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HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 4H LT 15AY
1
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP241005 PID Number: 020-551-29
Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: 0 New ❑ Upgrade
Name
TI BUILDING GROUP
ABSORPTION FIELD
❑ Deep Trench X Wide Trench ❑ Bed ❑ Mound
Site Address
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from .original grade
4
2.0 GPDtsF
3 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.0 Ft.
Gravel depth beneath pipe
2
Subdivision Block Lot
RABBIT CREEK VIEW & HEIGHTS BLK 4H LT
Ft.
Fill added above original grade
2.5 Ft.
Gravel length
46 Ft.
Township Range Section
Gravel width
5.0
Beds: Number of Lines
1
Distance between lines
SEPARATION
DISTANCES
Ft.
Ft.
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
335 Ft2
Ft.
Well
*501+
501+
50'+
TANK ■❑ Septic © S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCH TANK. ADVANTEX
Capacity
1500 Gal.
Surface Water
50'+
501+
Material
Number of compartments
Lot Line
101+
101+
NA
PLASTIC
2
Foundation
10'+
10'+
LIFT STATION
Manufacturer
Capacity
Remarks * ADVANTEX
ADVANTEX
1500 Gal.
Alarm location
NW HOUSE CORNER
Electrical installed by
BRICKS ELECT.
Installer
PIPE MATERIAL House to tank 3034 drTank
ld 3034
MIKE N ANDERSON PE
Drainfield 3034 Ci OIMTMT3034
Inspector MIKE N ANDERSON PE
BENCH MARK (Assumed elevation) 103 ft
Inspection 1st 2/19/24 2"d 2/23/24
dates:3'"
Location and description
4th
TOP OF MH LID
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
.--� : •' ' "' ' ; 4
.
r ?r' 49TH
Septic Sys em �G
Approved r Date
• MICHAEL N. At\DLRSCN
�,=�•
PF <�r`. CE -9 9
��'
.- --/
te: this approval does not include well permit requirem nts.
�P
k"" vV. V1
GRAVEL
D/W
WELL
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section M Fax: 907-343-7997
Well Log
Permit Number: # 241005 Date of Issue: 1-10-24 Parcel Identification Number:
Date Started: 1-10-24 Date Completed: 1-12-24 Is well located at approved permit location? Yes X No ❑
Legal Description: Rabbit Creek View Heights Blk 4H Lot 15A G:3340
Property Owner Name & Address: TI Build Group LLC
Site: 16712 Carl St.
Borehole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
stick up
0
2
sand & gravel
2
36
clay (brown) & fine gravel
36
54
boulder
54
56
sand & med. gravel
56
70
wet clay (brown) & gravel
70
88
boulder
88
91
wet clay (brown) & gravel
91
177
gravel w/ H2O
177
180
Water Sample Results:
Arsenic: ug/L
Nitrates: mg/L
Total Coliform Bacteria: colonies/100mL
Method of Drilling M air rotary ❑ cable tool
Casing type: mel
Wall Thickness: -250 inches
Diameter:6 inches Depth: 180 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: !__—gpm
Method of Testing: airlift
E]
Open End
❑ Open Hole
❑
Screened
Start _feet
Stopped feet
❑
Perforations
Start _feet
Stopped _feet
20 Start 0
Well Disinfected Upon (
Method of Disinfection:
Well Driller: JOMny Kay
Company: Hefty Dril
Mailing Address: Po box 1'
feet Stopped 20 f
pletion? Yes No
Comments:
Q ❑
ic.
