HomeMy WebLinkAboutPOTTER HIGHLANDS PH 2 BLK 2 LT 6POTTER HIGHLANDS
2m
Lot 6
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,JMW
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP241216 PID Number: 020-281-66
Dwelling: n Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: no New ❑ Upgrade
Name
Alexander Homes LLC
ABSORPTION FIELD
❑Deep Trench ❑■ Wide Trench El Bed ❑Mound
Site Address
5940 Potter Vally Rd
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
5
6 GPD/SF
2.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2 Ft.
Gravel depth beneath pipe
. Ft.
Subdivision Block Lot
Potter Highlands Phase 2 2 6
Fill added above original grade
155 Ft.
Gravel length
30 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
1
Dist. between trenches
From
Tank
Field
Tank
Line
150 Ft2
NIA Ft.
Well
>50'
>50'
NIA
N/A
>25'
TANK 0 Septic 0 S.T.E.P. 0 Holding Is -1
Manufacturer Capacity
Anchorage Tank 2500 Gal.
Surface Water
>50'
>50'
N/A
N/A
Material
Steel
Number of compartments
2
NA
Lot Line
>5'
>10'
N/A
I N/A
Foundation
>10'
>10'
NIA
N/A
L N
Manufacturer
Capacity
Remarks AWWTS
Gal.
Alarm location
Electrical installed by
Wiring Up AK
PIPE MATERIAL House to tank D3034 drainfield Tank to
D3034
Installer
Alex Enterprises
Drainfield D3034 CO/MT D3034
Inspector J Opheim
BENCH MARK (Assumed elevation) 100 ft
Inspection 151 10/21/24 10/22/24
Location and description
dates: 2nd
3rd 4'h
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
,��.. •
� A Benjarr rt Schiller
�'c� CE 12592 .•`��
Septic Syst
Approve DateAle
� p12/18/25���*2
toe: approval does not include well permit requirem nts.
.�.,�.�.,-..
(Rev 05/02/1,$]
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FD - FLOW DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
PERMIT # OSP241216 PID # 020-281-66
1"=50'
POTTER HIGHLANDS PHASE 2, BLOCK 2 LOT 6
FEET
0 50 100
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A L E N G INEER
12/18/25
PLAN AS-BUILT
ALTERNATE SITE
2500-GAL
S
T
E
E
L
TANK W/ (
2
)
A
X
-
2
0
FILTRATI
O
N
P
O
D
S
MH2
A B
FCO 53.1
MH1 54.3
MH2 59.6
A
B
2CO 64.9
CO1 83.2
MT1 81.4
CO2 71.6
14.6
20.3
30.9
28.4
42.8
41.6
13.0
MH1
5-BDRM
H
O
M
E
PO
T
T
E
R
V
A
L
L
E
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R
O
A
D
TH#2
2CO
FCO
MT1CO1
MT2 CO2
WELL W/ 50'
RADIUS
820 830 840
850
860
810800
790
WETLANDS
50' OFFSET FROM
WETLANDS
TH#1
MT2 73.114.2
BENCH MARK
30' LONG
x
5
'
W
I
D
E
,
0
.
