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TERI #2 LT 11
T ri Lof 11 #050- 751 - 17 Municipality of Anchorage ~"': Development Services Department ~ ! Building Safety DMsion On-S~te Water end Wastewater Program. 4700 Bragaw St. P.O, Box 196650 Anchorage, AK 99519-6650 Page 1 of 2 w'a~w.cl.anchorage.ak, ua (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number:. SW070134 PID Number:. 050-751-17 MICHAEL ALEXANDER Wastewater System: [] New [] Upgrade 1901 DELTA ST. SOUTH LAKE TAHOE, CA ABSORPTION FIELD LEGAL DESCRIPTION 5 GPO~' 0 ~,. t t I'ERI #2 0.T ABOVE F,. 0.7 14H tl:: 3:] 3.5 ~ 40 ~. Well: [] New [] Upgrade c.-,~,,,=: 5 Fi. ~gnetl ID~"enC~befw~enbne~0 FI EXISTING PRIVATE F,. Ft 200 Fe ASTM 3034 . GUARANTEED SVCS. 8/3/2007 G,'~ ~,_ TANK SEPARATION DISTANCES rn septic [] Holding [] S.T.E.P. [] Other:. ADVANTEX Tank Fie~d Station Tank Sewer- LineJ~VANTEX 1500 w,~ +100' +t00' - - +25' PLASTIC 2 ~,.w=. +100' +100' - - ~ / LIFT STATION ~,u.. +5' +10'/~ s;' - - NO LIFT c~ F~.,,~ +5' +10' - - .P~o~.--. .~.~-,... - - RISING SON ELECTRIC 2' SAND INSTAl [FO BELOW SEWER ROCK BENCH MARK E~r,~'~u~. ~y>"~,,v~ ,~r-B~[~ .~'~ ~D,~.~- FINISHED FLOOR AT GARAGE ~Rl'~- ~.O.A. ~5:~b~"_ tt6.2 Ft Inspections performed by: ERES Dates: 1'~ 8/3/2007 2"~ 8FJ~2007 Development Services DepaH.~ent Approval Conditiona) ^pprova~ Date: Reviewed and approved by: ~'"'~ W., '~<'~Date:.~-/~-07 ~.~' Permit No. SW070134 Page 2 of 2 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ON-SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6§50 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: TERI#2 LOT 11 050-751-17 LOT 10 SWING T1~$ 329.74' (R£C ,t. HELD) NEW 5'X40' DRA/NFIF. LO \ \ LOT 11 W/ AX-20 FILleR ~ TANK .'~1 15oo GAL 95.4/; ADVANT£X GROUND LEVEL AT~ 96.7 ~ 96.7 90.7. ~DTTnH DF' T.H. 8 ENC~NEER'S SEAL ~ oF,,. A/ ~':,,,~.. .......... .-:.~. ,,-o...)49~/)~ ,"..~'~I Ruc 10 ZOO? 3:33PM Risinc Son Electpic, Inc. 6Z~-6777 p.l ,~¥~.. .~. ,'. liieing ~on F=J,ecl:ri¢..Inc. ~~f~ 1~916 )VooclLand Price August 10, 2007 Guaranteed Services Attn: Robert Devote 18139 Misty Fall Circle Eagle River, AK 99577 Re: Lot 11 Subdivision Ted #2 T14N RIE Sec 33 - 3828 Delores Drive - Eagle River, AK Dear Robert: The lift station at the above referenced property has been wired in accordance wrch NEC and State/Local codes. Thank you. Sincerely, Admlnl~bator Uoense Number 1284 Sl:~alty Corltractor License Number 27285 cc: file. MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SI'rE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 28, 2007 Expiration Date: Jun 27, 2008 Permit Number: SW070134 Legal Description: TERI #2 LT 11 Design Engineer: 0848 EAGLE RIVER ENGINEERING SEI Owner Name: Michael Alexander Owner Address: 3828 Delores Dr. Eagle River, AK 99577- Parcel ID: 050-751-17 Site Address: 003828 DELORES DR Lot Size: 88514 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under cons~'uction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Da,e: 7 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 ~ Anchorage, AK 99519-6650 ~,, ~ www.munl.org/onsite (907) 343-7904 ON-SITE SEPTIC/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0~"0 - 7~1- Propertyowner(s) ~ [ ~ Mailing address :~',,~ S ~~% Site address ~ ~ ~o~ ~egal description (Sub'd, Block & Lot) Legal desc~ption (Township, Section & Range) Lot Size ~ ( I ¢ Sq. Ft. Dayphone '~ff0- $~I~ Zip Code Zip Code ct cl <J'[ L_CrT t~ Number of Bedrooms THIS APPLICATION IS FOR (~3all that apply): Absorption Field ~ Septic Tank ~ Holding Tank ~r~ Privy Private Well ~ Water Storage THIS APPLICATION IS AN: Initial ~ Upgrade Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Single FamiJ~w~llin~ and is~n accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) PermitJRush Fees: Date of Payment: Receipt Number: (Rev, 11/05) /3/ ~,O 'f 17/)~ J~o.~/aiverFees: ~ -- ~-- 2--'" o ? Date of Payment: q ~ '~ ~..'~ '~. ~ Receipt Number: Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW RD. Suite 201 (907) 694-5195 Eagle River, AK 99577 (907) 694-3297 fax June 20, 2007 Dan Roth Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re' Teri # 2 Lot ! 1 Narrative & Permit Application Dear Mr. Roth: Eagle River Engineering Services (ERES) was contacted by the owner of the property noted above to design a a septic system upgrade. It was determined that the leachfield was surcharged, probably in the groundwater table, and a new leachfield would have to be installed. A test hole and soils percolation test has yielded silty sand with some gravel, SM, with a percolation rate of 12 minutes per inch. We propose to utilize an Advantex treatment system to minimize the size ofthe leachfield due to topography constraints created by the existing failed system, steep slopes, and the on-site well radius. Please see attached site plan and leachfield cross section. In our cross section, we have shown the extent of fill required to create the mounded leachfield and 35' slope setback. There is a seasonal drainage ditch approximately I00' from the proposed leachfield site. The septic tank and leachfield shall be located more than 100' from this flowing seasonal drainage ditch. The