Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
ELMORE BLK 2 LT 1
Qit� Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL'SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 * Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Su'/ 9'7007/_� PID Number: O tis - t-]l —D i, Name' Wastewater System: 9 New ❑ Upgrade Address: ABSORPTION FIELD ba-O a Phone: No. of ISr oma: ❑ Deep Trench304Shallow Trench O Bed O Mound O Other LEGAL DESCRIPTION Sou Rating: Total Depth fromopgi�l grade PD/S Ft Lot: Block: Subdivision: Depth to pipe bottom Irom original Inside: Gravel depth beneath pipe OL A51_"2 o Ft 01—IS F1 Township: Range: Section: Fill added abov - original grade: Gravel length: Ft JrD WELL: New ❑ Upgrade Gravel width: Numberoflines: D4lante DetweM lines Ft Ft Classification (Private. A•S.C): Total Depth: Cased To: Total absorption area: pipe material: FI. /37. Ft. 02 So Ft I PVC Sc%044A- FD Driller: '' II Datep Drilled' 71i+T Static Water Level: Installer 1 / Date in felled: 6 7v, Ft. Asl_k7Pl '�• 7 Yield: �s Pump Set at: Casing Height Above Ground: TANK r2 GPM Ft. Ft. SEPARATION DISTANCES E3 Septic 0Holding ❑S.T.E.P. To S*pbc AbsorptioA Lilt HWding blWPdvsts I Manufacturer. Capacity In gallons: From Tank Field Station Tank $@.a, Lima I Fil 0 eye I IF Ito &-0 Well- /30' ' if Material: Number of Comp rtments: /3 30' Surface LIFT STATION Water p Lot Line / 70 ) 5 r / D Size In gallons: Manufacturer: p3locyr- it- E Foundation!� "Pump on'—'leve at: s l ^Pump off" level t: f tis l High water *tarrtrtrtrtrtsssss at. v�L A J o Z Curtain Pump aka a M"N Electrical Inspections performed by: Drain 0 .! Ko Remarks: BENCH MARK Location and Description: 1 S l � O'INI 1 1NT 0 /-L (iO LJ I rtI I Assumed Elevation: MV' ♦ /i(i'� e. '.' ENGINEER'S S4JIr , a Inspections performed by: � • -S Dates: 1s'; '�' G =nz gnu , Department of Heal and Humaan/ Services approval `` �rr 1�I Reviewed and approved b /F3 29_ 97 PP Y� Date. �:- ' Tz-0td (Fav 9,111) MOA zs DEEARMOU Q- WeH I I / 1 1 I 1 BIOCYCLE !tRY U \ V S Q ® TRENCH / I I 2 SO 1 REPLAI EMENT TRENCH ¢ IVell SWING TIES. AC /6 TT 1 eC 17 1 AD 41 OD 71 1 J 1 1, I ... N. I -•� .. . ..Well I .. .. .. .. .�,. Iy♦ - 49th j 22n. % TOB 'N SPURN AND 1,5 No. CE -222 rrr i I per, 25 0 I25 50 75 100 125 .. . SCALE: 1' = 50 FT. TOBB£N SPURKLAND P.E. LOT I BLUCK 2 ELMURE S/D SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE DATE: AUG. 8, 1997 ANCH. AK. 99501 JOHN AH -YOU 907 279-3916 11 4500 DE ARMOUN ROAD SHEET- 2/3 GRID: 3036 PERMIT N SV/970076 PID # 018-171-06 ELM02012.DVG 99.34 —\ r AIRCOMPRESSOR SAND BACKTILL —' 4 -INCH INSULATION AIR LINES z _II 1, will 11 PRIMARY TREATMENT, SEPTIC TANK QQ s O J. 5 X 50 DRAINFIELD 1-1/4 PVC WITH 1/8' HOLES AT 30' MTQ TOTAL DEPTH 3 FT TOTAL ROCK DEPTH 12 INCHES EFFECTIVE ROCK DEPTH 6 INCHES TOTAL COVER 3 FT. 981E n 11 11_11 11_II� 11 11 11 Ile ..11��� _II 1, will 11 PRIMARY TREATMENT, SEPTIC TANK 94.5 ` SILT BARRIER 94• TESTHOLEI 87.5 NO SCALE 10 FT DEEP 90.15 BIOCYCLE 6000 INSULATION 7 c j �s,,r- AA a !V 49th (� SPURKLAND LEGEND: 1. PRIMARY TREATMENT, SEPTIC TANK 2. AERATION TANK J. CLARIFICATION TANK 4. DISCHARGE TANK 5. SOIL ABSORPTION U" •+rrptM1''•�Hy„ of f �, BENCH MARK: BOTTOM SIDING ASSUMED ELEV. 100.00 -FT TOBB£N SPURKLAND P.E. LOT I BLOCK' 2 ELAIORE SID SEPTIC, SYSTEM AS -BUILT 103 Proge Ave WASTEWATER SYSTEM SCHEMATIC DATE. 'AUG. 8, 1997 Into, JOHN a Ak 99501 JOHN AH YOU SHEET. 3/3 GRID: 3036 PERMIT I SPI970076 PID NO 018-171-06 ELM01013.DWG 1N�3 Municipality of Anchorage !. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ` I 1.1 ---IV J LEGAL DESCRIPTION: 11e 1 o,rLc� Nfcy 0 0 2 o d 3- 4 4 L0 6 Na 7 J 9. 111111 H�d<„j� SLOPE �• .! •- "(ENGINEER'S SAL)'+ f � fir,—.. � •,:•t c` ce.ys DATE PERFORMED: �/ ± 4 y Section: 10 WAS GROUND WATER Al ENCOUNTERED? �`� 11 S IF YES. AT WHAT L 12 DEPTH? 0 P E 13 Depth to Water Alter Monitoring] Dale: _ 14 15 16 17 18 19 20 ITE PLAN l.