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CROMWELL HEIGHTS BLK 2 LT 2
Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water&Wastewater Program 4700 Elmore St. .P.O. Box 196650 Anchorage, AK 99519-6650 •http://www.muni.org/onsite•(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171265 PID Number: 015-332-23 ❑ New •Upgrade Name: STEVEN PETERSON ABSORPTION FIELD Address: ❑ Deep Trench ❑ Shallow Trench ❑ Bed ■ Mound 11500 HILLSIDE DRIVE 'ANCHORAGE, AK 99507 O Other Phone: No.of Bedrooms: S,.1 Rating: Total Depth hom or9gnal grade 952-5414 3 2.0(CAT III) oPors4 a 1 (MAX.) Fl. Depth to pipe invert hum original grade Gravel depth beneath pee LEGAL DESCRIPTION SEE DWG. Ft 0.5 Fl. Subdivision: Block: Lot: Fit added above orgnal grade Gravel length: CROMWELL HEIGHTS 2 2 SEE DWG. FL 35 Fl Township: Range' Section: Gravel Width Beds Number of ines: Distance between lines. 10 n. 2 5 Fl_ SEPARATIONDISTANCES Total aosorption area Number of trenches: Orst.between trenches: To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines 350 sq.Fl - Ft a Well •50'+ •70'+ •50'+ - 25'+ TANK 0 Septic • S.T.E.P. ❑Holding 0 Other Manufacturer Capacity: Surface Water 180'+ 100'+ '80'+ - ANCHORAGE TANK 1500 Gal. Material. Number of compartments: Lot Line 5'+ 10'+ 5'+ - N/A STEEL 2 Foundation 5+ 10'+ 5'+ - LIFT STATION•SECOND COMPARTEMENT OF 1500 GALLON STEP TANK. Curtain Drain +--� NONE KNOWN Manufacturer Capacity: ANCHORAGE TANK *500 Gal. Remarks: PER CONTRACTOR,OLD SEPTIC TANK AND DRAINFIELD WERE •Pump on'level at lump off'level at: High rater alarm at: DECOMMISSIONED PER UPC •oiR14OSV171103 _ TIMER TIMER 53 Pump Make 8 Model: Electrical Inspections performed by: 30-OSI-HHF MUNICIPALITY OF ANCHORAGE PIPE MATERIAL House to tank EXISTING/D3034 Tank to 03034 drainfield Installer A+ HOME SERVICES Drainfield D3034 CO/MT 03034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 99.00 Ft Inspection Dates: 1st 2nd Location and Description: 10/1(/901 7 10ri 0170 17 3rd 10/10/2017 4th 10/11/2017 TOP OF MANHOLE LID ON STEP TANK ENGINEER'S SEAL Community Development Department Approval `++� `ii ii_ .. Conditional approval: Date: ffi *• ... 4 I. 1 ••444 *. • %:• ff,•N •. Gar -ss::&: PERMIT NUMBER RECORD DRAWING PARCEL IDNUMBER: OSP 171265 015-332-23 A B C CROMWELL HEIGHTS; FCO - 40.4 46.5 BLOCK 1,LOT 12 CROMWELL HEIGHTS;BLOCK 1,LOT 1 STI - 35.4 67.4 (VACANT) MH - 39.0 73.4 AX1 - 34.4 71.8 ICO1 35.2 28.2 114.3 MT1 36.5 29.1 115.1 CO2 42.3 35.9 121.9 MT2 41.9 35.1 121.1 CO3 63.3 49.5 123.2 MT3 62.2 48.4 122.0 EAST 115TH AVENUE (UNDEVELOPED) _ C04 59.6 44.8 115.5 MT4 58.8 44.2 116.0 BED LAYOUT APPROVED BY TIM ECKLUND ON 10/9/17 I- I NEW DRAINFIELD W _ _ _ m NORTH LOT LINE.SURFACE WATER SETBACK.AND WELL W I M73r---,.!_�__ �T H.R2 RADII WERE FLAGGED BY SHANE HOLT,P.L.S.(RETAINED w C031 - I MT2 BY OTHERS)PRIOR TO CONSTRUCTION.TOP OF SAND 3- I T.H.#1 4 004,• 1CO2 AND BOTTOM OF EXCAVATION WERE INSPECTED BY ~ �iT4 L_____ ----WTI IC01 MOA ONSITE EMPLOYEE TIM ECKLUND ON 10/10/2017 T`, ' - - 'MTI D C-'' I \\ / ' ' - _ ^ `` -.\ /�B A -'l �' A' 'DRIVEWAY'0 J. 80'SURFACE WATER WAIVER �J`� .` / I i t. \ A A `� • /I •`�•� ` yds "x __• '{� , (EXISTING 3 \7 100'OFFSET FROM CREEK CENTERLINE / /I '� BEDROOM N� ‘� HOUSE I / • F NEW 1500 GALLON STEEL STEP TANK W/AX20 POD I I 1�\`�'I `,,�•� �'� f I 1 �` 70 OOT WTL RADIUS �- ' tA_ r Ir ' ` \ I 1 QPM\, - - ' ,i .4 / / ,� // L/7TL O Iltip/ ,L 11 I `;,,,,o•-‘-''''9- �`4 h�, / I .1. 4 / Cpf FK \ - I _ I / CROMWELL HEIGHTS; \ \ / / BLOCK 2.LOT 3A \ \ \ \ ' SURVEYED BY SHANE HOLT,P.L.S. CROMWELLBLOCK 2,LOT 1 HEIGHTS; / AS REQUIRED BY PERMIT. ` ` ' / O5U5 1 SCALE: // Ill0�0LL P N , =40 •A r t ..4 N.11111I&-.ra I I ii. •ig-4ss"c-I% A GARNESS ENGINEERING GROUP, Ltd - s '. �' ; A. CIVIL&ENVIRONMENTAL ENGINEERS 0 3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE.Al(99507'PHONE(907)337-6179'FO 19071 336-3246'WEBSITE.www garnessengmeenng.com . .• ; PREPARED FOR PHONE NUMBER PAGE NUMBER: •0 •• J• :. - ames •.-w IN STEVEN PETERSON 346-1324 2 OF 3 •� ... E-795 '• � {� PROJECT/LEGAL DESCRIPTION. DRAWN BY: .0 . 7-4' CROMWELL HEIGHTS; BLOCK 2, LOT 2 L.K.B. • i•'�p...bb... .RoF A\,�••� TYPE OF WORK: 'DATE: LICENSE ,� ���,S, r�4• RECORD DRAWING 10/19/2017 BAECC884 PERMIT NUMBER: RECORD DRAWING V Y I N G PARCEL ID NUMBER: • OSP171265 015-332-23 SEE EMAIL FROM A+HOME SERVICES REGARDING TANK&GROUNDWATER ELEVATION AT TOP OF POD=99.13 FINAL GRADE ELEVATION= 98.37-98.72 --\\ ELEVATION AT TOP OF MANHOLE=99.0 i I ,' \`'\'\."\�`��'\�'\\\����\ice --..— =r7- ---.. �i\/�\� ��';/\'�\'O., 1 '': -;:X.....,..,,, ADVANTEX II"� AX20 POD III TOP OF TANK @ INLET=94.79 w -=w ' 2'INSULATION TOP OF TANK @ ,l OUTLET=94.83 si. ..iii r� 111111111- I I II ELEVATION OFilijiI III INLET BUNG=94.17 ANCHORAGE TANK 1,500 GALLON S.T.E.P.TANK Ir (RATED FOR 7 FOOT BURIAL) BOTTOM OF BED AND TOP OF GROUNDWATER WAS NOTED AT 90.48 ON 10/9/17 DURING THE EXCAVATION OF THE BOTTOM SAND INSPECTED BY MOA OF BED(INSPECTED BY TIM ECKLUND).PER CONVERSATIONS WITH TIM ECKLUND AND ONSITE EMPLOYEE TIM REBECCA CARROL AT THE MOA ONSITE DEPARTMENT ON 10/9/17 ADDITIONAL SAND WAS LU ECKLUND ON 10/10/2017 IMPORTED/PLACED SO AS TO MAINTAIN 2'+SEPERATION TO GROUNDWATER. VAS p 0 V.SD VA �WMT CO CO MT TH42 -j0PSc.'.L•c' Pc ).. 'O sBED P i is FINAL GRADE=96.23-96.5 SLOPES VARY BETWEEN 3:1& 1.9:1.STEEPEST SLOPES ARE ON DOWNHILL(NORTHWEST) 2'BLUEBOARD END OF MOUND (HIGH DENSITY) ORIGINAL GRADE @ HIGHEST POINT=91.48 FILTER FABRIC TOP OF SAND= 92.98 _• 4.r_r_ r,_ r_o;•;•_r:•.o.r:►:r:•.e.r:•.r:r:►:r:•.V.r:•_•:r:I • :•:r:I.r:r:. _•••r rr•rL!•--••• ••• rr • • •• e • r • r • •_rrrr •.• • dir.." .•.•.•.•.•. mow+. yyyi. .?w-•'v-r`lIN. '`:t r-a:...:14e«a-�` ?•,4{ T :w�i 1e61."•.'',•er:0.4v: -r-• .-.. .- - JC:4-'Y.4.1"t•" e''.r-�.. -►Y?+M ti •ai"''t•C j7-nn• tjZ;cnVe.4`i{.;iJ.T• aM:• �'':4 . iq-r ie ya'4YA'�-n gt%Y,-;•reC- Otdv74 1'.