proposed L/bedroom septic system upgrade will have very limited impact on adjacent properties for th~ following reasons: The surrounding lots are large, so there is room for wells, septic systems and alternate sites. Immediate neighboring septic systems are all +20' distance, and no private (or community) wells within 100' of the proposed septic system. Drainage will not be affected and is not a major consideration in our design. A Category III Advanced Wastewater Treatment System shall be utilized thereby reducing any chance of future leachfield failure or potential contamination. ~.003'x07-029SEPTICNARRATIVE Installation of this 4 bedroom upgrade, to our best available knowledge, will not adversely affect the wells or septic systems or reserve areas on adjacent lots. Ifyou have any questions please call our office at 694-5195. Sincerely, Principal ~2003~7-029SEPTICN'ARRATIVE Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW RD Suite 201 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM - MOA CERTIFIED INSTALLER LEGAL: Tert #2 Lot I1 June 20, 2007 A. .GENERAL I. The septic plan is for a 4 bedroom single family residence only. 2. The drawing and or site plan shall be a part ofthis specification. 3. All materials and workmanship shall meet the Anchorage Department of Development Services and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the deslgn and ara to be verified or modified in the field by the englneer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Envirunmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. A licensed surveyor should locate any utility easements and exact 100' radius from the existing and neighboring on-site wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remalnlng open test bole excavations shall be filled and monitor tube removed. 9. It Is mandatory that a licensed land ,~urveyor mark the location of the 100-foot well radius and visible surface water offset prior to installing the septic tank and leachfield. B. ADVENTEX SYSTEM AND SEPTIC TANK I. Septic tank shall be a fiberglass or steel 1500-gallon tank capacity of MOA approved oonstruction for use with Advantex system. Install as per current manufacturers recommendations for conditions in Alaska. 2. Install one AX-20 filter pod over septic tank capable oftreating 600 gallons per day ofwaste flow. Set floats and timers per OSI Instruction. 3. No auxiliary pump basin is required if gravity feed can be achieved while maintaining adequate coverage over all piping and components. 4. A municipal inspection report or receipt from a licensed electrieial contractor shall be provided to the engineer verifying lift station wiring to all applicable {:odes and installation instructions. C. DRAINFIELD I. The drainfield is to be located as shown on the site plan. 2. The total depth of the initial drainfield excavation is to be approximately 2' deep, relative to existing ground elevation and end in native sandy GM-type soil. The excavation shall remove only the topsoil and layer exposing the free-draining soil beneath. 3. Contioous heavy mil vlsqueen shall be placed along the downhill edge and sides of the drainfield excavation prior to placement of sand and sewer rock, as shown in leachfield cross-section. 4. A two-foot minimum layer of sand is to be installed beneath the bottom of the leachfield sewer rock to achieve 4' separation to groundwater, and to level up the drainfield. The top ofthe sand layer shall be level, plus or minus 1.5". $. A twelve inch (12'3 layer of sewer rock is to be placed over the sand layer. The 4" effluent piping is to be buried within the gravel layer with 2" of gravel cover over the piping. 6. The completed drainfield gravel and piping is to be covered with typar fabric material. 7. Soil or combination of soil and extruded board insulation to a depth of Y or equivalent is to be placed over the bed. Mounded side slopes on uphill side and ends are not to exceed 3:1. ~2003\07-037-Advantex spec SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM- MOA CERTIFIED INSTALLER LEGAL: Tcri #2 Lot 11 June 20, 2007 Continued: 8. The septic tank and leachficld must not be closer than 100' to any existing private well or visible surface water, 150' to any Class "C" well, or 200 feet to any community well. 9. The existing leachfield shall be abandoned in place, and the existing septic tank shall be abandoned per applicable MOA codes RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 2' maximum GRAVEL DEPTtt = 0.5" under cffiucnt pipe, 2" over pipe (1.0 feet total) SAND DEPTtI= 2' minimum DRA1NFIELD LENGTH = 40' DRA1NFIELD WIDTH = 5' SOIL RATING = 5 GPD/~ BEDROOM CAPACITY = 4 EFFLUENT PIPE = 4" ASTM 3034 As required by AMC 15.65. SEPTIC TANK = 1,500 Gal Advantex compatible tank w/AX-20 filter pod and lift basin Twenty-four (24) hours notice required for all inspections. ~.003~07-037-Advantex spec A PERFORMED FOR: EAGLE RIVER ENGINEERING ,,,~...' _ A 10421 VFW RD, SUI~ 201 ~A~L[ ,,~R. AK. 99577 ~.~ .q~~...t.