� PERCOLATION RATE (m+nuleL+nch) PERC HOLE DIAMETER LLLL���JJJJ TEST RUN BETWEEN 3 FT AND VIE FT 1 DISCLAIMER• Grj ndy)atpr rnnditinnc indirAtodare for the dater, 'ch only. Past and future presence and/or depth of groundwater can not be predicted from these observations—. PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. UBS( Fax:907-248-0042 Aug 6 '97 11*3 F.02 'I-, M•W GRILLING, Inc. P.O. box 110778 a 10330 Old Seward Highway ("7) 049.0596 ANCHORAGE, ALASKA 09511 DKILUNG LAO Well Owner JON AH -YOU AND JUDITH MACK Use of We1KD0N1FST?S Location (address of: Township, Forge, Section, if known; or distance main road LOT ()1714 —AN^NORaGF, LLAT &� Size of caning—JQ Depth of Hole 1 I A Beet Cased to -L17-1 F; fcet Static water levet 78.80 et, A [below) land surface, rinish of well (check one) open end ( % ); Screen ( ); Perforated( . ), Describe screen or Derforation-WA Well pumping teat of drawdown from stalk Ie�{elat_12,. 16, p!} ) (minute) for -1 ----hours wit k 100% ft. Data of completio 25 JULY t 7= '.' Depthtnfeet from ,•. WILL LOG ground surface Civi t4U1a Of formations penetrated, sire of material, color and hardness 0 —T0-2L_ --2_T0_2D__ -. 2OL.-TO-34- 7 6 TO_2A_, ._TO i 6 —15TO_2A_, 94 TO 710 _ 110 TO 1— 13 _113_TO_L31.� _? 31–TO - L3.8 738 TO TO TO TO TO TO SILT: BROWNf GRAVELLY �Ceru 1, con 971 �Cert:%Oca . es_ 1 CUSTOMER M�� c�P� LSU cc,.QD u��� PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE p, DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970076 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:JON AH YOU S JUDITH MACK - OWNER ADDRESS:4500 DEARMOUN RD ANCHORAGE, AK. 99516 PARCEL ID:01817106 LEGAL DESCRIPTION: ELMORE BLK 2 LT 1 LOT SIZE: 69736 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 4/28/97 EXPIRATION DATE: 4/28/98 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM. UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: TOTAL DEPTH OF LEACHFIELD TRENCH MUST NOT EXCEED 2 FT. BELOW ORIGINAL GRADE. ENGINEER SHALL CONFIRM 100 FT. MINIMUM SEPARATION DISTANCE BETWEEN PROPOSED WELL AND THE SEPTIC SYSTEM SERVING LOT 5 (ADJACENT LOT - TO THE WEST). RECEIVED B ISSUED BY: DATE: 6(6?- /9 �? DATE: i .SPUREKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 1, BLOCK 2 ELMORE John Ah You Municipality of Anchorage Department of Health and Social Services 8201 Street Anchorage, Alaska 99501 March 11, 1997 We are submitting an application for the installation of a well and septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and septic system are subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. Based on previous experience in this area 1 suspect that groundwater will be present during and after breakup. A small seep was observed at 8.5 feet in testhole N3 on October 2, 1996 when the testholes were excavated, but there was not enough water flow to accumulate in the monitor. On March 10, 1997 the monitors were dry. Mr. Ah You desires to obtain a building permit this spring, before this site can be monitored through breakup. 1 have suggested basing a wastewater disposal system on groundwater level at 6 feet or shallower. 1 also suggested using the BioCycle pretreatment plant. The proposed design is tentative with respect to groundwater level, but the use of the BioCycle will give the owner sufficient flexibility regarding the depth of the drainfield, which can be installed at or above the present ground surface, if the groundwater level during breakup uShallowcr than 4 feet. �.� Soil Rating 4 min/in = 2.4 gal per sq.ft/day with BioCycle ���...•' � y '•.w� � , No. of Bedrooms 4 Required Area per Bedroom: 15012.4 = 62.5 sq.ft. ?�� st• ; �:. = ; Total area required: 62.5 x 4 = 250 sq.ft. • " """"""" Use 5 -wide Total Length 250/ 5 = 50 fl. To s::u, : ',,,W t Bottom Rock At 3 feet':o2 Cc -2225 Top Rock At feet / r z&�y% f` Fr-, •.,,, ••_,.•',, '_� T •, Rock Depth 12 inches total e404 -r- Cover 3 ft. 1 foot of additional fill material. The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. DEARMOUN READ e 14 4 5 � I well I ISI ° er v 2 I I � � LG✓c� (,�` � O O R Q I I I 16 I 15 —� SH SHONI A VE CF "may • ;s -y Z X1 SPUPKLAND ! . CE -2225 LtC per, • FROFESSlO••• I 0 50 100 1'50 200 250 300 SCALE., 1' = 100 FT, I UDDLIA JrUKNLAINU r.L. LLII 1 1fLLJI K if LLMUKL J/U SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE JOHN AH -YOU DATE- OCT. 18, 1996 ANCH. AK. 99501 ron7. 