HomeMy WebLinkAboutTHE TABLELANDS #2 BLK 7 LT 9 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page cit ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 161345 PID Number: 051-073-22 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: ABSORPTION FIELD GREGORY MILK & LYNNE MCCORMICK Address ❑ Deep Trench ❑ Shallow Trench ® Bed ® Mound 22443 SAMBAR LOOP, CHUGIAK, AK 99567 ® Other ADVANTEX Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.5 GPD/SF +1.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot +1.5 Ft., 0.5 Ft. THE TABLELANDS #2 7 9 Fill added above original grade Gravel length Township Range Section Var. 3.5+ Ft. 30 Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 15 Ft. 3 5 Ft. ToSeptic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 450 Ft2 -- -- Ft. well NA NA NA NA NA TANK ❑ Septic ® S.T.E.P. El Holding ❑ OtherAdvanteX Manufacturer Capacity Surface Water 100'+ 100'+ 100'+ NA Anchorage Tank 1500 Gal. Material Number of compartments Lot Line 5'+ 10'+ 5'+ NA Steel 2 NA LIFT STATION — E Foundation 5'+ 1U+ 5'+ NA Xf ST 7+v G Zoo S /ail STd}ufTlvw _ Manufacturer Capacity Curtain Drain NA *507+ NA NA Anchorage Tank 1500 Gal. Remarks *None knownPump on level at Pump off level at High water alarm at . Existing system decomtxl puede. Attached copy of original Northrim 41 in. 32 in. 45 in. Eng. IR I but `k- hea ]h�►1m Pump make and model Electrical Inspections performed by PSO 051 05 HHF Goldstar Elect. PIPE MATERIAL House to tankSCH 40 Tank to PVC drainfield Installer DIRTWORKS Drainfield H 40 CO/MT 3034 Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft Inspdates:ection 1" 12/8/16 2nd 12/8/16 Location and description - BOTTOM OF SIDING Ti 12/9/16 4th 12/9/16 COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin 01 /1/ Conditional Approval: Date _ `S ' `q *1d. 9T1-l* * OF -01 - - F'Us / � W 9 -. ,7-17l' Air 1 ,y „,,---,,,,- APP - ,� ._'...1 Date ' J E 0'' eer s Stamp Inspection Report_9-1-12.doc AS-BUILT SYSTEM DETAILS/SITE PLAN PID 051-801-68 THE TABLELANDS #2 BLOCK 7, LOT 9 PERMIT#: OSP161345 Fence A 4) / 42, L U O y " a EXISTING AX-20 POD / SYSTEM RIW/ 1500—GAL S.T. v LOt 7 LS c EXTENT OF C u_ MOUND FCO— z1, MH \ C• �.. NEW BED 15'X30' *BM Lot 9 1.25nPVC �� / �� Pad Shed B 0 40' Lot 10 25' Vegetation Buffer Easement GRAPHICS SCALE SCALE: 1:40 A—C=54.0' 99.05 99.10 B—C=43.5' 06.80 1FINAL GRADE w/soil&seed C106.70\ 102.1 A—D=59.0' w FILTER FABRIC&INSULATION`S „�E,r B—D=46.0 `` i i t . • . --,..„ A—E=251 .0 103.6 .';1461 -6-..........:,.........:...]:: .::.:<1.920.4".:,0.5' B—E=241 .5' ffg �I�1� 1 . .•jo31a' .- .2 MOA SAND 103.1 • 042100404 awe W. 1500 GAL 3' A—F=262.0' oa II ADVANTEX =.'I 1 ' TYPE II B—F=241 .0' C II TANK 4' •—ii—ii—ii—ii—i1=1 I--- 30' I 94.75 GW 098.16) EXISTING TANK / LS & AX-20 POD BOH 93,10 ABBREVIATIONS +_`\ BOH - BOTTOM OF TESTHOLE OF Az ` CO = CLEANOUT • 4 MT = MONITORING TUBE SCALE: NTS PAGE 1 OF 1 / C�� .�+ PREPARED FOR: ►j� '*`l �) GREGORY MICK&LYNNE MCCORMICK C 1 E 4 • H /\ * 22443 SAMBAR LOOP R �R CHUGIAK906-630-1159 99567 ,."°.1. ���/�� �1 ^k -. • •�.•f� I , KENNETH i�,! / FIELD BOOKS COMPUTED: 1 Ala 1`1\ VCE . ,rye p BOUNDARY: DRAM: BMW " II 11111111r."111111 STAIQi(` CHECKED: m . . / ASBUIl7: KLG OATS 11/23/16 , •"i . \w ; WII1� R \ FESS10�+ etli DWG. GRID: NW1559 re NG- `_� ACAD FILE: JOB Na: 4'11 SOLTI NG •,,ys l 16-248 Aa-99577' /Volumes/ArcTerra Shared/Storage/WELL & SEPTIC — Filed By Legal/The Tablelands/Add#2/Blk 7 Lot 9/2016 COSA Upgrade/AX Mound ASB.dwg r Kuf l .1 .ar t hK 1 mtn g Engineering FAX NO. :907 694-47026 May. 05 2006 01: 15F'M P2 • Municipality of Anchorage � :4, ` :t3.1:60, .;+#� Development Services Department :A`- -=� �, 1701. "3uiiding Safety Division Water and Wastewater Program,4700 Bragaw St P.0 Box 196550 Anchorage,AK 99519-6650 Page of www.ci.anchorage.ak us (907)343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number, ...S- 0:3 SO t"S _ __ PiD Number: art— SC/ *ei) Name. —.^--, �c mu, Ytl Wastewater System. X New ❑ Upgrade Adtlrece: ''te Lod P ABSORPTION FIELD d o ( +�.r Num6w d H ed'owns Phone --- r /J 7 ❑Deep Trend, 0 Shallow TltreM Q Bed Mound 0 ot,er: LEGAL DESCRIPTION Soil Rating: C TOW Depth hrvmonpinelgrao : . Bieck Lo! /6, /� 1u,L Ci,z,/ i7 GPD/FI' (Is S . Tbtq� / (6—ZA ie2 Deo}to pipe bottom hrJml MOMS'40grape: F Gravel xpth beneath plpg: Czin7.• Section Fill added above°mina!9-ede. .. G avec Length FC' 2 ii RAMC D t 3 t 1. 1 F__ Well: Crave width Number of lose! ntetaroa ro�lween lines ❑ .grade I Ctaee Aceuon(PrlWa(e A B.C': Tani Ft. Fi. 1 Depth: Cased x• TOW suao•pt.an area Pipe Material. Ft. Ft /( Ft- SCN6DJLA tLo Ave_ Giller -DMe Drage Stsec Ws! eve Irrawar ,gyp r L De:e IneLiYed / Fr. iumet2J' FS''Civ4 i it/(7/0,S` Yield. III 'erne Set sr Caringu Height ve Gru1 ed GPMJ Ft. F: TANK SEPARATI•N DISTANCES ❑ Septic 0 Holding pi S.T.E.P404Ni-ex a Other: To ' Septic I Absorption Lift Holding ouDiMJPrlvate Marwfa:wror capacity From Tank { Field Station Tank Sewer Line Af40#41 1Z,1Ce 4.A,& �ca /S� Gal. Weil Al Q U C r ttA f'j�` - li.lar tar. number or comparirian e: - STEEL. Z. st•.G.w. /OQ''r loci-t- 1 /00 iti- -- _ LIFT STATIONt- H 6 Le(L ne lo e� q 6 r¢ size. aZni fa-..a:rer 1 A--05 /� 4.10'+ r, Q Q Gal ��L ���IG., Fotnaatian i1 zoa r,4- I o 'f. •Pwnp tx�'ievyi at: •Piot' f iew at High watx a161+n at /fJ — r..r/ 3 z „., LIS n Grimm Drain .. Pump Make. Model Electrical impactions performed by P3.6 rt ôs- AW LDST' 2 p ' IC Remarks BENCH MARK Location ert JesLrpoon: TOP or: ()Eek. Aswmod Elniatwn; /Oa Ft. E OF 44 - Inspections performed by: { 2//)lf /C��ea_ Dates is' 7/ '�DS _ �`r49 `'`''}- ' 4 �- 2t,d ////7/Qs rim-. • Development Services Department ApprovaI : st+vort w• S 4P % PE dr25 �v.r Reviewed and approved by: Date: Q4 .4? ti..,4.,••",44•'� '� � « tone :AO) *0 ti PR0FEssP`,4AP m 01 0 In DESIGN NOTES: 1. Total Depth of Trench Is 0.5' 0 T.H. Remove Organic Layer. Terrain Is Relatively Flat. 2. Sewer Service Line minimum 2% slope. 