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Zed Lot 1 #051-031-64 _ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www d.anchorage ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. O C9 3 G PID Number: O,! 1 - 031 - (- y' NMp. JOSHUA RAY Wastewater System: ❑ New ❑ Upgrade /ula•N PO BOX 770103, EAGLE RIVER, AK. 99577 ABSORPTION FIELD Pe'1e 907-242-2485 Numb•r of e.aoom• 3 O D••D morn O SI,iii r Tlatc, O e<a O ltl e VI otrw LEGAL DESCRIPTION 0 Mom mm on, Mme` GP " a FI t71W La 1 Supnvwm ZED SID Dwi o P" mom trap •paoM 7•p• Gra..l Wtp b•1wm pp 2.25 FI. 0.25 F, Tow." RYIp• 5«00,1 Fe mw•eDN DVniii W1 Grly L"M 3 Ft. 30 Ft. Well: New ❑ Upgrade GNMI wWl Hump« d M1•• M P4YKe MM•n NF 1z F, 4 3 2 FI CM•NBCNa1lPngro. A B. C) 7"DwO Caw b TMM apwrom MN Fps MM PRIVATE 61 Ft. 61 Ft 360 FIT ASTM D3034/F810/SCH.40PVC D -W DM•Driw St Ww L•w INtrw D•M M•ti,w SULLIVAN WATER WELLS 5/15/08 8 Ft OWNER INSTALLER 6/13/08 V.4 25 PumpS t 40 C,*tv N•pp1AWw GpM 2 TANK GpM lid FL SEPARATION DISTANCES 0Septic ❑Holding ❑S.T.E.P. ❑Other. To Septic Absorption Lift Holding lubiciPrivate •tlw« •Gly From Tank Field Station Tank Sewer Line PREMIER PLASTICS 1000 Gr wa 112' 14T 123' �1 I p(J 4 MM" HDPE N.W dao Cq•m1•m• 2 ew7•c•wow 100'+ 100'+ 100'* LIFT STATION u• LO1 t"' 75' 69' 79' 550 c.l PREMIER PLASTICS f011e•Oan 15' SO' 25' 'Pwnp arr l M 44 'Poop •Ir W. n 38 H%w•I« MMm M as „ M C~ DNn I NONE KNOWN Pump M." MDe•I ENorIFM BRp•NM1• p•n by BLASTER20EB05 At ELECTRIC LLC RwnMN CONDITIONAL APPROVAL. TANK MONITORING TUBE NOT BENCH MARK lauton •nD Dewpupn INSTALLED DURING CONSTRUCTION, WILL BE BOTTOM OF SIDING @ POINT A INSTALLED IN SPRING WHEN ADDITIONAL FILL IS �Trowlun x(77✓ I FL ADDED. Engineer's Stamp Inspections performed by: Dates: 1111 6/1=8 `LIVI4% 6/13/08 `tet 0 ; Y,va 2n° .� 4 Development Services Department Approval ��c; `,' °..�`�fyca Conditional ApprovalDate: IL + r'� • r e -6-0q tto. 1417.e - A ` � " Reviewed and approved by: Date:? •' � ` • IRM Oltnl t V`.+v- Municipality of Anchorage Development Services Department • Building Safety Division On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.d.anchorage.sk.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: O D 0 3 G PID Number: D✓ , 031 - & 194 r.m. JOSHUA RAY Wastewater System: 91 New ❑ Upgrade AOh1N PO BOX 770103, EAGLE RIVER, AK. 99577 ABSORPTION FIELD Prwr 907.242.2485 teetw of bedooms 3 O DW Traxm O sway Tl O em O ii; e O 0aw LEGAL DESCRIPTION moo oam W"a,P. z0R� cvdF 0 txw La 1 SuPbwaon: ZED SIDDeem a l,Ps Poeom bvm apnM tF,o. G, w e.pm e m pya. 2.25 F,. 0.25 FI TownMp Rags S.CtOe. FM M abow plena Pr,P, Grew L.rgvi 3 Fr. 30 Fl. Well: ©New ❑Upgrade onw wam N.1w0 , aaaa. wwsen an 72 FI, 4 3.2 Ft Crnnu (Pma.. A e. C). Tar 0"m Gwe r Tow sb, r., Pp. Mitt" PRIVATE 61 Ft, 61 Ft 360 Fe ASTM D3034IF8101SCH.40PVC Oma Ow Dere St t Wna L.wl WWw Dn. aparo SULLIVAN WATER WELLS 5/15108 g Ft OWNER INSTALLER 6113/08 vra P40.;PS.Ia C2&" trprll •oo.. Gapq 25 2 TANK GP„ Ft. Ft SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Uh Holding lubl.dPrivatty '" iQuiOr ,air. From Tank I Field Station Tank Sewer Urge PREMIER PLASTICS 1000 G„ WOO 112' 147" 123' I 4 Mnaw Nr w a CpeDatnax. o15 HDPE 2 swimw,rr t0e+ 100'+ 100'+ LIFT STATION 10t L. 75' 69' 79' 550 Gr PREMIER PLASTICS 'Pump Pn rw sl 'PumpW W. Wen w,w slam,l Fp tm 15' 50' 25' 44 n 38 M 48 „ cunanonn NONE KNOWN Pump M.k. a MaeM Erana 1mpa9m. P.11arnl.o by BLASTER20EB05 At ELECTRIC LLC Ft~, CONDITIONAL APPROVAL. TANK MONITORING TUBE NOT BENCH MARK L t.w D.Wlpton INSTALLED DURING CONSTRUCTION, WILL BE BOTTOM OF SIDING Q POINT A INSTALLED IN SPRING WHEN ADDITIONAL FILL IS r",Wn �T r�b I Ft ADDED. Engineers Stamp Inspections performed by: Dates: 1 M 6113/08 f %'tt � 2n° 6/13/08 C'. Development Services Department ApprovalIL ~.� .•'��} `srvir Conditional A royal PP —Date: 3- 'O r .. »...i... ............ » - ort A.::tc}a <1`. 1407 Reviewed and approved by: — nate: r ••�� „_� PERMIT NO. SWO80036 PAGE 2 OF 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www.ci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, ZED S/D P.I.D. NO. 051-031-64 LOT 2 LOT 1 ' ---- 1 F----- ---- , i ♦THN1 NEW I.D.S.F. BM FV4 '- ------r ux[ A NEW BEDRO�I MT2 x. — ST2 TIL. ...3.. HOUSEOM... FVI A MTI MH iFC 50' CURTAIN '�, THM3 `CONTROL DRAIN SETBACK'i I -to' MIN. PANEL (� rALT. SITE B NEW Z LLON JNEW i HDLLON PE tS`OEPTIC00 ATANK ATHb2 ' NEW 550 GALLON FAT ALBERT HDPE S.T.E. P. TA K J 'I - I' `RESERVE AREA PER PLAT 2003-154 LOT 2 AIR /GUAGE COMPRESSOR, AND ALARM /INTEL N� W I" - 40' ,4 f { L p I• e,p•«• ••4•«•M{U• t .4obo A. LSolm ; �y.", ";;• �. 