+-'hiq -LAP?:1"ej J71''' :I.r,,4;•;.^1::t1 "i- �1:!i.' e -d.Ti 'ti',+'r,ti'i}'.',x, ..sJ.•i 5f:.::1e e�S:Yi1- •�a .ars. +vjiNt:`.}ti,t.r'';1;C-',1•'ye; � f;, *ti:1. }MT f NMI AA APPROVED SAND FILER �.> :q. �'��{`,�`, INVERT OF ' rt.• ti;a. .;,y - eve•?--r'4...J ,,Js Z..-i r ::_; /3517 1s4.L_ d// r t + -- _.7,rss� Ar I..LAS 8 3y8 ::, -mss— Use of Yla1� v. # ,,,f...':-_...i:!: •• :• ()f• i,.wn;;l;ip, Runge, & ; otion, if known; or distun.e f ' rem mnl >: . Cror»twe I id is p La as c per Cane upMrs. 1=..Ile" ^ rrevlt :i. Cf::::rf'.__ .{t _•_Dopth of Hole_ 7,i` feet. Cased to 7/ • ....1Lw•, ,.�.•..L :J fee:. CCK `.nrj t. •!:it' r lovol _1 -fust (sxhn� )(o+..ii:: ) land surface. finish of well (check b ) (11 on ,rrl X ); ,r,rue n ( ); Perforated ( ). D.,. •..r:l,u :;cruon or perforations i'_ ,. ,•:.r+;n;; test at 4"-c?(;) gallons per (1 our (minute) for yL hours with '— 8 foot of drawdown from :antic level. , .r'r.: 1.../Aa. 4"k- - .. '', • ••. 2 -e- _i"."-Z-24- ' ) r. — WELL LOG e4e- r? • L':.p'... i•t f.:+:t from Give details of formations penetrated, size of material, color, and tiurfacc hardness. t t�) f _age " __4_ _ _ _1 4.1 - Gi t, 7q . • 73 to gl _ ,ate �� • _. to _,� . _ _ i/cK� - , .. to _ ':° 7.1.--/Z,. ,A , 4les2-0 7./ to GO . w b t. QuemAir ie. GARNESS ENGINEERING GROUP, Ltd Advanced Treatment 5, `Y» Ce rftw CIVIL&ENVIRONMENTAL ENGINEERS Dealer October 23, 2017 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Cromwell Heights; Block 2, lot 2- Mound Slopes on new drainfield To whom it may concern: A new septic system was installed on the subject property under permit #0SP171265. After completion of the installation a GEG field technician Landon Bruce noted that the slopes on the north-northwest portion of the mound were steeper than 3:1. Attached are four (4) photographs of the mound and the field shots. Based upon the shots taken. the slopes are in the range of 1.9:1 to 2:1. The onsite wastewater code stipulates that mounds must have slopes of 3.1 or less. The drainfield is insulated and has 2.0+ feet of soil cover. Topsoil was placed over the mound (and mound slopes) and is reported to have been hand-seeded. Given that we are heading into winter, vegetation will not occur until the Spring/Summer of 2018 The drainfield is underlain by 2.5+ feet of MOA filter sand, so it is reasonable to believe that there will be rapid vertical migration of the CAT Ill effluent This will minimize the potential for horizontal migration and daylighting at, or immediately below, the drainrock/sand interface. This should also minimize the potential for freezing in the vicinity of the 2:1 slope It is my recommendation that only "Conditional" approval be granted until vegetation is established next spring and there is confirmation that drainfield performed adequately through the upcoming winter months. If you have any quettions, please contact us at 337-6179. Thank you for your assistance. Sincerely, • Jeffrey me P ., M.S. Pres/i° 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program _ S PO Box 196650 4700 Elmore Road 1� (. Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 „� r httpalwww.muni.orglonsite P • tar nicnt • On-Site Wastewater Disposal System Permit (0 -ro-(7 ed-f Permit Number: OSP171265 Effective Date: 10/4/2017 Work Type: Septic Upgrade Expiration Date: 10/4/2018 Tax Code Number: 01533223000 I0/11 J I-7 To Site Legal Address: CROMWELL HEIGHTS BLK 2 LT 2 G:2639 Site Mailing Address: 11500 HILLSIDE DR, Anchorage Owner: PETERSON STEVEN SCOTT Lot Size in Sq Ft: 29914 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field Q Septic Tank 0 Holding Tank ❑ Privy ❑ 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 {(ri� OCa 1e-kc1 Special Provision n-sits all observe bottom of bed excavation, prior to installation of MOA-approved sand, to verify soil strata at top of over-excavated portions of bed is made up of fill material (total excavation below original grade not to exceed 3 feet). Crtek shat\ toe Surveyled ir' on record a-Les -I-o a(cc.ra-{4.( SI►o w Se ckre*i a J Ib 101 Go tk 1 : V Qdd iso(\13, \160A" MoA afe roved n Sa --6 Cro V c e r rit r\um 2. s€f 1A�- o (\ Gu.). Received By: Date: C/51( Issued By: /e 6? Date: JO jr.20 1,.rnt Municipality of Anchorage ,),.par men P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orglOnsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV171103 COSA#: Permit#: OSP171265 PID#: 015-332-23 Legal Description: Cromwell Heights Block 2 Lot 2 `r G W0.; Ve t . `00- Re IAeS- 'cc Garness Engineering Group Y'e t re 1r 0° Seco-A-9--fl c -1-a rLk +v s'0'14 ce (,)4L 1 w n � Applicant: Steven Peterson bee' O ro ve . Pro Ve .t l� C :# e 5 8a. o Cf. ` Your request for a waiver of the required 100 feet horizontal separation from the septic tank and absorption field to the private well has been approved. The approved separation distances are 50.0 feet and 70.0 feet, respectively. In addition, your request for a waiver of the required 4 feet vertical separation from the bottom of the absorption field to groundwater has been approved. The approved separation distance is 2.0 feet. See engineer's waiver request for justifications. There is no well log on record in order to complete the ADEC well waiver calculation. However, proposed septic system is a CAT III AWWTS, which is a significant improvement from the existing undocumented septic system (also likely located within 100 foot radius of well). This waiver approval applies to the proposed septic tank and absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ►1 Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: 10/171200 Approved by: 72dee Name of Reviewer **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE vcD " JJfbir ,; Community Development Department Phone: 