HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 4H LT 8A
Rabbit Creek View &
Heights
Block 4H
Lot 8A
#020-551-22
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221416 PID Number: 020-551-22
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑■ New ❑ Upgrade
Name
ILNITSKIY
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed X Mound
Site Address
7903 VIOLA CIR,
❑ Other
Phone
Number of Bedrooms
Soil Rating
—
Total depth from original grade
7
4
2.3 GPD/SF
+1.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
+2,0 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
RABBIT CREEK VIEW & HEIGHTS BLK 4H LT8A
Fill added above original grade
5.5 Ft.
Gravel length
51 Ft.
Township Range Section
Gravel width
5.0 Ft.
Beds: Number of Lines
pistance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
255 Ft 2
1
Ft.
Well
501+
501+
501+
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding X Other
Manufacturer Capacity
ANCH TANK/ADVANTEX 1500 Gal.
Surface Water
50'+
50'+
Material
Number of compartments
Lot Line
10'+
10'+
NA
FIBERGLASS
2
Foundation
rJ01+
1 0'+
LIFT STATION
Manufacturer
Capacity
G�
"C'k Gal.
,/ �
Remarks �nr%lla ✓� /nn� /,,�a5 ilofl�terl
Y /rluahX r1-ud
Alarm location
Electrical installed by
���-C—T.
PIPE MATERIAL House to tank 3034Tank to 3034
drainfield
Installer
MIKE N ANDERSON, P.E.
Drainfield 3034 co/MT3034
Inspector MIKE N ANDERSON, P.E.
BENCH MARK (Assumed elevation) 105.5 ft
Ins daction 1-1 2/25/23 2/26/23
Location and description
tes: 2"d
OF ADVANTEX MANHOLE
3'd 4'" ITOP
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
�•'Q*.6ea8,tamp
Conditional Approval: Date
":•' • 'A�
r
..... ......•
p
r
f
•.ee.♦ . ... e........
Septic Syste
lith
;`, ; : c 9 c9
c 3 y .QV
Approved Date y/J
7 i . •'� 1::.4'
Note: this appro does not include well permit requirements.
iKev u5iuznr5)
W
April 5, 2023
Municipalities of Anchorage
Development Services Dept.
On-Site Water & Wastewater Section
Anchorage, Alaska 99519
Phone 343-7904
Re: Septic Field Revision
Legal: RABBIT CREEK VIEW & HEIGHTS BLK 4H LT 8A
To Whom it may concern:
This is my letter is to explain how the system is rated for a 4-bedroom system. The Advantex tank is 1500 gallon therefore it’s the correct size. The field is 51 feet long x 5 feet wide x 0.5 foot deep so the total area is 255 square feet. So, the application rate is 600 GPD/SF / 255 SF equals 2.35 GPD. The perc was 22 minutes so the application rate is within the MOA acceptable rates for a 4-bedroom system.
This change order will not impact any of the surrounding neighbors.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
�Moll ITWVMF�_
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section 0 Fax: 907-343-7997
Well Log
Permit Number: # osp221416 Date of Issue: 1120123 Parcel Identification Number: 020-551-22
Date Started: 1/25123 Date Completed: 1127/23 Is well located at approved permit location? Yes ❑■ No ❑