1437-2 ,4' 4- 4 PERMIT no. SWO80036 PAGE 3 OF 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone= (907) 343-7904 • www.ci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, ZED S/D P.I.D. NO. 051-031-64 / I I I I I I I I / OO I j I I 1 I I II I I 1 I1 I I 1 LOT 2 LOT 1 co L� .. IIRTYX RUN pRIaEW AT .I I I I 1 AIR `CSSOR, GUAGC E ANO 1 ARY LOT 3 ♦TN/1 NE,W I.O.S.E. I RN 1 IN NK 11[N, rr �IR QST 'STfi .. ..•Y'BCOR00Y...:. GARAGC P ELLEI I I� yT HOUSE I k1 YTI YX 50' CURTAIN IIS IINL! —CONTROL DRAIN DRAIN SETBACKm' N . rALT. SITE ' PANEL ,aJh I . NEW 1000 GALLON I a TANK S`CPRCG4L I, 1 HDPE ON I ATNIZ NEW 5X0 II EAI ALBERT NERC 8 I 1YII �I I x ; S.i.[.P. I K �I i I N `RCSME AREA PER PLAT 2005-154 Ftjy c LOT 4 1 LOT 2 V - Rp'i I {L�,Ep AMP I _ ` At YO •........Q sfi92� vrt� A. GORE yW pPyW #7 V Q C A••NM.. ♦�4`� A.L �Rf?c=gc nN�• �� PERMIT NO. SW080036 PACE 4 OF 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www.ci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, ZED S/D P.I.D. NO. 051-031-64 REL TO RC MODE T PROVIDE ADEOUATE COVER INSULATION &M, 96.7' MTI =98.7' hlTl = —� FINAL GRADE 107.9' 9-----F NEW 1300 GAL. I `�yi DISCHARGE PIPE POLY. TANK II 96.4' 550 GALLON FAT ALBERT WITH PUMP ASSFNIB Y FINAL GRADE A1T2 hIT2=96.9' ------ ---------- mTRRJ YR 109 �w R DIST. LINE=96.2' -J A GROUNDWATER AT 91.9' 87.9' B.O.H. FILL TO 6E-IADCD TO PROwDC ADEQUAT64MER CRADE=93.9' MT2=95.9' BOTTOM OF SAND=93.9' N. T. S. frti�11 I AS -BUILT I hereby certify that I hase surveyed the following described property L— :.•J 1 Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no toddways, transmission lines or other visible easements on said property except as indicated hereon Dated at Eagle River, Alaska this1 av of __7 •' P ` 2007 ROBERT C. JOHNSON I.:'.r SCALE: Registered land Surveyor No ARO -LS 1" - ;, f-� • &,x 77-04* Eagle River, Alaska 99577 Phone (9(7.r) 6Q4-2543 Certifteb �rttting log by DOC CO. da SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 688-2759 OWNER OF LAND: i OSHU19 �AI ADDRESS: T LEGAL DESCRIPTION: Z FI) L o / DATE: PERMIT NUMBEI`6(J6 H�Ck�E. Date of IssueM2__q_= OB TAX IDENTIFICATION NUMBER: 0-7, - 03 / -� Is well located at approved permit location? C O No Method of Drilling: ' air rotary O cable tool Depth of well: v ( �,,,, Casing Type�_Wall Thickness sem��_inches Diameter // Inches, depth 46'1 feet Liner Type: N4005' Casing Stickup Above Ground: o� feet Static Water Level: (9 feet Recover Rate: �gpm Method of Testing: Well Intake Opening Type: u4n end O open hole O Screened; Start feet Stopped feet O Perforations Start feet,r�Ined feet Grout Type: (3FOTN / 7Eyo0me7P Depth: from 4!�' feet, to A.0 feet Well Disinfected Upon Completion? 61yes O No Method of Disinfection: t_'114ae1A/F .SPM Comments: (.'/9..r/AJC J2774'M110 �j Driller's Name GD L F ,� U4Q UAn-1 ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. �/LLI iVV� YI.V• •�� ��� �� � �• O�bP� �rvicts De�'t�^t tliviston .• :: `•� ewow progrM :•TY aim �j�00 g� Street SA a•. P.O. Box 196650 Mchorage. A,( 99519-6650 Mr PYV Pump Installation Log Wen DrildoE permit Number: SW, pareel IdeatifieaDO° Nom' — Pump Iustall2tl0a DatC Pump U aUc Dtptk Bek + Top Of Wca Cjw'Pi- W � feeA _ �_—artarees Nawf-- PO 4'L pump Model: F -P 32J;( -1C' Pump Sim �-1 by Pide%A,UpterBarWDM*:I j Sect Piths Adapter' Maautaetarer's Name: P,tk='4a2Pwu5bDw D(.vn2/' We0 Dfslaieesed UP" Cespled"O dye, 0 140 Method of DMnfeeiioa: C,pmraeats: Date of Issue- -7 jj ds Z -e4 c�a Papp Ia:talNaaaC 5�6 �"� Qw �eLf S l -U Boy f�7o�7Z Atteetion: The Pump installer sbaU provide a parOP josu0aboo tog m the DSD .:Wa 30 days of Pump bL=1360 ' Feb 24 09 09:32a Scott (907) 746-5052 p.t Al EMabk ILC PO Baa "4 Palmi, AN "SO A7 LE ttC l9ar)7a63011 2/24/09 To Whom it may concern: Al Electric has Inspected the sewage lift station located at L3 Zed subdivision and found It complying with current NEC electrical codes. Al Electric's specialty contractor license number Is 31866. Sincerely, scoff W rtanen Al Electric MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW080036 Legal Description: ZED LOT 1 Design Engineer: 0003 S & S ENGINEERING Owner Name: JOSHUA RAY Owner Address: PO BOX 770103 EAGLE RIVER. AK 99577 - Date Issued: Apr 29, 2008 Expiration Date: Apr 29, 2009 Parcel ID: 051-031-64 Site Address: NHN KNIK VISTA DRIVE Lot Size: 50415 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field Q 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 construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE ENTIRE SUBSURFACE DISPOSAL FIELD IS NOT WITHIN A 30 FOOT RADIUS OF A PERCOLATION TEST. THE ENGINEER NEEDS TO DO AN ADDITIONAL PERCOLATION TEST PRIOR TO THE e CONSTRUCTION OF THE SEPTIC FIELD. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING ON-SITE REVIEW AND APPROVAL. SAND USED SHALL HAVE < 2% PASSING THE #100 SIEVE AND < 1 % PASSING THE #200 SIEVE. A GAUGE AND AN AUDIBLE ALARM MUST BE ADDED AFTER THE AIR COMPRESSOR TO HELP ENSURE THAT WHEN THE PUMP GOESQ.Uf, REPAIRS WILL BE MADE. THE ALARM WILL BE ON A SEPARATE CIRCUIT. 1 Received By. Date: J� Issued BY lrl�w� Date: 2a g Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. b51' b31-(oL1 Property owner(s)�(.- (pYS�I_ Mailing address r1160X -;�701,0�; �j �I)' c Site address A 1 o& Ur Sa Legal description (Sub'd., Block & Lot) Z-01 Legal description (Township, Range & Section) Lot Size �!l , U 115 Sq. Ft. THIS APPLICATION IS FOR (Z all that apply): Absorption Field V Upgrade Septic Tank Renewal ❑ Holding Tank ❑ Privy ❑ Private Well V Water Storage ❑ (phone Qy� �ygs Code q,%5777 Code Number of Bedrooms 3 THIS APPLICATION IS AN: Initial V Upgrade ❑ Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: - S Waiver Fees: Date of Payment: 24 Date of Payment: Receipt Number. 90—W0y507b Receipt Number: (Rev. 11/05) ROBERT C. COWAN . 11G CIVIL ENGINEERIgG 77 March ' PH: 907.694-2979 E FAX: 907.694.1211 MUNICIPALITY OF ANCHORAGE Development Services Department 1[A,14MJ7W"" P.O. Box 196650 APPPIQW 5 Anchorage, AK 99519 REFERENCE: Lot 1; Zed Subdivision SEWER&WATER MWEx1Emx" It is requested that you issue a permit to install a new well and a new I.D.S.F. septic system to serve the proposed three bedroom house on the referenced property. � C'�1ER Two test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. At the time of excavation on 8/19/03 water was found at 8 feet, and after monitoring ground water for seven days water was found at 4.4 feet. Ground water was recently monitored and was found at 3 feet. E4m4EERsaaluacs NwREPORIs We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The WEuravEOnor, construction of this system will not prevent any future development on any of the adjacent afLOWUST properties. If you requir ditional information, please contact us. SITE KNIS Sincerely, Ruwo[s1c4 rt hafer, P.E. S jj 5G% TEST Enclosure PF1A:OlAIiON TEST 81RUCIN14 a MEC+wa WECIK 4 04511E WASIEWAIER Db mq MUM Okw4 15861 S. Birchwood I,dop Road - Chuglak, Alaska 99567 ---------- C� f _ ='a' ` r KNIK VISTA DRIVE •..r ' .� � -s�.�� 35' ROW A0 --------------- LLJ nt ply 0t3pHbd)CD> ice-' (� - c 0 .Opt (/') M W00o W U ~ZO mo! \ m LL._ _ o �z� [—� m>2 OI - =n CL LLI O F�` OOQ JWW Onoo� NOW omo OON N_� m0 ^ 2� �( WL1W Om= 00, ZO 0 1..1... 0013 Um4 d U31r Z N` now U U I N^, JO I J -Yf� - OW 00 fNaW CZ f� OZ r OZU \\ L M - I W oJa \ � U I � au1Wn t �. n,. 1 Z N OSYWO \\ S 1 = NWa TWO C = 1 Ir Nm a0,: Wp \\ a - 1 LLJ a� oIn \ ..-- t Imo.__._..__T"_----.----- a N E"0000 ---- Ln uu 0 N O vi N W O J N z N Q mII O =Z—W o cr NL. U) m J V1 �..' N Z K NIY2J0 NIYl?1l1J� w OoO JNO Q MVl V— W OOW tT Fr . KW d CL >v WW a' > LJ a_ v� o v d4 w•1� Ynn W< t< W O E-1 E �•z WOWOZ o: 3 O 0NQ z N O - � itl Jti Ob = „L NOIS30 NVId-3115 O 0 N �o n goo' ^I poi 'sem= M Q Q — ------------------ 1r.4 �'• �< 0 p 0 LJ ~ L,: deciLL; U�(no OONN _— oa .-- W < KNIK �s> �. 3 M � ax opw W U"'w m C.7m IIOII as . 0F< N umo wQla W f7 ;mJON z UJw0y10Z 02 3o m ¢ O �d'r�ba) is O uoa3 a O 0 N �o n goo' ^I poi 'sem= M Q Q N a Y 1r.4 �'• �< 0 p 0 LJ ~ L,: deciLL; U�(no OONN N .-- V U -)N O ONIp Z �. 3 M W opw I I N I I U"'w m C.7m IIOII as W ; N EL w2d w N l� Oocwil wQla W f7 ;mJON z UJw0y10Z 02 3o Q Mlna is O N O .-- M a N� .09 = 11 TISTA DRIVE 35' ROW M t` N N 2NW W J W — W = v > Z �. 3 W (� J Q W opw a U"'w a>� N�w L4 W M m>v W ; N EL w2d CL a U Q W Oocwil wQla W f7 9`0e z UJw0y10Z 02 3o Q OOLn NNO .--i O N O .-- M O � IV'K .09 = 11 TISTA DRIVE \ ------------ 3 35' ROW 0 N 2NW L ~at- tH 30>-p �. 3 O (A' >- a NOD JN U"'w I -z0 m>v Spa EL w2d Oocwil f- O N-ir 9`0e z 03a J z - O yY 'al o7.w 2y \ [� E- zz- O \ OyO \ ------------ 3 E-\ E- O O 1 a z � o 3 yon - O o7.w zz- OyO dwo <su N9IS30 NVId-3115 W z_ W i 1 1 4 i�'•���s lf' �IS o 40 =0 1 ;oin Y 4 Q KIY...,, 1 • • i 1� l���i a z i �:v;:,s 1. 0 1t' 0 � � I 1 v d 1 z Y 1 1 O� 1� +' O 1 _,U Ud O J Ir a I ON O ZO p I�d Wr- a 1 p ttOx O 1 I J y Q N W 1 r) M �Ja U S Q i Q 11 Z.a-Oz - I v .l 0063 a z a 11 J TI' 00 d �I W 0rl Q 4H ii V U Z 1 N 04 M 3 IWi1 7 _� a i U I 2 Zm F VI Kr I N a Q o W J Z 1 4 ����YgggJJJ N � G N _ 1 " JC 1 1 .. m Cd L 1 zm Z_m 1 KF Z �w O O r X 1 OS m 1 0 2 N 7 / U O 1 y ? p i z a o C. • P 1 3 .f, Y 1 o"x 1 Ol 4_ 1�'I e ;vj� s = „� NOISM 311Joad /D/Z Municipality of Anchorage Development Services Department Building Safety D10slon �,. On-SitoWater and Wastewater Program - 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 995 M6650 W%W cf.anchora— sk.ve (907) 3457904 Soilss Log - Percolation Test Performed For. f(j/yi/J/%/��� �/ Date Perfa Legal Description: L O �' �O S ownshlp. Range. Section: (r{vl- r-, I Cottle q cTr iD -ra Qsy, EKlSr1Aj% (r --W) G-0,14 8- 10- .