907-343-7904 r 200 k Development Services Fax: 907-443-7997 ti On-Site Water & Wastewater Program `cam Mayor Dan Sullivan 3 L 9 5 On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 015-332-23 Property owner(s) STEVEN PETERSON Day phone 952-5414 Mailing address 11500 HILLSIDE DRIVE `ANCHORAGE,AK 99507 Site address 11500 HILLSIDE DRIVE*ANCHORAGE,AK 99507 Legal description (Sub'd, Block& Lot) CROMWELL HEIGHTS; BLOCK 2, LOT 2 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (Sall that apply) Initial ❑ Single Family (SF) Absorption Field ® Upgrade ® (w/wo ADU) Septic Tank ® Duplex(D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage 0 THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: TANK TO WELL; DRAINFIELD TO WELL, DRAINFIELD TO GROUNDWATER Distance: 50; 70; 2 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: /5(ol Waiver Fees: /tag Date of Payment: '71 s�I�' Date of Payment: q 1/` ' Receipt Number: //y�,,�� (>39/36) Receipt Number: 039/34�/34 Permit No. O3P/ /2105 Waiver No. 5V'W/03 (Rev.01/11) CO ua ICs GARNESS ENGINEERING GROUP, Ltd Advanced T eatmenf yotlrn CIVIL&ENVIRONMENTAL ENGINEERS Dealer October 10, 2017 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for Cromwell Heights; Block 2, lot 2 To whom it may concern: The existing 2 bedroom house is served by a private well and septic system. The drainfield is in a state of failure and needs to be upgraded. Per the request of the owner, we are designing a 3 bedroom system. We are proposing to install a new 1500 gallon STEP tank with Advantex components, one AX-20 pod, and a bed type drainfield. We are proposing to excavate down to the insitu GM material as shown on the attached soil log, import MOA approved sand as required to provide 2.5 feet of separation to groundwater as observed in bed excavation on 10/9/2017 and construct the drainfield. Two testholes were excavated on the property and the drainfield is designed around the 30 foot radius of T.H.#2. Comments regarding the design are summarized as follows: 1. SOILS: See the attached 2017 logs which show the soil classifications, groundwater monitoring, and the percolation test results. On 9/5/2017 GEG met with the MOA onsite department regarding the "fill" material shown on the site plan. Per our conversations with Rebecca Carroll, we would be allowed to over excavate" in the fill area, however, a special provision would be added that the bottom of the system would be inspected by the MOA. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There is a creek to the south and west of the proposed drainfield and tank. The drainfield will be greater than 100 feet from the surface water, and we are requesting an 80 foot surface water waiver for the septic tank and AX-20 pod. Prior to the design, Shane Holt, PLS surveyed in the creek on property. According to the MOA plat, the creek then headed northwest as shown on the design drawing. During the pre-construction layout, the surveyor (Shane Holt) flagged the 100' creek setbacks much further north and east then what was shown on the MOA plat. Per conversations with Shane Holt, PLS on 10/9/17, once off-property, the creek heads more northernly then shown on the plat. We are requesting a waiver to these surface waters and requesting that your department add a special provision that the portion of the creek within 100' of the new septic system be surveyed by a professional land 3701 East Tudor Road,Suite 101 'Anchorage,Alaska 99507-1259 Phone: (907) 337-6179*Fax: (907)338-3246'Website: www,garnessengineering.coni C_ # 1 • Page 2 of 2 surveyor for the as-built survey. 4. TOPOGRAPHY: As can be seen on the attached topography drawing, the average topography around the proposed drainfield, and downgradient is 0-5% running southeast to northwest. 5. WAIVER: We are requesting that your department issue a variance for the required separation distance of 100 feet from the well on the subject lot to the proposed drainfield down to 70 feet. We are also requesting that your department issue a variance of 50 feet from the proposed tank to the subject well and a 2 foot variance from the proposed drainfields to seasonal high groundwater. We are requesting a waiver from the septic tank and ax-20 pod to surface water from 100 feet down to 80 feet. Justifications for granting these waivers are as follows: • We will be utilizing CAT Ill Advanced treatment. The effluent quality will be much greater than that of conventional treatment. • We will be using a 1 foot (minimum) sand filter to help meet separation to groundwater. Once the effluent passes through the sand filter, it will be an even greater effluent quality. • The proposed code allows for a CAT II or Ill AWWTS to be as close as 50 feet to an existing private well • Per the well log, from 26-81 feet there is some sort of clay (clay with gravel, silty clay brown etc...) • The area between the tank and the surface water is highly vegetated. • The topography is such that if effluent were to overflow it would not travel directly towards the surface water. • The area of the proposed tank is highly visible by the property owner. We are unaware of any adverse impacts this installation and or waivers would have on adjacent wells or septic systems. If you have any questions, please contact us at 337- 6179. Thank you for your assistance. Sinc- ely, l Al Jeffre1. aaf ess, P E., M.S. Presiden 3701 East Tudor Road,Suite 101 *Anchorage.Alaska 99507-1259 Phone:(907)337-6179*Fax: (907)338-3246*Website:www.garnessengineering.com I I 11 °C \ CROMWELL HEIGHTS. fl WCHALET TERRACE;LOT 2 \\ BLOCK I.LOT 2 % / \ •G3, / \ / \ / C l O .4, zpF�t F D Y CHALET TERRACE:LOT3 2 CROMWELL HEIGHTS: I- BLOCK 1.LOT 1 VACANT I m CROMWELL HEIGHTS BLOCK 1,LOTS I O 1 6 2 ARE OWNED BY THE SAME X INDIVIDUAL,NO WELL IS BELIEVED VACANT TO BE LOCATED ON LOT 1. m CROMWELL HEIGHTS _—— -.1'-- BLOCK I LOT 12 I / \ // CHALET TERRACE.LOT4 t \ \ EAST 115TH AVENUE(UNDEVELOPED) _ / 100'OFFSET FROM CREEK CENTERLINE f- mus N io� .K ' _ o I / i\ p moo.m \ ` ....