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HomeMy WebLinkAboutLAKE SHORE LT 3BOnsite File Lake Shore Lot 3B PID# 011-111-33 Formerly Lot 3 � � s Municipality of Anchorage ° On -Site Water and Wastewater Program _ - (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D.011-111-22 1. GENERAL INFORMATION: Complete legal description Lake Shore; Lot 3 Location (site address) 5185 West 801h Avenue *Anchorage, AK Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: Received by: Expiration Date: 12_—Iq,Z_ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: COSA to be released to the engineer, unless otherwise requested by the engineer. Individual Holding Tank Community Public Sewer Date: istance: //�� CO✓►d1'lon�n \ COSA Fee $ Waiver Fee $ _ Date of Payment Receipt Number Q0gQ3 G COSA # 03C-2-1 / 97-3 Date of Payment Receipt Number Waiver # 0_� 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms Date: L I I 0 [ Zf System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following sti P,_,4 _ 1 � _ I,vt �A O w 1/j i' m WAST" V i ATER oz m PROGRAM ^ ' lations: J�J'1�S)ERVS By: (�---� Original Certificate Date:—�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 ` Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: LAKE SHORE; LOT 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1115/75 Total depth *214 ft * Parcel ID: 011-111-22 Structure served by this system Well production at time of test 6.5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ Nc Cased to 60+ ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L Mi Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic �' kr, ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by GEG Date of flow test for COSA 8/2/21 Date of Sample 7/26/21 Static water level at beginning of test 122.6 ft. Comments *PER AAROW PUMP AND WELL SERVICES - SEE DOCUMENT IN MOA RECORDS SEPTIC TANK TO BE DECOMMISSIONED; THIS IS A CONDITIONAL COSA B. TANK DATA C. LIFT STATION Age of tank(s) years ❑ Required maintenance completed * Tank type/material Age of lift station�year Measured operating fluid level in septic tank * Lift station material ❑ Standpipes/foundation cleanout per record drawing Comments: * Date of pumping CONDITIONAL COSA - ADEQUACY TEST WAS NOT PERFORMED D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, depth into effective ❑ Code -required soil cover over ❑ System presoaked (Required if vaca greater than 30 days prior to date of tes r G s introduced gallons Comments/Deficiencies: COSA.Checklist yellow sheet Adequacy test date Results ❑ Pass Fluid depth or o W dded New depth Elapsed time Final fluid depth _ bedrooms test in gal in min in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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 * Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft Q Yes if No ft Neighboring Tank > 100' Cj Yes if No ft Private Sewer/Septic Line > 25'F/_1 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑✓ Yes if No ft 0 Yes if No ft ft Ifc tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No *'65'+ ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft on Adjacent Lots: WlCommunit Absorption Field > 5' ❑ Yes if No ft vate Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft ells > 200' ❑ Yes if No ftWater Service Line > 10' ❑ Yes if No ft Ifc tank is under driveway comment below From Absorption Field on Lot to: (Please enter dish if less than required) Building Foundation > 10' �Ye ft If absorption field is under driveway comment below Property Line > 10' ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water S ce Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft urface Water > 100' ❑Yes if No ft F. ENGINEER'S COMMENTS *SEPTIC TANK AND DRAINFIELD ARE TO BE DECOMMISSIONED AND HOME IS TO BE CONNECTED TO PUBLIC SEWER - SEE ATTACHED LETTER WITH COSA PAPERWORK "PER AWWU RECORD DRAWING IN MOA RECORDS —THERE IS A "DOG KENNEL" SOUTH OF THE PROPOSED WELL; HOWEVER, IT DOES NOT APPEAR TO BE IN USE AT THIS TIME ****SEPARATION TO FORCE -MAIN SEWER SERVICE ON LOT 2 IS ASSUMED TO BE 25'+. SEE ATTACHED CONNECT CARD G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 qV GAKUNESSS EINGENEEKING GROUP, Ltd ENGINEERING = SALES � CONSULTING ., na:.x »,�,izi.,t 4:. __.,-r August 5th, 2021 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Request for Conditional COSA Lake Shore; Lot 2 To whom it may concern: The subject lot is serviced by a private well and septic system. Per the agent, they are trying to close on the property the week of 8/20/2021. A well flow test was performed on 8/2/21 and passed for a 6 -bedroom home (see attached COSA paperwork). Per the owner, they are going to connect to public sewer and decommission the existing septic tank and drainfield. Based upon this fact, we are requesting a conditional COSA with the stipulation that the tank and drainfield be decommissioned and the connection to public sewer be made at a later date. Atare three -Z bids from contractors and an escrow letter from the lender stating that 1.5x the highes bid amount will be escrowed. ��V:��: `r If you have any q estions, please contact us at 337-6179. Thank you for your assistance. Sincerely, Jeffrey A.'Gaigesss_P E., M. S. Prek�ident 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com 0 W, 6 c _c a3 �o T N U C (B 00 E c M m � a P 0 M 0 C E 'U N (�6 ru m c W ro a rn C N C) 'XCIJ Ssp 2S, 19 ti N d' 'S 0 LOT 3 a 0 a CD Z vent I&WO-E ii LOT 2 1.9 o 10' utilityEasement N89059'00"W 110.00 C:) a `Y' W. 80th Avenue `Y' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. JKD, FB 15-4, pg 9 BE SCALE: V= 50' OF AW Al 49th • ;� 00 G•• 00 00 Fred ;kala • t AW �T� • 3255 - S•'�! AM �� �F9 ��FESSiONAL•��� RECERTIFIED 4-22-2015,1, REVISED 3-17-2015V1,, AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 3. LAKE SHORSUBDIVISION Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 13th day of February 2015. FRED WALATKA & ASSOCIATES (907-248-1666) Engineers and Surveyors =`—Covered kennel +•i • 'i i �: .