S W SC SC PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. April 20th, 2021. Legend: Scale 1" = 25' Gas Meter Electric Meter/Outside Power Deck Septic Telephone Pole Fence Mailbox Overhead Utility Lot 23A-2, Shackleton Subdivision General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Heather Decker 21-128 4/22/2021 74-86 2630 Water Well Concrete MBSTA T E O F ALA S K A49 TH ROYEVRUSDNALLANOISSEFORP DERE T S IGER Pierre M. Stragier NO. LS-9812 4/22/2021 G E S [ W D.B.W.Daylight Basement Window SC Septic Cover MUNICIPALITY OF ANCHORAGE on -Site Water & Wastewater Program --- ' --0'- FC Box 196650 4701) $MQre X90 t AMC'`of e. Alosk.�L%579.0660 phone: (947) 34:1-7904 Fax: (907) 343-7997 � hl1p:[hAwr.mun1.cg1ansile ;:�) e�aa•nnent 0n -Site Waste ater Disposal System Permit Permit Number; O P211089 Work Type: Septic Upgrade Tax Coale Num<}er; U7 G741500DO SRO Legal Ad -dress; SHACKLE70N LT 23A-2 G:2630 S Pto Mailing Address: 121 JOAN OT, Anchorage Own or, SOOT? C HARLE S R& L LAVO N N E Desig n 'Engineer: FIRS7 VVAT E R CONSULTING This parmi# is f*r the -0onistraDtion of; 0 Disposal Feld Ef Sepbc Tank ❑ Hold Ing Tari k ❑ Privy Effective Date_ 4AI2021 Expiration Date,. 41 2022 i,ot Size In Std Ft, 14017 Total Bedroorn s; 4 ❑ Frigate WelI ❑ Water Storage Al I constru ction s h all be I n accordanas with: 1. The attached appmved des ig n, 2. All requ i re me n is spectFed in Anchorage Mun icipal code Chapters 15. a 5 an d 15.0 5 an d the -State of Ales ka Wastewater Dlsposai Reguletlons (1Sf AC72) and Drinking Water Regkjlati4ns (18AAC ) 3. TI'le Wasiervtirator ❑OUle fi rtq ui IQs ir1 O(4 Of 1$ �1 u1 i I L�j tl iu it is;Lull Aur i- T I ie -ungu ire i or ialt r iutlly itr® Develop me nt erVi 5 Depa rtrneernt per AMC 15.05. Provide naffication by calling (007) 343-7904 (24f7)- 4. From October 15 t April 15, a subsurface sail abso rption system underwnstructien during freezing weather Ghall be elthe r_ a. Opened and Closed on the same flay, or b. Covered. cpaled. aid heated to presentfrerzing S pecia I P my isiorns; 0 rrsite shall be pras$nt for bottom cf absorption field inspection Iri o rder to Con fi rim insitu matches grab sarnple designation eFsand- Reiae-d By; i Issued By: 4IW2I17 1 Date: Date: 13021 Montego Circle, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com March 30, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: SHACKLETON LOT 23A-2 The septic system installed in 1966 never received final approval. The crib monitoring tube was not found at the surface and from MOA record documents and recently conducted as-built survey it appears that the crib may be at or off property (see attached sketch). MOA record docs show the crib to be 40 from the existing tank. We propose to attempt to finalize approval of the original system by exposing / pumping the tank to determine size and material and attempting to locate the crib and perform an adequacy test if the crib exists on property. However if it is determined that a septic upgrade is required, we propose to upgrade the existing 4-bedroom system and install a deep trench with an Advantex system to serve the existing 3-bedroom residence. The design is based on the recent test hole conducted on March 24, 2021, which consisted of quick percolating sandy soil suitable as filter material. These soils are indicative of the area and a grab sample was taken at 10 for MOA review. The slopes are moderate at 3-8% at the proposed upgrade location. The lot and area are served by private water and public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211089, Rebecca Carroll, 04/09/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211089, Rebecca Carroll, 04/09/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211089, Rebecca Carroll, 04/09/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : SHACKLETON LOT 23A-2 PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 3/31/2021 DEPTH FEET OG SOILS 1 2 ORG/OL-FILL 3 4 5 6 7 8 9 10 SW SW 11 12 13 14 15 16 17 18 19 20 BOH Reading Date Gross Time Net Time