Legal Description: Rabbit Crk View & Heights BLK 4H IT 8A G:3340
Property Owner Name & Address: Taras ILnitskiy
7903 Viola Cir.
-
Anchorage,AK
Borehole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
Casing stick up
0
2
sand & gravel
2
4
peat
4
15
clay
15
18
sand & gravel
18
50
sand & gavel w/ silty H20_ _
50
52
sand & gravel
52
58
boulder
58
60
sand & gravel
60
60
sand & gravel w/ little H2O
80
82
sand & gravel
82
97
silt & gravel w/ clay & Iitfie H2O
tight silty sand & gravel
97
112
112
120
silty clay w/ wet lenses
120
190
wet silt & gravel
190
197
silty sand & coarse gravel w/H20
197
200
Water Sample Results:
Arsenic:
Nitrates:
total Coliform Bacteria:
ug/L
mg/L
colonies/100mL
Method of Drilling 0 air rotary ❑ cable tool
Casing type: steel
Wall Thickness: -250 inches
Diameter: 6 inches Depth: 200 feet
Liner Type:
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 0 feet
Pumping level: feet after
hours pumping __gpm
Recovery Rate: wpm
Method of Testing: airlift
E
Open End
❑ Open Hole
❑
Screened
Start feet
Stopped _feet
❑
Perforations
Start feet
Stopped _feet
20' Start 0
20
Well Disinfected Upon Completion? Yes No
Method of Disinfection: Tabs Comments: 11
Well Driller: Johnny Key El ❑
Company: Hefty Drilling, Inc.
Mailing Address: po box 112130 Anch AK 99511
Attention: The well driller shall provide a well log to the
On-site Water and Wastewater Section within 30 days of
completion.
e'trt'iDpment Services Departs }en"
Building Safety bivisimst
4700 Eirriore Road Uz
P.O Bax 196650 c
SP ETY
Mark Begich Anchorage, AK 99507
Mayor mm.muni.oro/onsite
(907)343-7904
Pump Installation Log /
Well Drilling Permit Number: ,SW_Q5_� A,�ILll 16 Date of Issue: TO ! a 3
Parrel Identifiration Number: a)o- `)5l' da
Legal Description p v
;5k-\ N
�f�`� S �6�V, L4
Le -06A
Property Owner Name & Address:
14��5 �Cn%k5�r�1
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: ISO feet
Pump Manufacturer's Name;�OW 1 0LS
Pump Model: !
Pump Size III hp
Pitless Adapter Burial Depth: () feet
Pitless Adapter Manufacturer's Name: C 0.f It
PitiessAdapter Installer. AnAwte-N
Well Disinfected Upon Completion? I Yes ❑ No
Method of Disinfection:
Comments: WEjt BkSk� ���1ti`Il� �or Qrr�Q�1(�h �lo�l%
Pump Installer Name: Johnny Kay
Hefty Drilling, Inc.
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
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
hftp://www.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP221416
Work Type: WellSeptic Initial
Tax Code Number: 02055122000
Effective Date:
Expiration Date:
Site Legal Address: RABBIT CREEK VIEW & HEIGHTS BLK 4H LT8A G:3340
Site Mailing Address: 7903 VIOLA CIR, Anchorage
Owner: ILNITSKIY TARAS
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
»Zcnt
a
96A I I
U �
r
Department
1/20/2023
1/20/2024
Lot Size in Sq Ft: 33876
Total Bedrooms: 3
Q Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: O A'S Date:
Issued By: AA, Date:
/h
U _
MUNICIPALITY OF ANCHORAGE
Development Services Department r Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 020-551-22
Property owner(s) TARAS ILNITSKIY Day phone
Mailing address 1120 HUFFMAN RD STE 2, ANCH AK
Site address 7901 VIOLA CIR, ANCH AK
Legal description (Sub'd., Block & Lot) RABBIT CREEK VIEW & HEIGHTS BLK 4H LT 8A
Legal description (Township, Range & Section)
Lot Size 33876 Sq. Ft. Number of Bedrooms -3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field 7 Initial FxJ
Single Family (SF) 0
(w/wo ADU)
Septic Tank Q Upgrade ElDuplex
(D) ElHolding
Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well F
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that
this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No. O S p �%)' alc2
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Dec, 28, 2022
Municipalities of Anchorage
Development Services Dept.
On-Site Water & Wastewater Section
Anchorage, Alaska 99519
Phone 343-7904
Re: Septic & Well Permit
Legal: RABBIT CREEK VIEW & HEIGHTS BLK 4H LT 8A
To Whom it may concern:
This is a request for a septic and well permit on the above referenced lot. Two test
holes was excavated and found 3 feet of organics then silty gravel (GM) mixed with
silty sands (ML) to the bottom of the hole at eight feet. Water was observed at 3 feet
with no changes after the 7-day monitoring period. The perc rate was 22 minutes per
inch. Due to the lot size and soils an Advantex system has been designed for the lot.