•. FWell 1.9 o 10' utilityEasement N89059'00"W 110.00 C:) a `Y' W. 80th Avenue `Y' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. JKD, FB 15-4, pg 9 BE SCALE: V= 50' OF AW Al 49th • ;� 00 G•• 00 00 Fred ;kala • t AW �T� • 3255 - S•'�! AM �� �F9 ��FESSiONAL•��� RECERTIFIED 4-22-2015,1, REVISED 3-17-2015V1,, AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 3. LAKE SHORSUBDIVISION Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 13th day of February 2015. FRED WALATKA & ASSOCIATES (907-248-1666) Engineers and Surveyors Arsenic Advisory Certificate of On -Site Systems Approval # OSC211473 Subdivision: Lake Shore, Lot 3 A water sample revealed an arsenic concentration of 78.6 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. R �..�: " t a :✓ `� zy-7"*�` '� ,u"' '�` 1'"`,auis ,�''x' Yt'." rJ ,-', zd jsS art" Ma�6ng Address P`O Box 196650* Anchorage] Alaska 99519 6650 *www muni org fi DocuSign Envelope ID: 12AD503D-A55B-4018-873A-76B1930BAD38 Beal partners. Real possibilities.*'m E15DS Ph (907) 274-2562 e Fax (866) 458-1764 480 East 36th Avenue ® Anchorage, Alaska 99503 1 am the Escrow Officer at Stewart Title for file # 1356110 for the property located at 5185 W. 80th Anchorage AK 99502. Legal; Lake Shore Subdivision Lot 3A and Lot 3B. It is a condition of closing that the escrow account outlined in the attached post closing escrow agreement be funded from the Buyers funds. We will collect $59,834.06 at closing and deliver to FNBA upon recording. Samantha Buchite, Escrow Officer q�c�[.2 ca Date DocuSign Envelope ID: 12AD503D-A556-4018-873A-76B1930BAD38 Milestone Account Instruction Agreement Title Commitment No: 1356110 THIS POST -CLOSING ESCROW AGREEMENT ("Agreement") is made as of Sept 13, 2021, by and among A. Nicholas Kern or assigns ("Buyer"), and David Disselbrett and Heather Bell ("Seller") and First National Bank of Anchorage - escrow department. (Escrow Agent) RECITALS: A. Buyer is purchasing the property located at 5185 W. 80th Anchorage AK 99502 ("Property"). B. Buyer is authorizing Stewart Title to retain from the Buyers Funds for the purchase of the Property the sum of $ 59,834.06 ("Funds"), which amount,shall be held in escrow by Escrow Agent. C. Stewart Title will deliver the funds to First National Bank of Alaska (Escrow Agent) on or before Sept 16th by check to FNBA - Escrow PO Box 100720 Anchorage AK 99510 Check payable to FNBA Escrow indicating deposit to New Escrow Account for Kern ATTN: New Accounts. D. These fiords once received will be held in a non-interest bearing bank controlled account and neither party will have direct access to this account. FNBA, as the Escrow Agent, will disburse only according to instructions in this agreement. So neither party has direct access to the account. We disburse per acceptable written instructions only. E. Buyer acknowledges the FDIC deposit insurance limit is $250,000.00 F. No funds will be released until full Municipality of Anchorage approval. THE PARTIES AGREE: 1. Recitals: The above recitals are incorporated below as if set forth at length. 2. Work: A. Nicholas Kern / or assigns (Buyer) shall be responsible for procuring performance of the following work (the "Work"): Connection of Property to public sewer to include but not limited to excavation, paving, and payment of AWWU assessment ( a copy of the contractor quotes are attached as Exhibit A). Buyer shall: (a) determine whether the Work has been satisfactorily completed, and (b) Arrange for MOA inspections and approval. 3. Release of the Funds: Escrow Agent shall hold the Funds until the first of the following events: A. On receipt of written instructions from Buyer directing Escrow Agent to disburse the Funds to a named party including documentation showing full MOA approval of completed work; Escrow Agent shall disburse the Funds as directed in such notice. B. In the event Escrow Agent does not receive written instructions under Section 3(A), above, on or before August 15, 2021 ("End Date"), Escrow Agent shall continue to hold the Funds until the first of the following events: i. Receipt by Escrow Agent of written instructions from Buyer to disburse the Funds to a named party and receipt of documentation showing full approval by MOA. (upon receipt of such notice, Escrow Agent shall make the disbursement as directed in the notice); i 1. Delivery of the Funds by Escrow Agent, at Escrow Agents sole discretion, to a court of competent jurisdiction. Such delivery may be by interpleader or other writ or petition. ill. Entry and receipt by Escrow Agent of an order of a court of competent jurisdiction ordering Escrow Agent to deliver the Funds (upon receipt of such order, Escrow Agent shall make the disbursement as directed in the order). 4. Additional Funds to Complete the Work: In the event the Funds are insufficient to complete DocuSign Envelope ID: 12AD503D-A55B-4018-873A-7661930BAD38 the Work, A. Nicholas Kern or Assigns (Buyer) agrees to deposit such additional funds with Escrow Agent as may be necessary to complete the Work. 5. Excess Funds: Any excess Funds remaining in escrow after the completion of the Work are to be returned to A. Nicholas Kern (Buyer). 6. Escrow Fee: David Disselbrett & Heather Bell (Seller) shall pay Escrow Agent the total sum of $290.00 ( $130 set up fee and $160 annual fee ) for its services as Escrow Agent under this Agreement, to be paid at the time that the parties enter into this Agreement. 