~ SOILS LOG PERCOLATION TEST *g%~ '... .... ..' MICHAEL ALEXANDER DA~ PERFORMED 5/12/2007 LEGAL DESCRIPTION: TERI#2 LOT 11 TEST HOLE # 1 D~PTH (~'T) TOPS~L~R~ BR0~N GRAY SM ,~ LI'~ SAND SLOPE / TOWNSHIP RANGE SECTION T14N, RIW SEC.16 SITE PLAN(NOT TO SCALE) SLOPE WAS GROUND WATER ~ ENCOUNTERED? YES WATER TABLE DATA DATE WATER LEVEL 05/12/2007 4' 05Y22/2007 4' PERC 'rEST RESULTS 22 READING I DATE GROSS TIME iNETTIME DEPTH TO WATER NET DROP(IN) 1 0511512007 10:19 0:00 3' 4 3/8 0 '~' 2 0511512007 10:49 0:30 3' 7 15116 3 9116 3 05115/2007 10:50 0:00 3' 4 3/8 0 4 0511512007 11:20 0:30 3' 6 718 2 1/2 5 0511512007 11;21 0:00 3' 4 318 0 6 0511512007 11:51 0:30 3' 6 718 2 112 PERCOLATION RATE- 12 MIN/~NCH) PERC HOLE DIAMETER=fi' TEST RUN BETWEEN 2 FT AND 3 FT COMMENTS; i_/_.,~_/(//~'~v~/ CERTIFY THAT THIS TEST WAS PERFQRMED IN ACCORDANCE W1TH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:~_.~' A EAGLE RIVER ENGINEERING 10421 VFW RD, SUITE 201 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-5297 SOILS LOG - PERCOLATION TEST PERFORMED FOR: MICHAEL ALEXANDER DATE PERFORMED 5/12/2007 LEGAL DESCRIP]ION: TERI~2 LOT 11 TEST HOLE # 2 BROWN TOPSOIL BROViN I~RAy SM SILTY SAND H20 SLOPE / WATER TABLE DATA DATE ~A'IE R LEVEL 05/12/2007 4' 05/22/2007 4.3' TOWNSHIP RANGE SECTION T14N, RIW, SEC.16 SITE PLAN(NOT TO SCALE) SLOPE 21 22 COMMENTS: GROVND WATER MONITOR ONLY S.~.~/.~/y/,~/~ CHARLES BALZARINI P ERCOLAllON TESTBY: I _~~~ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE W1TH ALL STALE AND MUNICIPAL GUIDEUNES l. EFFECT ON THIS DATE. DATE:_..~/~I/~2- EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-6t95 ERES Project No.: 07-029 Calculated By: CB Date: 06/20/2007 Legal: TERRI#2 Single Family 4 Bedroom Dwelling TEST HOLE Shallow Trench Subsurface Wastewatm' Disposal Field Water use at 150 galIons per bedroom = 600 gallons Percolation rate= 12 minutes per inch Wastewater application rate = 5 gallons per day per square foot Required absorption area = 120 square feet Trench width (W) = 5 feet Graveldepth (D)= 0.5 feet Required length = Shallow trench factor * Required absorption area I W Shallow trench factor = (W + 2) I (W + 1 +2 D) ShaIIow trench factor = 1.00 Total Excavation Depth = 2.0 feet Required length = 40 feet Use 2'-3' filter sand below sewer rock 07-TERRI.ADVANTEX. xls 11:10 AM06/20/2007 August 1, 1999 Municipality of Anchorage Department of Health and Human Services Environmental Services Division P.O. Box 196650 Anchorage, AK 99519-6659 Re: On -Site Wastewater Disposal System, Lot 11 Teri #2 Attached are the as -built drawings for the four bedroom on-site septic system for a single-family residence located on Lot 11 of Teri Subdivision #2. Myself, the property owner, completed the installation. As stated in previous letters, there is an existing well on the lot and the log is on file with your office. If you have any questions or require any additional information, please contact me at (907) 696-4908. Thank you. Michael Alexander, P.E. Attachment Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5WG1400,7—Z, r PID Number: OS0751/7 Name: Wastewater System: $i New ❑ Y Upgrade a� Address:ABSORPTION P.o. fox '77330 a % 14�,��- FIELD Phone: 07 6 �..13/ No. of Bedrooms: �J Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Q Total Depth f�moriginal grade: 0.8 GPD/Sa. Ft. Lot:I Block: Sub ivision: --g- 7—, Ter- Depth to pipe bottom from original grade: 2' Gravel depth beneath pipe 5 / /7Q . Ft. Ft. Township: % Range: / Section: ? Fill added above original grade: o S Gravel length: 4- so / / ! • Ft. .2— a-AbeS5w— Ft. WELL:(Fxj��,,� ❑ New ❑ Upgrade Gravel width: Numb' of DistancebetweenlinF Ft. t. Classification (Private, A,B.C): pr't V R Total Depth: 3;0C> Ft. Cased To: Z° 5 3 Ft. Total absorption area: 7 SO. Ft. Pipe matgr al:Q / 1 el' Driller. h Date Drilled: 7131179 Static Water Level: g® Installer: I /� A kwl Ax r Date installed: �s /i Y' 1Jir !l/ /t Ft. -'G ' Yield: Pump Set at: UN XHOW Casing Height Above Ground: 1.5 1�3'�I TAN K GPM FL Ft. Ft. SEPARATION DISTANCES If Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufactu/rgr: �%' k Capacity in gallons: 12--50 From Tank Field Station Tank Sewer Lines ree I , +,n Well- l�� . / 100 -- --• Material: j�,�e1 Number of Compartments: Surface LIFT STATION elm Lot / SQ Size in galls: Manufacturer. Line Foundation � CIO Q,m� vV � -- --. "Pump on" level at:High PIP- evel at: water alarm at: Curtain ��/7 Pump Make a Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: Qd P e i GOrYie r Assumed Elevation: I CF. 00 Ft EAL AF // Inspections performed by: Mrc�a�� 1�.�. Dates: 1st 7-z5-78 9t F°'"' ,24x��,d�, 2nd f Department of Health and Human Services approvals JOHN ARCH WARREN -F, .-�,�-�.•;,.� Reviewed and approved by:Date: ' ` 72-013 (Rev. 9/91) MOA 25 AS BUILT INFORMATION RECORDED BY MICHAEL ALEXANDER, P.E. uj 0 v o 4.1 � F- �'mti JU; Ci: ' 0 L., 0auZF- m�SnN tz..3 z FLOW SPUTTER MOUND BACKFILL MATERIAL TO ALLOW FOR SETTLEMENT NATIVE BACKFILL 4" PERFORATED PIPE WITH PERFS DOWN FILTER FABRIC DESIGN CRITERIA: '—DISTRIBUTION PIPE 4 BEDROOM HOUSE, INSTALLED 1250 GAL. SEPTIC TANK a SOIL=0.8 GPD/FT2 WASHED ROCK, 1/2" FLOW=150 GAL/BEDROOM TO 2 1/2" SCREENED ABSORPTION AREA REQUIRED=750 FT2 DEPTH OF USABLE TRENCH=5' LENGTH OF TRENCH=75' INSTALLED (2) 38' TRENCHES WITH 5' OF 6' USEABLE GRAVEL SEASONALLY HIGH 2 GROUND WATER ip BEDROCK OR ®®®OF A4 ' I, IMPERMEABLE LAYER AW AW 00 ® *• • 4 TH LEGEND ® EXISTING .... ............o..... ..... ........ ..... ......UTILITY...POLE................_.................. ~• '•.01 JOHN ARCH WARREN ®® `� •' t--; ® DRAINAGE ARROW TEST HOLE 0 J, :� CE -8603 : \�`"® ���..- 0 ®®���,FZ,3-No::-g•�C�i .... ...................................®....................................... ........_................... ................................. CLEANOUT......... SHEET 3 OF 3 ON SITE SEPTIC AS................................................ ..................................................... -BUILT LEGAL DESCRIPTION: LOT 11, TERI SUBDIVISION ADDI1ION NO. 2 DATE: 7/16/99 [DRAWN BY: MTA I August 4, 1998 Municipality of Anchorage Department of Health and Human Services Environmental Services Division P.O. Box 196650 Anchorage, AK 99519-6659 Re: On -Site Wastewater Disposal System, Lot 11 Teri #2 Attached is the final test hole log for the alternate on-site septic for Lot 11 of Teri Subdivision #2. The septic tank and field were installed over the past two weekends. The as -built drawings will be submitted within the next two weeks. If you have any questions or require any additional information, please contact me at (907) 688-4908. Thank you. `� �411 Michael Alexander, P.E. Attachment .m GI r ® Municipality of Anchorage . �' - . •° ' ��� DEPARTMENT OF HEALTH & HUMAN SERVICES, e, •, • , 825"L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST j Ir Michael L A xender •:, r c • CE -9781 �w j I n l 7/Z s/98 ` •00 .o���.d PERFORMED FOR: Mlc4ael R'�1 �a4'IG1G Ale—C3lnkr— DATE PERFORMED LEGAL DESCRIPTION: LO% 11 Te (- Z Township, Range, Section: SeG 33 T/Z/ Al R.�� DEPTH SLOPE SITE PLAN 1 2 3 4-1 (FEET) Ci- �g Dal� Br'owro ©.—o,aniC.c� / J 51��� S9�cl9nr� �rr7✓CI 5 6 6' 7 v — 8 9 c 10 G' WAS GROUND WATER /D ENCOUNTERED? 11 S IF YES, AT WHAT L O 12 DEPTH? �p -i o yv, p� 13 E /� E � e � 12-' Depth to Water After Monitoring? Date: 14 15 16- 17- 18- 19- 20 617181920 COMMENTS Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER - TEST RUN BETWEEN FT AND FT PERFORMED BY: IIGhQ�� /� ��° iL Gt )'1 C!� r 1 Z�� ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT 72-008 (Rev. 4/85) CERTIFY THATTHISTEST WAS PERFORMED IN THIS DATE. DATE: 0-7/ — `o ow�es m JPAGE 1 OF 1 SA-� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Svc P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980227 DESIGN ENGINEER: OWNER NAME:ALEXANDER MICHAEL & PATRICIA OWNER ADDRESS:3828 DELORES DR PARCEL ID:05075117 LEGAL DESCRIPTION: TERI #2 IT 11 LOT SIZE: 88514 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 7/10/98 EXPIRATION DATE: 7/10/99 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY DATE: ISSUED BY: f vat o DATE: JUNE 19, 1998 Attn. Laura Municipality of Anchorage Department of Health and Human Services Environmental Services Division P.O. Box 196650 Anchorage, AK 99519-6659 JUN 2 6 1998 'v'u[)1c;Pality of Anchorage Dept. Health & Human Services Re: On -Site Wastewater Disposal System, Lot 11 Teri #2 Attached is a four bedroom on-site septic design for a single family residence on Lot 11 of Teri Subdivision #2. The property already has a well that is permitted with your office and yields greater than 5 gpm. There will not be impacts to the adjacent property wells or septic systems. Surface water is diverted away from the proposed leach field as shown on the plan. The installation will be by myself, the property owner. I have sufficient experience and the installation will be under the direct supervision of a licensed professional engineer. If you have any questions or require any additional information, please contact me at (907) 688-4908. Thank you. Michael Alexander, E.I.T. 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AV �-40���' 01218b3 831113 NM00 SJ83d HIM 3dld (]31V8OJa3d „, 1113NOV8 3AIiVN 1N3W31113S 803 MO -11V 01 lt/12D1dH 7IJA0b8 GNnom d3,kV-1 318d3V483d1N1 80 AOOdG38 831VM GNnoao HOIH 111VNOSV3S Cli M® :"0:0,•. .P z r rn_ cn z N N C 2 r D � zmz rn �� rn z 19 3N3360S ,Z/1 Z Ol „Z/ L `>10021 a3HSVM 3dld 20AO-111dS Municipality of Anchorage . .� DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: &c ite C1r,c7� P'% J )+'ot y1de...r'1 DATE PERFORMED: LEGAL 2 3 4 5 6 7 8 9 DESCRIPTION: t I ! r r Township, Range, Se DEPTH (FEET) g� { y�er✓ �5/t?9i+1 i.�� �lJid (%etr cars�1 pp p�c"ar-C°r grid r -R Ve - 157 Al e' C' n r-0 (III/ CM 11 SLOPE S IF YES, AT WHAT L t' DEPTH? P E 13 rl 7/ Depth to Water After __ Monitoring? Date: fes' 0 rA "n 3� 0in111 iaf/S r E M rr - (ENGINEER'S SEAL) -tion: '3-?, 7-11/ F SITE PLAN 10 Date WAS GROUND WATER ��jj� /yo Net Drop ENCOUNTERED? 11 S IF YES, AT WHAT L 12 DEPTH? P E 13 rl 7/ Depth to Water After __ Monitoring? Date: 14- 15- 16- 17- 18- 19- 20 4151617181920 COMMENTS Reading Date Gross Net Depth to Time Time Water Net Drop i' n rl 7/ 0 rA "n 3� 0in111 iaf/S r E M rr PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER - TEST RUN BETWEEN FT AND 57• 0 FT PERFORMED BY: Wr,hpe- t A {e xoin CrCer I CERTIFY THAT THIS TEST WAS PERFORMED IN ' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) GRAIN SIZE DISTRIBUTI®N Project: Lot 11, Teri #2 % Passing I pecification Location: Perc Test #1 2" Collected by: Mike Alexander 92% Tested by: Mike Alexander #4 Date Tested: 5/2/98 COARSE FRACTION Sieve Size I % Passing I pecification 3" 100% ... 