Depth to Water Net Drop 3/24/21 2 min 6 6 6 6 6 6 6 6 6 6 6 6 PERCOLATION RATE <1 (MIN / INCH) TEST RUN BEWTWEEN 6 & 7 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 3/31/2021 TESTHOLE # 21-1 DATE PERFORMED: 3/24/2021 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER AT TIME OF CONSTRUCTION QUICK PERCOLATING SANDY SOILS INSITU SUITABLE AS FILTER GRAB SAMPLE TAKEN AT 10 PERFORMED FOR: LAVONNE SCOTT 3/31/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211089, Rebecca Carroll, 04/09/21 1 Carroll, Rebecca M. From:Brent Western <firstwaterak@gmail.com> Sent:Monday, April 5, 2021 2:20 PM To:Carroll, Rebecca M. Subject:SHACKLETON CRIB Attachments:SHACKLETON CRIB.pdf Follow Up Flag:Follow up Flag Status:Flagged [EXTERNAL EMAIL] From MOA docs the crib is supposed to be 40' from the existing tank and 120' from the well. If so, the highlighted squares should be possible the locations of the crib. We did not come across the crib monitoring tube when we scrapped the surface or any indication of a crib at the testhole. Our first thought was to just complete the documentation of the system as built per code at time of installation, but with the tank so close to the foundation, ... proceeded as shown on the design. However if we do find the crib on site and can test it ‐ what are your thoughts on just replacing the tank with waiver and keeping the crib assuming it passes an adequacy test? Otherwise if we do come across the crib, any biomatted material will be removed and the new field will be installed as designed. The site and area has good SW and I can show TIm the grab and you can make it a permit provision too. Please call me to discuss. Thanks, Brent M Western Office: 907‐350‐9566 To help protect your priv acy, Microsoft Office prevented automatic download of this picture from the Internet. DESIGN DETAILS: INSTALL NEW 1500—GAL ADVANTEX 4BR TANK / SYSTEM. MAINTAIN 10y+ FROM FOUNDATION, 50' TO WELLS, 5' TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR INSULATION. INSTALL 1 201 x 2'W x 7'ED TRENCH —12' FROM GRADE wl 3'+ OF COVER MAINTAINING 50' TO WELLS / SURFACE WATER, 10' TO LOT LINE,.... INSTALL PER AMC 15.65, 15.55, & MASS...TANK BEDDING, SEPARATIONS, MATERIALS,... SHACKLETON LOT 23A-2 PREPARED FOR: LAVONNE SCOTT 121 JOAN COURT ANCHORAGE, AK 99515 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWatorAK@gmail.com SUPPORTISERVICES: 0 F ewW,,i govs 4�zw- a> DATE: 3/31/2021 SURVEY: PMS DRAWN: FWCS SCALE: 1 to = 30' PAGE: 2 OF 2 AMP- N Aw OF AZ� "'A low: 4� TH /� rtis Huffman.- .4� CE 128991 AV AO E 3/31/202.1- .3 AW X LOT 23A-1 LOT 23A-3 LOT 22A-1LOT 22A ;;;;;;;;;;;;;;;;;;;;;;;;;50.0R.O.W.S89° 52' 30"W 100.00 S00° 09' 00"E 140.17N89° 52' 30"E 100.00 N00° 09' 00"W 140.17OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU JOAN COURT EDGE OF PAVEMENT 10' UTIL. ESMT.PAVED DRIVEWAYMBLot 23A-2 Shackleton Subdivision 14,017 Sq. Ft. +/- 121 Joan Court 1 Story Wood Frame House With Attached 2 Car Garage RETAIN. WALL (TYP.) W S S S 1 0 0 ' W E L L R A D I U S 12.3 44.36.8 GEOHUOHUOHUOHUOHUOHUOHU 51.8 2 7 . 2 16.0 1 0 . 4 10.9 1 0 . 4 24.9 8 . 7 22.4 2 9 . 2 22.4 6 . 8 D.B.W. PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. March 3rd, 2021. Legend: Scale 1" = 25' Gas Meter Electric Meter/Outside Power Deck Septic Telephone Pole Fence Mailbox Overhead Utility Lot 23A-2, Shackleton Subdivision General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Heather Decker 21-128 3/5/2021 74-86 2630 Water Well Concrete MBSTA T E O F ALA S K A49 TH ROYEVRUSDNALLANOISSEFORP DERE T S IGER Pierre M. Stragier NO. LS-9812 3/5/2021 G E S [ W D.B.W.Daylight Basement Window MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR�GREEMENT, herein the "AGREEMENT" made and entered into as of this Day of I of 20, by and between bo a i v%& L-- Sc -6 , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN ADVANTEX SYSTEM located at (legal description) SHACKLETON LOT 23A-2 2. Maintenance, Repairs anal Alterations. 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 AWWTS 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. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, o repairs or permitted alterations to the system. SVS Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 M UMCo PAU7Y OF Development Services Department On -Site Water & Wastewater Section Parcel I. D. 016-141-50 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description SHACKLETON LOT 23A-2 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: U 9 3 0 0)) Location (site address) 121 JOAN COURT, ANCHORAGE, AK 99515 Current property owner(s) CHARLES & LAVONNE SCOTT Day phone Mailing address Real estate agent 121 JOAN COURT. ANCHORAGE. AK 99515 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 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: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 2'30 Date of Payment Receipt Number 7 l 3 13 q COSA# 0SG7,1 l 1-71 Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE Date 4/13/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to 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 ��' • • • • �„� �� for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWN . � •• �� ® ........ .. � 6. DSD/SIGNATURE �(Curtis Huffman System #1 Approved for -1 bedrooms �00�'O% • CE128991 .��,��® �F�Flop SS System #2 Approved for bedrooms .� Disapproved Conditional approval for bedrooms, with the following stipulations: P , , ,cUt r6 ORI -SITE By:gj/ r%f/UL��/1 Original Certificate Date: Y 12,31Z0�2 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 Legal Description: SHACKLETON LOT 23A-2 Parcel ID: 016-141-50 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) Date drilled CIRCA 1967 Total depth 130 ft (PER MOA REC DOCS) Cased to UNKNOWN ft (ASSUMED 40’+) Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 3/25/2021 Static water level at beginning of test 43 ft. Well production at time of test 3.1 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic 5.0 ug/L Arsenic less than MRL (ND) Collected by Date of Sample 3/25/2021 Comments B. TANK DATA Age of tank(s) NEW TANK years Tank type/material HDPE / ADVANTEX Measured operating fluid level in septic tank NA Standpipes/foundation cleanout per record drawing Date of pumping NEW SYSTEM C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ALL standpipes present per record drawing Total measured depth from grade 11 ft (max) Measured depth to pipe invert from grade 3.7 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date NEW SYSTEM Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No *50+ ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No *50+ ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No *50+ ft Community Wells > 200’ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No *50+ ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS *ADVANTEX SYSTEM 50’+ TO PRIVATE WELLS 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. 4/22/21 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 1 Day of _ of 20L, by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment SFstems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN ADVANTEX SYSTEM located at (legal description) SHACKLETON LOT 23A-2 2. Maintenance 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 AWWTS 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. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality 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 AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. 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 AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS 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 continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. 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. (rev. 05/18/2018) Page 2 of 3 Date: + ) ------ (print Warne STATE OF ALASKA ss' THIRD JUDICIAL DISTRICT 0- The foregoing instrument was acknowledged before me this day f 20 by NOT-XRY PUBLIC FOR ALASKA My Commission MUNICIPALITY: By: a&.