Loading...
HomeMy WebLinkAboutMANN BLK 2 LT 1Onsite File e T x � r n Y�. Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191453 PID Number: 020-041-21 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name MGJ Inc. ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 16000 Elizabeth Ave. ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 4.0 GPD/SF +1.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade +1.5 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot MANN BLK 2 LT 1 Fill added above original grade +2.5 Ft, Gravel length 32 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines 0 Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Li ft Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field ( � Tank Line 160 Ft s 1 Ft. Well i (��' } '� 00',}- 5{��-I, TANK [:1Septic ❑ S.T.E.P. El Holding ® Other Manufacturer Capacity ANCH TANK/ADVANTEX 1500 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 10'+ 10'+ NA FIBERGLASS 2 Foundation10'+ 1 �' } LIFT STATION Manufacturer Capacity Remarks Gal. Alam? location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer Northern Contracting, LLC Drainfield 3034 co/MT3034 inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 111.5 ft Inspec2"dion tsi 8-15-20 8-16-20 Location and description dates: GARAGE SLAB 3`° ath ON-SITE WATER AND WASTEWATER SECTION APPROVAL Enginek„s stamp Conditional Approval: Date,` ii MICHAEL N. AhUEk5CN �� Septic System/�x,94 Approved t1'�R I. Date 13 0z @ �.r; • t.' �Qn� .�`.�. " Note' this approval does not include well permit requirements. 'IL trtev utvuuib) Permit No. OSP191453 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: MANN BLK 2 LT 1 MARK A B C c01 20 11 CO2 23 47 CO3 24 47 TC01 28 50 T C04 40 48 C06 45 37 M T1 48 31 TH46/ 1 �} CO'M C061 �\ 1 \\ LJ TH#11 k TA TCO2 PID No.: 020-041-21 STREAM BENCH, GARAGE / -- -- B ---- i / DRIVEWAY \\ I i l A 1 \ I G Q EXISTI G WELL NEW ADVANfEX TANK W/ POD IA � \ EXIT I \ I �\ \ ASBUILT SCALE 1"=50' SEPTIC SECTION N.T.S. NG WELL i i OG )RG 3P 3M H2O ® 99, OCT 1 2007 .*��11, .�� �� � )F.. 114 ...4. AW AIV '.� 49TH MICHAEL N. ANDERSON: L ' No. CE 9469 �•.�1-10-20 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Date of Issue Parcel Identification Number: Legal Description Property Owner Name & Address Mann Block 2 Lot 1 MGJ 16000 Elizabeth Street Pump Installation Date: 9-29-20 Pump Intake Depth Below Top of Well Casing: 230 feet Pump manufacturer’s Name: F&W Pump Model: 4F10G10301 Pump Size: 1 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Northern Contracting Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson *NOTE: Pitless was installed upside down* Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 1 11=40' PLAT NO. 65-105 MANN SUBDIVISION LOT 1, BLOCK 2 49,458 S.F. N 90000'00"E 300.00'(REC) N 89058'28"E 299.65'(MEAE S 89053'41"E 299.91'(MEAS) S 90000'00"W 300.00'(REC) AS -BU I LT I \ PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC I \ DETERMINE THE EXISTENCE OF ANY EASEMENTS, 2000 E. DOWLING RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99507 L----------------- PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR — — — — — — — — — — — — — ESTABLISHING BOUNDARY OR FENCE LINES. V)20'— 20' UTILITY ESMT.