` 1 1 20- r WAS GROUND WATER ENCOUNTERED? y,Q —5f a WYES.ATWII4,TDEPTH7 � L D.pthro Wabr Aho Monllodng? .4/ �� E ; ,5� 3-1703 Dal. /C 2,3 0 3 -r-14 K/ IPA Woe A Sbd.. Il,. 14:71 S -i h r7M.r~��M•l�f�s- Pr,� •ro3 *eading Date Cross Time Ne(rime Depth to Water Net Drop at 3 �•P ►vt 3a rlrii7 /X " 6:30 � ►priN /3'2" G r PERCOLATION RATE It:>—p" TEST RUN BETWEEN Q FT PERFORMED BY: jf2c//q 4 PERFORMED IN ACCORDANCE WITH ALL PERC HOLE DIANIETER FT 'N-- CERTIFY THAT THIS TEST WAS IN EFFECT ON 7H1S DATE. DATE: • Municipality of Anchorage Development Services Department Bullding Safety Division a„r On•SilaWater and Wastewater Program 4700 South Bragaw SL P.O. Box 190650 Anchorage, AK 99SIMS0 Ww CI emohMao nk.us (907) 743-7904 / Soils Log - Percolation Test Performed For. i/ , �/!/ice/Z P✓ Date Fork Legal Description: l—O i- Z e S h Townshlp, Range, Section: Depth ft 1F dt 2- IRC 3- ' f "9C - 4-�f lokl;loss• < 6• "• l: • 7• v 8• � ? 9- 1a 11- Site 6-41- F'Lc CUWCreiO TV G-wceyu570 g.O.%A• Me ig WAS GROUND WATER ENCOUNTERED? w 7 a IFYES,ATWNATDEPTH7 �� L DapthbWaur Marw a Ir O .--f[�—f�•� P MonhorN9T E >t Date*, 3 3-17-04 PERCOLATION RATE TEST RUI OMTEN PERC HOLE OLAACTER , FT _ i PERFORMED BY: /G /1 CERTIFY TNATTHIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND Ft Z t A UNES IN EFFECT ON THIS DATE. DATE: • » ; 1$• ti n A Shat. 3 ' ig WAS GROUND WATER ENCOUNTERED? w 7 a IFYES,ATWNATDEPTH7 �� L DapthbWaur Marw a Ir O .--f[�—f�•� P MonhorN9T E >t Date*, 3 3-17-04 PERCOLATION RATE TEST RUI OMTEN PERC HOLE OLAACTER , FT _ i PERFORMED BY: /G /1 CERTIFY TNATTHIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND Ft Z t A UNES IN EFFECT ON THIS DATE. DATE: S& IIEN T1I4R Pq TT APPROnNs SEWER E WAEn E VI TE161 6EWER6 WATER IHSPEc110N 11L MEIWGSILQE6 NWWP T$ WELL WSPECI" {PLOW IESE 6REPWIS EIDADDES"I 50k TEST PEICOlAWN TEST 61RUC1 AW 6 "(DWaCK MPECIIDNS ONSITE WASIEWAILA D6P06N6W1E1A DESIGN ROBERT C. COWAN CIVIL ENGINEERING PN: 907.694-2979 1 FAX: 907-694.1211 INTERMITTANT DOSING SAND FILTER SPECIFICATIONS Lot 1; Zed Subdivision March 18, 2008 GENERAL STATEMENT OF WORK The work and plans covered by these specifications consist of furnishing all labor, materials, tools, transportation, and equipment necessary to complete an Intermittent Dosing Sand Filter system as described herein and on the attached drawings. All work under this project shall comply with current Municipality of Anchorage (MOA) Regulations. The scope of this project includes the installation of a new I.D.S.F. septic system to serve the proposed three bedroom residence located on the referenced property. SITE INVESTIGATION The Contractor must carefully examine the project documents, have full knowledge thereof, have investigated the site, and be satisfied with the conditions affecting the work. Conditions include, but are not limited to those bearing upon transportation, disposal, handling and storage of materials, availability of labor, water, electric power, roads, and uncertainties of weather, physical conditions at the site including all underground utilities, the conformation and condition of the ground, the character of equipment and facilities needed preliminary to and during prosecution of the work. The Contractor must be satisfied with the character, quality and quantity of surface and subsurface materials or obstacles to be encountered. Any failure by the Contractor to become acquainted with the available information will not relieve him/her from responsibility of performing the work as stated in these specifications and drawings. Location of utilities will be the contractor's responsibility. 15861 S. Birchwood 1,6op Road - Chugtak, Alaska 99567 Pape 2 Lot 1; Zed Subdivision March 18, 2008 SEPTIC TANK/ LIFT STATION /AIR COMPRESSOR A. General The work under this section consists of the performance of all operations pertaining to furnishing and installing the septic tank/lift station, air compressor and piping to the sand filter. B. Materials 1. Tank a. Septic tank shall be a two compartment tank of at least the minimum size indicated on the drawings and MOA approved. b. First compartment shall have a separate 4" pump -out riser. The second compartment shall have a separate 4" pump -out riser. c. HDPE septic tanks are required to have a 4" monitoring pipe installed next to the tank extending to the bottom of the tank, a minimum of 2" direct burial insulation, and a maximum of 4 feet of cover. 2. Manhole Riser or Lift Station Tank a. An additional second compartment manhole riser shall be capable of being equipped with the following: 1. A junction (Nema 4x) box or equal, bonded or attached to the pump basin. 2. UL listed electrical cord grips, installed in the J -box. MR b. An additional tank (M.O.A. approved) may be provided for the effluent pumping assembly and the items in (a.) above. 3. Effluent Pumping Assembly, Controls, Alarm & Piping a. Effluent pumping assembly shall be of approved materials, including the following: 1. A 110 volt or equal U.L. Listed effluent pump. Page 3 Lot 1; Zed Subdivision March 18, 2008 2. High-density PVC cylinder housing the pump, with level controls and screen, serving as a baffle to prevent the screen from clogging. 3. All piping shall be PVC or other non -corroding material. b. Pump controls and alarm system shall be an approved system with the following options consisting of: 1. Event counter 2. Elapsed time meter 3. Program timer 4. 10 watt heater 5. Remote alarm panel option with a minimum of 80 DB sound pressure at 24", operating temperature 30AC to 65AC, continuous sound to be located in the home. 6. Oil -tight visual alarm with push -to -silence feature. Automatic audio -alarm reset. 7. 15 amp motor rated toggle switch, double pole, double throw with three positions; manual (man), automatic (auto) and center (off) (H.O.A.). 8. Nema 4x -rated, fiberglass, or equal, enclosure with hinged cover. 9. All controls to be installed as per manufacturer's recommendations. 10. Control panel to be installed on outside wall of home within sight of septic tank/lift station. c. Piping from the septic tank to the sand filter is to be 1 1/4" PVC schedule 40 solvent weld piping properly bedded as described in Materials Specifications and sloped to drain back to the lift station. Insulation board 2" thick and 2' wide centered over pipe is to be placed where soil cover is less than 4' depth over pipe. Page 4 Lot 1; Zed Subdivision March 18.2008 d. The airline from the house to the filter is to be HDPE insulated pipe 3/4"-2" SDR -11. The compressor will have a gauge (0-10 psi), a low pressure alarm, and be extended into the living area or garage for easy monitoring by home occupants. 4. Air Compressor a. Air compressor shall be a THOMAS LINEAR SERIES model number 5060-A or 5070V -A or M.O.A. approved equal. CONSTRUCTION SEQUENCE In order to insure proper installation, the system is recommended to be installed in the following order: I. Sewer line from house to tank H. Septic tank/lift station III. Sand filter IV. Leachfield bed (if required) V. Final grading CONSTRUCTION 1. Construction Instruments Contractor shall provide instruments such as transits, or levels, for establishing proper elevations and levelness of pipe or materials. 2. Pipe Laying All pipe shall be laid with material free of large or sharp rocks and organic matter. Each section of pipe shall be handled carefully and placed accurately. The spigot end shall be fully inserted pointing in the direction of flow and glued in place to make a water tight seal. Page 5 Lot 1; Zed Subdivision March 18, 2008 Each section of pipe shall be properly supported to insure true alignment and an invert which is smooth and free from roughness or irregularity. At all times, when work is not in progress, open ends of pipe and fittings shall be closed so that no undesirable substance will enter the end of the pipe or fittings. 3. Bedding of Pipe for Sewer Lines The pipe should be bedded with materials free of large or sharp rocks and organic matter, compacted. Native materials may be used as back fill material above the pipe, provided it is free of large rocks and organic matter. All lift stations shall be installed in accordance with the manufacturer's recommendations and standards. Electrical installation is to be in accordance with the National Electric Code (latest adopted edition) by a licensed electrical contractor, with M.O.A. inspection where required. If MOA inspection is not required, a licensed electrician is to provide a letter to the Engineer stating that the system meets or exceeds all applicable codes. 4. Excavation Excavate to proper depth to allow gravity flow, install tank level, tolerance 0.05 foot, on undisturbed or compacted classified sand fill material. Create a level sand surface over the tank and add 2" burial foam +35 PSI directly over tank. Mound unclassified soil over tank with a minimum of 2 feet of cover and anti -flotation weights that may be required in areas of shallow ground water. 5. Connections All connections to be as per MOA requirements, PVC 3034 piping with Caulder or equivalent couplings for inlet riser pipes. All tank connections are to be completely water tight. Pape 6 Lot 1; Zed Subdivision March 18, 2008 SAND FILTER The work under this section consists of the performance of all operations pertaining to furnishing and installing the sand filter. A. Materials 1. Sand Filter a. Liner (if required - not required for bottomless sand filter) - OSI Model LI or equivalent. 