-"'"...."..."".....d°°".""..""' ; "o - . - . •\'' c F�4 • ..•�� , '.i'- ' \ I \\ CARR;LOT 2 s yAeF( �ii • .. / / cI —/1...... �FFr — JI 11111 + RADIUS / V` \ ^ / , \ ezFr � Fq / \ \ SE',yF*1- I 1 :21111.............11.C1::)11 \_1 ,/ CARR.LOT 3A }� 'VACANT'F�� CROMWELL HEIGHTS. 1CROMWELL HEIGHTS. BLOCK 2.LOT 3A \ c'.7 , BLOCK 2.LOT t \ \\ 1 \\NN THE SUMMIT.LOT 1 S ALE: I 1"=100' ....:::. oF /4% _____________0400.rilligUldm,_ GARNESS ENGINEERING GROUP, Ltd I; • . .. E••b • imignmii... CIVIL&ENVIRONMENTAL ENGINEERS rPMEMMNEHIP 1 0 3701 E.TUDOR ROAD SUITE 101'ANCHORAGE,AK 99507'PHONE(9071 337-6179'FAX 1907)338-3246'WEBSITE www gamessenginering cam '.• A •h••1 • l• y ' PREPARED FOR: PHONE NUMBER PAGE NUMBER 11n Je y•• 1. Gayrness : Lv SCOTT PETERSON C/O GLENN BRACALE 317-4949 1 OF 2 0�J,'. t i CE- ,l •", • PROJECT/LEGAL DESCRIPTION DRAWN BY: I • CROMWELL HEIGHTS; BLOCK 2, LOT 2 L.K.B. �1 ��� ('�•'••', '.. TYPE OF WORK DATE: r4, Es„v �4. SEPTIC SYSTEM DESIGN UPGRADE 9/7/2017 itAECC884 �� co # 1 DESIGN CRITERIA: GEG,Lid.HAS A8 PAGE SPECIFICATION NUMBER OF BEDROOMS:3 LETTER THAT PERTAINS TO THIS DESIGN.TO NOTE:THE CONTRACTOR SHALL HAVE THE GALLONS PER DAY(GPD):450 FT' OBTAIN A COPY OF THE LETTER CONTACT NORTH LOT LINE,ALL PERTINENT WELL RADII, PERCOLATION RATE/S 60 MIN/INCH GEG.BY PROCEEDING FORWARD WITH THIS AND SURFACE WATER SETBACKS FLAGGED BY A PROPOSED APPLICATION RATE:'2.0 GPD/FT' INSTALLATION.THE ENGINEER,WELL DRILLER, REGISTERED LAND SURVEYOR PRIOR TO CONTRACTOR AND PROPERTY OWNER AGREE MINIMUM DRAINFIELD SQ FT. 225 Fr' THAT THEY HAVE READ THESE CONSTRUCTION. CAT III ADVANCED TREATMENT SPECIFICATIONS AND AGREE TO ACCEPT THE DRAINFIELD DESIGN: - TERMS AND CONDITIONS OUTLINED. THE RESERVE SITE WILL BE REBUILDING THE MAXIMUM DEPTH: 1 FEET PROPOSED DRAINFIELD IN PLACE VNDTH: 10FEET LENGTH:35 FEET M.O.A.APPROVED SAND FILTER:'2 FOOT MINIMUM EFFECTIVE:0.5 FEET EAST 115TH AVENUE (UNDEVELOPED) ACTUAL SQ FT.,350 FT' 'TOP OF SAND SHALL BE EQUAL TO OR HIGHER THAN THE HIGHEST ORIGINAL(NATIVE)ORGANICS ENCOUNTERED DURING THE EXCAVATION OR 2.5 FEET(MINIMUM)ABOVE GROUND WATER AS PROPOSED DRAINFIELD OBSERVED ON 10/9/2017 ,_ \5% - 0 OTHER THAN THE NOTED 100'CREEK OFFSET PER PLAT,SEE DESIGN 0.5/0 CREEK;NO SURFACE WATERS LETTER REGARDING WAIVER REQUEST -- APPROXIMATE LOCATION OF WERE NOTED DURING ANY GEG TOP OF SLOPE/FILL SITE VISITS \5% ' 4 H.# MATERIAL APPROXIMATELY ` 3-5 FEET ELEVATION CHANGE + MOUND TO HAVE 3:1 SLOPES, T.H.• i�U' INSULATION AND BE TOPSOILED I �� AND SEEDED IN SPRING OF 2018NN 1.11r \ • • / PROPOSED 1500 GALLONSTEP TANK . 4 WITH ADVANTEX COMPONENTS MH•�� ST ��\�. (DRIVEWAYI Q 4. EXISTING 3 �Q\ EXISTING SEPTIC SYSTEM TO BE /1114.* BEDROOM • PROPOSED AX-20 POD • DECOMMISSIONED PER UPC / HOUSE \ 0 I 1 � 1 Z W 70 FOOT EL RADIUS I I - w ~ w ` \J. d . INSTALL FCO fJ CREEK PER PLAT ION�w I P S . . ,4 / ! F 100 y0 / / CROMW \ELL HEIGHTS; o` \ / / / BLOCK 2,LOT 3A \ _ _ / CROMWELL HEIGHTS; / APPROXIMATE LOCATION \ BLOCK 2,LOT 1 / / ` OF CREEK CENTERLINE CREEK LOCATION SURVEYED - - ' SALE: / BY SHANE HOLD11 N. 1 1•=40' 7 _�� GARNESS ENGINEERING GROUP, Ltd - 49''./ _*••� 4 CIVIL& ENVIRONMENTAL ENGINEERS �0 3701 E TUDOR ROAD.SUITE 101'ANCHORAGE.AK 99507'PHONE 19071 337.6179'FAX(907)336-3246'WEBSITE www garnessengmeenng corn •. • PREPARED FOR: PHONE NUMBER: PAGE NUMBER - : • A. t- ess :kki t STEVEN PETERSON 952-5414 2 OF 3 f`C'� E 79 3 lr PROJECT/LEGAL DESCRIPTION DRAWN BY alr ��♦+'• • CROWELL HEIGHTS; BLOCK 2, LOT 2 D.J.G. 1• A . ID�ia,/pRoF ' � TYPE OF WORK• DATE: +4LICENSE l 'S„� �.4 SEPTIC SYSTEM DESIGN UPGRADE 10/10/2017 #AECC884 �� 1 - -. 2.5 FEET 2.0 FEET 2.5 FEET -- I*14 FEET► -14 FEET - T M1- 0 2.5 FEET dil CO (1O } FD 5 FEET FDQQQFD 10 FEET i °CO COO 2.5 FEET Qv,T MT° 35 FEET NOT TO SCALE �_�.......� ii?' •................. .... GARNESS ENGINEERING GROUP, Ltd i'' 4'..'. • ■ CIVIL& ENVIRONMENTAL ENGINEERS : is 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507'PHONE 1907)337-6179'FAX(907)338-3246'WEBSITE www gamessenyineenny wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: .• ''ff�-C -795; A. t: -ss l . STEVEN PETERSON 952-5414 3 OF 3 10421%: C -795 '.. PROJECT/LEGAL DESCRIPTION: DRAWN BY: ., �'•,'. Z........ CROWELL HEIGHTS; BLOCK 2, LOT 2 D.J.G. 1 .. ('�P •• TYPE OF WORK: DATE: 4.4 ESS\"..ii DRAWING OF BED LAYOUT 9/25/2017 tmEccee �`�������� .*,&`lL`ILYAjiI s� OF moll Alp Air _ GARNESS ENGINEERING GROUP, Ltd .. ' 4 CIVIL & ENVIRONMENTAL ENGINEERS ol 3701 ETUDOR ROAD, SUITE 101 'ANCHORAGE, AK99507-PHONE (907)337-6179- FAX (907133&3246*VJEBSITE—gam—nginee-g.— % `•,• • ••••••• ...........:•'Q•�•, , ♦ /� d// e ey . arness : �v SOIL LOG -PERCOLATION TEST C 79 3 ;� _AV LEGAL DESCRIPTION: CROMWELL HEIGHTS; BLOCK 2, LOT 2 # # ��` '•. ' ,.•' � PERFORMED FOR: STEVEN PETERSON DATE: $/9/2017 ♦♦ ,Fo•p.`� ""'••••P�'� LICENSE �4IROFESS� �. DEPTH #AECC884 "`, (feet) TEST HOLE #1 - UPPER BENCH 1 ORG/FILL 2 3 �;� �• SP GM . • • M%/% 4 • 14 5- �iy„piI �•i 6- 67 i i• 7— ML $ 15 TIGHT WITH LARGE B.O.H. ROCKS AND SOME 17 POCKETS OF GM 9- 18 10 11 .iowo� �.�. • •.• 12 ----•-� 136 �;� �• SP 8/9/2017 . • • M%/% NNN �IIIIIIII • 14 be �iy„piI �•i i i• 15 B.O.H. 16 17 18 19 SOIL CLASSIFICATIONS • � �1'Il"II 13 8/9/2017 1131191 M%/% NNN �IIIIIIII • " j Y`` m1 �iy„piI 3+% DEPTH TO GROUNDWATER DATE 13 8/9/2017 4.6 8/15/2017 5 9/5/2017 SITE PLAN N SCALE: i°=100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 8/10/2017 ABSORBED 5 GALLONS IN LESS THAN 1 MIN 2 TIMES PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3 FT. AND 4 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: ERIK WIDGER C.0MMFNTS- PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFfflqED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: q Os ***a`TAW ►1 ,.