3. Trench Is Minimum 10' from Lot Une. 4. Lots Served by Public Water System, 5. AdvanTex AX20— Mods lb to Meet Installation Requirements Per Orenco Systems & OAnchoroge Tonic". 6. Upper 6 Inches of Mound To Consist of Top—Sol & Be Vegetated. Septic System Construction Does Not Preclude Adjoining Lots From SQrdtatlon I P ovememts. - -f - 0 ItIrl r 4 Bdrrn 7AX="—b lb X I r _.I House 500O&IlmSWTmk .t J Effl=tPmPlin6, NORTHRIM 4�7; JiLds% ENGINEERING 172-37 Bear Pow C;rci* EaV* River. Alaska M77 ct� 907.6-94.7028 �Y\41 ...... "* Schedule 40 PVC F :__��orce mQln F.C.O. LOT PLAN PLAN VIEW Altemate 5% T. H. 1 w/ 1* PVC M. M.T. THE TABLELANDS S/D #2 BLOCK 7. LOT 9 /28/05F'-" ` SE 60 1 of 5 _J_ �— c�fl Municipality of Anchorage On -Site Water and Wastewater Program - (907) 343-7904 s; . E'T.Y Certificate of On -Site Systems Approval Parcel I.D. 051-801-68 1. GENERAL INFORMATION: Expiration Date: 10 -2,R -2z Complete legal description THE TABLELANDS #2: BLOCK 7, LOT 9 Location (site address) _ 22443 SAMBAR LOOP, CHUGIAK, AK 99567 Current Property owner(s) KODY & NICOLE BECK Day phone 507-676-3102 Mailing address 22443 SAMBAR LOOP, CHUGIAK, AK 99567 Real Estate Agent BRITTANY JAMES Day phone 390-7165 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 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: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �C rt 2 Q Waiver Fee $ Date of Payment 7^ S�-�ZZ %'27 Date of Payment Receipt Number ©(�' �.1 C 0 q3qq4 Receipt Number COSA # (SSL 2-71 3 6 cf 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: g ►t /ZZ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells 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 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 system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or parry (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. CE7 n\ cc, • :, rn 3. — #AECC884 DSD SIGNATURE System #1 Approved for �- bedrooms \\�``\'CY (OF((A����/j��` System #2 Approved for Disapproved Conditional approval for �v o bedrooms ON-SITE _ WATER AND r" _ bedrooms, with the following stip94i3on)NASTEV'fATER J� PROGRAM �VO 1,1 Original Certificate Date: '7,2-R 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10.10.12.doc H J,, `!• X lv( ........... CE7 n\ cc, • :, rn 3. — #AECC884 DSD SIGNATURE System #1 Approved for �- bedrooms \\�``\'CY (OF((A����/j��` System #2 Approved for Disapproved Conditional approval for �v o bedrooms ON-SITE _ WATER AND r" _ bedrooms, with the following stip94i3on)NASTEV'fATER J� PROGRAM �VO 1,1 Original Certificate Date: '7,2-R 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10.10.12.doc Sonja Blewett From: Tom Varney <tom@anchoragetank.com> Sent: Wednesday, August 3, 2022 2:03 PM To: Sonja Blewett Subject: FW: Sambar COSA Attachments: Image_20220803_0001 jpg Hello Sonja, I can now report the system at 22443 Sambar Loop in Chugiak has had a top to bottom rehabilitation. Please see attached. • Electrical and house breakers have been resolved. • Tank was pumped twice. • Pod has been leveled and reset. This ought to allow for the COSA to be granted. Tom Varney AdvanTex Coordinator Anchorage Tank 2723 Rampart Drive Anchorage, AK 99501 907-343-3704 anchoragetank.com From: Bruce Witt <bruce@aplusak.com> Sent: Wednesday, August 03, 2022 1:43 PM To: Tom Varney <tom@anchoragetank.com> Subject: Sambar COSA 1 �g7w = ; A O, Field Maintenance Report Unscheduled AnchorageTank 907-272-35.3 Property OwnerfDacking tt pH (6-9) Operator Outputs Dallas Dalton O Bruce Witt El" on �_J Off [ 1 ashin9 Site Address Contact Phone 22443 Sambar Loop, Chugiak AK 99567 907-250-1328 AX Silo in s County ID prd ° RTU 01UL : Date of 4st Inspection 105859 SWO50195 205256 RTU148080 07/29/2022 Dispatcher Comments Date: 08101/2022 Time: 12:00 AiVI Now that the system has been rehabilitated, please conduct another Annual Maintenance Inspection w/ samples. Please call ahead to new owner. Notification of site condition Made by VeriComms Monitoring System Made by Homeowner Other _ Site condition at time of call Alarm r_ Tank Overflow Odor Sewage Backup Other Field Sarnpling/Observations Necessary Not necessary NTLI (15 ± NTUs) pH (6-9) DO (2-6) Outputs O O O Odor of sample. Typical ..vfy1usty Earihy Moldy Non -typical Sulfide -. Cabbage Decay Conditions at site Alarm On `: Yes Li AD (If yes, alarm type ) Tank Liquid Level L✓ Normal I i High i Low Pump Operational? `�-;'Y s No Circuit Breakers Recirc........ ;_ � Tripped ;__ On `_ Off Discharge..... Tripped i._s On Otf i Controls ...... Tripped_' On Off VCOMI ATRTU Board: (if applicable) Document the panel status by shading the appropriate inputs and outputs as indicated by the yellow and red LEDs. Inputs e020(g)e0601 7Totalme - Outputs O O O Power (Green LED) El" on �_J Off [ 1 ashin9 Fax co m ple Cause of t4ahunction: Mechanical Process -Related Services Rendered: IZ i.. Parts Used: W = Warranty, B = Billable (V appropriate selection) Item Number Notes/Final Recommendations: i+System performing; no further action needed Final/Safety Inspection: � Lids bolted on? ✓Yes , No (If damaged, comment _ Control Panel reactivated? �(es `_ No Circuit Braskom: Additional service needed Recirc: ' On ?