5
'
EFFECTIV
E
D
E
P
T
H
ABSORPT
I
O
N
T
R
E
N
C
H
WETLANDS BORDER
20' DRAINAGE EASEMENT
10' T&E EASEMENT
5'
DEVELOPMENT
SETBACK
DRAINAGE
PROFILE AS-BUILT
(NO SCALE)
PERMIT # OSP241216 PID # 020-281-66
POTTER HIGHLANDS PHASE 2, BLOCK 2 LOT 6
AX-20 POD AND
MANHOLES
100.0 FINISH GRADE
30'
MOA APPROVED SAND
MT
TH
#
2
92.5 GROUNDWATER 5/22/24
96.0
96.5
CO CO
86.0
96.0
96.5
98.5 ORIGINAL GRADE MT
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A L E N GINEER
12/18/25
DRAIN ROCK
94.094.0
AX-20 POD AND
MANHOLES
95.1
90.4
95.7
99.7FC
O
MH
1
MH
2
2500 GAL
SEPTIC TANK
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
On -Site Water & Wastewater System Permit
Permit Number: OSP241216
Work Type: WellSeptic Initial
Tax Code Number: 02028166000
Site Legal Address: POTTER HIGHLANDS PH 2 BLK 2 LT 6 G:3638
Site Mailing Address: 5940 POTTER VALLEY RD, Anchorage
Owner: POTTER CREEK DEVELOPMENT LLC
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
�S1 � I7 1 15.E
rr
I)rpartrncfit
8/12/2024
8/12/2025
171614
2 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 0 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
c 1 ttor Z ,A�l0vi F/6eo
Received By: _ ``�- 'i-0 ' Date: _
Issued By: — _____ Date: z
5
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON -SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 020-281-66
Property owner(s) Potter Creek Development LLC Day phone,
Mailing address 561 E 36th Ave Suite 200, Anchorage, AK 99503
Site address NHN Potter Valley Rd, Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Potter Highlands Phase 2 Block 2 Lot 6
Legal description (Township, Range & Section)
Lot Size 171,614 _Sq. Ft. Number of Bedrooms Five(5)
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(0 all that apply)
Absorption Field
M
Initial UK
Single Family (SF) IN
(w/wo ADU)
Septic Tank
RX
Upgrade R
Duplex (D) El
Holding Tank
❑
Renewal F
Multiple Dwellings EJ
Privy
El
(SF and/or D)
Private Well
I -XI
Water Storage
F
THIS APPLICATION INCLUDES A VARIANCE I 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: Is 2-C) Waiver Fees:
Date of Payment: Z Date of Payment:
Receipt Number: Receipt Number:
Permit No. 0-S102412-1,6 Waiver No.
Permit App_-'-: - :'c -
August 5, 2024
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Potter Highlands Phase 2 Block 2 Lot 6 – Potter Valley Rd
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 5-bedroom home on the property, so we are
submitting this permit application for the construction of a new well and septic system. The
attached site plan identifies the location of the home as well as the proposed well, septic location
and alternate site. This subdivision requires an advanced treatment system. No conflicts exist
between this proposed system and any other well or septic system, whether on this lot or adjacent
lots.
The ground surface on the lot slopes to the west end of the property. Near the proposed home
slopes are milder and is the best location for the new system. There are slopes greater than 25%
within 50 feet downslope of the septic site, but the design meets the steep slope criteria of
15.65.210.B.4.a.i-iii, and the exception for iv.B. Please refer to the slopes profile to see that the
effluent will not daylight in the steeper slopes.
Stormwater drainage will not impact this septic system. The new trench will be constructed parallel
to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will
be a minimum of 50’ from all wells and surface water, and more than 5’ away from the septic tank.