74_001[ I I 45/1/1 Pr 4PMnlIN RITAA SHEET- 1/3 GRID 3036 PERMIT N0: SW97 PID NO: ELWOII.DWG DEAR QUN ROAD PROPOSED— I1'el1 1 1 / 1 2 I PR POSED 4- .GROOM SFD 14 1 ® I 1 / REPLAI [MINT TRENCH p'ell . J ® 12 1 I YCLE 6000 I 1 � I PRIMARY TRE H I V Q 1 (Q - - - - - - - - - - - - - - - - - ._` _ _ _ _ - - - :.: Gjt.+ ( � I Well #i/ I I i th i TOBB � $PURK AND = 15 I �� ff•,1 �. CE -222 tt V - 25 0 25 50 75 100 125 SCALE., 1' = 50 FT TOBBEN SPURKLAND P.E. L U I I BLOCK 2 EL MORE V/11 SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE DATE.- MARCH 12, 1997 ANCH. AK. 99501 JOHN AH -YOU . (907) 279-3916 4500 DE ARMOUN ROAD SHEET213 GRID: 3036 PERMIT k PID N ELM020120VG 4—INCH INSULATION r AIRCOMPRESSOR f • AIR UNCS SAND BACKFILL —♦ O J O , O 0 FIOCYCLE 6000 5 X 50 DRAINFIELD 1-1/4 PVC WITH 1/8" HOLES AT JO' TOTAL DEPTH 3 FT TOTAL ROCK DEPTH 11 INCHES EFFECTIVE ROCK DEPTH 6 INCHES TOTAL COVER 3 FT. OOOOOVOVO"O" O' A V v v SILT BARRIER TESTHOLE 10 FT. D! NO SCALE INSULATION LEGEND: 1. PRIMARY TREATMENT, SEPTIC TANK 2. AERATION TANK J. CLARIFICATION TANK OF 4. DISCHARGE TANK 5. SOIL ABSORPTION h = •## 0 i I SPURKLAND ?� Mrp IUua£N JruHALANU r.r. LOT 1 BLOCK 2 Eir110RE SID SEPTIC SYSTEM DESIGN 103 Yrage Ave WASTEWATER SYSTEM SCHEMATIC DATE. Anchoro a Ak 99501 MARCH 11, 1997 o_ JOHN AH YOU SHEET. • 3 3 GRID: 3036 PERMIT I PID NO ELM02013.DWG • v" Municipality of Anchorage + DEPARTMENT OF HEALTH 6 HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: F'0 ✓i VI yO 1) —DATE P LEGAL O 0n6rANICS 1 2- CJ Car0.vt�C 0 3. v tAn L -L. 4-000 bo✓laltrS s (7% * O GHSe 6- Q 7-00 7 0d 0 a 8 10 WAS GROUND WATER ' ENCOUNTERED? 11 X11 IF YES. AT WHAT 12 DEPTH? 13 Oep14 to Wller Aller Noniter:no? 14 15 18 17 18 19 20 COMMENTS SLOPE Section: (ENGINEER'55f i f CE -2215 8 L.; n i' ITE PLAN ■.■■■■■■■■ ■■■■■■■■■■ - ®®� Water PERCOLATION RATE (minutevineh) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: _ I S CERTIFY THAT FTy1 7EST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE — `t (/ (/ 72-008 (Rev. 4/85) O - PERFORMED LEGAL -7 a,2 $U I1.DIN 6 s17 1= Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST t "`� d26ANItS 2- O D aiPAFS0A 3 - 8 4-0 Colo Odo 6 0tottf--;, a0 6 i�••� 1/ 8 � Q G 'J �� 7 U 9 vTTD vA NO LC 10 11 12 13 14 15 18 17 18 19 20 Township, WAS GROUND WATER q o ENCOUNTERED? s T WHAT L O P E I Atter a/ IF YES, A DEPTH? Eepttt to Welt MonitN:np7 OF •• � V•` of •" ' (ENGINEER'S SEAL) 2. 'Fl -4711 0� y • �'• CL -2225 e A:�F4n• ct:1�l'•a __ DATE PERFORM Section - 9nEine Date Gross Time Net Time Depth to Water Net Drop aiPAFS0A —o —o 'J �� ? ; I n O _ 5 H� t77 JPERCOLATION RATE (M -n nev,ncn) PERC HOLE DIAMETER 4i �(/ TEST RUN BETWEEN — FT PI:D $ FT COMMENTS PERFORMED BY: - �• _ I CERTIFY THATT x/rrI TEST WAS PERFORMED IN : ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE — `97 72.0e8 (A". bas) • .., Munlclpallly of Anchorage �- DEPARTMENT OF HEALTH 3 HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST Q OF t?! ?^., .,e,(�`•,(ENGINEER'S SEAL) i PERFORMED FOR: oho All YoJ _DATE PERFORMI LEGAL DESCRIPTION: LLQ�l, BK2r jt�Lp"ofC. Township Range Section' O w SLOPE SITE OQ6�FN�ct r _rte—T--, r–r—,--r t 2 c o 0 aAvf_e tAjtN 3 � ODm 6ovlol<r3 4-0 o,, 5 pav - 00 U 8 �Oo 7- 8. 8 cc9 10- 11 12 13 14 15 18 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Otplh to water After Monitoring? O q-% 5--ading I Dela To:',b( 5PUi k'avd X11 8.225 J N Gross Not Depth to Not Time Tlma Water Drop PERCOLATION RATE ImmutaermCh) PERC HOLE DIAMETER ' TEST RUN BETWEEN FT AND 11Z- FT COMMENTS Y PERFORMED BY: ' CERTIFY THA7 T IS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATF_ DATE: - f"r —7 72-008 (Rev. 4/85) • . ," Municipality of Anchorage + DEPARTMENT OF HEALTH 6 HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 `T'J_ 1 SOILS LOG — PERCOLATION TEST PERFORMED FOR:. ,1%. At \701, LEGAL D � DY•�4u^CS 1 0 0• 2 F v. l.