•••••... . .. S,�•• kRNE55 ENGINEERING GROUP Ltd •••••• • CIVIL & ENVIRONMENTAL ENGINEERS �••• //, ••••••••�•• •••••••0 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE. AK 99507' PHONE (907) 337-6179 -FAX (907)338-3246 'WEBSITE�garne engineering mm 0'-;o •�• • • • •• • ...... •� 0" SOIL LOG - PERCOLATION TEST 0. c, :. CE 79 F •s•°=: LEGAL DESCRIPTION: CROMWELL HEIGHTS; BLOCK 2, LOT 2 ��i 410, PERFORMED FOR: STEVEN PETERSON DATE: 8/9/2017 �1 pR 0�'�P�" DEPTH LICENSE 1,1111iaa r��••• #AECC884 (feet) TEST HOLE #1 - LOWER BE 1 ORG/FILL 2 3 GM 4 5 6 7 DATE 111'11111 i//iI 8/9/2017 ML $ 5 HNN • a. TIGHT WITH LARGE �11"I'Il 'um 3 - VZZZA ROCKS AND SOME " IV"",• `4: 5-3/4" POCKETS OF GM 9- - 6" - 6 - 10 5-3/4" 1/4" 11 12 •i •••• 13 14 15 16 17 18 SP SOIL CLASSIFICATIONS DEPTH TO GROUNDWATER DATE 111'11111 i//iI 8/9/2017 I'�'ll�1l KOM% 5 HNN • a. 30 �11"I'Il 'um 3 - VZZZA 20111111 " IV"",• `4: 5-3/4" 1/4" DEPTH TO GROUNDWATER DATE 13 8/9/2017 4.6 8/15/2017 5 9/5/2017 2 30 SITE PLAN DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 8/10/2017 1 _ 6" - 2 30 5-3/4" 1/4" 3 - - 6" " 4 - 30 5-3/4" 1/4" 5 - - 6" - 6 - 30 5-3/4" 1/4" 19 PERCOLATION RATE 120 (MIN./INCH) PERC. HOLE DIA. _ TEST RUN BETWEEN 5 FT. AND 6 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: YES ❑ NO SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: ERIK WIDGER COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE C RNt D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: b 6 (INCHES) AV AAp GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 33&3246' WEBSITE: w.wi.gamessengin—ing.mm SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: CROMWELL HEIGHTS; BLOCK 2, LOT 2 PERFORMED FOR: DEPTH (feet) ORG 1 STEVEN PETERSON 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 DATE: 8/24/2017 TEST HOLE #2 SOIL GM CLASSIFICATIONS •- 8/24/2017 3.5 FEET 8/31/2017 3.6 FEET 9/5/2017 3.6 FEET 10/3/2017 30 5.5' 1111N • .. �. �I'I'll'� I' - :iiYYY11 �qy��p�I 30 5.5" 0.5" " • - 6" SC 6 GM/ML DEPTH TO GROUNDWATER DATE 4 FEET 8/24/2017 3.5 FEET 8/31/2017 3.6 FEET 9/5/2017 3.6 FEET 10/3/2017 SITE PLAN I �! Q N SCALE: I°=100' DATE READING CLOCK TIME NET TIME WATER LEVEL (MINUTES) READING NET DROP (INCHES) 8/25/2017 1 4:30 - 6" - 2 5:00 30 5.5' 0.5" 3 5:00 - 6" - 4 5:30 30 5.5" 0.5" 5 5:30 - 6" - 6 6:00 30 5.5" 0.5" 19 PERCOLATION RATE 60 (MIN./INCH) PERC. HOLE DIA. _ TEST RUN BETWEEN 2.5 FT. AND 3.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: YES ❑ NO SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: ERIK WIDGER COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PER O MED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: t) 6 (INCHES) • '� Municipality of Anchorage 2 �fj sL On -Site Water and Wastewater Program <` (907) 343-7904 s A F E�T: Certificate of On -Site Systems Approval Parcel I.D. 015-332-23 1. GENERAL INFORMATION: Expiration Date: Complete legal description CROMWELL HEIGHTS: BLOCK 2, LOT 2 Location (site address) 11500 Hillside Drive *Anchorage 99507 Current Property owner(s) Matthew Hunter Day phone 281-546-7537 Mailing address 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: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ Jr Waiver Fee $ Date of Payment 2Z/4-7- Date of Payment Receipt Number Receipt Number COSA # G S Ca 02 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Gamess Engineering Group, ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: t + 2.2- In z In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the dates of the n evaluation. Separation distances were measured to readily identifiable features. Hidden defects or G ���.•..... j +� encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions,+� groundwater levels (that may fluctuate during the year), quality of construction (materials and r, - .7 workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and J"""" "' are outside the control of GEG. Satisfactory test results do not guarantee future performance of the s stem/s; therefore, GEG makes no warranty ty (express or implied) regarding the future performance of rj • '; • • •1 the well or septic system. GEG makes no representation whether an alternative well or septic system A. Garne c:* can be installed on the property in the event either of the current systems fail to perform adequately in �; CE— the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or LL'c7p I party (including subsequent property purchasers) is not authorized, nor will it confer any legal right �R1 �, r whatsoever. 6. DSD SIGNATURE \`llot(tt((A�CC884 ./ System #1 Approved for a bedrooms System #2 Approved for bedrooms `Q@�' DisapprovedR �z P-StE ?' SER 0 - Conditional approval for bedrooms, with the followit �ipt Ii sf'G�PM�IJPPA,fchrr IN By: Original Certificate Date: 02 a ,24a� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: CROMWELL HEIGHTS; BLOCK 2, LOT 2 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA * F01 Well log is filed with Onsite (or attached) Date drilled 1964(?) Total depth 95 ft Cased to 71 ft H Sanitary seal is functioning correctly [0-1 Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 1/20/22 Static water level at beginning of test ARTESIAN ft Comments B. TANK DATA Age of tank(s) 4 years Tank type/material s'�°'s�` Measured operating fluid level in septic tank - M Standpipes/foundation cleanout per record drawing Date of pumping SEE ATTACHED MAINTENANCE D. ABSORPTION FIELD DATA Which system tested (date installed) 10/11/17 F01 ALL standpipes present per record drawing Total measured depth from grade 4.33 ft (max) Measured depth to pipe invert from grade 3.25 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 015-332-23 Structure