The alternate site is located more than 6’ away. Please refer to the attached test hole logs, plan and
profile pages for the septic design. If this design is followed, there will be no adverse impacts to
adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241216, Curtis Townsend, 08/12/24
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POTTER HIGHLANDS PHASE 2, BLOCK 2 LOT 6
DESIGN FACTORS: SYSTEM REQUIREMENTS:
750 GPD PEAK FLOW 5-WIDE TRENCH SYSTEM
PERK RATE: 0.7 MIN/IN CAT III 2500-GAL SEPTIC TANK W/
APPLICATION RATE: 6 GPD/SF (2) AX-20 FILTRATION PODS
750 GPD / 6 GPD/SF / 5' WIDE * 1.0 RED FACTOR [0.5 DEEP]= 25 LF TRENCH REQUIRED (30 LF SPECIFIED)
BOTTOM OF TRENCH: 2'-6" BELOW GRADE
FLOW LINE ELEVATION: 2' BELOW GRADE
CC) 1Pj
"' "DDITIONAL FILL TO
FOR SETTLEMENT
TEXTILE FABRIC
4" PERFORATED PVC
HOLES DOWN)
DRAINFIELD ROCK
MOA APPROVED
SAND LAYER
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE T OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
of
��..� BenCE1259211er •���%
.i/11/24 ,.�0
l�►i0 PRO F E 5 510NP�'.L'�'
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
6.0
5/15 1
2
3
GM (SILTY GRAVEL)
Professional Engineers Stamp:
NO
Potter Highlands Ph2 B2 L6
5/15/24 020-281-66
Alex Snegirev
12:32 1 0
16
12:33
12:34
2' OB
30:00
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
PERC TEST LOCATION
TECHNICIAN: M. Jakubisin
6 5
16
-
5.0
5/22/24
COMMENTS:
SITE PLAN
5 5
16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
7/18/24
1 0
1630:00 6 1
16 5 1
16
1 0
1630:00 6 0
16 5 0
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241216, Curtis Townsend, 08/12/24
C o
DEPTH
(feet)
1-
2-
3-
4-
5-
6-
7-
8-
9
1
11
12
13
14
15
16
17
18
19
SOILS LOG AND PERCOLATION TEST
E iOp
I N G
LEGAL DESCRIPTION: POTTER HIGHLANDS PH2 B2 L6
PERFORMED FOR: ALEX SNEGIREV
DATE: 10/ 11/2024 PARCEL ID#: 020-281-66
TEST HOLE 2
YES WAS WATER ENCOUNTERED?
7 ' IF YES rD WHAT DEPTH?
6 DEPTH TO WATER AFTER MONITORING
10/21/21, DATE OF MONITORING
DATE
READING
START TIME
NET TIME
(MINUTES)
WATER
(INCHES)
NET DROP
(INCHES)
10/11
1
10:24
1:28
1 0
7 0
6 0
2
10:26
1:26
1 0
7 0
6 0
3
10:28
2:06
1 16
716
6 s
4
10:31
2:13
1 16
716
616
5
10:33
3:39
11s
716
616
6
10:37
4:19
1 6
716 -
30
PERCOLATION RATE: 0.7 (MIN/INCH)
COMMENTS: USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
SITE PLAN
TECHNICIAN: J. O P H E I M
1"=10'
SLOPE CROSS SECTION
SEPTIC TRENCH
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
46
%
AN
G
L
E
OF
EF
F
LUE
N
T INF
L
UE
N
CE
2:1 MAX SLOPES w/ JUTE MATTING AND VEGETATION
6.0
FEET
0 10 20
8/22/23
ALTERNATE SITE
POTTER HIGHLANDS PHASE 2, BLOCK 2 LOT 6
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241216, Curtis Townsend, 08/12/24
iMUNICIPALITY 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 �e` of 20, by and between
- ( � herein the "OWNER," and the Municipality of
A nchorax,e, 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
A arecmcnt aarce as follows:
1. Advanced Wastewater Treatment Systems. The 1Vlunicipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as Advantex System
located at (legal description)
Potter Highlands Phas9 2 Block 2 Lot 6
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).
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 I of
PA_ 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 agrces to grant the Nunicipality 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.
ia Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vcndorlinstaller and approved by the Municipality are the governing
<Quidelines 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.
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. N onwaiver. 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.
�. 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
Anchora(le. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severahility. Any provisions of this Agreement decreed invalid by a court of competent
Jurisdiction shall not invalidate [lie remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: (signature) Date: S1. 9 ,ZS-
r
1print name)
Of
STATE OF ALASKA
) ss.
THIRD JUMCIAL DISTRICT )
The foregoing instrumen�,t, was aclulowledged before me this 0-day of
by GUGti!�b�SCGu
...............
\TO'ARY P,t`IBLI,C/`F0R,A Y,:KA �J;•' ••.9
:�
p y = :' NOTARY :3
.' cOl'llli'�iSSlL�rf zx]Y'eS� � .�1.3a�p �_
' PUBLIC,;'.
�OF P\-P�;x'
MUNICIPALITY
t
By: (signature) Date: Z Z-0 z
S (,print name) Title: C-,-( V1 C
rev. 05/1 S%201 S) Page 3 of 3
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Parcel ID 020 -281-66
Certificate of On -Site Systems Approval
OSC251556
Expiration Date: 10/23/2026
Legal description POTTER HIGHLANDS PH 2 BLK 2 LT 6
Site address 5940 POTTER VALLEY RD
Current property owner(s) ALEXANDER HOMES LLC
X The On-site system(s) is/are approved for 5 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
Original Certificate Date
1/12/2026
This C ifica�eof On -Site Systems Approval (COSA) is intended to demonstrate the subject
sy m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
development Service 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 submittal.
ATTACHMENTS:
COSA Checklist X
Absorption Field Advisory
Tank Age Advisory
Other
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
MUNICIPALITY OF ANCHORAGE
f
Development Services Department% Phone: 907-343-7904
On -Site Water & Wastewater ewate Section zQ Fax; :907-.343-.7997:.
Certificate of On -Site Systems ,Approval Application
1. GENERAL INFORMATION
Parcel I.D. 020-281-66
Complete legal description 'Potter HighlandsPhase 2, Black 2 Lot 5
Location (site address) 5940 Potter Valley Rd, Anchorage, AK 99515
Current property owner(s) pay phone
Alexander Homes LLC (907) 830 - 6211
2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS
3. TYPE OF WATER SUPPLY: Fm� Private Well serving #1_ dwelling units
❑ Other Non-public well as regulated by MOA ❑'Water Storage
❑ Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: R Private Septic ❑ Private Septic serving 2 dwelling units
Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK. no Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age NEW - See advisory if steel or fiberglass alder than 20 years
6. ABSORPTION FIELD; FO -1 AWW TS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for: Distance:
Expedited review requested:
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 $ -7, e, 0 Waiver Fee $
Date of Payment 12-11
Date of Payment
COSA # Waiver #
COSAApplication Ap2025.doc
COSA Checklist
Legal Description: Potter Highland Phase 2, Block 2 Lot 6
Parcel ID: 020-281-66
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1
A. WELL DATA
❑■ Well log is filed with Onsite (or attached)
Date drilled 10/23/24 Total depth 87.0 ft
Cased to 29.6 ft
❑■ Sanitary seal is functioning correctly
❑■ Wires are properly protected
Casing height (above ground) >18 in.
Date of flow test for COSA 10/23/25
Static water level at beginning of test 14.9 ft. Date 10/23/25
Comments System was disinfected at time of pump install.
Well production at time of test 20 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑■ Yes ❑ No
❑■ Coliform bacteria is Negative
Nitrate 3.45 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Collected by MW -Drilling INC
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping N/A
❑ Required maintenance completed, if AWWTS
Comments: NEW
D. DISPOSAL FIELD DATA
Which system tested (date installed) NEW
FE -1 ALL standpipes present per record drawing
Total measured depth from grade 4 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
ked required if
(Require a vacant or field not used for more
than 30 days prior of test)
Gallons introduced date
Any rejuvenation treatment (past 12 months)
If yes, enter date
STATION
[:1 Requir�
Age of lift station _
Lift station material
Comments:
ance completed
Adequacy test date NEW
Results L]Pass
Fluid th prior to test in
Water adde gal
New fluid depth in
Elapsed time mi
Final fluid depth in
Absorption rate gpd
FLD STATUS — POST RECOVERY
tectiv th (per record drawings)
Effective depth use in
Effective depth remaining
in
Comments/Deficiencies: The system has not yet been put into operation, and the house is currently vacant.
COSA Checklist_May2025.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100'
El Yes if No >50*ft
Neighboring Tank > 100' ❑� Yes if No ft
*
Disposal Field on Lot > 100' El Yes if No >50 ft
Neighboring Disposal Fields > 100'
R Yes if No ft
Sewer Line/Main > 100' R Yes if No ft
Sewer Manhole/Cleanout > 100'
❑� Yes if No
Sewer Service/Septic Line > 25'[E Yes if No
Holding Tank > 100' Yes if No
Animal Containment > 50' Yes if No
Manure/Animal Excreta Storage > 100'
❑■ Yes if No
❑ N/A — Served by Community Well (not on lot) or Public Water
ft
ft
ft
ft
ft
From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required)
*
Tank to Foundation > 10' 0 Yes if No ft Surface Water > 100' ❑ Yes if No >50 ft
Field to Foundation > 10'
❑■
Yes
if No
Tank to Property Line > 5'
R
Yes
if No
Field to Property Line > 10'
❑�
Yes
if No
Water Main/Service Line > 10'
❑E
Yes
if No
F. ENGINEER'S COMMENTS
*AWWTS
ft Wells on Adjacent Lots:
ft Wells > 100' ❑� Yes if No _
ft Community Wells > 200' ❑� Yes if No _
ft If tank or field is under driveway comment below
ft
ft
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 that 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 ofFirm Forge Engineering
Engineer's Printed Name Benjamin Schiller, P.E.
COSA Checklist_May2025.docx
Phone (907) 522-7773
Date 12/12/25
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J� '. • Benja. ' . chiller
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I,l`F�pROFESSI4N�t.� �
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as ofthis 0 Day of January of 20 24e by and betweenNatalie Wallace. 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 System
located at (legal description)
Potter Highlands Phase 2 Block 2 Lot 6
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
N 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.
N 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).
NW 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.
Nowner 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
Nw Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
NW Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
NW Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Nw Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On-Site Systems Approval.
Nw 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.
NW Owner agrees to maintain remote monitoring of the AWWTS asas 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
5.
6.
7.
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.
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.
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.
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
Bv
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THIRD J1 I)ICIA1. DISTRICT
The I*or'-umn, "IstrUTIME W, S t�cfort mQ this daN orj
202,
tea
SABRA GILLILAND
Notary PuDbl(c
as
State of Alaska
N P,,B1,.1('FOR 'AI
My
,\"I%- coriullissi011 �:XPH—Is: —)-ozi Commission Expires Jan 27, 2027
signature) DaLe:
_)tint name) Title:
(rev. 051,181,21(I 18) Pa -c 3 of 3
Job No. 24-121
Permit No: OSP241216
M -W Drilling, Inc.
♦ P.O. Box 110389 ♦ Anchorage, AK 99511
♦ 907-345-4000
GROUNDWATER WELL LOG
Well Owner: Alexander Homes LLC I Use of Well: Domestic
Site Description: 5940 Potter Valley Road, Anchorage, Alaska
Legal Description: Potter Highlands Phase 2, Block 2, Lot 6
Well Coordinates: 6°2'5"N 149°46'14"W
CONSTRUCTION
Drill Method: Air rotary
Hole Size: 6" Well Depth: 87'
Casing Material: A53B steel Casing Size: 6" Wall: .250 Cased to: 29.6'
TO
5Casing
Well Completion: I Open end: Screen: Liner: X Perforated: X Method: Skilsaw cuts
Screen/Perforation Description: 4 1/2" PVC liner installed from 87' to 15', liner perforated x 3 rows from 87'
TO20
-..........................
to 57', shale packer installed on 4 %2" liner at 42'
Gravel: medium, sandy .
...............................................................................................................................................................................................................................................................................
20
.............................................
Grout Notes:
Bentonite chips installed in
anulus between 4 % " liner and 6" hole from 43' to 15' below top of
23
.............................................
casing
Gravel: silty, dry
................................................................................................................................................................................................................................................................................
29
.............................................
TO87
_..........................
Well Development: Air surge
Bedrock: water fractures from 57' to 87'
...............................................................................................................................................................................................................................................................................
Well Disinfected: no I Method:
_..........................
Yield Test at 20 GPM for 1 hour(s) with 100% of drawdown (DD) from static level (SWL).
