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Home My WebLink AboutT12N R3W SEC 33 LT 103T12N R3W Sec. 33 Lot 103 #018-262-02 Municipality of Anchorage e .. Development Services Department Building Safety Division On -Site Water and Wastewater Program. 4700 S. Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 Page / of Z www.d.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5" 05'0 Z 0(' PID Number: (7t '?– 2 (o 2-02 Ha'a"Wastewater Way►,c PL.FL, System: New ❑ Upgrade Aaarnc '2(90 o, + 70 It" ABSORPTION FIELD Rww. ZZQ _ 0 a �I O Hu"Wr a se&omc l �Tt� 0sIWa+TWXit 0 S OMwN Xtwlw _ . LEGAL DESCRIPTION sea RabnT 3,0 Taal DeM eanaprw qbe: 2- GPVFe p FI. &aa: Lot: Suedwaon: DeM b pm E kan 09. 7b. Gra.al depth earamt, PPa: L/ (c)'3 2,0 Fl. at To. p. Range: seceon: I 'L W aaaea aoov. a,pn.l p.ar. 400 Gr.M Lerya: Z Ft. Fl. Well: (XNew Cl Upgrade (3vowln: S.O 1An aan.a: / PfWrc. earwaan anas: — Ft. FL Clamlm tPnwil A B. C1TOW DeP.r: Caa.a b: Taal sesapam arae 'Z 4 PW. wt.nal: (� Ft. 1'2 5- Ft. oo Fe pe.r OaN SM4C WataLM: Muter: nl✓-^I jlrf Dow 1gW1 /rl la'nC T O$' S�O it �`M1g6 /r% Y.pO Z0 Wrrp Sal at. Ca" heot Aoova Ground: 1KhUstF Z.01 TANK / GPM L4 FI. FL VPVt Yr SEPARATION DISTANCES O septic O Holding O S.T.E.P. !f.) Other. To eper Absorption Lift Holding . uPrivate a ♦ / �r From Field Station Tank Sewer Line ht.� '` a n Kj Jf �-Fl rp Gr./Svp we too 4 (LD � m 4. I rCO V_ MaMY. C c✓ 44:5 t Huns,a a CaryanrrwtM. Z sa4cewate, LIFT STATION 1 u.auua, TpSG OQ rhq Fwbaian Z S r f t 14— p Q 1416 y t G o I Ci h 1 U M { ( c~onan N � �/� Purq Maa.B Moats e 1./1 Ebcoini Mpaan Paaanaa trr -• �4SEhF(vn' P.11 ii 0(0=PGV e (.F fe k, §V6.5FF,a BENCH MARK rLf� 0. T,- ar YhlW nta� /S os t.aaoan.rfrq� D�a,mP.m. n % Aswn.a avawn. Fl. Engineer's Stamp OF A(,, II 111 5 9 � Inspections performed by: V(t Air?' 1 An d rT 4 F n P (• Dates: 1 to (& b 5— ow * : 4 gT14 2ne /I lU%S Development Services Department Approval .. ... `t 11011CHAEL M AADERSCINI00 Reviewed and approved by: Date: _1��'v �e IRry Cml" ` r��i��gF j04 9�.�`�i /v Permit No. SW050206 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: LOT 2B, T12N, R3W, SECTION 33, N.E. 1/4 LOT 103 PID No.: 018-262-02 MARK p PIPE ELEV. COl 3.0 97.1CO2 7.5 97.3TCOI 10.5 MANHOLE 19.0CO3 T23.99.1 .0 C04 30.5 19. COS 18.0 27. 98,,b 95.6 MT 30.0 17. B:B, 25% SLOPE NEICHBORING WELL RADIUS �— n CUA 1R11L CAI -E.1 \\ / ALT NATE nELD --_ i cz \ AD A-20 POO r \ �� ST HOLE RADIUS / tC '— — — CO �� I ;� M34 = JTC010 MH GE DOOR, BENCH MARK \ 1 \ � 1 CO1 co /rt MCD \B� ELECTRICAL PANEL earn Setback 26. MOUNTED ON WOOD d• POST N 83 C� ASBUILT SCALE: 10=30' M ml lcm wv.Yrtv rao oos r auY ovl wn, ow. Yw.nE .sass �� t '`.. ..� . ..................... s .Ya.Ys.o U n. 0 M 11: 49 Tw .•.j. nrts rrc W / J •s••..1.....0 ♦�'t,MICHAEL N. ANDERSONt i w ��j}•No. •'�� 1e C� •./ �(0 .S= SECTKA PIPE ELEV. COl 3.0 97.1CO2 7.5 97.3TCOI 10.5 MANHOLE 19.0CO3 20.0 .0 C04 30.5 19. COS 18.0 27. 98,,b 95.6 MT 30.0 17. B:B, EDS ELECTRIC INC SC7 272 4650 10/06.05 M49cm P. C01 Fror. +10076303507 Por. San 30 05:39:33 2006 Psy 1 of 1 INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 4700 SOUTH BRAGAW INSPECTION INFORMATION &HELP: 343-7962 IP:SPEC-ION. VOICE 373-53M •NSPECTIOY. FAX (907)Z49-7777 vnrv.'