__ Off Discharge: +71 rOn -'Off Controls: ;- Off Time at Site ) � Signature" Date—_—,CI / , ? ^_-Time �_- --- - - i J ted tcaran to 1®866-384-7404 Travel Time 7Totalme - Signature" Date—_—,CI / , ? ^_-Time �_- --- - - i J ted tcaran to 1®866-384-7404 (� fi d ��o rLd Municipality of Anchorage ° r On -Site Water and Wastewater Program = (907) 343-7904 5 i E T Y Certificate of On -Site Systems Approval Parcel I.D. 051-801-68 1. GENERAL INFORMATION: Expiration Dater� ZZ Complete legal description THE TABLELANDS #2: BLOCK 7, LOT 9 Location (site address) 22443 SAMBAR LOOP, CHUGIAK, AK 99567 Current Property owner(s) KODY & NICOLE BECK Day phone 507-676-3102 Mailing address 22443 SAMBAR LOOP, CHUGIAK, AK 99567 Real Estate Agent BRITTANY JAMES Day phone 390-7165 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 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: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $j y 5 a y o Waiver Fee $ Date of Payment 7 Z �' Z �(Z7'ZZ Date of Payment Receipt Number 41 j jn + 0H 3 9 °16 Receipt Number COSA #_0 S C )-_ S C 2 31� Waiver # U 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 Dater Zsrl' 22 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the ppm evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells 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 workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and bAl� are outside the control of GEG. Satisfactory test results do not guarantee future performance of the V system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of QO the well or septic system. GEG makes no representation whether an alternative well or septic system Q s can be installed on the property in the event either of the current systems fail to perform adequately in d� the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. ` sXp �J � I 6. DSD SIGNATURE v o W/ System #1 Approved for bedrooms < WAS m p System #2 Approved for bedrooms J<�� R Disapproved Conditional approval for "1 bedrooms, with the following st�i' By. Original Certificate Date: 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doe Legal Description: THE TABLELANDS #2; BLOCK 7, LOT 9 If more than 1 septic system on lot: COSA Checklist # 1 of 1 LL DATA AW1NU 1NAT ER ❑ WeII log d with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow test for COS Static water B. TANK DATA of test ft. Age of tank(s) 17 years z Tank type/material STEEL Measured operating fluid level in septic tank NIA c } ❑ Standpipes/foundation cleanout per record drawing �y Date of pumping SEE ATTACHED MAINTENANCE REPORT D. ABSORPTION FIELD DATA BED I Which system tested (date installed) 12/9116 i�c ❑ ALL standpipes present per record drawing Total measured depth from grade 2.9 ft (max) Measured depth to pipe invert from grade ft (min) N� ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state R depth into effective p—^ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced *734 gallons COSA Checklist yellow sheet Parcel ID: 051-801-68 Structure served by this system 1 Well production at time of test pm - Water storage tank volu gallons Well disinfect r coliform test? ❑ Yes ❑ No j ' orm bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) c ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station 17 years Lift station material STEEL Comments: (ADVANTEX) SEE ATTACHED MAINTENANCE REPORT I'So-ice Q' G.c sG, S Adequacy test date 9/29/20 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 611 gal New depth 6 in Elapsed time 120 min Final fluid depth **3 in Absorption rate 600+ and Any rejuvenation treatment (past 12 months) NONE If yes, enter date N/A E. SEPARATION DISTANCES Fro to Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Statio of > 100' Community Sewer M e Cleanout > 100' s if No ft Neighboring Tank > 100' ❑ Yes if No Absorption Field on Lot >-100' ❑ Yes if ft Neighboring Absorption Fiel ❑ Yes if No ft Main > 75' ❑ Yes if No ft ❑ Yes if No ft vate Sewer/Septic Line > 25' ❑ Yes if No ft Tank>100' ❑Yes if No ft Animal Containme _ ❑ Yes if No ft Manure/Animal Excreta Storage > Q Yes Absorption Field > 5' ❑ Yes if ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' ❑ Yes if No 50+ ft Property Line > 5' P1 Yes if No ft Wells on Adjacent Lots: Water Service Line > 10' Q Yes Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑ Yes if No 50+ ft Water Main > 10' Q Yes if No ft Community Wells > 200' ❑ Yes if No ft Water Service Line > 10' Q 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' ❑ Yes if No 50+ ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' [j] Yes if No ft Surface Water > 100' ❑ Yes if No 50+ ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL. - APPROXIMATELY 6' FROM EDGE OF DECK POST TO EDGE OF FIRST COMPARTMENT CLEANOUT OF SEPTIC TANK. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet c,���ooDO xo .... ............ ........ %...... ........ �Q f Go ess.