2" 100% 1" 92% 1/2" 83% #4 67% Job No.: Boring No.: #1 Location: Sample No.: #1 Depth: 5' FINE FRACTION -� Sieve Size I % Passing_ Specification #10 56% #20 46% #40 38% #60 30% #100 20% #200 11% 3" 2" 1" 1/2" #4 #10 #20 #40 #60 #100 #200 - — 100% - - — 90% i,.+ 80% i_ 70% }- — 60% ^� { j I opo _i- . , J_ _ i 50% A _ 40% a + i 30% a -LL I 20% TIMT 10% I if -� — — 0% 100.00 10.00 1.00 0.10 0.01 Particle Size (mm) Engineering Classification: SP -SM Poorly graded sand with silt and gravel Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES' 0* 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /1—y<) OqOe- r— DATE PERFORMED: LEGAL 2 - 3 - 4 - 5 6- 7 - 8- 91 DESCRIPTION: Township, Range, Se. PT �1E I ��H F nEE T, 7- SLOPE 10- 11 - 12 - 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS (ENGINEER'S SEAL) ,tion: <- .<_:, 33 7 IqAl pj_4!E: SITE PLAN E WAS GROUND WATER ENCOUNTERED? /Vo S IF YES, AT WHAT L0 DEPTH? Depth to Water After 7-Fi i Monitoring? Date: ®®�� Depth to Water a PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: 6e- r I cvma/e CERTIFY THAT THIS TEST WAS PERFORMED IN r= - � -C� e ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Project: Lot 11, Teri #2 % Passing I Specification Location: Perc Test #2 2" Collected by: Mike Alexander 68% Tested by: Mike Alexander #4 Date Tested: 5/2/98 COARSE FRACTION Sieve Size I % Passing I Specification 3" 100% __...... 2" 82% 1" 68% 1/2" 58% #4 49% Boring No.: #2 Location: Sample No.: #2 Depth: 5' FINE FRACTION Sieve Size I % Passing Specification #10 41% #20 33% #40 _ 28% #60 23% #100 18% #200 13% 3" 2" 1" 1/2" #4 #10 #20 #40 #60 #100 #200 100% 90% 80% 70% 60% 50% 40% a 30% 20% a� 10% 0% 100.00 10.00 1.00 0.10 0.01 Particle Size (mm) Engineering Classification: GM -Silty gravel with sand -. i -T- i ,! — _L i IN _I_, ;A- - -1 - - 100% 90% 80% 70% 60% 50% 40% a 30% 20% a� 10% 0% 100.00 10.00 1.00 0.10 0.01 Particle Size (mm) Engineering Classification: GM -Silty gravel with sand FEB -23-98 MON 17,19 POLAR REALTY Steven A. Johnson P.O. Dox 76 Chugiak, AK 99567 ' Phone: 907-688-3085 FAX N0, P.02/03 0 SOILS LOG SOILS LOG - PERCOLATION TEST d PERCOLATION TEST PERFORMED FOR: Dr. Peter Dohan DAT£ PERFORMED: 10/16/78 LEGAL DESCRIPTION: Lot 11 'ferry Sub. Y2 I SLOP--T SITE PLAN OEPTi 0'— gravely silt, WTIFEE organics (ML) 275 ft2/bm 2 1,5- 10' gray brown silty f- 3- sandy gravel(GM) --- W/ high content of coarse sand and= _ boulders to two feet 225ft?/bmn 4 -' GM - ---' s perc tested frpmn 4.5' - 6.' } 7 8 7 10 10'- 14' very dense 11 silty sandy grave$ GROUND wp GM- to gravelly ENCOUNTERED? PRL silt (GM -ML) 12 300 ft2/bm IF YES, AT WHAT 1 DEPTH? 14 15 16 17 18 19 total depth 14, Q - r o G v if T c4©' NO Is. ` - 0 1 i P�_� EI } Reading Date l Net Time Depth to Water Net Orap 1 10/1/7 30 3.750 2 30 3.250 3 i 30 2.040 4 30 1.500 5 30 1.250 ) t• i �. l f r -t r o G v if T c4©' NO Is. ` - 0 1 i P�_� EI } Reading Date Gross Time Net Time Depth to Water Net Orap 1 10/1/7 30 3.750 2 30 3.250 3 30 2.040 4 30 1.500 5 30 1.250 20 PERCOLATION RATE 24.o (minutes/inch) TEST RUN BETWEEN 4,5 FT AND 6-5 FT COMMENTS average absorption area required from soils lag = 245ft2/bm lot slopes steeply to south p- f1 n PERFORMED BY: Steven A. Johnson CERTIFIED BY: 77 008 17/761 10/19/76 OWNER OF LAND ADDRESS MUNICIPALITY OF ANCHORAGE ��(� ♦ ♦ ♦ ♦ � DEPT. OF HEALTH & �la VIRONMENTAL PROTECTION by JAN 4 1919 A & L DRILLING COMPANY RECEIVED BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 DEPTH OF WELL STATIC LEVEL OF WATER FT, LEGAL DESCRIPTION DATE, - Started PERMIT NUMBER Ended DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. a"�s From Ft. to Ft. From Ft. to Ft. �"�'`� 2� From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From_ Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft Zill-i" M1121 0] 11131111TIPLI DRILLER'S NAME rl U r-4 I I f '-i L_��� Cl F= FA PA CO V+ O Fl CA EE --- DEPARTMENT Or HEALTH AND ENVIRONMENTAL Ph'TECTION 825 'L' STREET, ANCHORAGE, HK. 99501 264-4720 f % I F--- L_KI E. F?_ 1 1 1-T' PERMIT NO. ( 780674 ) ' APPLICANT PETER DOHHN C/O PO BX 197 ER. 694-2588 LOCATION LEGAL LT. 11 TERRY S/D #2 LOT SIZE 88000 SQUARE FEET / MlNIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ���N 1 7* EE X F� I F:;?E:Z'_7-. ����Irl ���;, 3: _1_" ���:Ee. I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED & i—R& _40.0 APPLICANT PETER DOHAN ISSUED B Y MUNICIPALITY OF ANCHORAGE Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section �— Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050.751.17 1. GENERAL INFORMATION Complete legal description TERI #2 LOT 11 Expiration Date: 10 _ tr_Z 0 _0 Location (site address) 3828 DELORES DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) JAMES & DEBRA CIEPLAK Day phone Mailing address Real estate agent 3828 DELORES DRIVE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J �%� •� Date of Payment �ol�la Receipt Number 000175 COSA # C��01 A91 Waiver Fee $ Date of Payment Receipt Number Waiver # COVID-19 259'0 DISCOUNT APPLIED 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 611912020 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 & FWt.S �1 6. DSD SIGNATURE X_ System #1 Approved for A_ bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, F A sit e*: 49 ....