served by this system Well production at time of test 2.1+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes W Nc ❑■ Coliform bacteria is Negative Nitrate 1.67 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 1/20/22 C. LIFT STATION M Required maintenance completed Age of lift station 4 years Lift station material STEEL Comments: Adequacy test date 1/20/22 Results 0 Pass For 2 bedrooms Fluid depth prior to test 0 in Water added 589 gal New depth 0 in Elapsed time 0 min ❑■ Code -required soil cover over field Final fluid depth 0 in Absorption rate 300+ gpd F1 System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) NIA Gallons introduced NIA gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet i" E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes *50'+ Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft Q Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50'+ ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑✓ Yes if No ft 21 Yes if No ft ft If septic tank is under driveway comment below *AWWTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 21 Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' ❑ Yes if No *50'+ ft Property Line > 5'✓❑ Yes if No ft Wells on Adjacent Lots: Q Yes Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑ Yes if No *50'+ ft Water Main > 10' Q Yes if No ft Community Wells > 200' ✓Q Yes if No ft Water Service Line > 10' ❑✓ 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 if No *50'+ ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No *50'+ ft F. ENGINEER'S COMMENTS *AWWTS G. ENGINEER'S CERTIFICATION o PF I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with p�C�, " T i MOA COSA guidelines in effect on this date. .�. 6, e... _Garn, s. - CE -79 3 .CE-793 e 4� l 3a ��-'• ��oG COSA Checklist yellow sheet �Pa pr ofessionoon #AECC884 o Sullivan Water Wells Invoice ULLIVAN P. O. BOX 670269 WATER WELLS CHUGIAK, AK 99567 Drilling - Piling - Pumps 907-688-2759 sullivanwaterwelis@gmail.com Matthew Hunter 11500 Hillside Drive Anchorage, AK 99516 INVOICE # DATE TOTAL DUE DUE DATE TERMS'ENCLOSED 2011 01/31/2022 $1,150.00 03/02/2022 Net 30 ACTIVITY OTY RATE AMOUNT Artesian Packer 1 900.00 900.00 Cap & Conduit 1 250.00 250.00'' We appreciate your businessl BALANCE DUE $1,150-00 No discounts will apply if invoice is not paid within 30 days. If invoice is not paid within 90 days, a lien will be placed on the property. 06/29/2021 03:51 8696770 APLI_�S PAGE 05 3A9 23311 a 1111 signs e ow all lie so I lE *vanTex!, Field i AnchorageTank Annual Inspection 907-272_353 ©perator prmpany 0wnorfFMCking N Matthew Hunter S" Addrose 11500 Hillside Drive, Anchorage AK 99516 AX $M ID A Covnty ID A AX -143108 Retrieve O&M Info Daily flow Flocirc ratio _ — — Timer settingst Perform Field SamPI ng/observations NTU (is s NTUs) pl 1 (6-9) =-�� g'-be Odor of Sample Typical 7MUl F7 Earthy ❑ moldy Non -typical 03ulfi lc ❑ Cabbage 1_1 Decay ORY filth in PVu Ycs No Foam In tank [.] Yea ❑ No Check Control Pane Recirc Amps Discharge Amps 1 +� Audlblo and vlauAi al; `ms I OK Dial ton telt`metry s tl ! 1 Y,. r Na Inspect/Clean Pum r System Inspect Clean Riser/Lid ......... ........... Splice Box .... ... . .. ........III» Float Cords ..... .. • ... • • ... 7( Mats ...... ...... .......... }c Pump...................... BiotubO Fitter ..... ........... ,( Blatube Pump Vault .... 1 Recirculating Splitta Valve...... . comments signature_ Larry ignatures_,,. Larry Betts ContAd Phone (907) 555-5555 Pod k rrrU eNL S Date of Last InipeCtlon 42 i 38,6 RTU 136562 08!1012020 measure Sludge/Scum Sludge Scum 1stCamparment Curvy t11 Previous Current Previous 2nd Compartment Current Previous Gurrent Previous Inspect/Clean sdvanTex Filter Inspect Clean 40on Normal 0 Pungent Literala/0rlflces z BiOmat: Normal I.J ExcesslYe Pod Bottom Bridging/Ponding: None/Minor E)Exm-gsive IntAke Vent X Inspeot/Clean Discharge Pump Syst-rn Inspect inspect Clean Riser/Lid Floats n I -J splice Box Pump 7 Cl Float cords Inspect/Se-100 other System Components Inspect clean Inspect C1r9ran Dtainfmtlon Equipment Dispersal Lattr°rals/t7rSfices 1rJ observations ,Additional ServiCes Rendered [] Cleaned textile ah"? Q Replaced UV items? `-1 ReplacetllUsed othor Items? parts Used: W - warranty, 8 = Billable (✓ appropriate Sefeatian) W 0 Item Number Dsacription Aj i q Final/Safety Inspection RBV reinstalled Lids bolted on J Mangold reconnected; flush valves closed Control panel mactivAtcd Su%emery/Recti mmen dations System performing; no further action needed ❑ Tank needs pumping Call for service U Other? Date IFax completed form to 1.866-384-7404 Nlli N 10 PALITY OF A NNCI [ORAG E ADVANCED WASTEWAT ER NIAINT FNANCE AND REPAIR AGR.EEMENT AND REPAJR ACRFENIENT- he-:ein t1he -,ldiRhElvlll_,N T" mad -e and ,r 'n b" --d h Tc�l en"Cred nto as,.'f 0111's hcreln Phc, "CAWNER,- zuld tht:T%,lunicip Artchorage, hervin t)c Amchum.,-4e Munic-i"p:-d Cod": 0AX . i -IC") 15.65.165, TT-� ocnisid-urailor, C11,1ho, rnaunccwenmm-s c,)nlm,lned herein, the lees ta :his A=gyeern2t7 b 4 IAv&ncdWastewiterTreatment Systel"S 1,11cN"flinkII-, --� Ili,t n ,�� I Yr= -TS? Y3 C: r n I 2"�c 'a ", C, 'n pn n - I I an ^dvanccd Wastcwatcr SvsLLm (.,4A AJ 'S', b, v t6 ilt� alt "lt gal I I � J 2, Nilainte-nance, Re and Afteratio-s. Mirs � (Ownci, is -required rlt) read, and, mival eac-..-2 section) Nr� - Shal' u :1�ie �,Uk�,u -e hrCfuLrJ-zl-,PuL iht_ wnm—lf ,Jlli itte Owltel t,,)Lf illLO I'v" "L p h an AW'WTS SCT -vice and' rnaintenaricc Pnn'der approved by �-hz, Mun- -pality or te condition capbl'c of performilng, asde-siginked and producing -m-mic.d sep-6c. eftluent ill. &iLh the muUmmint7N am-licival 11 -Or ("Pe-ullwn It shudi be thc respo-ilsibilit-v cj-:he GxvTrcT- -lu 'r, Chetcmm ofth-l-s Au me-jitto rtav fbrat" . .