- Q 4 C —753 ✓ \c�G ��9s Ate, ed f'ro f e s sion�Q� #AECC884 016 Ecklund, Timothy J From: Jeff Garness <Jeff@garnessengineering.com> Sent: Wednesday, July 27, 2022 3:49 PM To: Ecklund, Timothy J; Sonja Blewett Subject: RE: Payment for Conditional - Already in Eplans - The Tablelands #2 B7 L9 [EXTERNAL EMAIL] Hello Tim, I am not aware of any risk to public health or safety associated with issuing a conditional COSA for the subject property. It is my understanding that the only remaining issue to get resolved is leveling the trickling filter pod. Jeffrey A. Garness, P.E., M.S. farness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 Mobile: (907) 244- 9612 Website: www.garnessengineering.com GARNESS ENGINEERING GROUP, Ud ENGINEERING -SALES, CONSULTING From: Ecklund, Timothy J <timothy.ecklund@anchorageak.gov> Sent: Wednesday, July 27, 2022 3:23 PM To: Sonja Blewett <Sonja@garnessengineering.com> Cc: Jeff Garness <Jeff@garnessengineering.com> Subject: FW: Payment for Conditional - Already in Eplans - The Tablelands #2 B7 L9 Sonja, I have conditional payment but I need a letter from your Jeff requesting a conditional with all the necessary verbiage, I still need the Escrow holdback letter. Thanks quanis AeroCell CORPORATION A rsska Authorized Dc.gW AtitivrotA ALx&t DiSabiw From: Ecklund, Timothy J <timothy.ecklund@anchorageak.gov> Sent: Wednesday, July 27, 2022 3:23 PM To: Sonja Blewett <Sonja@garnessengineering.com> Cc: Jeff Garness <Jeff@garnessengineering.com> Subject: FW: Payment for Conditional - Already in Eplans - The Tablelands #2 B7 L9 Sonja, I have conditional payment but I need a letter from your Jeff requesting a conditional with all the necessary verbiage, I still need the Escrow holdback letter. Thanks Ecklund, Timothy J From: Sonja Blewett <Sonja@garnessengineering.com> Sent: Wednesday, July 27, 2022 1:59 PM To: Ecklund, Timothy J Subject: Fwd: Sambar Loop [EXTERNAL EMAIL] Sent from my iPhone Begin forwarded message: From: Brittany James <brittanyjames@jjjrealtygroup.com> Date: July 27, 2022 at 1:35:57 PM AKDT To: Tom Varney <tom@anchoragetank.com> Cc: Sonja Blewett <Sonja@garnessengineering.com> Subject: Re: Sambar Loop Sonja, this looks good to me. Can you forward to Tim and request the conditional cosa be released to us for closing? On Wed, Jul 27, 2022 at 4:25 PM Tom Varney <tom@anchoragetank.com> wrote: Ladies, Here's what I know... Our Sr. Technician, Mike, visited the site and reports the following: • The system was not in operation which allowed it to fill up after it was initially pumped by JRs. It's been pumped again today. • Mike was allowed access to the electrical breaker panel in the garage. The system is connected to three different breakers ( a good thing!), and the one for the discharge pump was tripped (a bad thing!). • Mike re -wired the discharge pump by stripping back fresh wire and making new connections. • There is no need to replace the existing underground wiring as it was not the culprit, but the wire nut connections. • The lid for the Discharge Pump Basin was replaced with a new one. 1 Meanwhile, I believe a contractor has been selected to level the filter pod at a later date. There is no need to add anything else to their estimate, such as running new electrical wiring. The system is OK to operate now and we'll check it again after the pod has been leveled. I strongly suggest the buyer install an ethernet connection between the house internet router out to the septic control panel so it may utilize internet for remote monitoring. This allows me to see issues before they become problems (such as when breakers pop), and to make system setting changes, and to dispatch service personnel when needed. If this list looks complete, please share it with Tim at Muni Onsite. Please let me know how I may be of further assistance. Tom Varney AdvanTex Coordinator Anchorage Tank 2723 Rampart Drive Anchorage, AK 99501 907-343-3704 anchorapetank. com Sonja Blewett From: Nicole Beck <nickyliz3@yahoo.com> Sent: Tuesday, July 12, 2022 11:34 AM To: Sonja Blewett Cc: Brittany James Subject: Septic As of this morning the septic system is fixed and good to go for testing. Let me know if you need anything else. If you didn't receive the first email, the �-", c.syste- --has .never= frozen': Nicole Beck 507-676-3102 I 439 020 film 0 manomponag go we 0 ill ill o o.MEN tli I 1 ®ill NMI 'no a me all Ill *vanTexv Flet aintenaori Annual Inspection AnchcrageTank g07.979.1-4;e.'� Property Cwtwdimoking R pH (6-9) Operator - Nicole Beck 2nd Compartment Larry Betts Previous Me Addreea I vl l Contact Phone 22443 Sambar Loop, Chuglak AK 99567 Recirculating Splitter Valve...... . 507-676-3102 AX SRo ID rt County ID A Pad A RTU H/UL N Date of L=t Inspection AX -105859 SW050195 205256 RTU105612 12/21/2021 Retrieve O&M info Pally flow Recirc ratio _ Timer settings: Perform Field Sampling/Observations NTU (15:t NTUs) pH (6-9) DO (2-6) 53.3 Splice Box ................... 2nd Compartment Odor of Samplle/ r Typical (✓j sty C3 Earthy E) Moldy Nontypical Sulfkte ❑ Cabbag y ❑ Decay ORY film in PVU , ❑Year] 011 Foam it tank ❑ Yes L'1 No Check Control Panel Recire Amps D 1wharge Amps �t Audible and visual alarms EK Dial tone (telemetry only) ❑Yes []No Inspect/Clean Pump System Inspect Clean Rlser/Ud ..................... Current Splice Box ................... 2nd Compartment Float Cords .................. Floats........................ Previous Pump ............. .... ... . Blotube' Filter ................. I vl l Biotubo Pump Vault ............ LJ Recirculating Splitter Valve...... . Inspect Measure Sludge/Scum Sludne Scum let Compartment Current r 50 Previous Current Previous 2nd Compartment Currant Previous Currant Previous Inspect/Clean AdvanTex Filter �,,___�� /////Insp Clean Odor. ormai ❑ Pungent Laterals/Odnoos 1310mat:Normal ❑ Excessive Pod Bottom, Bridging/Ponding: None/knor 0 Excessive Intake Vent 's Inspect/Clean Discharge Pump System _ inspect' Inspect Clean Riser/Ltd 7 Floats b. Splice Box Pump 9� Float cords Inspect/Service Other System Components Inspect ean inspect Clean Distnfectlon EquipmentDipLaterals/ Prince. )C� C c (Observations { (Q e S Additional Services Rendered ❑ Cleaned textile sheets? ❑ Replaced UV Items? ❑ Replaced/Used other items? Parts Used: W - Warranty, B - Billable (✓ appropriate selection) W 8 Item Number Description Float/Safety inspection ���,/'V reinstalled I Kifold reconnected; flush valves closed Summary/Recommendations ❑ System perfomting; no further action needed Fax completed form to 1.866-384-74+041 Z-Lld bolted on rrtrol panel reactivated Tank needs pumping ❑Other? V /£ d OLL989SLO6 +Y P01 89:L0 Z202".90-Tnr DocuSign Envelope ID: 9A46CE08-CCA8-4F88-8869-8E2328DF3FCF GUARANTEED SERVICES, LLC 4400 East Diamond Way WasillaWasilla, AK 99654 US DeVoreAK@gmail.com ADDRESS Dallas Dalton Dalton Refreg. 