(signature) — P2� 2(' cel- (print name) Date: ,4-3 - 1,20:2 Title: (rev. 05/18/2018) Page 3 of 3 r APPLIV \NNT FILLS OUTUPPER HAI`- ONLY Time Propgjty.Ow.,rrr ..i.. i'�1 CE'./U.�-- Phone r� Mailing Address// Zip Code Buyer' (� [. z✓ C. -/ 7-7— b Date Address Zip Code Date Lending Institution �% %��M,� //%/� - Phone Inspector Inspector Address C) vi�%%� Zip Code Inspector Realty Co. & Agent Phone Address Zip Code Legal Description- S G%�y� %�f> `✓ - ,_ Street Location Type of Residence Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply Ul� Individual ATTACH WELL LOG: A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal X Individual Year Individual Installed: ,� El 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 Date Date Date D Inspector Inspector Inspector Inspector FieldPIT- ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL (3 ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72 023 (3182) January 18, 1963 Jenald C. BriS e Box 4-1252 Anchorage, [ill 99Su9 Subjects 23A-2 Sha cl.leton Subd. Approval for the individual sewer and water Lacilities cannot �__bp granted until the followinci. itelAs have been coillpletede ° 1he top of the well ca should be sealed so that it is water tight. ° The [Dater analysis report needs to be subillitted to this o"lice frofil the C;hey-ai Lab, 5631") B :street, for our review. ° 'filo septic-, tank pumped with a receipt subi.,litted to thiS departrlent. The total number of gallons puaiped needs to be, Oil the receipt and verified by a registered engineer a, to rile actual number of gallons puiiipe£i. `phis is to verif=y the size of the sceptic tank. ° An adequacy test needs to be perfoviried cln the existing leaching area. This test wili determine if the systei:l its adequate according to uational Standards. A listing of private fir?As performing the test is enclosed. This report needs to be :.iubiliitted to thi 3 office for our review. Please notify this Department for a reinspectiOn 41len the noted discrepancies have been corrected. if there are any further questions, please call this Office at 264-4720. Sincerely, :7i R noberts JR37/p/Ex Enclosure V/l I l l\L ,As cora (o - -3 ®- a`� TIME— TIME Lo _ ! �r1 DATE a DATE INSPECTOR _ INSPEC R NCHORAGE f = a C IONMENTAL PFI&Mll%I N-ITY OF ANCHORAGE Alaska 99501 DEPT. OF HEALTH & ENVIRONMENTAL PKOIECTION ATIOLp _I � .4720 N DIVISION APR 2 8 y981 r �fso F g i L WATER AND RE y � IEDES — DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing 1. PROPERTY OWNER / rnyrv❑ MAILING KESS s. PROTY RESIDENT (If diffe-r�en�t fr m above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS Tei a -a ��/ ler7/ �S� �� 7�1 ' /�✓�.3 MAILING ADDRESS f Tsai {r d� n r ('> Y r ��1Cc C'\ 4 5. LEGAL DESCRIPTION STREET LOCATIONI� �! 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS X ❑ Other EJ One Four 1 SINGLE FAMILY ❑ Two E:1 Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 11 72-010 (Rev. 6/79) Vv THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: / �� If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) LY DISAPPROVED DATE s- &b -<�- � BY a2 , 72-610 (Rev. 6/79) t ti "mss= � r5 !�� ; - •..-K, amt 's�.:� - 1 � S .)44 A, tiR h�� sem- _ `_s • ILI "mss= � r5 !�� ; - •..-K, amt 's�.:� - 1 tiR h�� sem- _ `_s • y� � ;•S k -,SR H �s 4 cc F� r r � BP'S•,'' r �- _ t: r�ry i. r F hf �� Aai"1 { May 1, 1.981 8?5 "L S IT „i , r ^,NGF'uFi Gf , .\Llaf;l<r; J9501 ((1)07) 26311 -^! 1 1 M;• YOR .. .,_T SND _ r,,.r_,.!E N, FA I FRS_ 11 _ RU Charles I1. BT eedlove Post Office Box 10-283 Anchorage, Alaska 99511 Subject: Lot 231% Shackelford Subdivision Approval for the individual sewer and water_ facilities cannot be granted until_ the following items have been completed: (1) The water analysis report needs to be delivered to this office from the Chem Lab, 5633 B Street, for our review, (2) The septic tank pumped with a receipt submitted to this office. (3) An adequacy test needs to be performed on the existing 1 leaching area. This test will determine if the system is adequate according to National Standards. A l-i_sti_ng of pr_i.vate firms performing the test is enclosed. This report needs to be submitted to this office .for our review. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/1jw cc: First 'National Bank of Anchorage Post Office Box 720 99510 y E:1 8?5 "L S IT „i , r ^,NGF'uFi Gf , .\Llaf;l<r; J9501 ((1)07) 26311 -^! 1 1 M;• YOR .. .,_T SND _ r,,.r_,.!E N, FA I FRS_ 11 _ RU Charles I1. BT eedlove Post Office Box 10-283 Anchorage, Alaska 99511 Subject: Lot 231% Shackelford Subdivision Approval for the individual sewer and water_ facilities cannot be granted until_ the following items have been completed: (1) The water analysis report needs to be delivered to this office from the Chem Lab, 5633 B Street, for our review, (2) The septic tank pumped with a receipt submitted to this office. (3) An adequacy test needs to be performed on the existing 1 leaching area. This test will determine if the system is adequate according to National Standards. A l-i_sti_ng of pr_i.vate firms performing the test is enclosed. This report needs to be submitted to this office .for our review. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/1jw cc: First 'National Bank of Anchorage Post Office Box 720 99510 r~ -a GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 1. Approval requested by: ate Received /G'7 Time of Inspection ♦O -'.d0 -/- Date of Inspection 0' -REQUEST FOR APPROVAL OF VIDUAL SEWER & WATER FACILITIES FOR 6. Well Data: A. Types r/ Fri C. Construction i B. Depth D. Bacterial Analysis 7. Sewage Disposal System: <<_a.�oen �t�� A. Installed�i B. Installer C. Septic Tank: 1. Size 0 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: i A. Well to: Septic tank �� Absorption area, Sewer Lines , Nearest lot line `f Other contamination ,f B. Foundation to septic tank :5 Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages. 4. Mailing Address: Phone: 2. Property Owner: Phone: Mailing Address: 3. Legal Description: 4. Location: 5. Type of facility to be inspected a No. of bec 6. Well Data: A. Types r/ Fri C. Construction i B. Depth D. Bacterial Analysis 7. Sewage Disposal System: <<_a.�oen �t�� A. Installed�i B. Installer C. Septic Tank: 1. Size 0 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: i A. Well to: Septic tank �� Absorption area, Sewer Lines , Nearest lot line `f Other contamination ,f B. Foundation to septic tank :5 Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages. 4. 1. 2. 3. 4. 5. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 . REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type' of Inspection: CMRO rr VA 'SHA CONV_ Property Owner.-' Mailing Address: /2U! y_S-v��'� Day Phone 3 `- 5 f� Name of Buyer: Mailing Address: Day Phone . Name of Lending Institution: Mailing Address: Phone Name of Realtor or Agent: X&O 4L Mailing Address: Legal Description: �A;� `2,3 :/ �- Phone Location:0 CU r b J f I.- G� �et .�� -4- 4 ry 7.- Type of Facility to be inspected: ,�,1� /JS;`��,�hNo. Bdrms. 8. Water Supply -Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served If Individual, depth of well% 9. Sewage Disposal System Type of System: Public Utility Individual (on -site) --{E, If Individual) date of 1n5Cd11gt1Gnw �5 Mil i • Page 2 of two pages - Rei--st for Approval of Individual :_.,er & Water Facilities 'Legal Description Comments Approved Disapproved Date * � Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information acccrabe rapr enta`tion of t 1 are operatin sa�isf'actori� SIGNED EQ -034 (1/74) ained in this request Tor approval Llo Ue a �[U= u„d emit sewer and water facilities and these facilities Date 7 f� �Cano� t" C) 0(2'00/ GO 'S I() 0 d C� v3 m v ° Cd ytko H FW- m �0 S w a2�; u a .N Ir W z Y o 2 oN O w w� z a V U 0 � o v o� •_ N U1 ay°vwoo 1 s° + -d w sem, `.3 (I ro wM� rn ti q Y F NC d v Y cd U Yr �w d `� OR cu 0 ,o N+P'C'.wN �cao °ao°,a L �'o.�� m N0ytiG J�4 '�k or- co o H°wcvnaw o by >, oYa�Ov x k a)d P4 OJ yOCL°oY aHiY.i Co.— r�.'r".r''>'p" N ai�gMk � 4 04 O W 0p00Y a)ONNQ -'F V. 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