^r Pat t/e- 3- 4- 3 4 t L 5- 6 7- I 88- I 9- 10. 11 12- 13- 14- 15- is- 17- 1111- 19 - 20 -1 21314151817181920 WAS GROUNDWATER ENCOUNTERED) IF YES, AT WHAT DEPTH) troth to Wait( Atter MonitoGnB) Tc' %, cp,:rVand °?. !r •. CE -2215 •AFI DATE PERFORMIpt]e+ �' L/i' 9' le, Section: m m m ■.■■■■■■■■ mmmmmmmmm J PERCOLATION RATE (m,nUMVInCh) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: _ ( S CERTIFY THAT H TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE —yF7 72-008 (Rw. 4851 Development Services Department - T Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-171-59-000 Expiration Date: 12/26/2023 Legal description ELMORE BLK 2 LT 1 Site address 14001 GREYBULL PL Anchorage AK 99516 Current property owner(s) FITZGERALD AMARANTE E &KIMBERLY D X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 9/26/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE i€ & Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 018-171-59 Complete legal description ELMORE BLOCK 2, LOT 1 Location (site address) 14001 GREYBULL PLACE, ANCHORAGE, AK 99516 Current property owner(s) AMARANTE & KIMBERLY FITZGERALD Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ® Fiberglass - BIOCYCLE Age 26 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ® AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 9,50 Date of Payment J�,3h3 COSA # 11-6-1 Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: ELMORE BLOCK 2, LOT1 Parcel ID: 018-171-59 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 7/25/1997 Total depth 138 ft Cased to 137 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/12/2023 Static water level at beginning of test 68 ft. Well production at time of test 2.9 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 3.12 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 9/19/2023 Comments Well appears to be capable of higher water production, but flow was decreased due to smaller size of septic absorption field with the well water level only dropping 1’ during the test. Please see attached Sullivan letter regarding the higher nitrates that appeared to have been an anomaly / sampling-lab error and per other water analysis. B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping 5/12/23 Required maintenance completed, if AWWTS Comments: MAINT PERFORMED BY BIOCYCLE C. LIFT STATION Required maintenance completed Age of lift station 26 years Lift station material FIBERGLASS Comments: Attached BIOCYCLE maintenance report. D. ABSORPTION FIELD DATA Which system tested (date installed) 6/6/1997 ALL standpipes present per record drawing Total measured depth from grade 3.8 ft (max) Measured depth to pipe invert from grade NA ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 5/12/2023 Results Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 5 in Elapsed time 1310 min Final fluid depth 0 in (DROPPED 3” 30 MIN AFTER TEST) Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA 0.5’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 6 in Comments/Deficiencies: Approximate total measured depths from existing grade. Assumed / approximate ED with ED depths per visual observations including visual of 10” of perforated pipe at bottom of MT & MOA file. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 9/25/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 9/25/23 Inspection Report 3705 Arctic Blvd #313 Anchorage AK 99503 Email: crbioak@gmail.com (907) 274-0314 Homeowner Info Initial Inspection: System Inspection Customer Name:Tank #: Install Date: Is System Lid Locked? Inlet plumbing in working order? Are all aerators functioning? Pump float operating? Date: Filter cleaned?Discharge line condition: Alarm float functioning?Any buildup of solids? Clarification return system operating? pH Reading: (pH of 6-8 is ideal) Dissolved Oxygen PPM (2-5 is ideal) Turbidity of discharge (in FTU) (Under 35 FTU is considered compliant.) Solids pillow normal? Any buildup of solids? Any buildup of solids? Lid hardware in working order?Is there any noticeable odor? Alarms Tested: Air High Water