22443 Sambar Loop Chugiak, Alaska 99567 Usa ESTIMATE 4 DATE 1046 07f26/2022 SPHP TO Dallas Dalton Dalton Refreg. 22443 Sambar Loop Chugiak, Alaska 99567 Usa Estimate DOTE SEr,VICE Qt SCRIPTION OTY' RAT[: Excavation Excavate a ax -20 advantex filter 1 5,950.00 pod that is roughly 3 inches out of level due to frost heaving process. Excavation consists of assisting manual laborers in uncovering and exposing pod and immediate plumbing in the area to adjust pod as needed for level. Back fill with pea gravel material to prevent further heaving. Felt existing area and cover with 6 inches topsoil for grass seed. Grass seed or hydra seed are additional costs if desired. Any plumbing that is sacrificed due to heaving that needs further excavating might result in additional costs. TOTAL Accepted By Accepted Date i�rfiCiJNT 5,950.00 $5,950.00 DocuSign Envelope ID: 9A46CE08-CCA84F88-8869-8E2328DF3FCF A mr frfitle Guaranty Agency roti5�r Hr.`s nat l vrd Order No. 75219 Alyeska Title Guaranty Agency 3801 Centerpoint Drive Suite 102 Anchorage, AK 99503 (907) 569-2842 Phone (907) 569-2843 Fax ESCROWED FUNDS AGREEMENT This agreement made this 26th day of July, 2022 by and between Kody A. Beck and Nicole E. Beck (hereinafter jointly referred to as Seller), part of the first part, Dallas Luke Dalton (hereinafter jointly referred to as Purchaser), part of the second part, and Alyeska Title Guaranty Agency (hereinafter referred to as Escrow Agent), party of the third part. WITNESSETH: WHEREAS, the Seller owns the following described real estate: 22443 Sambar Loop Chugiak, Alaska 99567 Lot 9, Block 7, The Tablelands #2 WHEREAS, the Purchase and Sale Agreement, dated May 27, 2022 provides for Seiler to complete the following to the above property: Escavation WHEREAS, the real estate has been sold to Dallas Luke Dalton and WHEREAS, weather and/or supply prevent the completion of said items, and WHEREAS, it is the desire of Seller and Purchaser to close the sale prior to the completion of the improvements and at the earliest possible date, and WHEREAS, the Lender is willing to disburse the loan proceeds provided a cash escrow is established to assure completion of the uncompleted item(s). NOW, THEREFORE, for and in consideration of the premises herein above set forth and in order to make possible the immediate delivery of possession of the property to the Purchaser hereinabove named and at the same time assure the satisfactory completion of said improvements, the parties hereto agree as follows: 1. The Seller covenants and agrees to complete the improvements enumerated below on or before October 1, 2022. 2. The Seller agrees to pay for all labor and material necessary to complete the work and improvements. The Seller further agrees to pay for the final inspection performed by the approved appraiser or lender hereinabove named, if applicable. 3. The Seller additionally agrees that he is personally liable to Purchaser for the satisfactory completion of the work, free and clear of all material and labor liens, and indemnifies the Purchaser and the Escrow Agent for any liability for Claims of Lien filed against said property for the improvements mentioned hereinafter the closing of this sale. 4. The Seller herewith deposits with the Escrow Agent and the Escrow Agent acknowledges receipt of the sum of Eight Thousand Nine Hundred Twenty Five Dollars and No Cents ($8,925.00) which said sum shall be held by the Escrow Agent in a 0 non interest or ❑ interest bearing account at a financial institution insured by the Federal Deposit Insurance Corporation, and disbursed as follows: a. In the event the Seller completes the work and improvements in full accordance with this agreement the Escrow Agent shall thereupon pay to the Seller the sum deposited, plus the accrued interest, if applicable. ALY Escrowed Funds Agreement Page 4 of 3 DocuSign Envelope ID: 9A46CE08-CCA8-4F88-8869-8E2328DF3FCF In the event the Seller fails to complete all or any part of the improvements enumerated below, on or before the date specified in Paragraph 1 hereof, the Buyer/Purchaser shall have the right to enter into a contract with any third party for the completion of such part of the work as the Seiler has failed adequately to perform. In such event Escrow Agent shall pay over, at the direction of Purchaser, all or any part of the escrowed funds in such amounts and to such persons as may be specified in the presentation of bills for work performed. The Seller hereby releases the Escrow Agent from any liability whatsoever to pay over or account for all or such part of the funds deposited hereunder as may be expended at the direction of the Seller as provided herein. c. If a dispute arises regarding the disbursement of the escrowed funds, the Escrow Agent shall not be required to take any action or disburse any funds but may withhold and stop all further proceedings without liability until such time as mutually, agreeing written instructions have been delivered to the Escrow Agent or court order. 