7. The Escrow disbursement fee is $30 for each request and shall be paid from the Funds in escrow. BUYER: DocuSigned by: Signature: FA N. d,&&-4 Date 9/13/20 C_.. Name: A Nicholas Kern 5007 W. 80th Ave Address: City, State: Anchorage, Alaska Phone#: 1.406.599.0484 SELLER: DocuSigned by: Signature:i7a11�- Drijelbre4 Date:// 9 13 fDA4604D134DA... Name:09/13/2021 Address:5185 W 80th ave City, State: Anchorage, Alaska Phone# 9073512052 SELLER: DocuSigned by: Signature: l4-t�4'1'z P Date 1 9/13/ fECE77965C4AC... Name: Heather Bell Address:5185 W. 80th City, State: Anchorage, AK Phone# 907-529-7330 DocuSign Envelope ID: 12AD503D-A55B-4018-873A-76B1930BAD38 529-7330 Current Owner: DISSELBRETT DAVID P & BELL HEATHER A Top of Form Tax Lot: 01111122-000 Ownership History Mailing Address: Deed Date: 5185 W 80TH AVE 061115 ANCHORAGE AK 995020000 CAMA Legal Description: LAK Site Address: 518 Exemption: Deed E SHORE LT 3 5 W 80TH AVE Plat: 710252 Grid: SW2224 . Status: ACTIV Book: 2015 Signed Date: 061115 E Tax District: 003 Zone: R1 Page: 002485 Recorded Date: 201506 1 11 Lot Size: 44,700 Units: S -Square foot Current Value 1 st Prior Value 2nd Prior Value Land $358,600 $358,600 $358,600 Buildings $481,800 $472,200 $474,700 Total $840,400 $830,800 $833,300 Card 01 of 01 Status ACTIVE Building Neighborhood: 09G00 Living Units: 1 Utilities: 2 -Private Multi -Use: SgFt: 4508 water, 6 -Septic Common Lease Hold: N Ownership Wellsite: N Land Category Area: 0- Interest: 0 Indicator: R -Residential AWWU Assessments DocuSign Envelope ID: 12AD503D-A55B-4018-873A-76B1930BAD38 AWWU Permits Application Inspection Appendage Permit Number . Utility Type Date Date 000 S091095 SEWER MAINTAPTO 04/15/2009 09/14/2009 Archived Permit Images There are no images available in the database for this tax lot. Well/Septic Permits ORA -01722: invalid number The Building Safety (1814) Database is unavailable at this time. Information as of 10.08 AM Tuesday, July 20, 2021 Element Assessme Element nt Assessme Eleme Assesse Assessme Amount nt Project Project nt d nt plus Levy Element Project Id Type Status Type Area Amount services Time Status 2386 Capital complete Sewer 16,500 $14,168.06 $20,168.06 Levy Estimate Improveme d Lateral Upon d nt Project - Conne Sewer ct Sewer 44,700 $1,341.00 $1,341.00 Levy Estimate Trunk Upon d Conne ct AWWU Permits Application Inspection Appendage Permit Number . Utility Type Date Date 000 S091095 SEWER MAINTAPTO 04/15/2009 09/14/2009 Archived Permit Images There are no images available in the database for this tax lot. Well/Septic Permits ORA -01722: invalid number The Building Safety (1814) Database is unavailable at this time. Information as of 10.08 AM Tuesday, July 20, 2021 DocuSign Envelope ID: 12AD503D-A55B-4018-873A-76B1930BAD38 David Duke Engineering Technician Hl Anchorage Water & Wastewater Utility Direct: 907-564-2713 Fax: 907-786-5681 david.duke()awwu.biz i 4g LA w Ak '.L } gg � S.. a P -� EL a r"n x' E i „ ppp _ A s?..,�...A ;1§ -1.1 David Duke Engineering Technician Hl Anchorage Water & Wastewater Utility Direct: 907-564-2713 Fax: 907-786-5681 david.duke()awwu.biz DocuSign Envelope ID: 12AD503D-A556-4018-873A-76B1930BAD38 PROPOSAL: - Mob/demob of equipment - Pump septic tank, seepage pit out - Demo/abandon septic tank, seepage pit in place as per MUNI code/cut off riser pipes below grade - Demo/haul off approx.1350 sf of asphalt - Haul off stripping/grass - Install approx. 1301f of 4" sewer line from city stub to property as per MUNI code/backfill/water/compact to best practice - Includes AWWU permit /inspection fees - Include replacement of D-1 /asphalt removed for new service line Total 25,550.00 Exclusions: - Any AWWU assessments owed to city - Landscaping/topsoil/seeding - Survey of west property line NOTES: - € his price is valid until end of July 2022 summer work season 'rice/proposal is transferable to new property owner. - Price could increase on paving only due to raising cost of oil prices possibly in 2022. To accept this proposal, please sign below and return. Thank You! Customer Signature: James Salas AK Underground Inc P.O. Box 111625 Anchorage Alaska 99511 (907)-351-3024 james@akundergroundinc.com Docu.Sign Envelope ID: 12AD503D-A55B-4018-873A-76B1930BAD38 ' Northern Excavation and Construction, LLC 15861 South Birchwood Loop Road Chugiak, AK 99567 (907)694-1373 NorthernExcavation@Gmaii.com ADDRESS LAKE SHORE LOT 3 5185 WEST 85TH AVE ANCHORAGE, ALASKA 99502 Thank you for the opportunity to provide you with this estimate. Changes which increase the specific tasks of machine/labor time spent of this contract, will be submitted in writing by the owner and accepted by the contractor and the contract modified accordingly. Payment to the Contractor for modifications to this contract which increase the work will be "charged. All agreements are contingent upon accidents, design changes, or delays beyond our control. Northern Excavation & Construction, (NEC) shall not be held liable for the affects`that may occur to the property during and after the install. Affects such as damage and structural integrity of decks or deck supports in or close by the work zone, trees left in close proximity of where machine work takes place or having to stock displaced excavated material around trees to be retrieved, damage and structural integrity of retaining walls that may need to be partially removed or traveled close too, disturbance to driveways, disturbance to any landscaping, etc. NEC only compacts soil to ensure structural integrity of components install by NEC. Soil placed above Pipes/Tanks/Etc will not be compacted. (Additional cost for further compaction). All methods and materials shall be in accordance with MOA regulation. Payment in full is due upon completion of backfill. Payments received after 30 days of completion shall be charged a 1.5% monthly fee on unpaid balances. Description: Excavate down to existing AWWU stub out on property, connect new sewer line, install an estimated 160' of 4inch sewer line encased in pipe bedding, and connect to existing sewer pipe exiting the house. Install clean out assembly @ 100' and within 2' of foundation. Insulate entire sewer line with 4' wide x 2" thick insulation. Compact up excavated areas and grade all disturbed areas. Haul off Aspahlt where removed. Replace an estimated 1080sgft of exsiting asphalt. Decommision' existing septic system per MOA code_ in place. Please note that a 48 hour notice to start digging is required by the State of Alaska for utility locates. 25,250.00'; DocuSign Envelope ID: 12AD503D-A556-4018-873A-7661930BAD38 Inclusions: Machine/labor/compaction time, sewer line pipe/supplies, pipe bedding, insulation, AWWU permit, and an estmated 1080sgft of asphalt replacement. Exclusions: Re-lanscaping, re -seeding, & import/export of any fill or gravel. **This estimate is only for the above property and not the proposed subdivided lot once subdivided. i **If ground water is present and requires de -watering solutions to achieve scope of work than the cost of de -watering will reflect upon the final invoice. "Northern Excavation and Construction, LLC is not liable for TOTAL any utility lines not located by 811 public utility locate e.g., any lines running to detached structures. Please notify contractor of any power/gas/communications lines, prior to starting the job, so private locate services can be called. An extra charge will be incurred for private locate services. Accepted By Accepted Date Please note that a 48 hour notice to start digging is required by the State of Alaska for utility locates. CLIENT: Heather Bell Phone: (907) 529-7330 SITE ADDRESS: 5185 W. 80th Avenue E -Mail: red heather2009(a)yahoo.corn SITE LEGAL: Lot 3 Lake Shore Subdivision Fax: SCOPE OF WORK: Mob/Demob Construction Equipment Pump, Crush and Fill Old Septic Tank Install 150 LF of new 4 -inch C900 PVC Sewer Service Line SEPTIC CONNECTIONS EQUIPMENT/DESCRIPTION QTY UNITS RATE TOTAL MOB/DEMOB EQUIPMENT 1.00 LS $ 750.00 $ 750.00 ABANDON TANK, INSTALL SEWER SERVICE LINE AWWU Permit 1.00 EA $ 225.00 $ 225.00 Asphalt Cutting 1.00 EA $ 750.00 $ 750.00 16 -Ton Excavator 25.00 HRS $ 215.00 $ 5,375.00 Skid Steer Loader 12.00 HRS $ 165.00 $ 1,980.00 Labor 30.00 HRS $ 110.00 $ 3,300.00 Pipe and Fittings 1.00 LS $ 2,843.70 $ 2,843.70 Pit Run to Fill Tank 30.00 TON $ 10.75 $ 322.50 Construction Trucking, End Dump 2.00 HR $ 125.00 $ 250.00 Dispose of Broken Asphalt 20.00 CY $ - $ - Construction Trucking, End Dump 2.00 HR $ 125.00 $ 250.00 ESTIMATED PROJECT TOTAL: $ 16,046.20 NOTES/ASSUMPTIONS: Assumes no clearing or grubbing required to install sewer service line. Assumes no high groundwater in the area. Assumes no conflict with shallow utilities. Assumes native sandy material will be adequate for bedding of new sewer pipe. Does not include any documentation for MOA On -Site. Owner can provide AWWU inspection report to MOA On-site. Does not include asphalt replacement or replacement of lawn/landscaping disturbed during construction. · ' Municipality of Anchorage Community Development Department Page On-Site Water & Wastewater Program 4700 Elmore St. · P.O. Box 196650 Anchorage, AK 99519-6650 · http://www.muni.org/onsite · (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 0SP151055 PID Number: 011--111--22 [] New []Upgrade Name:KLOUDA BERNARD ABSORPTION FIELD Address: [] Deep Trench [] Shallow Trench [] Bed m ound 5185 WEST 80TH *ANCHORAGE, AK []Other Phone: N/A No. of Bedrooms: So;I Rctlng: Total Depth from o~ol grade: LEGAL DESCRIPTION Dec" to P~Pe ir~vert f ..... ;g;n"l ¢)r°de: ~r°~~plh bane°th P;Pe: LAKE SHORE - 5 SEPARATION DISTANCES/" Well 100'+ - - 25'+ TANK [] Septic [] S.T.E.P. I-1Hold~ []Other Surface Water 100'+ - - GREER 1000 ~o~. STEEL 2 Foundation 5'+ - LIFT STATION Curtain Drain NONE KNOWN Monuloc[urer: C Remarks: OLD TANK DECOMMISSIONED '..m.o.',~.,o~: I'~,~ PIPE MATERIAL House to tonk D3034 Tank to D5034 dro[nfle~d Installer WILCO CONTRACTORS Droinfleld N/A CO/MT D3054 Inspector OEO, Ltd. BENCH MARK (Assumed elevation) 100.00 ~t Inspection Dotes: 1st 4/.3/2015 2nd - ~.,~o,lon and D~scrlpllon: 5rd 4th - BOTTOM OF SIDING @FCO ENGINEER'S SEAL Community Development Department Approval .=..~,,,~..~.%~ .. Conditional approval: Dote: ~'~,, .~' Inspection Report _1-1-12.do~ ~ ~'- PER~IT ~ PER~IT NUMBER: 0SP151053 AS-BUILT DRAWING PABC~L ,0 NUMBED:' 011-111-22 ~FCO 7.55 101.25 APPROXIMATE LOCATION 0 '~ ST1 12.28 102.56 100' LAKE SETBACK ST2 17.11 108.18 ~ ASSUMED LOCATION OF DRAINFIELDS SE4, NW4, NW4, LESS PIN // : GARNESS ENGINEERING GROUP, Ltd KLOUDA BERNARD - 2 OF AS-BUILT DRAWING PERMIT NUMBER: OSP151053 AS-BUILT DRAWING PARCEL ID NUMBER: 01%111-22 TOP OF TANK AT INLET=95.37 ~ f INVERT OF BUNG AT INLET = 94.96 -FINAL GRADE = 99.70'100.03 ST1 / Sc~T2 TOP OF TANK  ~.~ ~....~AT OUTLET: 95.37 NEW 1000 CALLON /~'~ INVERT OF BUNG SEPTIC TANK--%-// AT OUTLET = 94.60 GARNESS ENGINEERING GROUP,.Ltd PREPARED FOR: I PHONE NUMBER: KLOUDA BARNARD I ' LEGAL DESCRIPTION: LAKE SHORE', LOT 3 Permit Number: Tax Code Number: Work Type: On-Site Water and/or Wastewater System Permit OSP151053 01111122000 SepticTank MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Read, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Department Permit Effective Dates: March 26, 2015 to Mamh 25, 2016 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: LAKE SHORE Site Legal Address: LAKE SHORE LT 3 G:2224 Owner/Address: KLOUDA BERNARD J DECLARATION OF TRUST KLOUDA BERNARD J/TRUSTEE 5185 W 80TH AVE ANCHORAGE AK 995024114 Site Mailing Address: 5185 W 80TH AVE, Anchorage Lot Size in Sq Ft: 44700 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Documentation of the following items shall be submitted with the inspection report. 1. Confirmation of effluent flow to both the seepage pit and trench. 2. Seepage pit and trench separation distances to the west property line. Date:--~/'~ ~ //~' (- (- MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On-Site Water & Wastewater Program Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 011-111-22 Property owner(s) BERNARD KLOUDA Mailing address 5185 W. 80TH AVENUE *ANCHORAGE, AK 99502 Day phone C/O AGENT Site address 5185 W. 80TH AVENUE *ANCHORAGE, AK 99502 Legal description (Sub'd, Block & Lot) LAKE SHORE; LOT 5 Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: ([~llthat apply) Initial [] Single Family (SF) [] Absorption Field [] (w/wo ADU) Septic Tank [] Upgrade [] Renewal [] Duplex (D) [] Holding Tank [] Multiple Dwellings [] Privy [] (SF and/or D) Private Well [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS ~'~'~ ~~ March 12, 2015 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System for Lake Shore; Lot 3 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The 40+ year old septic tank is too close to the foundation and rather than issuing a waiver the MOA dictated that the tank be replaced. We are proposing to decommission the old 1,000 gallon septic tank and install a new 1,000 gallon septic tank. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for yourAssistance. Oeffjfpy~. Garness, P.E., M.S. Pre~idbnt 3701 East Tudor Road, Suite 101 "Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com TANK DESIGN ONLY LETTER THAT PERTAINS TO THIS DESIGN. TO O~TAIN A COPY OF THE L~ER CONTACT GEG. BY PROCE~ING FORW~D WITH THIS INhALaTION, THE ENGINEER, ~REE TO ACCEP~ ~E TERMS AND CONDITIONS OUTLINED. NOTE: THE CONTRACTOR x . lOO' SHALL HAVE THE WEST LOT LINE, AND ALL WELL RADII F~G~ED BY A REGISTERED "'--,, ~ND SURV~OR PRIOR TO ' CONSTRUCTION. NOTE: OONIRAOTOR IS RESPONSIBLE , zOR OONFI~MING WH~HE~ EFFLUENT FLOWS FROM THE SEPIIC TANK TO THE SEEPAGE PIT OR THE TRENCH. COITION OF CONTRACTOR MUST ALSO CONFIRM IF ~E S~BACK ANY PORTION OF THE DRAINFIELDS~ASSUMED LOCATION OF ARE LOCATED OFF PROPERS. ~//gRAINFIELDSKNOWNSEEP~E PIT C/o.LOCATIoNBASED UPONoF ~I~ING TRENCH C/O ~ TANK PER UPC Lc _ ~.~&c O~L c/o's ~  LESS PTN ~ 100' WELL r,= ~o, X~. 80TH AVENUE GARNES ENGINEERING GROUP, ~,:~ ~; ;~ CIVIL & ENVIRONMENTAL ENGINEERS BERNARD KLOUDA C/O AGENT 1 OF 1 LAKE SHORE; LOT 3 PNB ~ SEPTIC TANK UPGRADE DESIGN ~ ~' MUNICIPALITY OF ANCHORAGE ~ -- '/~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE . ~'0PGRADE MAILING ADDRESS LEGAL DESCRrPT[ON LOCATION ~NO. OF SEDROOMS ~ DISTANCE TO: [ Well/00' ~t~o n area Dwelling PERMITNO. , ~ ~ Manufacturer Material~ ~ ~ ~ G~ Liq. capac[W in gallons ~nside length Width Liquid depth ~O~O IF HOMEMADE; ~_~O Z ~ Manufacturer Material Liquid capacitv in gallons ~ Wall * Foundation Nearest lot line PERMIT NO.~ No. of lines Lenath of each lin Total length~nes~ Trench widt~.inches~ Distance between lines ~ Top of tile to finish grade~(/~.., Material beneath tile "1 inches Total effecti~t~aree Length Width Depth PEEMIT NO. ~ N Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: OTHER APPROVED DATE LEGAL 72-013 (Rev. 3/78) PERMIT N0. K~PF'L I CRNT RONRL[:' ]HL SON LOC:FIT I IN .... LEGP~L T",r'F'E ElF '-Serif Ab=,uRFTI-N _,'~-TEfl IS: MAXIMUM NLIMBER OF BE[:'RQOMS = ]'". FIN[:, EN',,ii I RQNMENT R _LiOTEC:T I QN RNF:HORRGE., AK 264-4728 SE~-..iE~: E'En:f4 Z T' 5:L85 I.,.I ~_,OTH THE REQljtRED .=,I~E Z[F THE SOIL RBSORF'TION :?_-,TLr1 I:,. [)EF"TH=- !£~t LEI".t~STH'-= ]:'~- __~F-.H . EL [:"EF'TH== 6 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE [:,EPTH OF Fi TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRC:E OF THE GROUND END THE BOTTOM OF THE EXCRVRTION ,:.'IN FEET) THERE tS NO SET WIDTH FOR TRENCHES. THE GRR',/EL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RN[:' THE E:OTTOM -"¢ THE EY:ORYATION '::IN FEET:'. E:E~2L# Z E:E[:" 2]EF'T Ii]: TRf-~[=:: S I ZE= F'ERfdIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE iNSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERYE TI-.-IC~ (] ---:,,_: :> I I'-.tSF'EC:'T I ~3f-,IS RF-:E I~: E ~_--:.~ UI I F-:ED E:BCKFILLING OF BNY _-,?_,TEM I.,JITHOLIT FINAL INSPEC:TION RND FIPPR. OY~L BY THIS [,EF'RRTMENT WILL BE SUE:..TECT TO F'R]SEC:UTION. MINIMUM DISTFINCE BETWEEN R WELL AND BNY ON-SITE SEWRGE DISPOSBL SYSTEM IS ±00 FEET FOR R PRI',,,'~TE WELL OR :L50 TO 2C'~0 FEET FROM A PUBLIC NELL DEPENDING UPON THE T'¢PE OF PUBLIC WELL MINIMUM DISTRNCE FROM F~ PRI¢~TE WELL TO B PRI',,,'BTE SEWER LINE IS 25 FEET END TO P, COMMLINITY SEWER LINE IS 75 FEET OTHER REQUIREMENTS r,!t~Y F~PPLY. SPECIFICF~TIONS END CONSTRUCTION E.',IF~GRBMS FiRE B',,,'BILBBLE TO INSURE F'ROPER INSTFiLLFiTiON. 2:: I LIN[,ERz, FHf.[ THRT THE uN-_,ITE =,EWER SYSTEM MR'?' REQUIRE RESIDENCE IS REMO[,ELE[:, TEl INBLLI[:,E r~,_..~ THRN ~. BEDROOMS ............... ~:~NT RC NRLD OHL:,ON ISSUE[:, B'~~~ ........ [:,RTE_~~- ..... ! CERTIF9 THBT 1: I 8M FRMILIFiR bJlTH 'THE REQUIREMENTS FOR ON-SITE SEWERS FiND WELLS RS SET FORTH BY THE MUNICIPFiLIT~ OF 8NCHORRGE. 2: I WILL INSTFiLL THE SgSTEM IN 8CCORDRNCE WITH THE CODES. ENLRRGEMENT IF THE V4. 0 Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 IGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TAN K: DISTANCE FROM WeLL INSIDE LENGTH MANUFACTURER MATERIAL NUMBER OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH __ LIQUID CAPACITY /(~0 GALLONS. SEEPAGE PIT: NUMBER OF PITS ! DIAMETER LINING MATERIAL~'~,~'~-~L~,~,,~2RIB SIZE: 1 BUILDING FOUNDATION__ OR WIDTH LENGTH DIAMETER NEAREST LOT LINE DEPTH DISTANCE FROM: DEPTH WELL TOTAL EFFECTIVE ~ ABSORPTION AREA (WALL AREA) ~'-~ "~ ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST ~ SEWER LINE "~--~ __ DEPTH DISTANCE FROM: SEPTIC SEEPAGE /,c~O' TANK /~,)0 SYSTEM REMARKS DISTANCES: LOT SlOPe: REMARKS: Form No. EQ-O31 DATE DIAGRAM OF SYSTEM G.A.A.B. GReATEr ANCHORAge AREA BOROUGH OEPARTM£NT OF ENVIRONMENTAL QUALITY 3330 "'C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK SEEPAGE PIT AIN FIELD OTHER FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL (;~UALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF FOUNDATION TO SEFTIC TANK ' ~ FOUNDATION TO SEEPAGE PIT ~ DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /~"~ r SEPTIC TANK , SEEPAGE PIT ~ DRAIN FIELD TO NEAREST LOT LINE, DRAIN FIELD , ALSO CONSIDER AREA WELLS, WATER MA{N TO SEPTIC TANK SEEPAGE PiT DRAIN FIELD GRAVEL BACKFI~ I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. EE-E8 AND THAT THE ABOVE Parcel I.D. 011-111-22 MAY 08 LU15 *'"" ~: ~, Municipality ofAncho~*~ St~iie~ '"'~ ~* On-Site Water and Wastewater Program ~:~. (907) 343-7904 Certificate of On-Site Systems Approval Expiration Date: GENERAL INFORMATION Complete legal description LAKE SHORE; LOT 3 Location (site address) 5185 W. 80TH *ANCHORAGE, AK Current Property owner(s) TRUSTEE BERNARD KLOUDA Mailing address 5185 W. 80TH *ANCHORAGE, AK Real Estate Agent LEIF HERRINGTON Day phone C/O AGENT Day phone 980-8249 2. TYPE OF DWELLING: [] Single Family (w/wu ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3, NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ' Community Class Well PUblic wa(er System TYPE OF WASTEWATER DISPOSAL: [] Individual [] [] Holding Tank [] [] Community [] [] Public Sewer [] WaiverNariance request for: LOT LINE WAIVER Distance: 0 FEET Received by: /~ COSA to be released to the engineer, unless otherwise requested by Re engineer. COSA Fee $. Date of Payment Receipt Number COSA # f')h('_/~- / ¢0¢© Waiver Fee $ Date of Payment Receipt Number Waiver # 0~15 - O,,oV t '5 105~ 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. Phone (907) 337-6179 Address 3701 E. Tudor Rd.. Suite 101. Anchoraae AK. 99507-3246 Engineer's Pdnted Name Jeffrey A. Garness In conducting this evaluation, GEG orovided an engineering evaluation of the well and/or sectic system in accordance with the guidelines and regulations established by the Municfaality of Anchorage and industry oractices. The re~ortod results describe the condition of the sysfam/s on the dete/s of the evaluation. Se~arattan distances were measured to readily identiftabfa features. Hidden defects or encroachments may exist that were not identified dudng the evaluation. The ooerational life of all we/is and septic systems deDend on a variety of variables including, but not limited to, sctl conditions, groundwater levels (that may fluctuate during the year), quality of c~nstruction (materials and workmanshfa), and the water usage of the family utilizing the sysfarn/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future oerformance of the system/s; therefore. GEG makes no warranty (express or imctfad) regarding the future oedormance of the well or seotic system. GEG makes no reoresentation whether an altamat/ve well or seotic system can be installed on the Dro~elly in the event either of the current systems fail. The eonfant of this reoort is for the sole benefit of the ~erson/oa/~y who retained GEG. Reliance uoon the information z~rovided in this re~ort by any other ~)erso~ or oarty, including hut not limifad to subsequent orooerty ~urchasers, is not authorized. In ,~hort, GEG disavows any legal duty to anyone other than the oerson/~arty who Daid for this re~ort DSD S/I~ NATURE System #1 Apr;roved for __ System #2 Ap;;roved for __ Disapproved Conditional approval for bedrooms -- ~ WATER AND bedrooms ~O_ WASTEWATER bedrooms, with the following sbpu~ _~% The Munic~alif'y or'Anchorage t'~,~.veJopment Services DJvistan (DSD) issues Cerfi§cates of On-Site Systems Approval (¢)SA) based only of Anchorage is not responsible f~r errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist seP:fic System Ad'~ sory Well Flow AdvisoR,~ Nitrate Advisory Arsenic Advisory Other COSA blue sheet_9-1-12.dec If more than I septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: LAKE SHORE; LOT 3 Parcel ID: 0t 1-1 t 1-22 A. WELL DATA I'PER ,~ROW WELL AND PUMP SEE ATfACHED INVOICEI Well type PRNATE IfA, B, otC provide PWSID~ N/A YES Date completed 1/15/1975 Sanitary seal (Y/N) YES YES Totaldepth '214 ft. Casedto *60'+ ff. FROM WELL LOG Date of test 1/15/1975 Static water level 140 Well production 15 Foundation cleanout (Y/N) YES Date of pumping NEW C. ABSORPTION FIELD DATA Date installe~l 10/74- & 7/82 Length 25 & 40 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mi. Arsenic: 81.2 ugJL. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Depression over tank (Y/N) NO Pumper - Nitrate 0.104 mg./L, Date of sample: Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION *2/24/2015 '122 ff. *4.7 g.p.m. 12+ in. Collected by: GF'G. Ltd. Date installed 4/3/2015 Cleanouts (Y/N) YES High water alarm (Y/N) N/A I**BB.OW EXlSTIN(3 (~RAn~ I CRIB & TRENCH I Soil rating (g.p.d,/ft~or(~'~ 125 &: 150 System type CRIB & TRENCH Width 13 & ,3 f. Gravel below pipe 6 & 6 fL Total depth ~'10.88 & 8.08ff. Eft. absorption area 452 & 4-80 ft2 Monitoring tube YES Depression over field Date ofadec~acy test *'2/18./2015 Results (Pass/Fail) ***PASS For 5 bedrooms Fluid depth id absorption field before test DRY in. Water added***2450 gal. New depth 50 in. Elapsed Tim& 10 m'in. Final fluid depth DRY in. ' Absorption rate >=. 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE if yes, give date - **HOUSE W.~S VACANT; PRE-SOAKED AND TESTED ON SAME DAY ***TESTED CRIB ONLY; TRENCH WAS DRY NO D. LIFT S~'ATION ~ate ins:~lad Size in gallons ~ ~ Pump on' level at ~ water ~ level at __ in. ~ ~ Cycles tested. Meets alarm & circuit requirements? E. SEPARATION DISTANCE8 *SEE ATTACHED AWWU DWG. **SMALL DOG KENNEL ON EAST SIDE OF HOUSE. SEPARAT ON D STANCES FROM WELL ON LOT TO: SEE ATTACHED SURVEY Septic tanldllff station on lot 100'+ Absorption field on lot. 100'+ Public sewer main *65' Sewer/septic service line 25'+ Animal containment areas. *.40' On adjacent lots .100'+ On adjacent lots .100'+ Public sewer manhole/cleanout N/A Holding tank N/A. Manure/animai excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundaiton 5'+ . Property line 5'+ AbsoJpiton field Water main N/A Water service line 10'+ Surfac~ water.__ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pmparty line **0'+ Water servioe line 10'+ Curtain drain NONE KNOWN F. COMMENT8 Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 5'-~ '(ASSUMED) 100'+ Water main N/~. Driveway, parking/vehicle stor~-ge 100'+ 0'+ ***SEE ATTACHED WAIVER LETTER. THERE ARE TWO WELL LOGS FOR THIS PROPERTY. OELY ONE WELL COULD BE LOCATED. STATUS OF' OTHER WELL IS UNKNOWN G. ENGINEER'S CERTIFICATION I cerUfy that I have determined through field inspec~ona and revfew of Municipel mconfs that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Pdnted Name JEFF.REY A. GARNESS D.te (Rev. 11/05) Municipality of Anchorage Comnmnity Development Department Development Services Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # 151202 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 3 of Lake Shore Subdivision. This inspection revealed an arsenic concentration of 81.2 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. ~0 ~.~ '~..~uO~. SAND LAKE LOT 3 vent 10' Utile Easement N89°59'00"W 110.00 W. 80th Avenue 8409Y ~ SCALE: 1"= 50' ~ LOT 2 '~;Fred Walatk~:~ ~ 5;*4;.. RECE~IFIEO REVISED ~17-~15 ~ ~UILT ~ CO~ERS S~ ~IS ~ 1.9 ~t~fol~~ ~: LOT 3. Anchorage Recording District, Alaska, and that ~e improvements situated thereon am within the property lines and do not ore,ap or encmaoh on the property lying adjacent thereto, that no ~npmvements on the pr~ lying adjacent therat~ encroach on the premises i~ queation and that there am ne roadways, transmission lices or ather visible ~ on said prol~ except as indicated hereon. Dated at Anti.age, A~ska ~his 13th day of Februaw .201S. FRED WALATKA & ASSOCIATES Engineem and Surveyom (907-24S-lSSS) EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. JKD, FB 15-4, pg 9 BE Municipality of Anchorage P.O. Box 196650 · 4700 Elmore Road Anchorafle, Alaska 99519-6650 · (907) 343-7904 · Fax ,~907) 343-7997 htt~):l/www.mu ni.omlOnsite Development Se,trices Division On-Site Water and Wastewater Proaram partment **** VARIANCE/WAIVER REVIEW **** Waive~: osv151032 COSA#: osct51202 PID~: 011-ttl-22 Legal Description: Lake Shore L-3 Engineer: Garness En;ineerina Group Permit~:os=151053 Applicant: Your request £or a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 0.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this departmem. [] The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. [] Notarized letter(s) of non-objection have been received from the owner(s) of the affected adjacent property. [] Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name of Reviewer GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS ~ ~'~:~ ~ April 29, 2015 Municip~ityofAnchorage On-SReWaterandWa~ewater 4700 Elmore Road Anchorage AK, 99507 Re: Lake Shore; Lot 3 - Permit #OSP151053 - Septic Tank Installation and Waiver Request To Whom It May Concern, Per the special provisions of the tank permit, the contractor had the west property line flagged, and then exposed the drainfields (see attached record drawing of septic upgrade). Based upon this limited investigation, the crib, nor the trench, appear to cross over the property line; however, they will require a waiver to the property line. The contractor also verified that flow from the septic tank runs directly to the crib. This was determined by running water in the new post tank cleanout and listening for water in the crib. Per the i982 inspection report, the crib then spills over into the trench. The beginning of the trench was not exposed, and it is unknown exactly where the beginning of the trench is located. Per the 1982 inspection report, there is 40' of trench located after the crib. It is also unknown exactly how much effective area is located within the crib system. During the excavation and inspection, it was observed that much of the crib effective area was bedded in clean, sand. Per discussions with Jay Crewdson atthe MOA On-site department, it was decided that this was acceptable for the following reasons: · The combined absorption area between the crib and the spill-over trench is more than adequate to support the 3-bedroom home. · The system has been in place 33-years, and continues to operate with no known issues. · The initial crib drainfield was tested on 2/18/15 with a total of 2450 gallons of water over the course of approximately 410 minutes, with no indication of any standing water. In short, the trench stayed dry throughout the test. · No bio-matt was observed around the crib during the limited investigative excavation. We are requesting a zero foot lot line for the trench and the crib drainfields at this time. Please contact Rob Campbell or Jeff Gamess at 337-6179 if you have any questions or concerns regarding this project. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.corn Aarow Pump & Well Service, LLC AnChorage, AK 9@511 ." Office: (907) 346-935~ - Fax (907).~,4,~Q202. Eagle River: (907) 622-933~' PAGE 01/01 NO. 10361 .,'.. '..' ... ...,'-.'..... '. :.' DE~CRPTON.'. ;. :~..., . .... , ...... '.:.'.'.'; i:"'?RlCSE :'/ ; ::'.'".'AMOUNT:.., >-~- · I "~1 ~~~ AMOUNT TOTAL MATERIAL ~ ~lm ' . ' r,~=~ ~;,~ ~ . , TOTAL ~ORK~ ,___ .;":"' ,: .., · ? · "~ ':"' :: ...... P~V THIS &MO~N~ : . ,: . .' '" . · alONATURE . .: ' . .. ..'....' (I Hereby Acknowledge the'SatlafaOtory CompJetioh of the Abev~ D asarli:~ci Woik and ~gm~'thai if above work 10 not paid for n 96 days I ~.~eO tO- a oW Askew. Pu~p'& Well Se~ic~, L.L.C. the right to re'move (Inpaid f~r equipmbht e, na oh~.rge for/labor slm~dy'perf~i'n')ed & labor to r~mo~e unp~d.l~r.e~luil~me~i ) ' .' ' .' ' .;; "'..' ' TEAMS[ ACCOUNTS'PAYABLE A"~',IOTH'O~F MONTH FOLLOWING PUR~; HASE. :'" ' ' ' ' ";'"" ' '' ' ' '..,.,.,'.::..' ' . '"."'~ :.~ER~J (.~L,ci:iARG'E AY'IRATE OA I,~%'P~R ~oNTH.~iLI:.i~IE'cH~i:IGE~'OI~ OVERDUE ACC01~NY$_' ." ' '.' ['" ' : · " ASPi ALT 2-STORY FRAME HOUSE m Z < I1 ~l..' Z .'.i '., .... ~1' ~ Lr;,' ,~r '~,~'~"r~,~ SCALE N WL) : : : 115 19~00 20+00 .--.-"~..?. z;¢' ~--~",,, 49 .... 21+00 MUNICIPALITY OF ANCHORAGE : WATER, ~ WASTEWATER UT,L,TY SEWER PLAN AND PROFILE STA 1,+60 TO 21+20 Use of We]} Dom ]an~ ~urf~ce. Finish of weU (check one) open end ( × ); WeLl .(r-lnu~e) for 2 . hours wiCh - .~ '~ Depth ~ ~et f~om · groundsu~.~ ; 'D Location!~(address of: Townskip, Range, Section, if known; or distance main road -- · sta~c water. DAte Depth kf~e'[ _~om' ~round; surhce ~.e'~''- :~ TO' - £TO · '" ' t · d. Case~ to ?_~tT. Ceet surface.' F~ni~h of well (check one) open end ( X ); '. silty, heavin~ from 112. dO'~,r~, oc " ~, / MUNICIPAUTY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY ApPRovAL OF ON-SITE SEWER AND WATER FACILITY /~oplication Date 1. GENERAL INFORMATION (") Lege! Description.~n.~ude lot, block, subdivision, section, township, range) Location (addJ:~s_. or directions) . / , (b) Applicant Name /~"~''"' '~ Telephone: Home "; Business ~'~'~'~'~'~'~'~'~'~-~/~-,.~'~ _7 {c) Applicant is (check one): Lending Institution []; Owner/builder []: Buyer []; Other~ (explain); ~ (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (t) Mail the HAA to the following J)ddress: .~ TYPE OF RESIDENCE ,Single-Familyx Multi-Family 4~lumber of Bedrooms ,"~ Other WATER SUPPLY Individual Wel~ Community I-I Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL · Onsite/~ Public I'1 Community I'1 Holding Tank r'l ,r - Note.~l f Community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 ENGINEERING, R SPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION , As certified by my seal affixed hereto and as of the validation date shown below, I varify that my iqvestigation'of this Nestth Authority Approval shows that the on-site water supply and/or westewater disposal system is safe, fun~tiohal 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 tiles and from my investigation and inspection, the on-site water supply and/or wastewater ~lispnsal system is in compliance with all Municipal and State codes, ordinances, and regulations in effec~ on the date of this inspection... ~ _ . Name of Firm ' /~' ' Telephone _~'~ ~'~ ~-,/'O "'7 Address · ~ ~ Date Engineer's Seal 6. DHEP APPROVAL ~ Approvadfor~'~) bedroomsby ~ ~ Date "~-~'~'' ~' Approved Z' Disapprove~l Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations givan in paragraph ,~above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchoreg~ is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MO~. HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHOP. AG; CHECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION ~'~' F '~ ~ U ~ 0 ~ ~ Legal Description: ~. WELL DATA .RE C E IV E D Well Classification ....~ /[/'J DLJ]Ot J- if'A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~--~DateCompleted .~z:, ,~.~"'~,.~L, Yield Total Depth ~--z~'7 / Cased to ---~'7~Depth of G~outing /[~,'~'"~--~" Static Water Level //"~:) / Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well; To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line PUmp Set At /_./.~-,1~ '~/~ Sahitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots /%~)O ~ / ~/~ ; On Adjoining Lots / ~ I~/'-~' To Nearest Public Sewer CleanouVManhole /V,/,~ To Nearest Sewer Service Line on Lot ~'"/ Water Sample Collected by d, ~,,,~-¢'-,4,C~z,~te~ ; Date ~/~ Water Sample Test Results ~ :~~. , B. SEPTIC/HOLDING TANK DATA Date Installed standpipes (Y/N) ¢~' Depression over Tank (Y/N) ' To Water-suPply Well To Property Line To Water Main/Service Line Course Size { OOC> No. of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y~/N) . /4,/' 0 Date Last Pumped e~' Pumping/Maintenance Contract on File (Y/N) ~,~ ; for Holding Tank High-Water Alarm (Y/N) ,~/~'.'~ Temporary Ho d ng Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: TO Building Foundation ~ / To Disposal Field / ~ ! To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata / ~ ~"/'~/~'~>~ Date ,nstaJled "'~ ~/'~..'~/~:'."Z. / Length of Field .'~::~) / Width of Field '~'/ Depth of Field "~. ~ / Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / To Building Foundation, / Z / Lot To Water Main/Service Line ~) / To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) To Property Line ~,~"~ / To Existing or Abandoned System on ; On Adjoining Lots / ~) O ! ~ To Cutbank (if present) ,'~/'//~" Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments /~ ~3 PJ-z:~, ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I halve chec~:,P..d~ver~ied, or conformed to all MO~ and HAA guidelines in effect on the date of this inspection. Signe~~~-Date Company ~ ~, MOA No. Receipt No. ~ Amount: $ ~O~ Engineer's Seal Page 2 of 2 72-026(11/84) Standpipes Present (Y/N) ~'~' Date of Last Adeqqacy Test Time, I~UNIClPALITY OF ANCHORAGE ~ Time v ' Date · Date Date 'nspectoRE C~ l ~ j~~ Inspector Inspector Cu...,.unts Conditional Approval Date Sewer Installed Permit No. Septic·Tank Size ' I {~ -'~ ~ Holding Tank Size Soils Ratlhg Well To Absorption Area Well Log Received Well to Tank Buyer Address ' Lending Institution Phone' Address Realty Co. & Agent Phone ~ddress ~; . . Type~ ~esidence 'E]Slnl~le Family [] Multiple Family No. of Bedrooms ~' [] Other Water. SuPply 13 Individual A~ACH WELL LOG. A well log Is mquir~ ~r all wells drill~ since June D ~mmunl~ . 1975~ For wens ~lll~ p~or~ th~ dat~ give well depth {attach log if Sew~ Dlspoeal ~ Individual ~ Year Individual InstallS: ~ ~ ~ ~ ' · D Public ~ility * When ~nn~ted to Publle Utility: D Holding Tank ~ NOT~ THE INSPE~ION FEE M~ST ACCOMPANY ~CH REQUEST BEFORE P~OCE~ING CAN BE INITIATED.