30 mil PVC cut and fabricated to provide water tight enclosure of filter sand volume. Seams to be permanent as per Manufacturer's recommendations. All connections, such as boot flanges, through sand filter to be permanently bonded to the liner. b. The Contractor shall provide a washed sand to meet ASTM C-33 Concrete Sand Specifications with the additional requirement that all but 1% of the materials passing the #100 sieve be removed. All sand shall be approved for use by the Municipality of Anchorage (M.O.A.). if the sample does not meet specifications, all sand will be removed and replaced. c. The Contractor shall be responsible for providing pea gravel that shall be a washed material containing no fines (0% passing the #100 sieve) and a maximum size of 1/4" diameter. d. The Contractor shall provide the manifold assembly. The manifold assembly shall be of approved materials with orifice shields and flushing assembly. All drilled holes to be cleaned of buns and pipes flushed, prior to assembly. Flushing valve to include riser to finish grade. Lateral distribution piping is to be laid level (@ t 0.05'). e. Top of the filter box to be insulated with 2" direct burial polystyrene insulation. f. The Contractor shall be responsible for providing filter fabric. g. Air coil in sand filter to be geofiow WF16-4-24 150 LF placed 6" above bottom of sand. Pape 7 Lot 1; Zed Subdivision March 18, 2008 Construction of Sand Filter The sand filter construction is to follow procedures as outlined below, as applicable to this design. Pea gravel and filter sand are to be hand leveled to proper depth (tolerance within 0.05 feet) in filter, taking care not to allow mud or fine soil material into the filter or gravel layer. This would include any soil material picked up by excavation machinery buckets while loading specified material. The Contractor should estimate filter material volumes such that allowance is made for wastage of material in contact with the ground at site. The area over the sand filter to be finish graded with a minimum of 2 feet of cover and to prevent ponding of surface water runoff. Side slopes shall not exceed 3:1. The Engineer will reject any sand or pea gravel that does not meet specifications or is contaminated in transit or while handling. If such material is placed in the filter, all soil material may be required to be removed and replaced with new material. CONTRACTOR / INSTALLER Z ��Ell owyl� - o zed / i n'see 1l 1 e d Se Vc ✓C(l S1/STtrv�S %h 1 dal�o cJ�t�r�� I 4-v,C 1045 O� I0 years on 0 !fie �„s�1le' fiG� LrAGnor4�/� /' /c,.'rllSccK7�'C `p(�C �L 3 • Municipality of Anchorage On-Site Water and Wastewater Program < ` (907)343-7904 i t. Certificate of On-Site Systems Approval S`p t _9 7_G14 Parcel I.D. 051-031-64 Expiration Date 1 d r 1. GENERAL INFORMATION Complete legal description Zed, Lot 1 Location (site address) 22074 Knik Vista St. Current Property owner(.) Emil & Desiree Nlederer Day phone Mailing address PO Box 671361 Chugiak, AK 99567 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: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual ❑ Individual Water Storage ❑ Holding Tank ❑ (:nmmii nits r'.lacc Wall ('nm.m..iinity I-1 Public Water System ❑ Public Sewer ❑ Waiver/Variance request Received by: KOtma" PcJ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Eja4. Date of Payment Cl 110, [10 Receipt Number Q t7-6- i 6 R� COSA# 03(_mLiga 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 [slate) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MCA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 272-8218 Date 9/17/2014 /*.49 TH'* S}even R'. Can In b CE -8149 . sem Conditional approval for bedrooms, with the following stipulations: 3� By:/ Original Certificate Date: P The Municipals 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 t If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Zed, Lot 1 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 5/15/2008 Sanitary seal (Y/N) Y Total depth 61 ft. Cased to 61 ft. FROM WELL LOG Date of test 5/15/2008 Static wafer level 8 Well production 25 ft. g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 1.36 mg/L Arsenic ND ug/L Date of sample: 9/8/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Plastic Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (Y/N) N Date of pumping 7/3/2014 Pumper JR's Pumping Parcel ID: 051-031-64 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 9/8/2014 22 ft. 5.3+ 9.p -m. Collected by: PES Date installed 6/13/2008 Cleanouts (Y/N) Y High water alarm (Y/N) Y C. ABSORPTION FIELD DATA Date installed 6/13/2008 Soil rating (g.p.d./ftZ or ftp/bdrm) 2.0 GPD/SF System type IDS n� �c Length 30 ft. Width 12 ft. Gravel below Total depth 2 ft. Eff. absorption area 360 ft Monitoring tube Y Depression over field N Date of adequacy test 9/8/2014 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 461 gal. New depth 3 in. Elapsed Time: 120 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date D. LIFT STATION Date installed 6/13/2008 "Pump on" level at 44 in. Datum Bottom of Tank E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons 550 "Pump off"level at 38 Cycles tested 4 Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ in. Manhole/Access (Y/N) Y High water alarm level at 48 in. Meets alarm & circuit requirements? Yes On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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 Steven R. Pannone Date 9/17/2014 COSA brown sheet -1 0-10-1 2.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ MUNICIPALITY of ANCHorAG£ • Community Development Department • On -Sate Water & Wastewater Program P: 907-343-7904 • F: 907-343-7997 • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org Intermittent Dosing Sand Filter Maintenance Log OwnerZ� 0_4� A,/& 'Street Address Z -O =? Lf Lll)f IC t/rS�oQ Cz Phone Legal Desc. `e5(��o Co c ( PID 0.9_1 —03I G Septic Tank: -Sludge level I inches -Pumping: required yes no -Pumping completed es no Absorption Field: -Liquid level 'ba( inches -Flushing valves per approved design jjLno -All flushing valves opened, distribution lines flushed, and flushing valves closed (MW no Lift station: -Pump basket cleaned esno •Biotube effluent filter cleanedes no -Timer float setting inches •High level float setting inches •Reference pointBs< < M4 -Pump on �$� seconds -Pump off :30 minutes -Cumulative lifetime cycles -Cumulative run time hours -Operation satisfactoryes no Air System: -Air pump filter cleaned ea no -Air pressure 15— psi -Date of latest install or rebuild -Air system operation satisfactg not satisfacto y Alarm System: -Dedicated electrical circuit Cj2 no -Audible and visual alarm inside dwelling ZD no -Float setting inches -Alarm system operatio sa sfacto not satisfactory Comments: ........... ................ I ......... ...... _..._............................................................................................... Maintenance Provider: Technician �—_>aVO WW_�C Company S 0 C Signature Date of maintenance Date ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND Aaxun _�-I)rmicoANl TIES MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this Day of S;eV jtyv z K of 2014, by and between zJk eK herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Svstems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as . . 5. F7 located at (legal description). 2. Definitions. Alteration. Any change to the design or function of an AW WTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC') 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AW WTS that were included in the original design which would allow the AW WTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AW WTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AW WTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Eauinment. Prior to performing any alterations to an AW WTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AW WTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AW WTS service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. H. 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. I. Owner agrees to provide and maintain a telephone connection to the AWWTS as required by the AWWTS approval. 6. Nonwaiver. The failure of either parry at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: 0(a 4'v\ _SV),0 --IC)JACIY, b. Municipality: Director, Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair 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 Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNE By: v (signature) Date: p rr / A%Aw, a,", (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this � (,p day o . e4 -n , 20A, by c L.CLe e- - Ci ALASKA ms's LI FOR ALASKA NOTARY PUBLIC A MyVommission expires: I a < Jessica ;.ace 4 My C®mn*pinn �0Ire® f®namber 10, 201a MUNICIPALITY: By: (signature) Date: name) Title: Municipality of Anchorage Development Services Department Building Safety Division _ . On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL �y FOR A SINGLE FAMILY DWELLING n � CJ Parcel I.D. _ o 5 i -or?j y COSA # CA -7;1 Ir, Expiration Date: 1.2 — 10 " Q q 1. GENERAL INFORMATION Complete legal description LOT 1; ZED SrD 2207Air Location (site address) 2201+KNIK VISTA ST., CHUGIAK AK, 99567 Current Property owner(s) JOSHUA RAY Day phone 242.2495 Mailing address PO BOX 770103, EAGLE RIVER AK 99577 Lending agency Day phone Mailing address Real Estate Agent ROB KING W/KELLER WILLIAMS RE Day phone 351-9099 