5. It is the intention of the parties that this Agreement is made for the benefit of the Buyer. The Escrow Agent, in the execution thereof, shall act solely on the request and instructions of the parties as specified herein with respect to all sums deposited hereunder and for so doing, the Buyer and the Seller hereby expressly release and relieve the Escrow Agent of any and all liability or claim of any nature. 6. The Escrow Agent shall have a prior lien on the funds deposited herewith for any costs, including costs and reasonable attorney's fees which may be incurred by it consequent to its being made a part to all legal or equitable proceeding which is brought by any of the parties hereto, concerning the disposition of the funds held. 7. Upon payment of invoices, any remaining funds will be returned to Seller. ITEM Excavation SCHEDULE OF IMPROVEMENTS TO BE COMPLETED COST TOTAL ESCROWED $5,950.00 $8,925.00 TOTAL COST OF IMPROVEMENTS $5,950.00 ESCROW HOLDBACK FEES $8,925.00 **IN ORDER TO RELEASE ESCROWED FUNDS, THE FOLLOWING INFORMATION IS REQUIRED" ❑ Final CO from MOA Q Mutual Written Instructions from Buyer and Seller Q Presentation of Paid Receipts ❑ Written Instructions from Lender ❑ Other: $150.00 crow Holdback Processing fee will be collected at closing and fee of $50.00 per month for maim nre may be charged if the agreed completion date is not met. Initial ''//��// Initials IN WITNESS WHEREOF, the parties hereunto caused these presents to be executed on their behalf and their seals affixed the day and year first above written. Dated: BUYERS); ALY Escrowed Funds Agreement Page 2 of 3 Doc R),EWgkapa�D: 9A46CE08-CCA8-4F88-8869-8E2328DF3FCF h���ak�®alton TIN Address Phone Numbers E-mail Dated: 7/27/2022 SELLER(S): Kody A. Beck TIN Address Phone Numbers E-mail ESCROW AGENT: Alyeska Title Guaranty Agency By: Laura A. Downing Its: President 19625 Adrian Ave Chugiak, AK 99567 486-04-1805 292 Fishwheel Ave Jber, AK 99505 Nicole E. Beck ALY Escrowed Funds Agreement Page 3 of 3 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 _� Day of -:57�i (1 of 20 2 Z, 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 Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AlmnvA located a_t legal djcription) -- _ — 2. Maintenance, Repairs and Alterations. _ (Owner is required to read, understand and initial each section) DD 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) Pagel of 3 MOwner acknowledges that the Municipality may request records of maintenance and p repairs from the manufacturer's representative or maintenance provider. 4/P 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. DOwner 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 inthe 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 OWNER: By: r' STATE OF ALASKA THIRD JUDICIAL DISTRICT signature) Date: } ) ss. name) The foregoin instrument was acknowledged before me this �Iciay of 20-"-, by V L S 1)04-, -o OTARY PUBLI FOR AA My Commission expires: [ �?y STATE OF ALASKA NOTARY PUBLIC Aurora Lancia i,4ycorwmm Boo 0 2 MUNICIPALIT • / Y= (signature) (print name) (rev. 05/18/2018) Date: `Zz Title: Page 3 of 3 Parcel I.D. 051-801-68 GE _ sUi Municipality of Anchorage T On -Site Water and Wastewater Program Q _ (907) 343-7904 S ,A .F C T Y Certificate of On -Site Systems Approval Expiration Date: 0("';2 7 _ 2 02- 7- 1. GENERAL INFORMATION: Complete legal description THE TABLELANDS #2; BLOCK,7,--L-GT--2- Ly'Aet Location (site address) 22443 Sambar Loop *Chugiak 99567 Current Property owner(s) Nick Marceaux Day phone 423-320-8307 Mailing address Real Estate Agent 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: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ q� a, 56(WG I b- i i Date of Payment J O 1 i g ?u C) Receipt Number M39'9 9 C COSA # 0SC ,:2_ () 1 S 11 Waiver Fee $ Date of Payment Receipt Number 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 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells 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 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 system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever./� i. Date: 'D 2� 6. DSQ —�— SIGNATURE System #1 Approved for � bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, J� #AECN :9'4. g ON-SITE '. WATER AND � �rrrt WAST"=v'ATE R -z �� PROGRAM r .O C C with the following stip,# mrr3FRV'C,� ,,� A%. ��ilri'. \i'. YL�_ d1� S 1 �LI 'c -to By. Original Certificate Date: 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 _ Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other Legal Description: COSA Checklist THE TABLELANDS #2; BLOCK 7, LOT 9 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected G; Casing height (above ground) in. 7 Date of flow test for COSA 4 Static water level at beginning of test ft. Parcel ID: 051-801-68 Structure served by this system 1 Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes 0 No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample L4 Comments AWWU WATER PB. TANK DATA Age of tank(s) 15 years ,i► Tank type/material 51Ev,S`EEL Measured operating fluid level in septic tank N/A ® Standpipes/foundation cleanout per record drawing Date of pumping SEE ATTACHED MAINTENANCE REPORT D. ABSORPTION FIELD DATA BED C. LIFT STATION ® Required maintenance completed Age of lift station 15 years Lift station material STEEL Comments: (ADVANTEX) SEE ATTACHED MAINTENANCE REPORT Which system tested (date installed) 12/9/16 Adequacy test date 9/29/20 ffil ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 2.83 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade ft (min) Water added 611 gal © N/A — pressurized field 6 New depth in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 120 min depth into effective ***3 ® Code -required soil cover over field Final fluid depth in ® System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced * 734 gallons If yes, enter date N/A Comments/Deficiencies: -80TH MONITORING TUBES SET TO THE SAME ELEVATION "PRE-SOAK PERFORMED ON 9/28/20- DRAINFIELO DRY AFTER 24-HOUR RECOVERY COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No *51+ 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' if No ft Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ 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 *51+ ft Surface Water > 100' ❑ Yes if No bU + ft Property Line > 5'✓❑ Yes if No ft Wells on Adjacent Lots: 0 Yes Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑ Yes if No 50'+ ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' ❑ Yes if No 50'+ ft Water Service Line > 10' F/71 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No 50'+ ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL - APPROXIMATELY 6' FROM EDGE OF DECK POST TO EDGE OF FIRST COMPARTMENT CLEAN-OUT OF SEPTIC TANK. G. ENGINEER'S CERTIFICATION l certify that / have determined through field inspections and review of Municipal records that the above systems are in confonnance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC684 L4 1 IS?i? V<ermea: GL1_) IG-)>( UD>- r -+r Jf-1-f L)-)k,.,-,t5c601lli `UL)17U MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE ANIS REPAIR AGREEMENT THIS MAINTENANCE. AND REPAIR AGREEMENT, herein the "AGREEMENT" made and ('QRS entered into as of this i Day of of 20 cl , , by and between \,�.t:tu= >ecVL herein the "OWNER," and the Municipality of Anchorage, Herein the "IALTNICIPALITY", 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 Advantex Systemjd�Q%/�, located at (legal description) the Tablelands #2 L9 B7 PI -fl 1111PI) 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 Nlunicipality 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. f ; Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. <Y ; Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. P5 /0 t? Owner agrees that the AWWTS installation and maintenance requirements as provided by the A)t`WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's ANVWTS. rNs:P 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 AWIAITS is operational or until title is transferred. 4. Nonvi,aiver. 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 Lave. 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 qp,--)iLyn verinea:�L)-) ji(5.Luuru OWNER: By: .(signature) Date: 'sL - rint name) STATE OF ALASKA ss. THIRD JUDICIAL DISTRICT The foregoing instrument was acknowledged before me this A day of 20'2P by 'k3'�C-Ckr-- e Skae qf1A1aBka] NOTARY PU IC FOR ALASKA NOTARy pUBLIC My Corn III il--aexpires: Sh rC Macy Crim, My cwnLsajon E)plms Aug 7.2MI AIUNICIPALIIX: 2- -2 -zip iy�: (signature) Date: (print name) Title: (rev. 05/18/2018) Page 3 of 3 Perform Field Samp ng10bserv8ti0nS rw1 (6-9) DO (2-6)� Odor of Sample Moldy Typical ivlut y [I Earthy CI DOM Nontypical Suit ie ❑Cabbage Oily flim in Pvu Yes 0 No foam in tank IYos ((eNo Check Contrat Parr Roclro Amiss ...� Discharge Amps Audible and visual i arms I OK Dial tone (telemetry )nly) ayes VNo Inspect/Clean Put 1p System l inspect Dean Riser/Lid .... _ .. ... .. , Splice Box ...... ....... . . . ., Float Cords .... ............. Pump.......... ........ Biotube° Filter ... ..... • • • • • alotube Pump Val t ....... • . • • . Recirculating Sol' or Valve....... Comments ---1 1 signature - Inspect/Clean Advarni'ex Filter inspect Clean Pungent Norma! Pungc Odor: Normal (IExcEaeive Pod Bottom Siomat: None/Minor ❑ Excessive Intake Vent .1 Bridglrrg/Ponding: 364 931 Sol N 11On N s Clean io A 1! I on on Splice Box 1011111 N 10 an Ill � Glean Inspect Clean �,( Di`Pel�mismdes IJJ Disinfection Equipment Observetiane Additional SerVICes Rendered ❑ Replaced UV ;tams? Mjintenancee Cleaned textile sheets? AnchorageTank [� RoPleCOWUsed other items? ZAdva~Field Parts Usedt W = Warranty, B = Billabia (✓ appropriate selection) 907-272-3543 Annual lnspec kion of*ter � r/Ttachtng R Larry Setts marceaux C4ntwtMOM 423-320-8307 !Uta ambar LOOP EA Chugiak AK 99567 RTU d1uLa DatscrL&StW"pactlon �� ro d Pod d 205256 RTU105612 105612 01/1512020 59 $W050195 Measure Mudge/Scum M1 ! q1 Retrieve O&M Info Sludge scum Dally flow,—•-- �r--"— 1st Compartment Currant 11 pr9vlo f 1 Current Previous Recirc ratio - 2nd Compartmont re Previous Current Currr:nt Previous Timer settings. Perform Field Samp ng10bserv8ti0nS rw1 (6-9) DO (2-6)� Odor of Sample Moldy Typical ivlut y [I Earthy CI DOM Nontypical Suit ie ❑Cabbage Oily flim in Pvu Yes 0 No foam in tank IYos ((eNo Check Contrat Parr Roclro Amiss ...� Discharge Amps Audible and visual i arms I OK Dial tone (telemetry )nly) ayes VNo Inspect/Clean Put 1p System l inspect Dean Riser/Lid .... _ .. ... .. , Splice Box ...... ....... . . . ., Float Cords .... ............. Pump.......... ........ Biotube° Filter ... ..... • • • • • alotube Pump Val t ....... • . • • . Recirculating Sol' or Valve....... Comments ---1 1 signature - Inspect/Clean Advarni'ex Filter inspect Clean Pungent Norma! Pungc Odor: Normal (IExcEaeive Pod Bottom Siomat: None/Minor ❑ Excessive Intake Vent .1 Bridglrrg/Ponding: Inspect[Clean Discharge Pump System Inspect Clean inspect Floats Ricer/Ud ' Pump {�{ Splice Box Float cords Inspect/SOrwice Other System COMPOnents inspect Glean Inspect Clean �,( Di`Pel�mismdes IJJ Disinfection Equipment Observetiane Additional SerVICes Rendered ❑ Replaced UV ;tams? Cleaned textile sheets? [� RoPleCOWUsed other items? Parts Usedt W = Warranty, B = Billabia (✓ appropriate selection) Final/Saf®tY Inspection Lida bolted on RSV reinstalled Manifold reconnected; flush valves closed Control panel reactivated Summary/Recommendations ❑ System performing; no further action needed !1i(T nk needs pumping ❑ other? ( ] Call for tarvic� r r r _� i k .n . l' 0~1 Date v jFaX completed form to 1-$66-384-7404 X67 8 9 70 • • 77r4-E ; eon • Municipality of Anchors_ • .. £ k�f5 On-Site Water and Wastewater Progra �. d (907) 343-7904 SEP 2 5 201? n,1 E T Y CERTIFICATE OF ON-SITE SYSTEMS !