The lot slopes at 10 to 15 percent towards the north. No open water or cut banks
exist with 100 feet of the proposed site.
This new well or septic system will not impact any of the surrounding neighbors.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221416, Curtis Townsend, 01/20/23
1"=50'
PROPERTY LINE
PROPOSED
NEW HOUSE
PROPOSED
WELL 50'
RADIUS
WELL
SCALE:
DJRDRAWN:
DATE:
RABBIT CREEK VIEW & HEIGHTS BLK 4H, LT 8A
Anchorage, Alaska
TARAS ILNITSKIY
12/21/2022
DRIVEW
A
Y
NEW ROUND 1500 GALLON
FIBERGLASS ADVANTEX TANK
W/ PUMP BASIN, MAINTAIN 10'
FROM THE FOUNDATION & 5'
FROM FIELD TYP. BALLAST W/ 4
YDS OF CONCRETE
MT MT
TH#1 SLOPE 10%-15%FCO
10' UTILITY
E
A
S
E
M
E
N
T
TCOSLOPE 10%-15%TH#2
VACAN
T
VACAN
T
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221416, Curtis Townsend, 01/20/23
1"=200'
PROPERTY LINE
PROOSE NEW
WELL 50'
RADIUS
-VIOLA C
I
R
-
PROPOSED
3-BEDROOM
HOUSE
SCALE:
DJRDRAWN:
DATE:
RABBIT CREEK VIEW & HEIGHTS BLK 4H, LT 8A
Anchorage, Alaska
TARAS ILNITSKIY
12/21/2022
SEPTIC
SEPTIC
PROPOSED
3-BEDROOM
ADVANTEX
SEPTIC
WELL
WELL
WELL
VACANT
VACANT
10' UTILITY
EASEMENT
DESIGN CRITERIA:
0.5' EFFECTIVE
3 BDRM X 150 = 450 GPD
SOILS = 450 GPD/2.3GPD/SF = 200 SF
HORIZONTAL DISTRIBUTION
5.0' WIDE
50' LONG
(1) MOUND
+2.0' DEEP -8
(TH#1 & 2)
-3.0
GM/ML
ORG
+1.0
MOUND OVER W/ 6"
FILTER FABRIC & 2" INSULATION
24" OF MOA COURSE SAND
39&:#2&
TOPSOIL & SEED
WATER @ 3.0' OCT 2022
MIN. 24" OF SOIL COVER
3:1
+4.0
-3.0
24" OF TYP IIA CLASSIFIED FILL
FOR TANK BUOYANCY
4,000 LBS CONCRETE (4YD)
50' & 100' WELL RADIUS ON
NEIGHBORING LOTS, NO
IMPACT
MIN. 6" OF ROCK BELOW PIPESIDEWALL AREA, (50+5)*2*2( FILTER SAND) = 220 SF
2' W/ HORIZONTAL DIST. INTO THE TRENCH SIDEWALLS
W/ 12" TOTAL OF SEWER ROCK
REMOVE ALL ORGANICS (-3')
DOWN TO THE ML LAYER
ML LAYER
5.0'
+2.0
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221416, Curtis Townsend, 01/20/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221416, Curtis Townsend, 01/20/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221416, Curtis Townsend, 01/20/23
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this 7 Day of October of 20 22 , by and between
Taras Ilnitskiy 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 Advantex Septic system
located at (legal description)
RABBIT CREEK VIEW & HEIGHTS GLK 4H LT 8A
2. Maintenance Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Ti Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
TI 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).
TI 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.
TI 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
Ti Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Ti Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
TE Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
TI Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
T! 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.
TI 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.