• ... • '. Curtis Huffman CE 128991 Q/1 9120k tti 'PROHSS10NA <<<ccccc««r with the following stipulati�ss �� Y OF,q,�r(I"', \\ ON-SITE _ m Rt WASTEVMTFR JJq� PROGf AM ))j))))))))))W)')1,, B l.� Original Certificate Date: 7riS r �y 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 Legal Description: TERI #2 LOT 11 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 7/31/1978 Total depth 300 ft Cased to 253 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/18/2020 Static water level at beginning of test 138 ft. Well production at time of test 3.7 gpm Comments B. TANK DATA Age of tank(s) 13 years Tank type/material STEP -AX / PLASTIC Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping 9/12/2019 — MAINTENANCE D. ABSORPTION FIELD DATA Which system tested (date installed) 8/3/2007 ® ALL standpipes present per record drawing Total measured depth from grade 3_8 ft (max) Measured depth to pipe invert from grade 3.1 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 050-751-17 Structure served by this system _ 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 ug/L ® Arsenic less than MRL (ND) Collected b F & SULLIVAN Date of Sample 6/18/2020 & C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: *SEE ADVANTEX MAINT. REPORT Adequacy test date 6/18/2020 Results M Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 1 in Elapsed time 20 min ®Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons NESComments/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 Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® 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 From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ 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' ® 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' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l 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. TH Curtis Huffman CE 128991�o�'� P OfESSON�'��� ft ft ft ft ft ft ft ft MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE ANIS REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this '7-3 Yj. Day ofc��v�e of 20 7.0 , by and between 'p, vi d -D6�C'tA, , 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) Xb-5 %clans 'D.(. aOgLt Ri4'�r, I� 995-1-t 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. AD 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 tv� Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. M 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. TINi 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 OWNER: By: (signature) Date: b - 23 " 2020 (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this � day of 20.` G, by - OC- SABRA L. GILLILAND Notary Public NOTARY PUBLIC FOR ALASKA State of Alaska My Commission expires:` MX Commission Expires Jan 11, 2023 ` �% ;� MUNICIPALITY:-,---- v� (signature) (print name) (rev. 05/18/2018) Date: (o —Z S --2-0C 0 Title: Page 3 of 3 _' _ e i Q 0 cUl-I _ f . v 0000I?U Ht'L_Ub HAiE I ProportyOwnarIT}uoidngq Previous Operator James &Debra Cieplak Bridging/Ponding_? None/Minor Larry Betts Site Alttlress Frevlous - Contect Phano 3828 Delores Drive, Eagle Diver AK 99577 Current revious Ax 58a Ib a County ID 8 Ppd z RTU HIUL 0 Oete of Leat Inspection AK -113353 SWO70134 209996 RTU 111821 08/08120/8 Retrieve O&M Info Daily flow Recirc ratio Timer settings_ Perform Field Sam pling/ObservatIons NTU (151- NTLIs) pH ((3-9) DO (2-6) odor of sample Typical Z 1 Musty ❑ Earthy J Moldy Non-typicalsul ldo ❑ Cabbage 711 Decay Oily film In ❑ Yes No Foam in tank 1W Yes No Check Control Panel Pecirc Amps Discharge Arrlp9 Audible and visual alarms OK Dial tone (telemetry only) l�il Step Q No inspeot/Clean Pump System Inst Clean Splice Box ................... Float Cords ...................I/I Floats .......................' Pump........................ i Biotube"••' Filter ....... . . ....... . Siotube Pump Vault ............ Recirculating Splitter Valve...... . Comments signature Measure Sludge/Scum Sludcm A im 1stCompartment Ourrent Previous CUrrerit Excessive Bridging/Ponding_? None/Minor 17. Excessive Inspect/Clean Di//scharge Pump System Frevlous 21)d Compartment Current Previous Current revious Inspect/Clean AdvanTex Filter Odor; 2I Normal ❑ Pungent Blamat_. Y Normal Excessive Bridging/Ponding_? None/Minor 17. Excessive Inspect/Clean Di//scharge Pump System Inspect Rlser/Lid ❑ Splice Box ] Host cords ❑ Clean Inspect/Service Other System Components Inspect CIPan Inapect Clean DiSinfectlon Equipment [ Dispersal Laterals/OrifcWT' •^'1 Observations Y Additional Services Rendered n Cleaned textllg shute? ❑ Replaced Ulf Items?' ❑ Rnplacedtused other items? Parts Used: W = Warranty, B m Billable (,/ appropriate selection) W B Item Number Deaerintlon Final/Safety Inspection 1 RSV reinstalled anifold reconnected; flush