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ❑Q Individual Water Storage ❑ Community Class Weil ❑ 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 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 S N S ENGINEERING Address 15661 S. BIRCHWOOD LP RD., CHUGIAK AK. 99567 Engineer's Printed Name ROBERT A- SHAFER 5. DSD SIGNATURE ✓ Approved for bedrooms. Disapproved. Phone 6942979 Date 0 r A. lihalo _ 1457 -fa. _0 0 % Conditional approval for bedrooms, with the following Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: —1 d (Rw 11A5) l'Anchorage° Mun>Ic><pa Municipality of Development Services Department Building Safety Division ` �— --� On -Site Water & Wastewater 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 CHECKLIST % Legal Description: 1 � Zfb Parcel O3% A. WEL�,DAT Well type 1{f Date completed 'S /!5/69 Total depth —61—Lft. Date of test Static water level Well production If A. B, or C provide PWSID # Sanitary seal a) I Cased to ('/ ft. FROM WELL OG I f3 ft. C25 g.p.m. Well LogMYN) l Wires properlyprotectedON) _ rr Casing height (above ground) n. AT INSPECTION ft. g.p.m. WATER SAMPLE RESULTS: Coliform (7 colonies/100 mL NitrateN mglL Other bacteria colonies/100 mL Arsenic: ug/L date of sample: F3 � Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Date installed e, ) 03 Tank size l gal. Number of Compartments Cleanout('N) Foundation cleanouIY 1) � Depression over tank (Y iU} %�Q High water alarm Y/N) 11,, ( �%w Dateof'um'in�_ _ Pumper___,, V.�l7Ct.:r.�fi� l� �/i��c�ieJ J — , r... C. ABSORPTION FIELD DATA ' 0 Date installed Soil rating g.p.d.lftZ r i?/bdrm) o2-0 System type /DSI" r t Length ft. Width ft. Gravel below pipe ft. � �//� E Total depth ft. Eff/ absorption area Lf, �Wl3M nit r; ing tube ,�5 Depression over field D 'v�0 Date of adequacy test h Results (Pass/Fail) '— For5 bedrooms Fluid depth in absorption field before lest = in. j Water added =gala New depth= in. Elapsed Time: — min. Final fluid depth = in Any rejuvenation treatment (past 12 mo.) (Y t' type) i� 'E •ti Absorption rate >= -- g.p.d. If yes, give date D. LIFT STATION Date installed e,1131m n 'Pump on' level at YT Datum E. SEPARATION DISTANCES Size in gallons SJD Manhole/Acces&N) ve If 'Pump off" level at in. High water alarm level at 40 in. Cycles tested_ Meets alarm 8 circuit requirements?_ SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift station on lot Absorption field on lot Public sewer main Aim r Sewer /septic service line C?JC '/- Animal containment areas .rte f On adjacent lots r On adjacent lots Public sewer manhole/cleanout �y Holding tank f Manure/animal excrete storage areas /LYS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ! Property line f Absorption field Water main Al & Water service line /0-/- Surface water Wells on adjacent lots 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /O Building foundation /O / Water main N i Water Service line /O + Surface water leln f Driveway, parkingivehicle storage /0-- Curtain 0--Curtain drain "/ Wells on adjacent lots 11�0t F. COMMENTS G. ENGINEER'S I certify that I have determif review of Municipal records conformance with MOA COS/ Engineer's Date field Inspections COSA Fee $ !q% 0/ / Date of Payment / _ / - O �1 Receipt Number -2 S O G (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Nom. A. am 1 AS -BUILT 1 herebv certtty that I hase surveved the following described property -'— - Anchorage Recording Pre•onct, Alaska. and that the impn.,ve- ments s,tua!ed thereor are with;r the pn,p.•»v Ices and d,, nor overlap or encroach on the pr,p•rty lemg adldcen; lhen•to, :hat no improvements on Iuupenv htn • adjacent thereW encroach on the premises to que,non and t. at there are no road,a:,. transmission lines or otrer vis,H" ra,en,enN on said prop. --t% except as indicated hereon. Dated at Eagle River. Alas,a this IL -L, elav of ROBERT C. 1OHXSO\ SCALE Registered Land Sumcvo• No iI IS I • B•. a "-0.:;(., Eagle Kr:cr. AiAi a 9u;^ Phone (Wn 694-25.13 l, l c • I r h_ AS -BUILT 1 herebv certtty that I hase surveved the following described property -'— - Anchorage Recording Pre•onct, Alaska. and that the impn.,ve- ments s,tua!ed thereor are with;r the pn,p.•»v Ices and d,, nor overlap or encroach on the pr,p•rty lemg adldcen; lhen•to, :hat no improvements on Iuupenv htn • adjacent thereW encroach on the premises to que,non and t. at there are no road,a:,. transmission lines or otrer vis,H" ra,en,enN on said prop. --t% except as indicated hereon. Dated at Eagle River. Alas,a this IL -L, elav of ROBERT C. 1OHXSO\ SCALE Registered Land Sumcvo• No iI IS I • B•. a "-0.:;(., Eagle Kr:cr. AiAi a 9u;^ Phone (Wn 694-25.13 Sep 04 OS 12:35p Timberline Excavation 15074573005 p.l 691/1Z/( y� 1 0 2.,-20 7 y Kn:� �'s�� SVS L✓a� y o ooq