\•° 'ROVAL ti \<< � o� ssLg Parcel I.D. 051-801-68 Expiration Date: �- Z7—I g 1. GENERAL INFORMATION Complete legal description THE TABLELANDS#2 BLOCK 7, LOT 9 Location (site address) 22443 SAMBAR LOOP, CHUGIAK,AK 99567 Current Property owner(s) GREGORY MICK & LYNNE MCCORMICK Day phone Mailing address 1817 LODGEPOLE ROAD, HELENA, MT 59601 Real Estate Agent Day phone 2. TYPE OF DWELLING: • Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 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: Date: 9/2f// COSA to be released to .• - eer, unless otherwise requested by the engineer. COSA Fee $ q Waiver Fee $ Date of Payment qP09" Date of Payment •Receipt Number O63 O Receipt Number COSA# 85C/ -fC Sr 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 ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 12/13/2016 Engineer's Comments:This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics,groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future -ft:IL\ occupants or can ArcTerra guarantee that no unseen OF AL\ i encroachments,deficiencies or discrepancies exist. 4.� TIi v ,r 6. DSD SIGNATURE �— low System #1 Approved for bedrooms. ( � KENNETH ir. DUFF ffirAlf System #2 Approved for bedrooms. (� o '°Z /4o--4'A. Disapproved. Nk Conditional approval for bedrooms, with the following stipulations: • �F tier ;. ��`l AA/c ,,,.‘ 0N-SITE csc. WATAND WA5IEERWATER pROGRAM �= reNr sk05 B ��1—�—� / Original Certificate Date: Cr—21— 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 blue sheet 1x10-12.doc 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: THE TABLELANDS#2 BLOCK 7, LOT 9 Parcel ID: 051-801-68 A. WELL DATA— PUBLIC WATER Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (Y/N)Y Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production _ _ g.p.m. _ g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/8/2005 Tank size 1500 gal Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 11-14-2016 Pumper A+INSPECTED SYSTEM C. ABSORPTION FIELD DATA Date installed 12/9/2016 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.5 System type BED-MOUND Length 30 ft. Width 15 ft. Gravel below pipe 0.5 _ ft. Total depth 2.5+ ft. Eff. absorption area 450 ft2 Monitoring tube Y Depression over field N Date of adequacy test NA-NEW SYSTEM Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test _ in. Water added gal. New depth in. Elapsed Time: min Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed 71812005 Size in gallons 1500 Manhole/Access (Y/N) Y "Pump on" level at 41 in. "Pump off" level at 32 in. High water alarm level at 45 in. Datum BOTTOM OF TANK Cycles tested 2 Meets alarm&circuit requirements?Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA On adjacent lots NA Absorption field on lot NA —_ On adjacent lots NA Public sewer main NA Public sewer manhole/cleanout NA Sewer/septic service line NA Holding tank NA Animal containment areas NA Manure/animal excrete storage areas NA SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ _ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ _ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWS Wells on adjacent lots 200'+ F. COMMENTS 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. i, OF' A 4 Engineer's Printed Name KENNETH M.DUFFUS Date 12/1312016 COSA brown sheet_10-10-12.doc r` Ke*� a v Ai I` D `I 1114,444 f SSI - ' AlEr \ \ N Lot 8 \ . /-15' T&E EASEMENT \\ Lot 7 WOODEN FENCE \ \ 30.0' 1N 89'56'06"E 353.19' _ i ./ ♦ A / I N M A AI �' //- b RETAINING WALL 32.2' x x to ID I o I PORCH—\\ fl 4.0' U x x D z 0 3.' a Trr ( 7CHAIN-LINK FENCE t!t N„tz o a SEPTIC PIPES �A CO MANHOLES x x v'r,. / 23 ti t- 4,0' > s ("� 11 Lot 9 �; / -' 0 ~ TREATMENT POD x 51,413 s.f. x / / 0 : : N �S,oy 6.0. N o 12.3'x24.7' SHED / / / o �?/ q�T.p.. �N I SEPTIC PIPES I • �+ / / / / q•r. 35.3' • I / / 9 .. ;.. 1, CONCRETE PAD I / / // x , • / / RETAINING WALL �! / • - / /,-- ,/�� //_.. „_- .,---t- x -� x _ x -- x J / ..— ,,_ „ „_ „— II— / USO' / S 89'56'06"W 422.14' TOP OF SLOPE / \V// / / WOODEN FENCE / / 25' VEGETATIVE / / O BUFFER EASEMENT / "PN” Lot 10 15' T&E EASEMENT / / / / 43- / / / // (§) / / ,/ / PLOT PLAN _ AS BUILT X SCALE 1" = 40' GRID NW 1559 Project No. 16-370/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone 000OpppO (907) 522-4625 Fax oa F A p�4 NOTE: LOT IS SERVED BY COMMUNITY WATER Professional Land Surveyors kenOlangsurvey.com v 9 Q JonathanOlangsurvey.com �'� .• •s n I hereby certify that I have surveyed the following described property: °t(')'. Q1(< �� LOT 9, BLOCK 7, THE TABLELANDS SUBDIVISION, ADDN. No. 2 (PLAT 2005-13) *:. 49I� i\ • *�p Anchorage Recording District, Alaska, and that the Improvements situated thereon are a AVA within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed a'p'.:'KENNETH G premises and that there are no roadways, transmission lines or other visible Q / QD easements on said property except as indicated hereon. 0 '�, i•2L�rttto ,•' Q {{) QO`A�'•. L -5202...- y)00 Dated this the I Day of v0v,AC5ir\. . 7.+01 , at Anchorage, Alaska Q ,oR o� It is the responsibility of the owner to determine the existence of any easements, �Oppooc" covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963