Does system have a septic tank ? Battery Tested:Yes No Yes Yes Yes Good Replaced Yes Yes Yes Yes Yes Yes Strong Mild None No Yes Yes Repaired Replaced Replaced Replaced Replaced No Adjusted Requires Pumping No No Yes Repaired N/A Primary Chamber Aeration Chamber Clarification Chamber Effluent testing result Discharge Chamber Yes Comments: Inspected By: N/A (Recommend pumping tank every 2 years) (Please make sure alarm is on "normal", not "mute") Address:Area: Has emailing or mailing of form been requested? (contact office to request...)Yes No P.O. Box 670269 Ghugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259 TO: Brent Western Hello, following are the results of the well scope on 14001 Greybuil Road. 0-12': pitiess adapter, no issues found. 12-67': casing to static water level, no issues found. Thank you, Sullivan Water Wells. Date: 06/23/2023 Nil NI( IIF \1 I IN 011 VNCTIOR Vd. 1 1) 11 1` I I k1 ! I [-.It I It► 1 I \I1 `1 ',1 k, I I. 11 11 ll'N I I 1 \\( I \!I) ltll 1' 111t 1(1I4I U.:\ll \ I THIS MA1NTENAN( 1ND IZI MIR Nt d,' I I MI I iii i, iit iI,,• "A(iRt, MIE=NT" made and entered inlo as of this `� Day Of NV 0I )n A by and between =ITY"', herein the"OWNER," and the Municipality of nchca�,age, hcrc►�� the 1lUin accordance with Anchorage Municipal Codc (AMC) 15,65.305, in consideration of the mutual covenants contained herein. the parties to this Agreement afve 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 A BIOCYCLE SYSTEM located at (legal description) ELMORE BLOCK 2, LOT 1 2. Maintenance, Repairs And Alterations. (ONN,ner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an A\VWTS 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). rM <_! Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfeld replacement. (rev, 05/18/2018) Pagel of 3 ■ Ik C-(- I�L Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. E ( Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030, cc o_ Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. GC- � - 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: S\ (tiigiialtlre) Ilim, r i,print name} i SI -ATE OF AL.NSK.-k 1 SS. THIRD JUDICIAL DISTRICT Tlie Foreeuing tnstnimentwis acknowledged before me tlhisuBl(.Iay cit 20" bl --Y1µr�� _ t NOTARY..Pb$LIC FOR ALASKAI BOBBY J. LITTLEM Mir Commission expires: Notary Public State of Alaska My Commission Expires Apr 26, 2026 ---7 --- • . — yr .v1U_N1L1N 'Y' (signature) Date: <sw {print name) Title: r2 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 �o Certificate of On -Site Systems Approval Parcel I.D. 018-171,08 Expiration Date: 1. GENERAL INFORMATION Complete legal description ELMORE; Location (site address) 14001 GREYBULL PLACE *ANCHORAGE, AK Current Property owner(s) JUDITH MACK 0_/6-- /S Day phone 345-6118 Mailing address 14001 GREYBULL PLACE -ANCHORAGE, AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well © Individual 19 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNarianoe request for., N/A Distance: - Received by: A Date: 7 6 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 7_115115 Receipt Number 676&6 COSA # 05C1513!29 Waiver Fee $ Date of Payment Receipt Number Waiver # im ley 5. STAMENT 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, Anchorage AK. 99507-3246 Engineer's Printed Name Jeffrey A. Garness Date 1 ' In conducting this evaluation, GEG orovided 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 systems on the dates of the evaluation. Seoaration 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 ancr septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workrtanshio), and the water usage or 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 systems; therefore, GEG makes no warranty (exoress or imolied) regarding the future performance of the well or seotic system. GEG makes no representation whetheran altemative well or sootic system car be installed on the property in the event either of the current systems fail. The Content of this report is for the sole benefit of the oerson/party who retained GEG. Reliance noon the intormation