— uj — — — — — — — — — — — — — zo 00 O co �(O m \ N w \ W \ O O J \ n03 �I 00 O O O 0 0 z z I SEPTIC SYSTEM ca EXISTING BUILDING RAP DRIVE GRAVEL DRIVE . cy E3 .moo .. WELL N N S 89053'41"E 299.91'(MEAS) S 90000'00"W 300.00'(REC) AS -BU I LT I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC IT IS THE RESPONSIBILITY OF THE OWNER TO JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, 2000 E. DOWLING RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR SW3238 1 10/21/2020 ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA F.B. JOB NO. NOTE: NO CORNERS SET THIS DATE MANN12 51.0' W3. Lo 0 30' M r� O O 00 00 R 0 F A441# •'`:•.'� AV * : 49TH / m •: Jeffery A. Gastaldi .� •o• Aff . •. LS 6091 �� AV �'m '.• 10/21/2020 • �J r s. ••�sionG A 05us%*'* BUILDING DETAIL SCALE: 1 "=20' MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water & Wastewater System Permit Permit Number: OSP191453 Work Type: WellSeptic Initial Tax Code Number: 02004121000 Site Legal Address: MANN BLK 2 LT 1 G:3238 Site Mailing Address: 16000 Elizabeth ST, Anchorage Owner: SMULICK DANE ANDREW & Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: �lY,c nt Q � 4 f 15opartm ut Lot Size in Sq Ft: Total Bedrooms: 10/9/2019 10/8/2020 49458 Q Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: - • IMA11111i Date: Date: 4 ��WIWAJU? MUNICIPALITY OF AHCHORAGE O I„ A Development Services Department s7 Phone: 907-343-7904 On -Site Water & Wastewater Section -- Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-041-21 Property owner(s) DANE & ERIN SMULICK Day phone Mailing address 10285 CARLSON ROAD, ANCHORAGE, AK 99507 Site address NHN ELIZABETH STREET, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) MANN BLOCK 2, LOT 1 Legal description (Township, Range & Section) Lot Size 49,458 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ® Initial © Single Family (SF) (w/wo AD U) Septic Tank ® Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FWCS - Brent Western (Signature of property owner or authorized agent) Permit/Rush Fees. 1 Waiver Fees: Date of Payment: `U �� �I 1 Date of Payment: Receipt Number: c��°���� Receipt Number: Permit No. CEJ`' p l 9 «S3 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345-3377 / Fax 345-1391 October 7, 2019 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: NEW WELL & SEPTIC SYSTEM PERMIT LEGAL: MANN BLOCK 2, LOT 1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIAN( OSP191453, Deb Wockenfuss, 10/0t We've been requested to obtain a new septic & well permit on the above referenced lot. We propose to install one elevated trench / mound with Advantex system to serve the proposed 4 - bedroom residence. The design is based on the test holes previously conducted in 2007. Recent groundwater monitoring showed shallower groundwater than previously observed per the 2008 testhole and permitted design. The average slope of the lot from east to west is 12-14% with the steepest slopes along the eastern portion. Slopes flatten out on the western portion and are,?0% at the proposed septic location. The lot and area are served by private water. The design will not impact any of the neighboring properties. AA4Y4&-., Michael N. Anderson, P.E. Municipality of Anchorage DESIGN CRITERIA: REVIEWED FOR CODE COMP Art( INSTALL NEW 1500 GAL. ADVANTEX TANK WITH AX -20 PODS ANCHORED WM'ni�tWf'. acva. MAINTAIN 10'+ FROM FOUNDATION, 5'+ TO FIELD & 50'+ TO WELL / SURFACE WATER WITH 4' OF COVER OR INSULAITON, ADD POST TANK PUMP BASIN. EXCAVATE 1' & ADD 2' MOA APPROVED SAND FOR GROUND WATER SEPARATI❑N 3' OF COVER OR 2' W/ INSULALTI❑N OVER ABSORPTION TRENCH WITH S❑IL / VEG. PRESSURISED DISTRIBUTION LINE: 3/16" HOLE SIZE = 1GAL/HOLE @ 30 PSI 30 GALS (PUMP DELIVERY) = 1 GAL/HOLE = 30 HOLES USE 30 HOLES @ 1' SPACING. 