valves closed S mmary/Reaommendatlons (� System performing; no further action needed ❑ Call for service Date Fax completed form t4 1-066-384-7404 Uds bottod on Control panel reactivated ❑ Tank ncKsds pumpirtl Other? Inspect Clean Latarals/Orifices /E], Pod Bottom ,rt Intake Vent i_, ll)VeCt Clean Floats ❑ �j Pump Inspect/Service Other System Components Inspect CIPan Inapect Clean DiSinfectlon Equipment [ Dispersal Laterals/OrifcWT' •^'1 Observations Y Additional Services Rendered n Cleaned textllg shute? ❑ Replaced Ulf Items?' ❑ Rnplacedtused other items? Parts Used: W = Warranty, B m Billable (,/ appropriate selection) W B Item Number Deaerintlon Final/Safety Inspection 1 RSV reinstalled anifold reconnected; flush valves closed S mmary/Reaommendatlons (� System performing; no further action needed ❑ Call for service Date Fax completed form t4 1-066-384-7404 Uds bottod on Control panel reactivated ❑ Tank ncKsds pumpirtl Other? Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and VVastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-751-17 1. GENERAL INFORMATION Complete legal description' Teri # 8, Lot 11 COSA# Expiration Date: Location (site address)· 3888 Detor`es Dr'ive Current Property owner(s) Mailing address Lending agency Mailing address PhitLip GoLds-tine .RR;:>R 'l]Plnreq T~r'ive Day phone 347-1567 Day phone Real EstateAgent Eve Loken Mailing Add~ess Pr'udent;ic!,- Ec~g[e River' Unless, otherwise reguested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 4 Day phone 689-6476 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Commu'nity On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems APproval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 NorthRim Engineering Phone 694-70;:)8 Address P,FI, Box 7707;:)4 Engineer's Printed Name S-t;eve Eng bedrooms. DSD SIGNATURE Approved for Disapproved. Conditional approval for Date 9/16/10 ,*'"*'_.o ,.'q.~ · · bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: (Rev. 11105) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ?':¢--~C¢,~~ Original Certificate Date: Municipality of Anchorage. Development Services Department Building Safety Division On-Site Water & Wastewater Program. 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type P Date completed ~ Total depth '300 ft. Teri # 8, Lot 11 Parcel ID: 050-751-17 IfA, B, or C provide PWSID #. 7 / 31/7 8 Sanitary seal (Y/N) Y Date of test" Static water level 18 5 Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Cased to -/FROM WELL LOG 7/31/78 253ft. ft. g.p.m. Nitrate 0,10 mg/L Foundation cleanout (Y/N) Date of pumping Well Log (Y/N) Y Wires properly protected (Y/N) Y casing height (above ground) 18" . in. AT INSPECTION 9/7/10 125 ft. 3 g.p.m. · Arsenic: 4,31 uglL date of sample: 918/10 B; SEPTIC/HOLDING TANK DATA Adv(~ntex (p[.ct'stic) 8/3/07 Tank Type/Material Date installed Tank size__1500 gal. .Number of.Compartments~ 2' Cleanouts (Y/N) Y Y N Y Depression over tank (Y/N) . High water alarm (Y/N) R°u~cine Pumper Anch°rcge Tcnk Other bacteda 0 'colonies/100 mL Collected by:. NRim E n 9 ABSORPTION FIELD DATA Date installed 8/3/07 Soil rating (g.p.d./ft2 or ~/bdrm) ~ 5 System type t; r e n c h Length 4 0 ft. Width 3 Total depth ~ ft. Eft. absorption area 9/7/10 Date of adequacy test Fluid depth in absorption field before test 0 5 ft. Gravel 'below pipe 0,7 ft. 2'00 ffz Monitoring tube__Y Depression over field. N Results (Pass/Fail) P c~ s $ For~ 4 bedrooms . in. Water added 600~al. New depth 0 in. ~ in. Absorption rate >= ~)00+ g.p.d. Elapsed Time:~60 min. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT.STATION Date installed nc~ Size in gallons nc< "Pump on" level at nn in. "Pump off" level at, nn in. Datum n(~ Cycles tested, nc~ SEPARATION DISTANCES ManhOle/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. ' SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100' + 100' + Absorption field on lot 'Public sewer main NA Sewer/septic service line 25' + Animal containment areas 100' + On adjacent lots 100' + 100' + On adjacent lots Public sewer manhole/cleanout N~ Holding tank NA Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10' + Property line~10' + Absorption field Water main NA Water service line 10' + Surface water *Wells on adjacent lots 100' + 100' 5' + 100' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' + 10' + Water Service line Curtain drain 50'+ Building foundation Surface water Wells on adjacent lots 10'+ 100' + 100' + Water main N A Driveway, parking/vehicle storage 10' + 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. Engineer's Printed Name St~eve Eng Date 9/16/10 COSA Fee $ Date of Payment, Receipt Number ,, (Rev. 11/05) V-/G -/o Waiver Fee $ Date of Payment Receipt Number ANALYTICA GROUP Northrim Eng Attn: Steve Eng 17237 Bear Paw Circle Eagle River, AK 99577 907-694-7028 Fax: 907-694-7026 Client Sample ID: Sampling Location: Client Project: Sample Matrix: COC #: PWS#: Residual Chlorine: Comments: 3828 Delores Various Drinking Water SP-Analytica, Inc.