- f -u 7, -- - CIC, i zepaiY(,5,4, rnminicnanc, rcp1-,,c;=4 unt cost,.5, and ilmsm-clion, Costs, 1 -his ivicludts an annud rnainwsunce fi�e (-mpLaflly S-400 toSM'110j, ownc---, ag-recs :J;,at mly mainterianuc. and zmaiT p-crstmncl apprcrved by the 'MIumicip --z-i-,v or the manufc�cturcr'sre�,-CK�ntativc wifl "Mspcct 2-nd -make, ary necessam nlmintenanc, Ovvncr acknow1cdges, fl-lat. maintenarcc o AWera' T'S- rcC�ucczs the potemlial i,yjfurt� ofilte syslern, .vhi�:h could inqludk� svvaiw v 7 � c1. -up,, and costiv repairs or drainfieldl repla-cenient. (rev. PaL owner ackm)iivtedgw�.,- that the M Lanci pal, Ly rota ['&C[Ue�t fef_-Md-. OF V1a1;Tl1V.rN4FiOV 4-nd I re air 1vorn the znanufactumrs iepresenta6ve or t nn and repair an AW WT S m.av be C -me.r acknowledges athe tha - fine ffor failing to mai tai lqsL—sied ;n amordance with AMC 34 601,030, 0 w n e r agars to -rani Cott, M u a, i cip. -i I ty real on�a b I e. actress to 1 s t am d 1 n sDec t the AWWTS. The Municip,.ffity will ijvc at ]cast' -'-hour not' 4 lee, gees than, any safe or transretuffitte will �t ur witImt a new Owner W, t no -YZC Cells of On -Site Svl,�Iems Anap voval Owner agre-pvidw�,l s that the AWWTS inst, by the AVV W T S v en dorArnsiafl e, r and; ap.p. Troved, 11 v they ty ),,,I u n I clipa I I ty a. -c tb c goverm ng 'delines for the construe -- , onmaintenamc and repai� olffhe ,VL L; 9 1 L, AWWTS. 0,�Vflel- a S to rn a in't a i P Tarn otv. mon i t�ri nE, of th c AA VN,' f 1_3 as required by the AWWl's approval Term, Tbr- t emn of thi s evam erl t shall beg I In 0 f i it e dal 0 0J pp roval by the municipxalktv to trate tn~ 4sucticd syst"Im, or UpLan ndnsfer of utle, and shO (xiwinim vwbili: 411v ANIT S is cpera.fion:�] car unto tithe is L"ansferred 4. Nonwaiver. The blurt ��if tht:, %,1ur:ii;7paj1'N, at any time to etilloree a prov;!km of this, A, gn�e mentshall in novv;,15, consu'rute a -.,Vaiver C-4- the plovisions, n r-,ir in anv - way allect thcv,ijid4y ofthe kgreementor any Haat or the -i r I _ghi of the INMunicipality thefeafter lo 1�11 f"m ev cvcry provi Sion huervE 5 Amendment. This Azreementshall .rani ,, be xnt:rlded by authorized represem4ijves of zhe Own,ar;,,ind Mtnnripalit?,. kr,.v aitempL to a -mend tinv, agrcem�rnlbv tither arl unauthOlTized representative, or tin` lauthaii74-d mearts shill bevoid, 6 4misdictioen: Clio -ice of Law- Any civil 'IC6011 ahsing ffool dlisAgree-mcni shall bc broug,N in they Superior Couo fx the Third Judit.lial Ovotrict oft, the State of Alwika at Anchorage. The laws of tdw Si; e orAlaska shall orvern L P he rights and obligations of the , lay Pies undcr this kgreement 7 Any provil si ckqs oC dihs A -,:-i t.,ervi oun, I decrecd i nvati d by a cou izi orcompetent jmri� tion shall net Frrvalidatu the remaining pmvislvn:; of ffic A Hmeemcni- trcv, 05. 1 8X201 8) Pkge 2 oi 1 3 OWNER: --;I— Date- 5 STATE OF ALASKA TH[RD JUDICIAL DISTFUCT 11-- lfQf_egOi.l,- hlyirument. wa.,�, ACk-TuLiwlcdgcO 1;4-Fbrr� Tne this,` -a 1.;-,v of o,- -'l 20 L-1 AX L-ucl?vj)N-.3 SAP-nISTE X. oF NO L X -Y PLI b 1,�c 5�aLe of A, p J FOR ALTASK;k ssm Z5, 1-324 My an Ex j-, Z-324 r Commission x ires t p 7 541T."NICIP-iLLITY: Bv- (print n-,lMQ) Date: (rev.. 051'11S/2018) Page 3 of 3 rQ 1 4 S )� • tv. a =' ' � • unicipality of Anchorage ° OCT 23 2017 =.1,0n-Site Water and Wastewater Program (907) 343-7904 ^�F0:.e/ertificate of On-Site Systems Approval Parcel I.D. 015-332-23 Expiration Date: f 0 _ , LH j 1. GENERAL INFORMATION: Complete legal description Cromwell Heights; Block 2, Lot 2 Location (site address) 11500 Hillside Drive*Anchorage, AK 99507 Current Property owner(s) Steven Peterson Day phone 952-5414 Mailing address Real Estate Agent Glenn Bracale Day phone 317-4949 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: ID/V- 4 it COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ u29.0 Waiver Fee $ Date of Payment /00,110 Date of Payment Receipt Number t' G Receipt Number COSA# 05C-l/414Q? Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER S.. 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 bedroom"s and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road,Suite 101-Anchorage, Alaska 99507 12- 1 (1-4-- Engineer's Printed Name: Jeffrey A. Garness Date: i 0 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o O r 4 C QQ4 in accordance with the guidelines and regulations established by the Municipality of Anchorage and a C•,.•••... S�OQn industry practices. The reported results describe the condition of the system/s on the date/s of the p• .•• 1. 4 v evaluation. Separation distances were measured to readily identifiable features. Hidden defects or 11/ encroachments may exist that were not identified during the evaluation. The operational life of all wells 4• T `P \ .J Oa and septic systems depend upon a variety of variables, including but not limited to. soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials andVA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and .. are outside the control of GEG. Satisfactory test results do not guarantee future performance of the //1 ••J. _ looess. system/s;therefore, GEG makes no warranty (express or implied) regarding the future performance of 00,, • E— .' Q� the well or septic system. GEG makes no representation whether an alternative well or septic system v �Q can be installed on the property in the event either of the current systems fail to perform adequately in �Q 0/ •jp..2.3'f °� the future. The content of this report is for the sole benefit of the person/party that retained GEG to ��Pa Pr o f e s 510116" perform the evaluation. Reliance upon the information provided in this report by any other person or �4p4p000g party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for - bedrooms `��1,�1111L(1,I f1 System #2 Approved for bedrooms `�,`-,�'6� ANCya,.,, Disapproved `yC