658' N 90'00'00"E 300.00' MANN BLOCK 2, LOT 1 NHN ELIZABETH STREET, ANCHORAGE, AK 99516 Michael N. Anderson, P.E. DATE: 10/9/2019 4661 Natrona Ave. DRAWN: FWCS Anchorage, Alaska 99516 (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 60' 0 PAGE 1 OF 2 Idw ��. of ALS IIIII Af 4 9 TH 70 .p '.MICHAEL N. ANDERSON.' N. CE 9469 �� ��c� 10/9/19_ • AO 'e' �'Q pYQFESSIO 0 20' UTILITY ESMT. 10 STAKE O m ESMT o� wPRIOR TO pr a �awo —i 4BR HOUSE fez CONST. A.C. DRIVE 00 mrnoxn .cu UT o0 O 51.D 704' o -,x O p o Z O ruw w/ii to noo t otw. B+Sw rco G� TMl, NO WELLS W/IN 100' OF PROPOSED SEPTIC SYSTEM N 90'00'00"E 300.00' 662 ELEVATIONS BASED ON MOA AERIAL TOPO (TYP) DAREA APPROX. SEPTIC AREA PREPARED FOR: DANE & ERIN SMULICK MANN BLOCK 2, LOT 1 NHN ELIZABETH STREET, ANCHORAGE, AK 99516 Michael N. Anderson, P.E. DATE: 10/9/2019 4661 Natrona Ave. DRAWN: FWCS Anchorage, Alaska 99516 (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 60' 0 PAGE 1 OF 2 Idw ��. of ALS IIIII Af 4 9 TH 70 .p '.MICHAEL N. ANDERSON.' N. CE 9469 �� ��c� 10/9/19_ • AO 'e' �'Q pYQFESSIO 0 30' W O m PROPOSED o Z —i 4BR HOUSE w A.C. DRIVE 00 mrnoxn .cu C6 Cd 0 N N 51.D 704' MANN BLOCK 2, LOT 1 NHN ELIZABETH STREET, ANCHORAGE, AK 99516 Michael N. Anderson, P.E. DATE: 10/9/2019 4661 Natrona Ave. DRAWN: FWCS Anchorage, Alaska 99516 (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 60' 0 PAGE 1 OF 2 Idw ��. of ALS IIIII Af 4 9 TH 70 .p '.MICHAEL N. ANDERSON.' N. CE 9469 �� ��c� 10/9/19_ • AO 'e' �'Q pYQFESSIO 0 DESIGN CRITERIA: 3:1 SLOPE TYP 4 BDRM X 150 = 600 GPD SOILS = 6000PD / 4GPD/SF = 150 SF 150SF / 5 = 30' ORIGINAL GRADE (THI 2007) (1) SHALLOW 5—WIDE o.5' OR 1' ABOVE GRADE 1' GRND. WTR. GP 0.5' EFFECTIVE loilil9 a' 5' WIDE GM /10% i' 5.0' Municipality of Anchorage TOPSOIL AND VEGAi?.kWEWED FOR CODE ILTER FABRIC & INSLMI Wj�453 Deb W,,) i-1.25' DISTB. PIPE '--6' OF SEWER ROCK MOA APPROVED FILTER 2'+ OF SAND TO MAINTAIN 2'+ TO GRND. WTR. SEPTIC FIELD SECTION TH #2 20' UTILITY ESMT. EXTENT OF MOUND MT 7RESERVE MT 'n, TH#1 W /0 NO WELLS W/IN 100' OF PROPOSED /07 SEPTIC SYSTEM 100' RADIUS STAKE CO 1-z ESMT 4 � PRIOR TO L,J CONST. POD & PUMP BASIN O O J I— PROF O 4BR O O O z i' 5.0' Municipality of Anchorage TOPSOIL AND VEGAi?.kWEWED FOR CODE ILTER FABRIC & INSLMI Wj�453 Deb W,,) i-1.25' DISTB. PIPE '--6' OF SEWER ROCK MOA APPROVED FILTER 2'+ OF SAND TO MAINTAIN 2'+ TO GRND. WTR. SEPTIC FIELD SECTION TH #2 20' UTILITY ESMT. EXTENT OF MOUND MT 7RESERVE MT 'n, TH#1 W /0 NO WELLS W/IN 100' OF PROPOSED /07 SEPTIC SYSTEM t0-157 N 90'00�Og� 23(b�.OQ' 662' ELEVATIONS BASED ON MOA AERIAL TOPO (TYP) PREPARED FOR: DANE & ERIN SMULICK *�, OF.AL4�, MANN BLOCK 2, LOT 1 NHN ELIZABETH STREET, ANCHORAGE, AK 99516 * 4TH* . * Michael N. Anderson 1. E. p.MICHAEL N. ANDERSON. DATE: 10/9/2019 �� � No. CE 9469 ' ,�� 4661 Natrona Ave. Af DRAWN: FWCS ���0 10/9/1.9� Anchorage, Alaska 99516 Pte...... Ati (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30- 100, 100' RADIUS 10-15% INSTALL NEW 1500 -GAL TANK W/ AX -20 POD & PUMP BASIN FCO PROF MH MH MH 4BR t0-157 N 90'00�Og� 23(b�.OQ' 662' ELEVATIONS BASED ON MOA AERIAL TOPO (TYP) PREPARED FOR: DANE & ERIN SMULICK *�, OF.AL4�, MANN BLOCK 2, LOT 1 NHN ELIZABETH STREET, ANCHORAGE, AK 99516 * 4TH* . * Michael N. Anderson 1. E. p.MICHAEL N. ANDERSON. DATE: 10/9/2019 �� � No. CE 9469 ' ,�� 4661 Natrona Ave. Af DRAWN: FWCS ���0 10/9/1.9� Anchorage, Alaska 99516 Pte...... Ati (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30- 100, Municipality of Anchorage p�u . t ICv � l..i �. tJPCaIN� Rs��EA4js`r, fic. Development Services Department Division 4 9 H Building Safety On -Site Water and Wastewater Program �• • • •;.,9,° ° • • • • o ° ..± 4700 South BraawSt V.•••••m°••e•••e•°•�•e• P.O. Box 196650 Anchorage, AK 99519-6650 ® e ' r � 0 MICHAEL N. ANDERSON vy; �vww.ci.anchorage.ak.us �� 0„°. CE - 9469 e :`:� ° (907) 343-7904 • Performed For: Legal Description: Soils Log - Percolation Tess I 06Fesi���"�� I IPu F fir+ ✓1 __ Date Pcjc m.ed: L I 13 2 t` t, 7 1 Township, Range, Section: Slope Site Plan _ / Depth , (Feet) 1- C -? P 2- 4- 5- 6- 7-1 M a M 1 G. 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- Sr�%y �rov-c WAS GROUND WATER ENCOUNTERED? V- s S r� L IF YES, AT WHAT DEPTH? , 0 0 ep ater After �7 P Monit ring? L..0O —7,9 E �7- Date: r0 /0 �xd ��r MA1�' 0 1 ing Date Gross Time Net Time Depth � Water Net Drop f0 1/0 y'r�j M 3DM .n I pit ^ 90A V rr , I�� rr Z, 4 V -P I Ir I yrs r• I PERCOLATION RATE ( Z (minctes!mch) PERC HOLE DIALIE 1 ER TEST RUNT fBE PNEE : 3 F AND �_ FT COiNIMENTS h -ex G �urA� `,r S,S c S�a�v'c1 Ca Ni PERFORMED BY: 1V/1 LG 'r—A, d -0 4s'0A I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE ANDMUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage Development Services Department Building Safety Division ® On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchor2ge.ak.us (907) 343-7904 'V0 s e � ° MICHAEL N. ANDERSON CE - 9469 Soils Log - Percolation Tess $�`�%,�n ° ° • ° °;,; ' I Performed For. - l if y�a>'t ! U f �m o ✓1 _ Date Pejo ned:--- Legal Description: L Township, Range, Section: Slope Site Plan 7 # 2- 1 �( Ud �jon IGTF-S ee :1r 1- C' 2- l T F In LZ r 0 v c- l 4 5 6 7 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- C its r 116'7 `,rvv-r I I I sklI PdA WAS GROUND WATER ENCOUNTERED? T rj DEPTH? s L �r� 0 Depth to Wat r After Mnitoring. p rE ,�F�AT Date: to9 /uJ 1�e✓ t ding Date Gross Time I Net Time Depth KWater Net Drop p30 1,„�N I P,e- So, QJ ShI f l% r -2,5,- rr I I I I I I I I I I PERCOLATION RATE I '(/ (,J=teeinc,) KrHU HULt UTArat i tr, Le, TEST RUN BETWEEN -77 F -i AND L( FT COMMENTS r (S V_- OrY ,-- S 41- PERFORMED BY: NiI � � 0 r l /� � N > f dtl � CERTIFY THAT THIS TEST VAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (d 1 '�/U�- MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this g14' Day of CC-6V)u- of 20 1 q , by and between lb. Gwj. swmv"lVu , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as 6JVtvA4V i? located at (legal description) MAvm L /V NN �`�L �cf4 S!✓ � �hctr 61�S1t 2. Maintenance, Repairs and AIterations. (Owner is required to read, understand and initial each section) V/ Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This .ncludes an annual maintenance fee (typically $400 to $600). Y Owner agrees that only maintenance and repair personnel approved by the Municipality P tY or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. VOwner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 t/ Owner acknowledges that the Municipality may request records of maintenance and / repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. / V Owner agrees to grant the Municipality reasonable access to test and inspect the /AWWTS. The Municipality will give at least 24-hour notice. t/ Owner agrees that any sale or transfer of title of the property will not occur without a new / Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval.. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: (signature) Date: lo/40101 N,V\c, $w�v�\uk� (print name) STATE OF ALASKA ) )'ss. THIRD JUDICIAL DISTRICT ) The Coregoinc, instrume kwas acknowledged before me this_ day of J u, 2019, by�,i„_2. b C'\ c= A A r i r L STATE OF ALASKA , .. NOYAP P BIj, C OR ALASI A . NOTARY PUBLIC rte` ' M C mmissio ex res: Q :?-Z Zc)Z.O Jill A. Jaeckel MY COMMIssion Expires: April 2-2,2 MUNICIPALITY: By: (signature) (print name) Date: Title: (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW080256 Legal Description: MANN BLOCK 2 LOT 1 Design Engineer: 0088 ANDERSON CONSTRUCTION & E Owner Name: BRYAN PROTZMAN Owner Address: 5049 CAPE SEVILLE DRIVE ANCHORAGE, AK 99516-7520 Date Issued: Dec 17, 2008 Expiration Date: Dec 17, 2009 Parcel ID: 020-041-21 Site Address: NHN ELIZABETH STREET Lot Size: 49458 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: 0 Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy 0 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 duri freezing weath, must be either: A. Open and closed on the same day. / B. Covered, sealed, and heated to prevent freezin `G L 5. The following special provisions. 2�e2 '-�-?O Driveway must be built so that tank access is less than 100'a ay. e\\ v as � Pei � Received By: Issued By: z7i ;5'/o e Date: 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 6T' g4 p�..'.. __.. on` .:1 v.= o SAF ET�Y ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel 1. D. d7, d — 6 L4 ( —Z� I, Property Mailing phone 'ode qq js 1 to -1�5ab Site address �jl ELI -,-,?-AT-;',6::�711 5 112.1=El Zip Code Legal description (Sub'd., Block & Lot) MgiAn T—m(x� �4, Lur 1 Legal description (Township, Range & Section) Lot Size `i"I , Ll J� Sq. Ft. Number of Bedrooms i i THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN: Absorption Field [ Initial 0/ Septic Tank 0 Upgrade ❑ Holding Tank ❑ Renewal ❑ Privy ❑ Private Well [� Water Storage ❑ 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: �fD ' i� Waiver Fees: Date of Payment: ��Ub Date of Payment: Receipt Number: ��% ``�� �� Receipt Number: (Rev. 11/05) MU Il ter] ll C it !! A UTY oF o!1A N C Il !1 V RA I� Rv � � ""f y� �r tl Development Services Department `, Phone: 907-343-7904 On -Site Water & Wastewater Section Pax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-'041-21 Expiration Date: - 1. GENERAL INFORMATION Complete legal .description MANN BLK 2 LT 1 Location (site address) 10000 ELIZABETH ST, ANCH AK Current property owner(s) MGJ Mailing address SAME Day phone Real estate agent Day phone 2. TYPE OF DWELLING, [� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) a Al S. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well [j Private Septic Q Water Storage ❑ holding Tante ❑ Community Well L] Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for; Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. Date of Payment Date of Payment Receipt Number 010605 Receipt Number COSA # O S C C�LW 3 Waiver # S. STATEMENT OF INSPECTION BY EWGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 7278864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E, pate 10-31_20 DSD SIGNATURE M !1� ��•ff 6f� Qfrf if '� T H f�f . f•. a.• a. f, o. o e f f• f a. a a' j System #4 Approved for 4bedrooms. System #2 Approved for {' ,°. Mlcx�<< - at:oEasc.a : �; ;,d bedrooms �. � CE - 91' 9 Disapproved �" ;, , l Ail ;j� Conditional approval for bedrooms, with the following stipulations ��� ,'•� �'�'°`" `t�tttt�r�r GRAM By: Original Certificate to Date: '� � 3 07 d 2 D The Municipality of Anchorage Development Services Division (DSD) Issues Certillcates 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 englneer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory ..__ Well Flow Advisory Other -COSA Chcchlist blue shoal COSA Checklist Legal Description: MANN BLK 2 LT 1 Parcel ID: 020-041-21 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Q Well log is filed with Onsite (or attached) Date drilled 215109 Total depth 286 ft Cased to 46 ft X Sanitary seal is functioning correctly X Wires are properly protected Casing height (above ground) 30 in. Date of flow test for COSA 9/4/20 Well production at time of test 1.6+ glom Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes No FE -1 Coliform bacteria is Negative Nitrate mg/L 9 Nitrate less than MRL (ND) Arsenic 10.1 ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 10/26/20 Static water level at beginning of test *0 ft. Seeker"' Comments * Artesian well with packer, WELL LOG STATES NON -ARTESIAN B. TANK DATA Age of tank(s) 2020 years * Tank typelmaterial Measured operating fluid level in septic tank NEW 7 Standpipes/foundation cleanout per record drawing Date of pumping * new fiberglass Advantex w/ pod D. ABSORPTION FIELD DATA New Advantex System Which system tested (date installed) new ❑■ ALL standpipes present per record drawing Total measured depth from grade 3.0 ft (max) Measured depth to pipe invert from grade 2.5 ft (min) ❑ N/A — pressurized field X Monitor tubes go to bottom of effective. If not, state depth into effective ❑■ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date new Results JZ Pass For 4 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) 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' F,(J Yes if No Community Sewer Manhole/Cleanout > 100' ry Yes if No ft r Yes if No ft Neighboring Tank > 100'[]✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ✓� Yes if No ft E✓ Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [✓ Yes if No ft M✓ Yes if No ft From Septic/bolding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ED Yes if No ft Surface Water> 100' Yes if No ft Property Line > 5' F,(J Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' [Z Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' F71 Yes if No ft Community Wells > 200' F71 Yes if No ft Water Service Line > 10' P� Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' p✓ Yes if No ft Surface Water > 100' 0✓ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 49L! P �P�.'�INE• .... t}.� o+'ft!'E*'?,EL N. ANDERSON '�•, CE -9 9 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343- 7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Arsenic Advisory Certificate of On-Site Systems Approval # OSC201613 Subdivision: Mann, Block: 2, Lot: 1 A water sample revealed an arsenic concentration of 10.1 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. SGS Ref.# 1212735001 Client Name First Water Consulting Services (FWCS) Project Name/it Mann B2, L1 Client Sample ID Spigot Matrix Drinking Water Sample Remarks: Printed Date/Time Collected Datc/Time Received Date/Time Technical Director 06/09/2021 14:45 05/25/2021 15:30 05/26/2021 12:40 Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Total Dissolved Solids 259 10.0 mg/L SM21 2540C A (<500) 05/28/21 EWW Metals by ICP/MS Hardness as CaCO3 146 25.0 mg/L SM21 2340B C 05/29/21 06/03/21 DMM Waters Department (Provisional Cert for Nitrate—N) Total Nitrate/Nitrite-N ND 0.200 mg/L SM21 450ONO3-F D (<10) 06/03/21 EBH Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B B 05/26/21 A.L Total Coliform Negative 1 100mL SM21 9223B B 05/26/21 A.L Private Individual Analysis Chloride 7.80 0.200 mg/L EPA 300.0 A (<250) 06/02/21 06/02/21 A.A Conductivity 429 5.00 umhos/cm SM212510B A 06/01/21 SEM Fluoride 0.512 0.200 mg/L EPA 300.0 A (<2) 06/02/21 06/02/21 A.A Sulfate 38.7 1.00. mg/L EPA 300.0 A (<250) 06/02/21 06/02/21 A.A. Alkalinity 170 10.0 mg/L SM21 2320B A 06/01/21 SEM Aluminum 95.7 20.0 ug/L EP200.8 C 05/29/21 06/03/21 DMM Antimony 1.70 1.00 ug/L EP200.8 C (<6) 05/29/21 06/03/21 DMM Arsenic ND 5.00 ug/L EP200.8 C (<l0) 05/29/21 06/03/21 DMM Barium 35.5 3.00 ug/L EP200.8 C (<2000) 05/29/21 06/03/21 DMM Cadmium ND 0.500 ug/L EP200.8 C (<5) 05/29/21 06/03/21 DMM Calcium 34100 2500 ug/L EP200.8 C 05/29/21 06/03/21 DMM Chromium ND 5.00 ug/L EP200.8 C (<100) 05/29/21 06/03/21 DMM CO3 Alkalinity ND 10.0 mg/L SM21 2320B A 06/01/21 SEM 2of6 Received Date/Time 05/26/2021 12:40 05/25/2021 15:30Collected Date/Time 1212735001 Matrix SGS Ref.# Client Sample ID Spigot Client Name Project Name/# Printed Date/Time 06/09/2021 14:45First Water Consulting Services (FWCS) Technical Director Stephen C. Ede Mann B2, L1 Drinking Water Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Private Individual Analysis DMM06/03/21EP200.8ug/LCopper 05/29/219.47 1.00 (<1000) C SEM06/01/21SM21 2320Bmg/LHCO3 Alkalinity 170 10.0 A DMM06/03/21EP200.8ug/LIron 05/29/21ND250(<300)C DMM06/03/21EP200.8ug/LLead 05/29/213.91 0.200 (<15) C DMM06/03/21EP200.8ug/LMagnesium 05/29/2114900250C DMM06/03/21EP200.8ug/LManganese 05/29/2116.9 1.00 (<50) C DMM06/03/21EP200.8ug/LNickel 05/29/21ND2.00 (<100)C SEM06/01/21SM21 2320Bmg/LOH Alkalinity ND 10.0 A SEM06/01/21SM21 4500-H BpH unitspH8.1 0.100 (6.5-8.5) A DMM06/03/21EP200.8ug/LPotassium 05/29/21769500C DMM06/03/21EP200.8ug/LSelenium 05/29/21ND5.00 (<50)C DMM06/03/21EP200.8ug/LSilver 05/29/21ND1.00 (<100)C DMM06/03/21EP200.8ug/LSodium 05/29/21405002500C DMM06/03/21EP200.8ug/LThallium 05/29/21ND1.00 (<2)C DMM06/03/21EP200.8ug/LZinc 05/29/21ND10.0 (<5000)C 3 of 6 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this t i t"' Day of �5v y\/,- of 20 a \ , by and between D i vy A v\c�- E C� VN S VV1t- l kC tC , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN ADVANTEX SYSTEM located at (legal description) MANN BLOCK 2, LOT 1 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) p Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Q&L� Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. V9 Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 S ! j Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. N � S Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. D, 5 SLS Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. S Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. �S 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. D5 S Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNI•;R: By: (signature) Date: 6111/ d I ( ltit/1� t "iC (print name) STATE OF ALASKA THIRD JUDICIAL DISTRICT The foregoing instrument was acltn 20V, by -Da,,`C- ss. •,rr edged before me this ( day of C OR AL SI STATE OF ALASKA xres: P NOTARY PUBLIC Jill A. Jaeckel My Commission Expires: April 22, 2024 MUNICIPALITY: (signature) Date: (print name) Title: (rev. 05/18/2018) Page 3 of 3