Anch AK 99511
Attention: The well driller shall providel a well log to the
On-site Water and Wastewater Section within 30 days of
completion.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Section
Pump Installation Log
Phone: 907-343-7904
Fax: 907-343-7997
Well Drilling Permit Number: Date of Issue: W- - /0- 1-y
Parcel Identification Number: -
Legal Descri tion L Block Lot erty lhvuer Name &Address: I
l�cbh� t- ✓� ���kk� 40 lz A Prop'j� I b,(I& Gq%up L.` L
l5A G.31 R `
Pump Installation Date: _L2rL- /ts
Pump Intake Depth Below Top of Well Casing: 1,5 O feet
Pump Manufacturer's Name:
Pump Model: S 7P `i ft
Pump Size: V, hp
Pidess Adapter Burial Depth:
A - k,,'re
05 22-1 - 02
/b feet
Pidess Adapter Manufacturer's Name: C` ti+�'�' Q to
Pitless Adapter Installer:�� D`^
Well Disinfected Upon Completion? l Yes ❑ No
0
Method of Disinfection: 1 Lo- ,A
7 5 Pry, Z3v� 2 w
Comments: y A Y` e` 1 z ✓l Lt C l I i&5 Gi Vu l
Pump Installer Name:
ll 1/Pill(',
`9(n-"1 K s' i
Company: Ae ! QA-, V/( l (• , c
Mailing Address: (� ua� 112,M
City: An(., State:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
C\ 63.34
o '0
v'o
J I
LOT 7A
BLK 5H
I
w
• w
LOT 15A
BLK 4H V)
w �-
00
1 "=40' U
d- N
CO
N
VAULT W
SEPTIC %
W PIPE 00
LOT 14A d- MH (typ)
00
B LK 4HDECK N I
0
0 42.0'
� o /
o EXISTING
8.5
NO HOUSE 13.5'
14.0' o
18.4 N 11.5' N
DECK
0 0
� 19.0'N 11.0
GRAVEL
D/W
OO 30' 30' LOT 6A
WELL BLK 5H
10' UTILITY ESMT
N89'26'52"E 98.58'
ASBUILT OF: OO = FND 5/8" REBAR
RABBIT CREEK VIEW & HEIGHTS REPLAT ANCHORAGE RECORDING DISTRICT, ALASKA
LOT 15A BLOCK 4H PLAT 2004-91 SLj
SURVEY CERTIFICATE. I John L. Schuller Have conducted aAW 0 F 4Z ✓p N L�
physical survey of this property as shown on this drawing and that the k ; . • • ;�%lot�"� ° SG��
improvements situated hereon are within the property lines and no 4,.. � ,
enchroachments exist other than noted. Under no circumstance should/
/ � • 4 9TH
any information on this drawing be used for construction of fences,
structures, improvements, or for establishingboundary lines. /PA
ry F /L a
EXCLUSION NOTES: It is the owners responsibility to determine FA .. ' : ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' : ' '� 'OVA -
�o co OHN L. SCHULLER.•
the existence of any easements, covenants, or restrictions which •.
do not appear on the recorded subdivision plat. , ��'e LS -10408 ` ' •.,,,.,,�. ,,,,
• ., 2 •• �� ... • �J / 1831 Talkeetna Street
WORK ORDER NUMBER: DATE. SCALE: �_ E-IrI/UL• 1 �O, . , • . 7 �'• 6 Anchorage, Alaska 99508
FEB 25, 2024 1 =40 hullerakOgmail.c Ar O� �
ECKED BY GRD NUMBER: BOW/PAGE: `\ °fes nal �- �' (907) 227-1455 office
24-003 DRAWN BY: CHSLS SW3340 240113 ��\ sl `��' (907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE ,„t_
On -Site Water & Wastewater Program �0 Is,
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 , �v
http://www.muni.org/onsite
Uepartntertit
On -Site Water & Wastewater System Permit
Permit Number: OSP241005 Effective Date: 1/10/2024
Work Type: WellSeptic Initial Expiration Date: 1/9/2025
Tax Code Number: 02055129000
Site Legal Address: RABBIT CREEK VIEW & HEIGHTS BLK 4H LT 15A G:3340
Site Mailing Address: 16712 CARL ST, Anchorage
Owner: TI BUILDING GROUP LLC Lot Size in Sq Ft: 30685
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 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
Special Provisions: An additional percolation test is to be performed in the GM/ML layer to confirm rates. If a
design change is required, submit a change order before proceeding with construction.
Received By: 1 S 5 UED Date:
Issued By: L �- Date: c l 0 702—
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Vol-.
tl
J
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 020-551-29
Property owner(s) TI BUILDING GROUP LLC Day phone _
Mailing address 1120 HUFFMAN RD STE 24-797 ANCHORAGE, AK 99515
Site address 7970 VIOLA CIR
Legal description (Sub'd., Block & Lot) RABBIT CREEK VIEW & HEIGHTS BLK 4H LT 15A
Legal description (Township, Range & Section)
Lot Size 30,685 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
0 Initial R
Single Family (SF) El
ADU)
Septic Tank
❑ Upgrade El(w/wo
Duplex (D) El
Holding Tank
❑ Renewal El
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
0
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: (S/ Z Waiver Fees:
Date of Payment: h 'Z-02, y Date of Payment:
Receipt Number:
Permit No. 19,5P z y / OOS
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Jan. 10, 2024
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 15A
To Whom it may concern:
This is a request for a septic and well permit on the above referenced lot. A single
test hole was excavated and found 5 feet of organics (OG) then silty gravel (GM)
mixed with silty sands (ML/GM) to the bottom of the hole at ten feet. Water was not
observed during the excavation or after the 7-day monitoring period. The perc rate
was 8 minutes per inch. Due to the lot size and soils an Advantex system has been
designed for the lot. The lot slopes at 15 to 20 percent towards the northeast. No
open water or cut banks exist with 50 feet of the proposed site. The neighboring lot
17A (test hole #2) had a perc of 28 min/inch in the GM layer and water at 7.4 feet. A
note has been added to the design to perc the ML/GM layer prior to installation.
This design will incorporate both the organic side-wall for absorption and the
bottom of the system. And the length has also been increased to 50 feet total. If we
had water, it would be at the interface of the ML/OR layer and our design would still
be acceptable.
This new well and septic system will not impact any of the surrounding neighbors,
most are vacant.
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
OSP241005, Curtis Townsend, 01/10/24
1"=200'
PROPERTY LINE
PROOSE NEW
WELL 50'& 100'
RADIUS
-VIOLA C
I
R
-
PROPOSED
4-BEDROOM
HOUSE
SCALE:
DJRDRAWN:
DATE:
RABBIT CREEK VIEW & HEIGHTS BLK 4H, LT 15A
Anchorage, Alaska
TARAS ILNITSKIY
12/21/2023
SEPTIC
PROPOSED
4-BEDROOM
ADVANTEX
SEPTIC
VACANT
VACANT
10' UTILITY
EASEMENT
DESIGN CRITERIA:
2.0' EFFECTIVE
4 BDRM X 150 = 600 GPD
SOILS = 600 GPD/2.0GPD/SF = 300 SF
300SF/5*0.70 = 42 LF OF TRENCH
5.0' WIDE
50' LONG
(1) TRENCH
5.0' DEEP W/ 2' OF MOA FILTER MATERIAL -10
(TH#1 )
-5.0
GM/ML
ORG
MOUND OVER W/ 6"
FILTER FABRIC & 2" INSULATION
3,3(
TOPSOIL & SEED
NO WATER OCT 2023
3:1 +1.0
-3.0
TANK BUOYANCY IF REQ.
4,000 LBS CONCRETE (4YD)
100' WELL RADIUS ON
NEIGHBORING LOTS, NO
IMPACT
ML LAYER
5.0'
-5.0
VACANT
VACANT
24" MOA FILTER MATERIAL
REMOVE ALL ORGANICS
24" DRAIN ROCK
LOT 17A TH#2 WATER @7.4 OCT 2006
LOT 17A (TH#2) WATER @7.4',
PERC RATE 28 MIN/INCH
LOT 17A
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241005, Curtis Townsend, 01/10/24
1"=50'
PROPERTY LINE
PROPOSED
NEW HOUSE
PROPOSED
WELL 50'
RADIUS
WELL
SCALE:
DJRDRAWN:
DATE:
RABBIT CREEK VIEW & HEIGHTS BLK 4H, LT 15A
Anchorage, Alaska
TARAS ILNITSKIY
12/21/2023
DR
I
V
E
W
A
Y
NEW ROUND 1500 GALLON
ADVANTEX TANK 10' FROM THE
FOUNDATION & 5' FROM FIELD
TYP. BALLAST W/ 4 YDS OF
CONCRETE IF WATER OBSERVED
CO/MT
CO/MT
TH#1
SL
O
P
E
1
5
%
-
2
0
%
FCO
10' UTILITY EASEMENT
TCO
SL
O
P
E
1
5
%
-
2
0
%
VACAN
T
VACAN
T
SECOND PERC TEST REQUIRED
IN THE ML/GM LAYER TO VERIFY
APPLICATION RATE FOR DESIGN
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241005, Curtis Townsend, 01/10/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241005, Curtis Townsend, 01/10/24
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Section
4700 Elmore St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 3437904
Soils Log - Percolation Test
........ . .
4444, P •
49Ty`' '
e• ..........•.
.•"�„ MICHAEL N.:. ANDLRSCN ;
rt CE 9,469 a
Performed For: ((�� T Q Oct Date Performed:
Legal Description: Rq b 6, 1- C !Ce (.i g ,gk j�s Township, Range, Section:
Slope
4 hl rTr—r-1 I I I
7
11
13-
14-
15-
16-
17-
18-
19-
COMMENTS
vre� ,
Ci N( /5 rvl /M t-
4- o r-ev 5
WAS GROUND WATER
ENCOUNTERED?
s
30 IF YES, AT WHAT DEPTH? L
Depth to Water After P
Monitoring? E
Date: I I I
Pere- L v, r -.n LA,-,, ..1. -
Sita Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
217%12 L'(
�DA/�
�7r
(t(trr
b /r
t/
to /�
6 tic ,
(� q
PERCOLATION RATE 4?V (e nutesnnch) PERC HOLE DIAMETER i �)
TEST RUN BETWEEN S FT AND 93FT
PERFORMED BY: " /l(.{., I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:I t 2.ft
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 -,raa'l "40 of 20 Z� , 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 x }�
located at (legal description)
RZ .'j-- Crtek K t,/ Yt r` L. 15—A-
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).
'- 1 Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
�_ Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or 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.
'� Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
i 'i.. Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
mil— 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:
r
By:. Gti (signature) Date: l 2
(print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this_ day of ��'►wA1P�-(
20;A, by �-A1QAs� l �.1;11"i'S1G.►
N ARY BL FOR ALASKA rNOTARY
ATE OF ALASKA ••��, ;.•;
M Conmussion expires: �i-�-2� PUBLIC
Paul A. Hatcher
Commission Expires: April 8, 2024
MUNICIPALITY:
By: L(signature)
CU MSS -N (print name)
Date: [ l 0 20 z �°
Title: C 1 v / L C- ^-6 i•,�,�,�
(rev. 05/ 18/2018)
Page 3 of 3
MUMUP " U u "Y OF P%HCHORA GE
Development Services Department — --
p p Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-551-29-000
Expiration Date: 1/25/2025
Legal description RABBIT CREEK VIEW & HEIGHTS BLK 4H LT 15A
Site address 7970 VIOLA CIR Anchorage AK 99516
Current property owner(s) TI BUILDING GROUP LLC
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 3/19/2024
'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
MUMCPAUTY OF ' HCH FAL G
0;4
�.,„f �6
Development Services Department
On -Site Water & Wastewater Section
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application )p
3flq'Mbit �.
1. GENERAL INFORMATION C ll
Parcel I.D. 020-551-29
Complete legal description RABBIT CREEK VIEW & HEIGHTS BLK 4H LT 15A
Location (site address) 16712 CARL STANCH AK
Current property owner(s) TI BUILDING GROUP LLC Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 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: 0 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: 0
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 $ Z Waiver Fee $
Date of Payment 2'Tz �/2�✓ Z `1 Date of Payment
COSA # V S C ” J ( 0 Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: RABBIT CREEK VIEW & HEIGHTS BLK 4H LT 15A Parcel ID: 020-
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this
F-111 "11-411110 07-74 110
N Well log is filed with Onsite (or attached)
Date drilled 1/12/24 Total depth 180 ft
Cased to 180 ft
❑� Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA NEW
Static water level at beginning of test ' ft.
Comments *ARTESION WELL
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping NEW ADVANTEX
❑ Required maintenance completed, if AWWTS
Comments: ` PRE-SET LEVELS
D. ABSORPTION FIELD DATA
Which system tested (date installed) 2/23/24
0 ALL standpipes present per record drawing
Total measured depth from grade 5.5 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑o 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
Well production at time of test 5 c
Water storage tank volume 0 gall
Well disinfected for coliform test? ❑
X Coliform bacteria is Negative
Nitrate 2.21 mg/L ❑ Nitrate less 1
Arsenic
Collected by
Date 1/25124
N No
MRL (ND)
_ ug/L H Arsenic less than MRL (ND)
MNA I
C. LIFT STATION
N Required maintenance completed
Age of lift station NEW years
Lift station material PLASTIC
Comments: ADVANTEX SYSTEM
Adequacy test date NEW
Results Q 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 RECOVERY
Effective depth (per record drawings)
Effective depth used 0 in
Effective depth remaining 24 in
24 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'* Community Sewer Manhole/Cleanout >
Yes if No 50 ft Yes
Neighboring Tank > 100' Q Yes if No _ It Private Sewer/Septic Line > 25' Q Yes
Absorption Field on Lot > 100' E Yes if No _ ft Holding Tank > 100' Q Yes
Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yesl
ifNo_It
ifNo_ft
ifNo_ft
ifNo_It
Yes if No _ It
Manure/Animal Excreta Storage > 100' 1
Community Sewer Main > 75' e❑Yes if No _ It Yesi if No _ It
❑ 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'
M Yes
if No
_ ft
Surface Water > 100'
FEI
YesII
if No—ft
Tank to Property Line > 5'
Yes
if No
_ It
Wells on Adjacent Lots:
Field to Property Line > 10'
Yes
if No
_ ft
Private Wells > 100'
Q
Yes
if No _ ft
Water Main > 10'
❑Q Yes
if No=
ft
Community Wells > 200'
Q
Ye
if No _ ft
Water Service Line > 10'
Q Yes
if No
ft
If tank or field is under driveway comm
nt below
F. ENGINEER'S COMMENTS
" ADVANTEX SYSTEM
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my inv stigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that t e on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal an State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm M/ht/] Ld•-eV 4 -VK Pr E" Phone 727-886
Engineer's Printed Name Spw.e. • Date 7-ILZ 2
C 4!
• • ��NNGiR�� ..'. .
f•�• MICHA=r N. Ah.nkR-G•J•'
CE949
/IZ 4114
i�a� �0tval::
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 M&Y LAn of 20-9q, by and between
Mi(-�taLk PA/.h «A , 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
located at (legal description)
4U,. ;,- L 4, 1 10511 iZ" —
2. Maintenance, Repairs and Alterations. I Alckl "c6 c AV 9 g51(o
(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.
S2 M_V 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).
SP PSf 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.
"JA 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
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
�Q Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
MSP Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
S�f Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
p 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.
Zf 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 fiom 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
STATE OF ALS- )
G tip( p� N�'uJPo2'rlVt-U�s ) ss.
T n r nr�mDrnm )
ature) Date: 0S/ 15 I o q
name)
The foregoing instrument was acknowledged before me this da of
20 *by—SUanC�MY /1�f112cif ,
03KE D&o
NO PUBLIC F R I LA -&i -,j i P-(, 1;71r+ ". " P.•'`-" s �•
O .
MY Commission expires: X13117 tf
Z n : W�Qf�iON
��'�i,��f�LTM C�► woe°°°°
(rev. 05/18/2018)
(signature) Date:
print name) Title: �NCVVO,41-P,(,� %
Page 3 of 3
OWNER:
By' (signature)
c %as 1 Ped.11 (print name)
sT viPC,loiA
ATE OF- L*81tt— � )
G N J A N E+ Pct r N Crus ) ss.
1'rJu Tl Tr rnrrr n r T1Tc�mn rr,
The foregoing instrument was acknowledged before me this
20_q, by m1CHAtk PA -0 i LLIt
NOT PUBLIC FO
pd�Si�4-J 12��N� rt -
My Commission expires: Z
Date: 15 I fiR O lq
iSFday of A &Lqi-
By: (signature)
Date:
w (print name) Title: C✓L� � -P, u)
(rev. 05/18/2018)
Page 3 of 3
GRAVEL
D/W
WELL