Method: Air surge
Static Water Level (SWL): 14.9'
Start Date: 10/21/24
Completion Date: 10/23/24
Test Pump Date:
Final Pump Install Date:
WELL LOG
Depth in feet from top
of casing.
Details of formations penetrated, size of material, color and miscellaneous details.
0
..........................................................................
TO
5Casing
Stick up
...............................................................................................................................................................................................................................................................................
5
.............................................
TO20
-..........................
Gravel: medium, sandy .
...............................................................................................................................................................................................................................................................................
20
.............................................
TO23
-..........................
Water gravel: silty
................................................................................................................................................................................................................................................................................
23
.............................................
TO29
-..........................
Gravel: silty, dry
................................................................................................................................................................................................................................................................................
29
.............................................
TO87
_..........................
Bedrock: water fractures from 57' to 87'
...............................................................................................................................................................................................................................................................................
.............................................
_..........................
............................................................................................................................................................t............`.....................................................................................................
President, M -W Drilling, Inc.
.............................................-........................................................................................................................................................................................................................................................................................................
.............................................-........................................................................................................................................................................................................................................................................................................
.............................................-..........................................................................................................................................................................................................................................................................................................
Alaska Gen Contr Lic #1000
610 E 5th Avenue
Anchorage, Alaska 99501
(907) 306-8104
mail@S4AK.com
Land Surveying
Land Development Consultants
Subdivision Specialists
Construction Surveying
AECC#173042
S4
Group Lot 6, Block 2,
Potter Highlands
Subdivision Phase 2
As Built
12/31/2025
NOTES:
1) WETLAND AND DRAINAGE LOCATIONS ARE PER PLAT 2015-10.
2)DRIVEWAY LOCATION IS APPROXIMATE DUE TO SNOW AND ICE COVER.
35'
LOT 5 10AGE EASEMENT ;:0 F-
lo'
718.6 3
S83°31 43' 0-)
�7
O O�
0-
DRAINAGE 00
(8fZ
..........WELL
33.5' ''.'..'.'....WELL * ..........................
..................
............................
8.3 ............
.......... EXISITNG.*-V-'.'-'-'-'-
0 LOT 46 7.3' ........ GRAVEL
EXISTING TWO to - ' I... DRIVE
06. ............ Cf) U
Q6 171,514 SQ. FT STORY HOUSE W/ 7.0' ......... .. ....
2 .........
00 DAYLIGHT BASEMENT 22.0, ......
13.0' ........
C? ....... ......
I NN
WETLAND 6 7.2' .......... .....
S CLEOUT
STANPIPES (2) (5 C11
C,�t� 0 --AMANHOLES-(2) ....... .......
0 STANPIPES (2) qe TANKS (2)—W- I N
STANPIPES (2) (M
0-)
C
............... 70' T&E EASEMENT
5DEVELOPMENT SETBACK
...........
N88*03'30"W 719.28' 35'
.....................
.............
......................
........... I ......... I ....
LOT 7 .................
Survey Certification: I hereby certify that a Mortgagee's
OF
Inspection was performed on the described property.
I Legend A
Notes: It is the owner's responsibility to determine the As Built
610 E 5th Avenue existence of any easements, covenants, or restriction which Rebar 0 A" 'j Vnn
Anchorage, Alaska 99501 are not on the recorded subdivision plat. Well Q 49!-H***
(907) 306-8104 It is the contractor's responsibility to check top of foundation ............................
mail@S4AK.com grade & building setbacks in relation to property lines and Legal Description: Septic QS O -
easements
Gravel
Lot 6 Block 2 Steve..
n Callaghan• 04
Sie
Parcel Number: 020-281-66-000 Address: 5940 Potter Valley Road Overhang
Potter Highlands EM LS-12034
Grid: 12026
• Job: 2025-142 SW3638 Drawn by. AK Wood Deck a,
1• — 1�1� Itj ra
— Subdivision Phase 2 �,N\I_Ofelsiono�
Plat: 2015-10 Scale: 1" = 50' Field Book: 158 Date: 1/26/2025