S. 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
MUNICIPALITY OF ANCHORAGE
,I
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 020-551-22
Certificate of On -Site Systems Approval
Expiration Date: 7/7/23
Legal description RABBIT CREEK VIEW & HEIGHTS BLK 4H LT8A
Site address 7903 VIOLA CIR
Current property owner(s) HOME RENEWAL CO
XThe On-site system(s) is/are approved for 4 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
By: Original Certificate Date: 4/7/23
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
MUHJUPJ UT7OF
Development Services Department
On -Site Water & Wastewater Section
T
5 �1
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 020-551-22
Complete legal description
Location (site address)
RABBIT CREEK VIEW & HEIGHTS BLK 4H LT 8A
7903 VIOLA CIR
Current property owner(s)
TARAS ILNITSKIY
2. ON-SITE SYSTEMS SIZED FOR Ll BEDROOMS
Day phone
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: ®❑ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age NEW - 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 $ 1 ZU
Date of Payment
COSA # 0-!�)G2 31 07 -r -T
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: RABBIT CREEK VIEW & HEIGHTS BLK 4H LT8A parcel ID: 020-55122
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
X Well log is filed with Onsite (or attached)
Date drilled 1/27/23 Total depth 200 ft
Cased to 200 ft
X Sanitary seal is functioning correctly
FM Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA NEW
Well production at time of test 5+ gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes ❑ No
0 Coliform bacteria is Negative
Nitrate 1.54 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L F11111 Arsenic les than MRL (ND)
Collected by MNA
Static water level at beginning of test "RTES'"" ft. Date 2/2/23
Comments ARTESION WELL PACKER INSTALLED
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping NEW
❑ Required maintenance completed, if AWWiS
Comments: "ADVANTEX PRE-SET LEVELS
D. ABSORPTION FIELD DATA
Which system tested (date installed) NEW
0 ALL standpipes present per record drawing
Total measured depth from grade 4.0 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑� Monitor tubes go to bottom of effective.
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)
If yes, enter date
COSA Checklist June 2022
C. LIFT STATION
❑ Required maintenance completed,
Age of lift station _ years
Lift station material
Comments:
Adequacy test date NEW
Results [C Pass
Fluid depth prior to test _ in
Water added _ gal
New fluid depth _in
Elapsed time _ min
Final fluid depth _in
Absorption rate _ gpd
FIELD STATUS — POST RE
Effective depth (per record drawinc
Effective depth used 0 in
Effective depth remaining 6 i
6 in
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'
,50,+
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
_ ft
g Yles
if No It
Neighboring Tank > 100' ❑o Yes
if No
_ ft
Private Sewer/Septic Line > 25' Q Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if NoX50+
ft
Holding Tank > 100' ❑ Y!es
if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' Q Yes
if No ft
Ri Yes
if No
ft
_
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'❑ Yes
if No
_ ft
Q 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' Q Yes
if No
_ ft
Surface Water > 100' Yes
if No -ft
Tank to Property Line > 5' R Yes
if No
_ ft
Wells on Adjacent Lots:
Field to Property Line > 10' ❑I. Yes
if No
_ ft
Private Wells > 100' Yes
if No _ ft
Water Main > 10' Q Yes
if No
_ ft
Community Wells > 200' ❑� Nes
if No _ ft
Water Service Line > 10' ❑� Yes
if No
_ ft
If tank or field is under driveway comijnent below
F. ENGINEER'S COMMENTS
ADVANTEX SYSTEM WELL
RADIUS >50'+ REQ.
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 tha 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 MI L N kA %ci e vs.u.-t P. G. Phone 727
Engineer's Printed Name 4CAV� C� - Date
-a
M; t,1'L N K i RSCrJ� eA
CE - 9469
COSA Checklist—June 2022
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of ] '(VC \ 1 of 20 �3 , by and between
be-C (� �,�Y�'l�ame�� , 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%S C/tC1(Ge (, fC,lec'
located at (legal description)
/n 4 19: -�— /'-r -e-,, Z /x- i,
2. Maintenance, Repairs and Alterations.
(Owner 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 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).
vFN�'J 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.
1�' 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
l�
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.
nNIJ
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. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: (signature) Date: 1(t 2023
2(ccl - \J Yn \At"MCi (print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this 14�' day of
20
TARY PUBLIC FOR ALASKA State of Alaska
My Commission expires: NOTARY PUBLIC
Peyton Tilton
My commWon EvIres Dec 22, 2024
MUNICIPALITY:
By: A (signature)
(print name)
Date: C( ?
Title:
(rev. 05/18/2018) Page 3 of 3