provided in this moort by any other person or oarly, including but not limited to subsequent property purchasers, is not authorized. in short, GEG disavows any legal duty to anyone other than the pemonloarty who paid for this report 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for By: bedrooms bedrooms, with the following ,���kk tOF �Crr' y0'Q ON SITE fi WATER AND WASTEWATER oz pRpGRAM� Original Certificate Date:, The `V runic�tyyX Arrd�&Gage 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 COSA blue sheet &i-12 eoc If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: ELMORE; B2, L1 A. WELL DATA Well type PRIVATE If A, B; or C provide PWSID# N A Date completed 7/25/97 Sanitary seal (Y/N) YES Total depth 138 ft. Cased to 137.36 ft, .FROM WELL LOG Date of test 7/25/97 Static water level 78.8 ft. Well production 12 g.p.m. WATER SAMPLE RESULTS Coliform 0 colonies/100 ml. Arsenic: ND ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate 3.83 mg./L. Date of sample: 4/29/15 Parcel ID: 018-171--W-15-7 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 4/29/15 67 3.96 g.p.m. Collected by: GFG. Ltd. Tank Type/Material BIOCYCLE/FIBERGLASS Date installed 6/16/97 Tank size 1600 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 4/23/15 Pumper ISAAC'S PUMPING SERVICE C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 6/16/97 Soil rating (g.p.d./ft'or /bdr 2_4 System type SHALLOW :TRENCH Length 50 ft. Width 5 ft. Gravel below pipe 0.5 ft, Total depth *4.25`` ft. Eff. absorption area 250 fC Monitoring,tube YES Depression over field NO Date of adequacy test 4/29/15 Results (Pass/Fail) PASS For . 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 694 gal New depth 8 in. Elapsed Time 'S0 min. Final fluid depth E in. Absorption rate >= 600+ g.p_d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — *SYSTEM MAINTAINED BY BIOCYCLE **PER 1997 INSPECTION REPORT. LID IS LOCKED. D. LIFT STATION ***ASSUMED YES BECAUSE SYSTEM WAS APPROVED BY MOA IN 1997; HOWEVER, NO ELECTRICAL INSPECTION REPORT IS ON FILE. Date installed 6/16/97 Size in gallons 1600 Manhole/Access (Y/N) YES 'Pump on" level at **25 in. "Pump off" level at**44.5 in. High water alarmlevel at **22.5 in. Datum TOP OF TANK Cycles teed * Meets alarm & circuit requirements? ***UNK E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank(lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas50'+ Public sewer manhola/cleanout 100'+ Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' Properly line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 1o'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *SEE MAINTENANCE REPORT G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Munir ipalrecords that the above systems aro in conformance with MOA COSA guidelines in effect on this date. Engineers Printer ame JEFFREY A. GARNESS Date `7 &rr— (Rev. 11/05) 30 30 SCALE: I"= 40' DeARMOUN ROAD N89046'30"E 208.71 o --WELL 2 STORY FRAME o HOUSE v 51.0 SHED� SEPTIC VENT-----�—o LOT 1 10' UTILITY EASEMENT tank boardwalk vent O LO N89046'30"E 208.71 LOT 16 REVISED 7-01-15 ADDED SEPTIC V AS -BUILT NO CORNERS SET THIS _ OF 1 �?�� • A(qS�- �l 00*: ' 49th • *�� %� .s .Fred Walatka.' `"r, • 3255 - S • �� O ssloN t- EASEMENTS OF RECORD, OTHER THAN (� %X%%N— THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 15-7, PG 2-3 CB 8415C r 06 O 04 O O 0 O 0 0 Z LOT 2 LOT 15 W I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 1. BLOCK 2. ELMORE SUBDIVISION 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 22nd day of MAY 2015. FRED WALATKA & ASSOCIATES f907-248-16861 Engineers and Surveyors ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this „1 Z Day of .. j „ \! of 2015 by and between 1 ' herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description). 51U 2. Definitions. Alteration. Any change to the design or function of an AW WTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AW WTS that were included in the original design which would allow the AW WTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AW WTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AW WTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations. Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AW WTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AW WTS service and maintenance provider approved by the municipality and the manufacturer of the AW WTS for the entire tern of the AW WTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AW WTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AW WTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the properly will not occur without a new Certificate of On -Site Systems Approval. H. Owner agrees that the AW WTS installation and maintenance requirements as provided by the AW WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: b. Municipality: Director, Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) Date: -7/Z /S The foregoing instrument was acknowledged before me this _I day of 20145, by ��°0 el � /riVOA I.tXil.Wr" NOTARY is LIC FOR AL`� My Commission expires: � MUNICIPALITY: By: (signature) name) Date: Title: p:/BL1C �9 BioCycle Alaska 3705 Arctic Ave. #313 Anchorage AK 99503 (907)274-0314 E-mail: crbioak@gmail.com Customer Judith Mack 14001 Greybull Anchorage, AK 99516 345-6118 242-6497 cell 2nd Quarter Maintenance 2015 BioCycle Location Lower DeAlmounBuffalo Install Date: Oc October -95 Tank # 31 MAINTENANCE DESCRIPTION COMMENTS PRIMARY CHAMBER SCUM LEVEL O HIGH BE SUREYOUR ALARM IS AERATION MBER &AERATION SYS BLOWERCHASIZE 60 80 120 L/MIN ALWAYS ON "NORMAL" NOT ON AERATION PRESSURE HIGH LOW "MUTE" NOISE LEVEL HIGH GENERAL CONDITION POOR SYSTEM: AIR LEAKS- LEAKS AIR DIFFUSERIAIR SUPPLY POOR - MIXED LIQUOR CONDMON ODOR NO ' YES CLARIFICATION CHAMBER SLUDGE ACCUM IN HOPPER HIGH CLARITY OF EFFLUENT CLEAR FAIR CLOUDY DISCHARGE CHAMBER DISCHARGE PUMP OPERATING YES NO ALARMS CHECKED AND OPERATING AIR/POWER NO HIGH WATERINS NO WQuarter Maintenance performed by: i' G BY: LARRY BETTS (962-743 CHRI 331-7978 DATE: I J BioCycle Alaska 3705 Arctic Ave. #313 Anchorage AK 99503 (907)274-0314 Email: biocyclealaska@gci.net Greybull race. AK 99616 18 cell 1st Quarter Maintenance 2015 MAINTENANCE DESCRIPTION COMMENTS PRIMARY CHAMBER SCUM LEVEL K HIGH BE SURE YOUR ALARM IS AERATION CHAMBER & AERATION SYSTEM BLOWER SIZE 60 0120 UM1N ALWAYS ON "NORMAL" NOT ON AERATION PRESSURE HIGH LOW "MUTE" NOISE LEVEL HIGH GENERAL CONDITION POOR SYSTEM: AIR LEAKS LEAKS AIR DIFFUSER/AIR SUPPLY POOR MD(ED LIQUOR CONDITION ODOR - YES - CLARIFICATION CHAMBER SLUDGE ACCUM IN HOPPER I. W HIGH ' CLARITY OF EFFLUENT C FAIR CLOUDY . DISCHARGE CHAMBER DISCHARGE PUMP OPERATING NO ALARMS CHECKED AND OPERATING AIRIPOWER I YESI NO HIGH WATER NO 1st Quarter Maint a erfornled by: BY: L 2-7 S 3 - DATE: I J pyy BioCycle Alaska 3705 Arctic Ave. #313 Anchorage AK 99503 (907)2740314 Email: biocycleaWka@gci.net 14001 Greybull Anchoraae. AK 99516 3rd Quarter Maintenace BioCycle Location Lower DeArmoun/Buffalo 3 Install Date: Or October -95 Tank # 31 MAINTENANCE DESCRIPTION COMMENTS PRIMARY CHAMBER SCUM LEVEL O HIGH BE SURE YOUR ALARM IS AERATION CHAMBER & AERATION SYSTEM BLOWER SIZE 120 L/M1N ALWAYS ON "NORMAL" NOT ON AERATION PRESSURE (e HIGH LOW "MUTE" NOISE LEVEL HIGH GENERAL CONDITION POOR SYSTEM: AIR LEAKS LEAKS AIR DIFFUSER/AIR SUPPLY POOR MIXED LIQUOR CONDITION ODOR 9YES CLARIFICATION CHAMBER SLUDGE ACCUM IN HOPPER HIGH CLARITY OF EFFLUENT FAIR CLOUDY DISCHARGE CHAMBER DISCHARGE PUMP OPERATING r YES/ NO ALARMS CHECKED AND OPERATING AB2/POWER NO HIGH WATER NO 3rd Quarter maintenance performed by: BY:, LARRY BETTS (562-7434/CHRIS 331-7978) DATE:• I y /IV " MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Nvipp' '� ffyrq Or�Clio GE 0C 0 SIL191t -IVIS'` CERTIFICATE OF HEALTH AUTHORITY wEDAPPROVAL FOR A SINGLE FAMILY DWELLING C Parcel I.D. # 0/8 — /71— D , HAA # Vl (fin 1©L\ 1. GENERAL INFORMATION Complete legal description I—O i Location (site address or directions) Property owner h Mailing address Lending agency Mailing address Agent Address Day phone Day phone _ Day phone Unless otherwise requested, HAA will lll be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site f Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(R...1/01) fot MOAni 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, l verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate forthe 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm / abbe" �ou COAL $1 � E phone A -71-191h Address b 3 t.% # 0 3 Engineers signature 6. DHHS SIGNATURE A _tl—. Approved for `� bedrooms. Disapproved. Conditional approval for Date ° 17 .. •e' . � ;ate.. I v ti� p0. c55;:i�i;;✓ bedrooms, with the following stipulations: Additional Comments By Date h9'21"9! The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. r2.=MW.1A1) 9. k Mwm OF • , A wk Municipality of Anchorage o DARTMENT OF HEALTH & HUMAN SERVICES CT 08 1997 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 RECEIVED Health Authority Approval Checklist Legal Description: LFLMO 17 E B)4 2 . Lo T I Parcel I.D.: 01,61 – l7 A. WELL DATA Well type R If A. B, or C, attach ADEC letter. ADEC water system number "�A Log present (Y/N) Y Date completed -%619 % Total depth / 38 Cased to /37. 31•i Casing height (above ground) &;� r Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test /4; �1 _7 Static water level 78,,g Well production / e2 g.p.m. WATER SAMPLE RESULTS: Collform / Nitrate Other bacteria Date of sample: D/O 7! 17 Collected by: B. SEPTIClHOLDING TANK DATA B l o C -VL L - E Date installed 610197 Tank size /' Oa s Number of Compartments Cleanouts (YM) Foundation cleanout (Y/N) -Y Depression (Y/N) _N High water alarm (Y/N) Date of Pumping NSA Pumper C. ABSORPTION FIELD DATA g.p.m. Date Installed 4/11,477 Sal rating (g.p.d.Htr or ft'/bdrm) _ _�.� System type f ! ! Length --&V t Width -,!:;1 Gravel thickness below pipe 49. -'1 Total depth 3.5 Effective absorption area .25 b Monitoring Tube present (Y/N)–Y— Depression over Held (YM) N Date of adequacy test N�A Results (Pass/Fail) For _ bedrooms Fluid depth In absorption field before test (in.); "Ar Immediately after ✓gal. water added (in.): 4"'� Fluid depth (ins) Minutes later: Absorption rate = '� a.p.d. Perwdde treatment (past 12 months) (Y/N) 72.028 (Rev. 3MS)' ✓ If yes, give date 0#1 D. LIFT STATION Date installed 'Ili,l 97 Size in gallons `/ ,r y/ Manhole/Access (YM) � "Pump on" level at' 'L1 5 "Pump Off" level at' -Al _- X, High water alarm level at' Z /� 'Datum Cycles tested N/A E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ii✓O I On adjacent lots i 10.0 Absorption field on lot 130 On adjacent lots 1 coq Public sewer main N/A Public sewer manhola/deanout N/A / Sewer /septic service line ha / Litt station !3 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation I 1 Property line 70 ! Absorption field 12 / Water main/service line ?2b Surface water/drainage t'410 Wells on adjacent lots �Y 1 °� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line 155 r Building foundation 1425 / Water main/service line X25 Surface water N 1,0 Driveway, parldng/vehicle storage area 35 Curtain drain tJ, b Wells on adjacent lots l b O I F. ENGINEER'S CERTIFICATION I certify that 1 have determined thru field inspections and review of Municipal recon ftt Me above systems.are in conformance with MOA HAAguldelines in effect on this date. r� :• , Signature Engineers Name 1 Date DrA 7 4 1R4� - i,.. ° �� �I' HAA Fee S Date of Payment 0 �/ Receipt Number 72-026 (Rev. 3190)' Waiver Fee $ Date of Payment Receipt Number r C;�-i 7 15:05 ME ESI ANCHOPAGE /4J�_. CT&E Pnvironmental Services Inc. A:IA CT&£ Ret.# 976124001 Client Name Tobben SperklAnd P.E. Project Name/k N!A Client Sample ID 1f2 E::: i,: Matrix Dtinkici Ordered By PWSID 0 arr:tle Remarks: 5075615301 P.02iO3 Client MY Printed Date/Tinte 10/13/97 10:35 Collected Date/Time 10/07/97 11:00 Received Date/Time 10/07/97 13:45 Technical Director AAa-" : StteephenC. £de Released By 4 Allowable Prep Paranerer Results POL Units Method Limits Date Nitrete•N 2.62 C.100 mR/L EPA 300.0 10 max Tonal Coliform 0.0C Col/100:K SM18 9222E t Analysis Date Init 1C/07/97 GCP 10/07/97 TM'e