Conditional approval for bedrooms, with the fall +vvingC3� s• Z o `N �OG4tP o FNS , 7-Esy: Original Certificate Date: _Z �� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10.12.doc 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: Cromwell Heights; Block 2, Lot 2 Parcel ID: 015-332-23 A. WELL DATA *Per Anchorage Well & Pump Service Well type Private If A. B. or C provide PWSID# N/A Well Log (YIN) Yes Date completed 1964(?) Sanitary seal (YIN) 7 Wires properly protected (YIN) Yes Total depth 95 ft. Cased to 71 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 1964(?) *10/18/2017 Static water level Artesian ft. *Artesian ft. Well production 10 g.p.m. *2.5+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.73 mg./L. Collected by: Anchorage Well & Pump Service Arsenic: <5 ug./L. Date of sample: 8/24/2017 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Advantex/S.T.E.P./Steel Date installed 10/10-11/2017 Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) Yes Foundation cleanout (Y/N) Yes Depression over tank (YIN) No High water alarm (Y/N) Yes Date of pumping New Pumper - C. ABSORPTION FIELD DATA *Below Final Grade Date installed 10/10-11/2017 Soil rating .p.d./f or ft'/bdrm) 2.0 System type Mound Length 35 ft. Width 10 ft. Gravel below pipe 0.5 ft. Total depth *3.2+ ft. Eff. absorption area 350 ft` Monitoring tube Yes Depression over field No Date of adequacy test New Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test New in. Water added New gal. New depth New in. Elapsed Time: New min. Final fluid depth New in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) None If yes, give date - *Second compartment of 1500 gallon STEP tank. "Per recent MOA electrical inspection report (attached). D. LIFT STATION Date installed 10/10-11/2017 Size in gallons *500 Manhole/Access (Y/N) Yes "Pump on" level at Timer in. "Pump off" level at Timer in. High water alarm level at 53 in. Datum Bottom of Tank Cycles tested New Meets alarm & circuit requirements? **Yes E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *50 + On adjacent lots 100'+ Absorption field on lot *70 + On adjacent lots 100'+ Public sewer main 75 + Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5+ _ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water *70'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS *WR#OSV171103 ao6�4d � G. ENGINEER'S CERTIFICATION °F 1,71%1(1 oGliN — •-f't certify that!have determined through field inspections and l* 4r9 T '•.77*4 review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this ,, date. �1 "...Jet, ey #'. ..mess` 1 Engineer's Printed lName JEFFREY A. GARNESS v0017. —7953 ftp' Date /v/ 2. / d�e*;ed' •1.P. .?.30 0� �ofessior 4 400ODd� #AECC884 (Rev. 11/05) EAST 115TH AVENUELUNDEVELOPED) . 4 N 89 55' E 180.00 C.1 .y2 ' 0 00 8 ,0 I. ? LOT 2 ..._...__ o `� - .-- in . ._._----.---- o� aw,�6'- °� AY Oo i o OM.HOO Z t� FM o in f konC.`r oO a f PATIO Z C i o� wi I i S dr' rEt �$O v4, u , (.94, _.... k / � ' UJ ` .------- N 89 55' E 200.00 0 PROP. LINE CnI HOUSE CORNER ENCROACHES -- 1.E'INTO LOT 1 J _l = i .- . Nat et N �•'� o LOT 1 3 0 In -. o I f1 I `N 10'UTILITY EASEMENT N 89 59' E 200.00 a OFq�o G(�P TH , '. v v . 49 * 0 aTi.S" ,,�, /l.Le 0 AS—BUILT SURVEY b°° - 30 m V i o NO CORNERS SET THIS DATE V-- SHANE A HOLT �0 V Din:,••. LS-6914 •-.bg�o� i HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY N4 1 6.1 OF THE FOLLOWING DESCRIBED PROPERTY �044pq�a' LOTS 1 AND 2, BLOCK 2, CROMWELL HEIGHTS ( PLAT 65-80) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS;AND IS EXIST OTHER THAN NOTED. NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES,IMPROVEMENTS,OR FENCELINES. EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT,ARE NOT SHOWN DATED AT ANCHORAGE,ALASKA THIS _14TH DAY OF HEREON(UNLESS INDICATED) OCTOBER , 2017. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING ANY PAYING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9304 6ROVER DRIVE ANCHORAGE AK 99507 13638, FB 183-60,184-65 345-5513 // ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND 1 kot+441e I w - i4-er THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this lb Day of WO je r of 2017, by and between Ma+4410h! 11,411lier, 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 Aavav +ex located at(legal description). Crovn,,leo lie;.jkfsLZ �Z 2. Definitions. Alteration. Any change to the design or function of an AWWTS 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 AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On-Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 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 AWWTS 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 AWWTS 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 AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1)repair(s), (2)maintenance, (3) adjustment(s), (4)replacement costs, and(5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws,regulations,rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance,repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction,maintenance and repair of the Owner's AWWTS. I. Owner agrees to provide and maintain a telephone connection to the AWWTS as required by the AWWTS approval. 6. Nonwaiver. The failure of either 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: ac'V+Aeu u11T�'r 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. OWNER: =.2° By: ' 1Z2/; (signature) Date: i0/14 /a17 Ma41-1et-J NAA+er (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was ackn wledged before me this I L day of Q�-Q(o0-f 2011, by 1,11- tl \ -� NOTARY PUBLIC Ny5O • BESSIE O'RYAN CARPIO ARY P : G OR ALA KA STATE OF ALASKA MY COMMISSION EXPIRES JANUARY 2,2019 My Commission expires: to 0 a1 at:49 MUNICIPALITY: Ap z (signature) Date: ( v v l (print name) Title: