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Home My WebLink AboutRABBIT 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