-Anchorage 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258~2155 Fax: 907-258-6634 Report Date: 9/15/2010 Receipt Date: 9/2/2010 Sample Date: 9/2/2010 Sample Time: 9:00:00AM Collected By: Flag Definitions: MRL = Method Reporting Limit MCL = Maximum Contaminant Limit B = Present also in Method Blank H = Exceeds Regulatory Limit M = Matrix Interference J = Estimated Value D = Lost to Dilution ** = RL higher than MCL; target not detected TNC = Too Numerous to Count - result rejected CF = Confluent Growth - result rejected TCNG = Turbid Culture No Growth - rejected Lab#: A1009043-01A Analysis Method Parameter Result Units Flags MRL Prep Prep Analysis MCL Method Date Date Analyst 4500-NO3E (Aqueous) - Nitrate+Nitrite pres Nitrate-Nitrite as Nitrogen <MRL mg/L Lab#: A1009043-01B 0.10 Test was conducted by: Analytica - Anchorage 10 9/13/2010 9/13/2010 KM Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 9223B-PA (Aqueous) - Coliforms in DW Test was conducted by: Analytica - Anchorage E. Coli Pass PASS/FAIL 1.0 1 9/2/2010 9/2/2010 CW Total Coliform Pass PASS/FAIL 1.0 1 9/2/2010 9/2/2010 CW Lab#: A 1009043-01C Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 200.8/200.8 (Aqueous) - Family Well Water I Arsenic 4.31 ug/L 0.15 Test was conducted by: Analytica - Thornton 10 200.8 9/9/2010 9/9/2010 RM Page 3 of 3 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. cos^# Expiration Date:. GENERAL INFORMATION 'Complete'legal description Location (site address) Current Property owner(s)"'~[x,A~.~ Mailing address Lending agency Day phone Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: ~r ,. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site [~ Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples,) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 ouUined 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. Eagle River Engineering Services Name of Firm I^,.,~£~ VTW Rd., 3u;;~ 201 Address Eagle River. AK 99577 Engineer's Printed Name Phone (,,'~/- ~1'~.~ Date 5. DSD SIGNATURE V'"' Approved for ~ Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: O~.'~f~ ~ '~"~~Original C edificateDate: ,~" / Z~, - {~) 7 Municipality of Anchornge Development Services Department Building Safety Division ~ ' On-Slte'Watm'.& Wa~Jtewater ~-'~-... '_-- :~ .:--_.- ...... 4700 Bragaw Street P.O. Box lg6650 Atw, t~rage, AK 99519-6650 www. munLorg/onsite (go7) 343-?g04 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: WELL DATA we, Data completad~/~lh g Total depth .'~'~0 fl. Date of test Static water level Well production WATER SAMPLE RESULTS: ifA, B, or C provide PWSID #__ Sanitary seal FROM WELL LOG ~, g.p.m. Pame~ ~o: O-~e - 75'/'/7 Well Log (~) d Casing height (above ground) ./~'~ In. AT INSPECTION g.p.m. c._,eli~mm .~- aelonles/100 mL Nllmta ~ m~ ~n~: .~ m~ Dam ~ sam~e: B. S~OLDING T~K DATA Tank s~. ~. ~ ~, Numar ~ ~m~e~ F~a~ d~ ~ ~ Da~n C. ~SO~ON FIE~DATA Other bacteria Date installed ~' / ~/D'~' Cleanouts~N) ~ High watar alarm ~1) ~ Oatek~stalled.~p_,~ SallraUng [~ort~?~) ~ Length ~ ft. Width ~; ft. Graval below pibe t") - 7 fl. Totaldepth~,,~_~Eff. absorption area ,~:xp ~ Monitoring tube.~ Depression over field ,In Date of adequacy task. Results (~Fatl) ~ For ~- bedrooms Fluid depth in absorption field before test ~ in. Water added ~ gel. New depth.~ in. ELapsed Time: ~ min. Final fluid depth ~ in. Absorption rate >= b, oo g.p,d. Any rejuvenaUon treatment (past 12 mo.) (Y~& type) A/o If yes. give data D. LIFT STATION **-.: - * -.Date installed - - - .Size in g~iio~'~ Pump on' level at in. "Pum ~m level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic servioe line Animal containment areas On adjacent lots 4- I (2 ['} ~ On adjacent lots 4 I~I-~ ~ Public sewer manholelcteanout Holding tank ./ ~c~ ~ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation -t-' c;, Property line t-~ ~ Absorption field '~ ~ Water main -~ ~ ¢) ~ Water service line +' I0 ~ Surface water +-t OO ' Wells on adjacent lots .~1~0 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properlylire- '{' IQ' Building foundation 4 Io~ Water main -~ Water Service line ~c* f t~~ Surface water 4 !/30 ~ Driveway. parking/vehicle storage Curlain drain -~ ~ o ' Wells on adjacent lots '~-I 0 o ~ F. COMMENTS --~/.t.~, ~4,~,od~- .f~.~,-,~ . --- , . , CATiO. I ~ that I ~ de~rm~ t~h ~ ~s~s a~ rev~w of Mun~l m~s t~t ~ a~ sy~ ~ in ~ ~ '~ ~ ~ma~ ~ U~ C~ gu~.~s ~ eee~ on ~hi= dam. ~~~ ..,. , COSAF~ S ~$0 ro¢~17~ Wai~rF~$ ~_ i .~ip, Numar qCg~5 R~i~ Numar (R~. 11~) Z SHED DICK [NTRY GRAV[L NTRY UNO[R: 30' 30' ANCtlORAGE RECORDING DISTRICT ASBUILT OF: TERI SUBDIVISION ADDITION NO. 2 LOT 11 PLAT 73-177 SUP~,VEY CERTIFICATION: I, John L. Schuller, have . counucted a physical survey of this property as shown on this .,drawing and ~at the improvements situated thereon are within me property lines and no encroachments exist other than noted. t~XeCL. U. SION ~NOTES:It is the owners responsibility to determine existence ozany easements, covenants, or restrictions which do not appear on the recorded subdivision plat. ,Under ,no~ circumstan.ce should any information on this drawing ye ~usea ~.o.r .c.o. nstructmn of fences, structures, improvements, or mr estanfisning boundary lines. WORK ORDER NUMB£R: I AUG 6. 2007 I 1 -40 07--065 I I JLSI NW1258 0702/04