.Mj-i.OfG!BSD/In3D*sC4Ong C',: NAME: cuano PERMR t: Oe -7C06 COMPANY: etl'se,oclic INSPECTDATE: 1:3012COG PHONE M: 272-4591 PHONE Y: PHONE 1: ADDRESS: 3500 LO-- SAULT AVE LOT 103 51iUDIVISION: TiZN R3W SEC 33 GRID k: SW3035 COrdMENTS or DIRECTIONS am T!PE OF INSPECTION: Re!:o'Etec7ia' CCMMENTS: ;FOR INSPECT03 USE ONLYI G PFIINTED NAME �; _ DATE:_ ALPINE DRILLING & ENTERPRISES Permit Number. #SW040239 Date of Issue: 7-1-04 Parcel Identification Number: 018-262-02 Date Started: 5-08-05 Date Completed: 5-08-05 Is well located at approved permit location? ® Yes ❑ No Legal Description: TI 2N R3W Section 33 Lot 103 Property Owner Name & Address: Wayne Dick 1200 E 70M Anchorage, Alaska 99516 Borehole Data: Soil Type, Thickness & Water Strata Depth (ft) From To Method of Drilling ® air rotary ❑ cable tool Casing type: steel stick-up 0 2 Wall Thickness:.250 inches gravelly silt 2 7 Diameter: 6 inches Depth: 125 feet silty Cobbly gravel 7 55 Liner Type: gravelly sift silt gravelly silt 55 71 78 71 78 118 Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 56 feet Pumping level: 125 feet after water sand & gravell 118 125 2 hoursum in 20 gPm P P 6— Recovery Rate: 20 gpm . Method of Testing: airlift Well Intake Opening Type: ® Open End ❑ Open }sole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite granules Volume: 1 Depth: Start 0 feet Stopped ? feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: chlorine tablets Comments: Well Driller. Alpine Drilling & Enterprises PO Box 110496 Anchorage AK 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Renewal Date Issued: Jul 05, 2005 Expiration Date: Jul 05, 2006 Permit Number: SWO50206 Parcel ID: 018-262-02 Legal Description: T12N R3W SECTION 33 N.E. 1/4 LOT 103 Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: Wayne Dick Owner Address: 1200 E. 70 th Anchorage , A 99516 - Site Address: none Lot Size: 108900 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Date: 7AS-OS Issued By: Date: Vier/0) �e��i.CJ� 11lunicapalfty of Anciioc age Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. In I 0 —o2(LR - DA Permit Number SW Propert Mailing oil Legal description (Lot, Block & Sub'd.) phone ,ode gg670 Legal description (Section, Township & Range) 712n1 VZ3W Ser, 33 LpT ID3 Lot Size 1bT, ono_Acrs/Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR: Sewer Only M Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. of property owner or authorized agent) Permit/Rush Fees: 91n1\11, , Y�\%R5 Waiver Fees: Date of Payment: Date of Payment: Receipt Number: �(3 ,�_ Receipt Number: (Rev. 09/04) MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Jul 01, 2004 Expiration Date: Jul 01, 2005 Permit Number: SW040239 Parcel ID: 018-262-02 Legal Description: frl2N R3W SECTION 33! " LOT 103 , Design Engineer: 0088 Anderson Construction & Eng'g Site Address: none Owner Name: Wayne Dick Lot Size: 108900 SQ. FT. Owner Address: 1200 E. 70 th Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , A 99516 - This permit is for the construction of: ❑✓ Disposal Field Z✓ Septic Tank Holding Tank [] Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Issued By. ✓'� Date: / Date: —�' f7 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.ci.anchorage.ek.