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HomeMy WebLinkAboutTERRACE HEIGHTS LT 15ATerro¢e Heights Lot I§A #017-074-58 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201256 PID Number: 017-074-58 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ME Upgrade Name John & Cathleen Clark ABSORPTION FIELD ❑ Deep Trench FOR Wide Trench E] Bed ❑Mound Site Address 7900 Upper deArmoun ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.0 GPD/SFi 3.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original 2.0 grade Ft. Gravel depth beneath pipe 1.0 Ft. Subdivision Block Lot Terrace Heights 15A Fill added above original grade --2.2 Ft. Gravel length 3@ 36 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number n/a of Lines Distance between lines n/a Ft. SEPARATION DISTANCES To Septic Absorption Lift Station I I Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 613.6 Ft2 3 6 + Ft. Well 100'+ 100'+ 100'+ 25'+ TANK ❑ Septic I9 S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1500 Gal. Surface water 100'+ 100'+ 100'+ Material Number of compartments Lot Line 51+ ( 6.1 51+ NA Steel 2 Foundation 10'+ 10'+ 10'+ LIFT STATION Manufacturer Capacity Remarks Orenco 250 Gal. Alarm location North Side of House Electrical installed by Capstone PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer A+ Home Services Drainfield 3034 CO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 104.0 ft Inspdection v' 9/16/20 d 9/17/20 Location and description 2„ 3'd 9/17/20 4m 10/1/20 NE Bottom House Trim ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date co ,.' Steven R.Pannone � � � . CE 14� � �.'...:� Septic System Approved 1 10 p.p Date a0�0 Note: this approval does not include well permit requirements. ���� (Kev ubiuzl16) Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panenRak.com 6 November 2020 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Terrace Heights L15A Inspection Report & Record Drawing Comments Permit Number: OSP201256 Ladies and Gentlemen: On 11/3/2020 we received comments in response to inspection report and record drawing submittal. The comments have been addressed as follows: 1. The drain fields are short of cover (a minimum of 2 ft of soil cover is required). Response: After final inspection of installation was conducted the homeowner had the site regraded there is now "'2.2' of native material added over top of the new drain fields. There is now — 3.7' of ground cover over the drain field with 2" of R.I. It should be noted that the "Drainrock" ends at the invert of the lateral drainpipe. As defined in 15.65.010 "Drainrock (aka Sewer Rock and Sewer Gravel) — Coarse, washed aggregate place in a disposal field excavation to provide retention and distribution of treated effluent before it passes into the accepting soil". By this definition the "Drainrock" ends at the invert of the distribution pipe and the 6" of material added above that is pipe bedding not "Drainrock". Therefore, without the additional fill this drain field complies with 15.65. for minimum ground cover. 2. Please confirm a flow splitter was installed to equally split the flow between the three field sections. Response: A flow splitter was installed to evenly distribute treated effluent between the three drain fields. 3. To utilize the reduced vertical separation to groundwater for an AWWTS (accounting for seasonal high adjustment), either a pressurized system is required, or the field segments cannot exceed 20 ft. Response: The Distribution lines were connected to center of each of the drain fields. Which creates 18 - foot trench segments. The record drawing has been changed to reflect this. Please contact me if you have any comments or concerns. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Anchorage ya ding: P.O. Box 100217, Anchorage, AK 99510-02 17 Palmer Mailim:,: P.O. Box'18�}7. PaIrner, AK 99645 Teiephone: (967) 74.5-8200 FAX: (907) 745-8201 cnmc)Ov � = D OD o OD �u _ c n m v- m mxovmi< 00 c:zOSp Zc Cp O o O Q r co-' z UJ � *��' 1 O O m Z`L mD O m m 1n rn D r Nm No m f'i z N K: n K nK: z(np.. nK: ` I 0 K: 0 2 0 —1 � �t = U CT o) Cn Cn -P -P CA C'1 N N , o Cf) fr1 r , z Q N —, n (fin z CA '� � a Irl O Xv Oz FT p N N tv 03 Cn Co D m Dco� - Zoo��D� ��( / / t� P O V V Cn (n V V -P .p 0) M C4 C,1 N N N C,1 V CD CA -P C,j C,4 Cr Cn CD to 00 CO Cr1 N (D -P p0 60 - c0 (r CD CD (T - W "P "P Cn P I (b I) II 1 / =wz (A 11 a I)I it f I I 1 i I{ mom oom /�' I G1 CA cD UD O Co (.D CP Cn C7 N 00 Co -. CX1 V U1 Co L4 N 6) (n OC'`lo � Q>O10;D7prTi>z-0CD AM 1,1m Di z(np.. mF�zo ` I rn A� W D� mx z m� �m D D D <� �Z z D to = U mfNT.IO O O m °'0 x -p0' CD coo) F)D w Ln c/) 0 0 °) 0 -1' n cLf)� ;J , o Cf) fr1 r , z o � � � D Lf) p Q O '-'1 o = (fin z CA '� � a Irl O Xv Oz FT p Ul / vcn O II �m I /-- - - - - -I r— Imo! -- I 1 1 i I m \ / / ( m n NOTES: PANNONE ENG SVC LLC C.I. 1088) """"t+,, REVISIONS DATE RECORD DRAWING PHONE 907} 745-8200 FAX (907) 745-8201 =�P��' �F" A<�s 'h REV 1:11/6/2020 SCALE E >r' 1' TERRACE HEIGHTS L15A P.I.D. NO DRAWN ACP JOHN & KATHLEEN CLARK ... -�' 017-074-58 c, ste CERal4e�ne PERMIT NO. 7900 UPPER de ARMOUN OSP201256 SITE PLAN'a " ...,...' ANCHORAGE, AK 99516 �`�, �Ess1�:�' SHEET " 2 OF 2 / ` I \ or I— z Oz ' m Dco� - Zoo��D� ��( / / P� o�m ZO>m , c)z 'oo� I / ox oDc mfg l \ -_0 0 0 z M ��� ` O I) l I 1 �x n o/ r A 1-m m D a I 11 c o / �1On O/ I I of I) II 1 / =wz (A 11 a I)I it f I I 1 i I{ mom oom /�' I m Ul / vcn O II �m I /-- - - - - -I r— Imo! -- I 1 1 i I m \ / / ( m n NOTES: PANNONE ENG SVC LLC C.I. 1088) """"t+,, REVISIONS DATE RECORD DRAWING PHONE 907} 745-8200 FAX (907) 745-8201 =�P��' �F" A<�s 'h REV 1:11/6/2020 SCALE E >r' 1' TERRACE HEIGHTS L15A P.I.D. NO DRAWN ACP JOHN & KATHLEEN CLARK ... -�' 017-074-58 c, ste CERal4e�ne PERMIT NO. 7900 UPPER de ARMOUN OSP201256 SITE PLAN'a " ...,...' ANCHORAGE, AK 99516 �`�, �Ess1�:�' SHEET " 2 OF 2 7226E UPPER DEARMOUN ROAD CD CY) S89054'00"E C:) co 87.81 131.72 Well Storage ui fft� SIVIC system X:" ' 0 Gravel driveway I Story Frame House CO r7Ooff Septic vent (typ) C> —19. 27.3os 6. 0 C:) CNi p CY) 0 CL CD C3 6 U1 CY) CD 2.0 OHN27.3 Lot 15B —24.. Lot 17 C:) LOT 16 CN 2A OH W C) Chain rink fence (typ, C) C) Wood fence CD UJ Zo a 0 CD Z 0 LOT 0 15A Fbb Z C:) (Y5 0 C:) Z 10, Utility Easementl 87.81 1 131.72 Lot 4 N89054'00"W Lot 7 Lot 5 Lot 6 RECERTIFIED 10-12-20 4?J;�W AS-BUILT NO CORNERS SET THIS DATE ()F A4 I hereby certify that I have performed a Mortgagee's inspection AW * - # •-t •.00 described in accordance with ASPLS Standards of the followingbed property: LOTS 15A & 16, BLOCK • 49th TERRACE HEIGHTS SUBDIVISION 00 00 Anchorage Recording Precinct, Alaska, and that the 00 I improvements situated thereon are within the property lines do th L. ala• tka te- 40 liza p o and not overlap or encroach on the property lying SCALE: V= 50' O'�. Aw adjacent thereto, that no improvements on the property lying 8036 - LS• J�' AW adjacent thereto encroach on the premises in question and •C3 "W ftw that there are no roadways, transmission lines or other ARorzss I ONAI- �0�p visible easements on said property except as indicated % hereon. Dated at Anchorage, Alaska C) - ri `7 — Zb this 21st —day of September 2020. EASEMENTS OF RECORD, OTHER THAN /_U THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON FB 20-6, pg 33-34 BE Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 75-4, pg 48 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and Is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. A RX MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On-Site Water and lWastewater Section 90i ii--��04 www.muni.org/onsite Fax: 3437997 Well Decommissioning Log Legal Address: Subdivision 7Tpr rBlock - Lot k5 T R Section Lot On-site Water & Wastewater Section certified contractor performing the well decommissioning- Name: r Signature: OcSo1 vn Company: 5kyar) wa-�er Well decommissioning date, c) 11 -L 1 -21> Method of decommissioning: AMC 15.55.06011 a.n b.[:] C_ 1 Location: Use the space below to provide a drawing of the property showing the following items: North arrow • Decommissioned well location • Location of other water wells on the property • Two separate swing4ie distances for each well shown on the drawing Note: The swing tie distances shall be measured from either permanent structures or the property comers- T 15A 3BR HOUSE Q DOCUMENitD - TH— 1 R CODE WELL (E) TO BE DECO1v MISS4 10' UTILITY EASEMENT' G!Deveiopment Servimswuitaing ,iatetyun Site Water and WastewaterFom*isXClient Foffrts%VVell Decommisioning form.doc MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Can -Site Wastewater Disposal System Permit Permit Number: OSP201256 Work Type: Septic Upgrade Tax Code Number: 01707458000 Site Legal Address: TERRACE HEIGHTS LT 15A G:2940 Site Mailing Address: 7920 Upper De Armoun RD, Anchorage Owner: CLARK JOHN D & KATHLEEN Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: t��tnt n' llcparrmcnt Lot Size in Sq Ft: Total Bedrooms: 7/27/2020 7/27/2021 30559 Q Disposal Field Q Septic Tank ❑ 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 Received By: Date: f Issued By: C�2�'ii`{:�� R v Date: 7� I d 010 3 MUP41CIPALITY OF ANCHORAGE , Community Development Department "� c>- Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERANELL PERMIT APPLICATION Parcel I.D. 017-074-58 Property owner(s) Jonn & Kathleen Clark Day phone Mailing address 7900 Upper DeArmoun Road, Anchorage, AK 99516 Site address Same Legal description (Sub'd., Block & Lot) Terrace Heights, Lot 15A Legal description (Township, Range & Section) Lot Size 30,559 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo AD U) Septic Tank ❑X Upgrade p9 � (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of perty owner or authorized agent) Permit/Rush Fees: —4 (4 yG.ZS CoUIP Waiver Fees: Date of Payment: _77�� j 5 F202- 0 Date of Payment: Receipt Number: 09 � $ (_G Receipt Number: Permit No. OJ PW 1254 Waiver No. Permit App__- :- :'-.,:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201256, Rebecca Carroll, 07/27/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201256, Rebecca Carroll, 07/27/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201256, Rebecca Carroll, 07/27/20 TMS'MAINTENANCE AND REPA TM AGREEWENT herein the "AGREEMENT" made and entered into as of this Day of ,j UL --1 of 20 „2c� by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as q4 A V-11 /V `r ,- located at (legal description) /IC 1 -451Z,1 -if `> i 1:5-lq 2. TMaintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the teen of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of tile 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). 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 back-up and costly repairs or drainfield replacement. (rev, 05/18/2018) Page] of Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14,60.030. Ct 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. 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. Jurisdictiou: 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 t, parties Linder this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: / By: (signature) -int name) Date: / �/- : - STATE OF ALASKjk ss. THIRDJUDICIAL,DISTRICT The f6re2Y,0iJ1,g was ackno\vIedged before me this day of IN 20 by N otary Public J�) 4., mf "l— VIESUSA GAMBOA NOTARY PUBLIC FOR ALASKA' State of AImka My,qmnussion expires: I My Commission Expims March 12, 2023 MUNICIPALITY: By: d/u//(siuiiatLI1 -C - At e ec-A (/—I- t—ro /(--- (print .name) Date: -1-2 7 Title: (rev. 05118/2018) Page 3 of 3 ~'" . '%'°"~-~GREAI~R~ ~[11 ANCHORAGE AREA .~ .,~ ~l~, 3330CSIreeJ . ~ ~ ,~, ~k~ Anchorage, Alaska 9950~ LOCATION. SEPTIC IAI,It(, ' ' DISTANCE NUMBER OF FROM WELL ___ MANUFACTURER MATERIAL .... COMPARTMENTS INSIDE I. ENGTI-I ........ INSIDE WIDTH. LIQUID DI~PIH ..... LIQUID CAPACITY GALLONS, WELL, ~'" X ~' -'"'S'7'/'4t' ~/- ' TYPE ................ ,- CIi$1'RUCTION ................ CESSPOOL APPROVED. OTH,CR SOURCES_ · DISAPPROVED REMARKS DEPTH DIsTANcE FROM: SIFP;G~ DISTANCES: INSTALl. CO 3Y ..~'lJA -l?.. LOT SI_OPE: _~.~ ............. ~, REMARKS= -- DIAGRAM OF SYSTEM I?- v' , MUNMP UTY OF ANCHORAGE 0 Development Services Department Phone: 907-3437904 On -Site Water & Wastewater SectionFa-.* 907343-7997 Certificate of On -Site Systems Approval Parcel I.D. 01707458000 Expiration Date: —QpLtd 1 1. GENERAL INFORMATION Complete legal description Terrace Heights Ll 5A Location (site address) 7900 Upper De Armoun Rd Anch AK 99516 Current property owner(s) John Clark Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: [D Single Family (w/wo ADU) El Duplex 0 Multiple Dwellings (Single Family a lex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic F-1 Water Storage El Holding Tank 0 Community Well 11 Community 1771 Public Water System El Public Sewer El Waiver request for: Distance: Receivedby: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 280 Waiver Fee $ D P — Date of Payment Date of Payment Payment CC Receipt Number q Receipt Number,. COSA 0 -- OSC21 1001 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MCA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. � v )5CUrGIlIZU System #1 Approved for Y bedrooms System #2 Approved for bedrooms Disapproved Date `Z l© 10 q CE 8149 Conditional approval for bedrooms, with the following stipulations: By: %C �/ C�2fJ�t9 fes' 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA CheCklbl blue sheet 6 Legal Description: Terrace Heights L15A If more than 9 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled unknown Total depth unknown ft Cased to unknown ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 14 in. Date of flow test for COSA 9/17/20 Static water level at beginning of test 132.2 ft Comments well drilled prior to 1975 B. TANK DATA Age of tank(s) new years Tank type/material STEP/Steel Measured operating fluid level in septic tank n/a ❑ Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 9/17/20 ❑ ALL standpipes present per record drawing Total measured depth from grade 5.2 ft (max) Measured depth to pipe invert from grade 4.2 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 01707458000 Structure served by this system 1 Well production at time of test 4.0 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes No ❑ Coliform bacteria is Negative Nitrate 2.93 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 12/23/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station new years Lift station material Steel Comments: Adequacy test date n/a Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate '600 god Any rejuvenation treatment (past 12 months) If yes, enter date no 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' P-1 Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' E✓ Yes if No ft Private Sewer/Septic Line > 25'✓0 Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' R Yes if No ft Neighboring Absorption Fields > 100' Q Yes if No. Water Main > 10' Animal Containment > 50'(x✓ Yes if No ft P/1 Yes if No ft 0✓ Yes if No. Water Service Line > 10' M✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' [✓ Yes if No ft n Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' P-1 Yes if No ft Surface Water > 100' Yes if No. Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Yes Absorption Field > 5' ft Community Wells > 200' Yes if No Yes if No ft Private Wells > 100' Q Yes if No. Water Main > 10' Yes if No ft Community Wells > 200' 0✓ Yes if No. Water Service Line > 10' M✓ 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 6.1 * ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *AWWTS Field Required Separation 5.0' G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ,10 1M -20t,.' -q, -1'11i50 . LL�i •� Imh 20 � :, "" . Ste�.re R. ranWo'rie" , i, CE 81 c,t £4 AW ft ft ft ft ft MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEMS MAIN'T'ENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR. AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day of � ` of 201A, by and between � t t l , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as (91-e-- C Co LL -P+ S�- Q } located at (legal description) ,(Q k±S C._..0 5 A 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the tern} of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and snake any necessary maintenance, repairs or permitted alterations to the system. -Zwl Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 f' 6Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. 4— gh Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. 1� Owner agrees to grant the Municipality reasonable access to test and inspect the Ff;#i t-^ AWWTS. The Municipality will give at least 24-hour notice. oqg-y\ Owner agrees that any sale or transfer of title of the property will not occur without a never Certificate of On-Site Systems Approval. . Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Terni. 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. Jui-isdiction: 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 *Wall - OWNER: By: - (signature) Date: •2 *20 61 �F ¢ le {print name) STATE OF ALASKA ) )ss, THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this tOday of t nn bee-, 2010 byCicteiJ-aC>, I 4-hgd NOTARY PUBLIC 0 SKKA �� c, , My Conunission expires: t 1p 26L _q MUNICII'ALITY: By: &W# (signature) ll e b2C' L1 A (RY' O (print name) PUBLIC Date: Title: (rev. 05/18/2018) Page of MUNICIPALITY OF ANCHOP.~GE D!VI$IC~ OF ~NVIRON~ENTAL HEALTH APPLICATION FOR HEALTH AD~mORITY *I°PROVAL CERTIFICATE (a) Legal Description (include lct, block, subdivision, section, township, range) Lccation (address or directions) .Applicants Address ~,f~), Z~C' %l~lephone ~6- ~o I ~ (c) Applicant is (che~k cae) Lendi~.g Institution Buyer ~[ ; O~her ~ (e:~lain); (d) ~nding Ir. st:ituticn ~5~ ~ ~ lephona (e) ~al Estate Co. & Agent Adck-e ss Telephcr~ 2. T_ffpe of ~sidence Single-Family Number of ~edrccms 3. Water Supply Individual ~11 Multi-Family O~er (~s~i~) Ccramunity ~--] Public ~-~' Note: If ccrarunity ~11 system, must ha%~ written ccnfi~maticn, frcm the State D~pa~t~0ent of Envirormmntal Con~ervation attesting tc the legality and status. Is the ~11 adequate fcr the n-~mber of bedrccras specified in this ~i~A (Y/N) ~ 4. Se~e Dispcsa_l , Onsite .~.~.--_~ ~ablic ~ Ccr~x]nity {---] Holding Task ~. Is the wastewater dis!xDsal system adequate fcc the ~u~lber of b~drocms (Y/N) ~ [Page 1 of 2] 2-15-84 Engineering Firm P~ovidinG Inspections~. Testsr Data and Ir I certify that I have chscked~ wrified, c~ confczm~d to all MOA HAA effect on the date of/drks~i~.pecti.on, Sigmd by Date (ENGINEER SEAL) The MuhiClpality of Anc. mage Dapa~Dt hot ~arant~ t~ ~t~nued ~tiSfact~Y was~te~ dis~sal' system, ~is a?pr~l t~ State of ~aska, the ~te~ supply ~d ~stewate~ dls~al ~ste~ tional fo~ t~ r~ of ~ ~d t~ of s~uct~e Indicated.. 1. pHOP~RT OWNER :~ ..... ~-- ': PROPERTY MA LING ADDRE: 4. REAL OCATION 6. TYPE OF E . I--I MULTIPLE F~;,'II LY L-] Three .Foul Other CONOIT!,ONAI- APPI~VAL (!9!le, ,m,~.t ac~mpa6¥ ce[tificate~ ~~ ,~ ~' DISAPPROVED