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. h18 -2&?, -07 Permit Number SW O O a3 tj Property owner(s) tiV Mailing address phone Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Zvi, rm3, A -F_ %-'-46g 3'L r 2t4 r?- S, W Legal description (Section, Township & Range) Lot Size 2. '5—Aures 6q.Ft. THIS APPLICATION IS FOR: Number of Bedrooms I Sewer Only ❑ Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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 Fees: Waiver 3D '� l sZS Waiver Fees: Date of Payment: (0Ad%� Date of Payment: Receipt Number: /�� ,2 Receipt Number: (Rev. 12100) Michael N. Anderson, P.E. Civil/Structural Engineering 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 June 10, 2004 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 103 NE 1/4, Section 33, T12N, R3W, Seward Meridian, Alaska To Whom it may concern: This is a request for a new septic & well permit for the above residence. The 2.5 acre lot is divided by a small creek as the plan shows. Also on the west side by a very steep bluff. After all of the offsets have been shown the remaining room for a septic system is small. Therefore the Advantex has been selected as the design shows. The perc rate was good at 14 minutes per inch with no water table observed. The soils consist of silty gravels (GM) with large rocks. Drainage is to the west at about 10 to 15 percent. The slope on the west side is over 25 percent and a 35 feet buffer has been shown. The lot was surveyed to give correct locations and offsets to place the new system. This new system will not impact the neighboring properties due to the large lots and layout of the existing systems. The maintenance agreement has been included with this submittal If you have any question please call me at 345-3377 Sincerely Michael N. Anderson, P.E. bESIGN CRITERIA: 4 BDRM X 150 = 600 GPD MOUND OVER SOILS = 600/3.0 = 200 SO FT REO'D GRADE 200/5x0.5=20 —1' OR 5' TRENCH SYSTEM GM o 6 DEEP 4' EFFECTIVE 5.0' WIDE o 20' LONG -8.0' SM 5.0' DRAIN ROCK —14.0' LL PROPOSED WELL iiXEXIS�TI�N�G,Wl 100' RADIUS ri PROPOSED SEPTIC SYSTEM —'r—_ _� VgCANT LOT PROPOSED HOUSE f CREEK---Tl$�(�3W i r I VW+4J LOT 102 § PARK LAND L-----1J j BUM LOT 10.3 X — T W I L I G H T L A N E— Septic Design Prepared For WAYNE DICK •�� OP(E,�...... LOT 103, NE 1/4 SECTION 33, T12N, R3W, SEWARD MERIDIAN, ALASKA : ' • r 49TH >?�� i.... Prepared By ... ... . ............ MIC1IAEL N. ANDERSON, P.E. 4640 SIIOSIIONI DRIVEI�:MICHAEL N. ANDERSON;: �� (907) 345-3377 / FAX (907) 345-1391 ' No. EE 9469 SCALE: 1"=200' APRIL 3, 20054oil�1:•• q0X` ��4�/ ' 25% BLUFF SETBACK —SECONDARY DRAINFIELD ----- TING WELL RADIUS PROPOSED DRAINFIELD' ,' - ---------- SHED 35' ROADWAY &,PUBLIG'UTILITY EASEMENT `. 50' FRONT YARD BUILDING SETBACK W 100' PROPOSED V 107 I v 1 O 1/'---------- _p WELL 1/1 S 1 x /' / %% REEK 3p • I � , /0 —� L --MT — f / 1 0 o'FCO /`,PROPOSED HOUSE LJ ' GALLON I S TANK I x I I CREEK I � / J I I I L-------------- ------- ----� \I • I SETBACK. TYPICAL I °d I � I I N I I I I I --------------J 50' REAR YARD BUILDING SETBACK Septic Design Prepared For WAYNE DICK LOT 103, NE 1/4 `�`p',• SECTION 33, T12N, R3W, SEWARD MERIDIAN, ALASKA is 49rH Prepared Byyf•jlf MICHAEL N. ANDERSON, P.E. :..... 1.1.(.✓..!?!/fi 4640 SIIOSIIONI DRIVE 1. °MICHAEL N. ANDEF (907) 345-3377 / FAX (907) 345-1391 No. PE 9465 SCALE: 1"=50' APRIL 3, 2005 'ti.�ss%( 0 Municipality of Anchorage OCW-FAf ( l Development Services Department --1P,.• •. Building Safety Division h: •'�'91+ �• On -Site Water and Wastewater Program *:491—H % *I 4700 th agave SL / •./'/" t�' • •.�.. P.O. Box 756650 6650AnAn4horage, AK 595146650 www Ci anchcrxe.ak.us •;••• •• ••••••••••••• (907) 343-7504 c; Soils Log - Percolation Test rtf Pe,formea For: Via4 n e- __Date Peer.m.eJ- Legal Description: L-rA- 1 J ,�> b f+M Township. Range, Section: _ Stooe Depth O 1 5- 04 C. Ci 12- 13- 0 1- 12- 13- 15- 16- 17- 1113- 19- 1 1516- 17- 18- 19- COMMENTS COMMENTS MICHAEL N. ANDERSON :�c CE -9469 Site Plan ■.■M■■■■■ ■■■■■■■■■■ Reading Date ■■■■■■■■■■ Net Time Depth 16 Water Net Drop 7 p �ir4r. /y crriOfLf ■■■■■■■■■■ 7,0 ZeO� ■■■.■■■■■■ 3y 7 MENEMEMENE ONNOMEMENN ■■■■■■■.■■ ■■■.■N■■■■ WAS GROUND WATER ENCOUNTERED? _ �� S IF YES, AT WHAT DEPTH? L D Deem to Water after P klonitoringt ti AP v E Reading Date Gross Tune Net Time Depth 16 Water Net Drop 7 p �ir4r. /y crriOfLf 7,0 ZeO� 3y 7 GERCOLATION RATE (r( (ru+vles5rcl) PERC HOLE DW.IETER �� T -ST ggUN eer?IEEv 3 FT AND �FT 4L rK ed yr ,4t!uPnRex PERFORMED BY: x,(1�[�v �('t:, of - t CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: T / 0 Municipality of Anchorage Development Services Department_ Building Safety Division / On -Site Water and Wastewater Program s 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.DQV$=.;2_-L_1—,_ D 21– 1. GENERAL INFORMATION COSA # O 0 3 g 7 Expiration Date: /– 2 –7-10 Complete legal description T12N RiW Sec 33I Lot io3 Location (site address) -45oo Loc Sault Avenue Anchorage, AK Current Property owner(s) Doreen & Wayne Dick Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 12oo E. 7eh Anchorage, AK qqq18 Day phone Roger Briley Cal Keller Williams Day phone 865.6531 ioi W Benson Blvd Ste Sot Anchorage AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 11 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 11 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102gS4. Anchorage AK ggqio Engineer's Printed Name Steven R. Pannone, P.E. Date 20/26/o Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. 'Th••u� e operational life of all sells and septic systems depend on the local soil Condition, ground water OFpa4 levels that may fluctuate during the year, and the water usage of the (amity being served by the system. �•�P��••• These conditions are outside the control of the evaluator of this system. All systems eventually fail and : r'•• 1 ''•�., y �j� satisfactory lest results do not guarantee future performance of the system, nor dothey guarantee that / garw 's>t there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future -1-00 performance nor give any estimate of how long the system will continue to meet the operational • requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed %' 'µ5teven RTvonnone i above. Any reliance upon or use of this report by any other person or party is not authorized nor will it 0ic%'X No CE 8149 confer any legal right whatsoever. 0i *. . 5. DSD SIGNATURE to. r�:'� Approved for — bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: _PUver :fQ �I1 Dn-S,�r: 31/3-7�ID�i' Septic System Advisory Well Flow Advisory Nitrate Advisory ru 0c1 nv nuvwvl y Maintenance Agreements Supplemental Engineer's Report Other - By: Original Certificate Date: /0 —., 7— O q (Rw 11005 Municipality of Anchorage y..,,, • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: T12N Raw Sec as Lot 1oi Parcel ID,�, _ A. WELL DATA Well type p If A, B, or C provide PWSID # Date completed g/812oor Sanitary seal (YIN) Y Total depth 125 ft. Cased to 125 ft. FROM WELL LOG Date of test c/8t200c Static water level t6 ft. Well production 20 G.P.M. WATER SAMPLE RESULTS: Coliform O colonies/100 mL Nitrate f4h) mg/L Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) 2& in. AT INSPECTION so/2�hoog r ft. Other bacteria O colonies/100 mL Arsenic: _ ugA Date of sample: 101221200o Collected by: Luke Mattson B. SEPTIC/HOLDING TANK DATA 5rcP Tank Type/Material Anchor and r n o iter las Date Installed 713,0200S Tank size %goo gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 6/2212009 ins elation Pumper Inspector A+ Home Services C. ABSORPTION FIELD DATA ftk Date installed zo11612ooc Soil rating (g.p.dJft2 or tt2/bdrm) 3.o System type Dee Tp rench Length 22 ft. Width S.o ft. Gravel below pipe 4.o ft. Total depth 7,s, ft. Eff. absorption area 20 ftZ Monitoring tube Y Depression over field N_ Date of adequacy test io/23 20oo Results (Pass/Fail) Pass For.4 bedrooms Fluid depth in absorption field before test IZ in. Water added600 gal. New depth48 in. Elapsed Time::L"o min. Final fluid depth 21 In. Absorption rate >= 60o. g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 71%gl2oos Size in gallons 25oo Manhole/Access (Y/N) Y c "Pump on" level at 9s.8 in. 'Pump off" level at ,ga.e in. High water alarm level at I� — in. Datum Bottom of Tank Cycles tested 2 Meets alar & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot aoo+ Public sewer main NIA On adjacent lots ioo+ On adjacent lots aoo+ Public sewer manhole/cleanout NIA Sewer /septic service line a6'+ 100 t Holding tank aoo+ Animal containment areas aoo+ Manure/animal excrete storage areas aoo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation so' Property line ao+ Absorption field ;+ Water main NIA Water service line so+ Surface water loo+ Wells on adjacent lots zoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ao+ Building foundation ao+ Water main NIA Water Service line ao+ Surface water loo+ Driveway, parking/vehicle storage 5+ Curtain drain None Observed Wells on adjacent lots aoo F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and LV1. review of Municipal records that the above systems are in �`()TH " conformance with MOA COSA guidelines in effect on this date. .i j k k ste�nnor,e r f' Engineer's Printed Name Steven R. Pannone, P.E. 000 s W CE e 1 a0 ,i•. Date ee ##a- ?j(JT . ''� �•' 4�R�"K,r1J'�.� COSA Fee $ % q4( Date of PaymentReceipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number R�aal,,R ., X INvo 'p-, e., weer RrF FIMNerN QRPa 3 WSJ•]!' B 329 y Rt RAr IMf1At..... ................ .................... er ..................... IERI naARR NF1Rv • • •3Y ROADMY • RINUC UTL ESWT -------�^------- ----------------------- Wei,s,Ria r Y � Y sense ly J r : 2a.6' e Y R'R pyY NN 102 P S p3E0NE 3ftW SURVEY CERTIMATION��.v w� �''y Prepared by PLOT ,,, r�E � ' Robert E. Johns, Jr. & Assoc. MAd. r P Professional Land Surveyors re.rlrArrrrm. 170 ADRIVE. . Y�r+ror4=0YrrZ Ty ALASKA $91104.Vorssd_ 17WIsec"' 1 = 60' Rea, LN S.F. bw NEI FU FOL FONDAIM ADULT OWI t Ate, a. A.+r wF Rr I �.e.rr A.yA1 rr Dob SYIRITRQ 10-23-09 Drawl •,t LMW by rw m'x .:.:.......�.r...M. •Iai 4121 meDi-- Grim 30 TEa 10-23-09 FINAL 71Rt1CRM AS-NET +°�� • Lead Description: L WR t AM, A. r one, MI I ry_�i yLlr� 7777 rRN rrwerr NrwAP.r rr.r rie.rr Ta/°FMend IOt 103 T12N P3:4 Sac 33 UT BRKY SURVEY TYPE SYMBOLS FOUNDATION AS-PAT • SET R®M m; 'Zr DRAINAGE MPHALt MAL BRINCRRE AN-S LT 0 FOUND RMAR CG OVAIK Rot HAW ... AayILT ... tot .AI.NY ... t°No.IAR.. A&4hAY --- 21) 0111111111112 ._._.� vOOD FENCE ® ASRIMED ELEv. {I—R—N• METAL /gem "DOG Dew PLOT PLANS At LOT SU n NOTE: IT NS THE RESPONSOLITY OF THE WILDER OR ChIMER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VROWLE VALL K CONSTRUCTION. TO VERIFY PROPOSED BUILDNO GRADE RELATIVE 1HO°e41. i[HCE•. YRELAiL SOrTIC CLEANOkrM fD[YMIxL ORIKMAYR TO MOWED GRADE ANO UTILITY CONNECTIONS AND TO DETERMINE ETC.. 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Daft & —2-Z —b Fox completed form to 1-886-384-7404 ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEENM1 ti IPALM QFAN ORAGE AND THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this ,gL Day of Ol-1A'_ of 2049 by and between hcrein the "OWNER;' and the Municipality of Anchorage, heroin the J "MUNICIPALITY." In consideration of the mutual covenants contained hcrein, the parties to this Memorandum of Understanding agree as follows: I. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as _4 .0 kK located at om ,n(%- Saud Anchorage, Alaska. 2. Definitions. A. Alteration. Any change to the design or function ofan AWWTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AW WTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AW WTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of 6 (5.00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AW WTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterations installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s). (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWWTS Operating Permit is: k>Alld . C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7. NonwaiVcr. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way cfTcct the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner. e Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Cboice of Law. Any civil action arising from this Memorandum of Understanding 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 Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER: By: Date: a Z STATE OF ALASKA THIRD JUDICIAL DISTRICT NIUNICIPALITY: By: Title: Date: ) ss. The foregom instrument was acknowledged before me this A'3 day of 200 by ��-t-t 1�2u Vrn f, ooh n . `x,�IIII IIIdUi S\x .: NN P�/n Z� TA NOTARY PUBLIt FOR ALAS K — 0 A ;00 My Commission expires: