HomeMy WebLinkAboutTHE TABLELANDS #2 BLK 7 LT 11The Tablelands
#i
Block 7
Lot I I
#050-801-70
Municipality of Anchorage
.•:?;' .'°.,•
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Boz 196650 Anchorage, AK 99519-6650 Page / of 3
www.ci.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SbtlOS02g7 PIDNumber: 0,o5l— $01-70
Name
K 0 LJJ76viQM,ES Wastewater System: New ❑ Upgrade
�feP'O PDX 3a97
ABSORPTION FIELD
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O Deep Tesnrn O Slullov T� O Bea O Mann 001W
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FROM :Silva Service FAX NO. :892-2498 May. 08 2006 09:40AM P1
Sgv$s$ ServicesPO ft � AK 9Ms2
W7402-2AN phone%■
To. Alaska Custom Nanus
Fax (907}745-8335
Re- Lit Station
L• I I &7 Tags
Peters Creek, Alaska
This is P17A d as confsnrotion that Suva's Services completed the wiring instwwm for the above
rekmnoBd Ift Station.
I may be tbnWdod at (907) 092-2496 if Vwe are any quesbons or i addit" W=ywucn Is r;MW.
sw"rely.
ALASKA
Custom
Homes
Dick Griggs Brian Turner
907.244.1550 907.244.3369
PO Boz3897 Pzlmr.AK 99617
Olirz (907) 746.6000 Paz (907) 745-9733
May 12, 2006
RE: Lot 11 Blk 7 Tablelands
To Whom It May Concern:
This letter is to acknowledge that Alaska Custom Homes will apply topsoil and
Hydroseed to the septic mound on Lot 11 Block 7 Tablelands as soon as weather permits
us to do so.
Thanks,
Brian Turner
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Silo Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519.6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Aug 18, 2005
Expiration Date: Aug 18, 2006
Permit Number: SWO50297 Parcel ID: 051-801-70
Legal Description: THE TABLELANDS #2 BLOCK 7 LOT 11
Design Engineer: 0838 North Rim Engineering Site Address: NHN SAMBAR LOOP
Owner Name: AK CUSTOM HOMES Lot Size: 49024 SO. FT.
Owner Address: P.O. BOX 3897 Total Bedrooms: 4 Permit Bedrooms: 4
EAGLE RIVER. AK 99577 -
This permit is for the construction of:
n Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by catling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
a.) The upper six (6) inches of the mound absorption field shall consist of topsoil and be sufficiently vegetated to
prevent erosion.
Received
Issued By:
i
Date: t 81
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.CF
jl - Permit Number SW
Property owner(s)� SL th,,, 01�% c t Day phone 7e//,r—
Mailing address /'10. fox 3A"?. Zip Code 2
Site address address S/- m g/i/Z 1,oof Zip Code
Legal description (Lot, Block & Sub'd.) _�$LELitRr9S -3!� 2 4 461- OJCAf 70 LGT" //
Legal description (Section, Township & Range)
Lot Size qQ 00_Acre q.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms
Sewer Only /131 Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property ow�or authorized agent)
Permit/Rush Fees: 7py. Waiver Fees:
Date of Payment:
Receipt Number:
(Rev. 09/04)
Date of Payment:
Receipt Number:
�C2TI-Z1�-
ENGINEERING
NorihRim Engineering
17237 Bear Pow Circle
Eugle River. AK 99577
907-694-7028
August 15, 2005
Julie Makela, P.E.
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Tablelands #2, Block 7, Lot 11
Dear Ms. Makela:
We have been monitoring this system for quite some time. The lot has low relief and run-
off from spring melting has slowly been leaving the lot. The test hole on 5/4/05 was dry
to 10 feet depth but surface melt -water above an ice layer flowed into the hole.
A 3rd test hole was augered at the east side of the lot. This is the highest ground on the lot
and is adjacent to a vegetative easement. After monitoring the groundwater in this
undisturbed area, none was present. We are however placing the system as high as
possible due to the long spring break-up and slow run-off.
After discussions with your office, we are proposing an AdvanTex AX -20 Mode b to
serve this lot. A Category III drain field has been sized for the highest ground.
We are requesting your approval.
Sincerely,
'Ove PE, PH
Design Enclosures
ENGINEERING
Tablelands # 2, Block 7, Lot 1 I
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing:
This is a new single family home to have 4 bedrooms. Iligh groundwater exists in the
area. The most recent soil test on the east side of the lot revealed no groundwater. The
Category III absorption system will be located at this site. The Orenco Systems,
AdvanTex Treatment System will be utilized. This system requires a 1500 gallon
processing tank and 1-AX20 filter pods. A Category III System drain field will be
utilized, which will allow an application rate of 6 GPD/FT; This allows a 5' x 20' bed.
The top 6 inch organic layer will be removed and a elevated trench will be constructed. A
I foot thick effective layer will be utilized. Adequate separation to groundwater will be
maintained by elevating the entire system. No adverse impacts are expected from
development, especially due to the fact that a public water system serves the subdivision.
Most of the neighboring lots are undeveloped or under construction. No water wells are
impacted by this construction. Soil tests found typical soil for this area; a silty sand, with
relatively high groundwater table. A 25' vegetative easement on the back property line
will not be encroached upon. This is the highest ground on the lot.
Specification Requirements:
All components and work must comply with the Municipality of Anchorage
Specifications (AMC) & State of Alaska Drinking Water Regulations and
Wastewater Regulations, Orenco Systems AdvanTex Treatment System
Design/Installation Manuals, Anchorage Tank & Welding requirements.
• Installation by an Authorized AdvanTex Installer only; approval issued by Orenco
Systems & Anchorage Tank & Welding, Inc.
• 1500 gallon, two compartment AdvanTex processing tank, 1-AX20 filter, VeriComm
Monitoring System & Mode Ib package requiring a discharge basin to pump to the
elevated absorption field, per AdvanTex Treatment System Manual.
• Watertight couplings on inlet & outlet.
• 5 foot minimum between the tank and bed. 10 foot minimum to property lines.
• 3 feet of cover or insulation is required for trench; an equivalent of 1" insulation for
each foot soil cover.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required 1 to 4 feet from foundation
wall, prior to any 90 degree bend in 4 inch line, prior to the processing tank
compartment, and two opposing cleanouts at either end of the absorption bed.
• All cleanouts must extend to at least ground level
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron
• Trench to be placed level, minimum of 3 feet to groundwater, 6 feet to bedrock from
drain -rock
• Drain rock to be'/2 inch to 2 %2 inch screened. Drain rock to be distributed uniformly
throughout the trench.
1
�rim!C,�11NEEWING—' Tablelands # 2, Block 7, Lo[ 11
• Perforated pipe to be installed level with perforations down
• Silt barrier (filter fabric) to be installed above the drain rock
• Smeared trench sides must be raked or scarified before drain rock placement
• Backfill over drain rock must not be less than 36" or insulation required
• The finish grade must be mounded to promote drainage over the bed
• Insulation must be placed over any pipe installed under driveways or parking areas.
AdvanTex Treatment System and absorption bed shall not be located under driving or
parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope
• Maintenance agreement for the AdvanTex Treatment System is required for approval.
• Insulation board shall be extruded direct burial polystyrene (Dow Styrofoam HI or
equal)
• Distribution pipe shall be 1.25" Schedule 40 PVC w/ 1/8" orifices @ 27" on center.
• Force main shall be 1.25" Schedule 40 PVC, conforming to Anchorage Tank &
Welding/Orenco Systems specifications. Force main burial to be 4' minimum.
• Silt barrier (filter fabric) to be installed above the drain rock
• The finish grade must be mounded to promote drainage over the bed
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Under Constr.
DESIGN NOTES
1. Total Depth of Tr.nch M ON O T.H. 11 m0" Orgm'c Lo W.
Terrain Is Relatively FIaL
2. Sewer SwNc. Lin. minkmam 2% Mp..
& Tronth Y Mlnlr a 100 from Lot Lina
{. Lot. Served Ey Public Wato Sy.t.m.
AdvanT.x A%2D— Mod. 1D to Meet kutallation Rsaair.m.n61 Po DI.naO $yst"s h 'Anchmo9. Tmk'.
'6� Inch.. of Momd To Cm.l.t of Tp—SW ! 90 V09.tat.d.
1-----`-------------------.---__._----- ---------100, i
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NORTHRIM I TABLELANDS #2 NEIGHB❑RH❑❑E
ENGINEERING "`
17237 8.01 PC- VIa1. -. _----___—..ILAY❑UT
cagl. an.r. A,aaMa 9917
'BLOCK 7, LOT 11
907.69.. 7028 1 8/15/05 2 of 5
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PZM�GINEERING
LOG —
ATION TEST
Date Performed: 8/7/05
Performed For: AK Custom Homes
Legal Description Tablelands #2, Lot 11, Block 7
20 -
21 - Percolation Rate 3 min./inch Perc Hole Diameter —
Test Run Between 1' and 2'
Comments) - 1 CERTIFY THAT THIS TEST WAS
Performed By Nor hRim ung.
Performed in Accordance with All 'State /Municipal Guidelines in Effect
ON THIS DATE. DATE, 8/15/05 --
NORTHRIM 3�y�P I TESTHOLE LOG ,T. H. 3
ENGINEERING
3* .
17237 Bear Pow Circle p r... eyN i '11-0-F-3
_ .
'Eagle RNer. Alaska 99577 •..a .•'Od: GEOTECHNICAL °o8/15/05"'
1-0- -3 _
DEPTH
(FEET)
Organic
1 -
'.r•
2
.0
SM
Fine Sand
Slope < 5%
3-
::•..,
w/ Silt
4
5 -
6
-
Groundwater? No
Depth '-
7
_
Water Depth
8
-
After Monitorin
None Date,
8/15/05
9
_
i; Date Gross
Time Net
Time
De th
Net Dr
10 -
1 8/7 0
__
3'
--
11 -
2 8/7 2
2
min.
3.75'
.75'
12
-
3 8/7 5
__
3'
--
13
-
4 8/7 7
2
Min.
3.75'
.75'
14
-
5 8/7 10
--
2.75'
--
15
-
6 8/7 12
2
min.
3.5'
.75'
16
-
17
-
18
-
19
-
20 -
21 - Percolation Rate 3 min./inch Perc Hole Diameter —
Test Run Between 1' and 2'
Comments) - 1 CERTIFY THAT THIS TEST WAS
Performed By Nor hRim ung.
Performed in Accordance with All 'State /Municipal Guidelines in Effect
ON THIS DATE. DATE, 8/15/05 --
NORTHRIM 3�y�P I TESTHOLE LOG ,T. H. 3
ENGINEERING
3* .
17237 Bear Pow Circle p r... eyN i '11-0-F-3
_ .
'Eagle RNer. Alaska 99577 •..a .•'Od: GEOTECHNICAL °o8/15/05"'
1-0- -3 _
Municipality of Anchorage
On -Site Water and Wastewater Program,
(907)343-7904
APR 14
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-801-70
1. GENERAL INFORMATION
Expiration Date: 7-/ 6"
Complete legal description The Tablelands #2 Block 7 Lot 11
Location (site address) 22409 Sambar Loop, Peters Creek, AK
Current Property owner(s) Thompson Day phone 406-249-0066
Mailing address same
Real Estate Agent Hope Russo Day phone 301-0701
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class C Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
Received by —- \ Date i /;
-,>
COSA to be released to the engineer, unless otherwise re0ested by the engineer.
COSA Fee $ 5-9(0
Date of Payment 41141
Receipt Number
COSA # 6S0W 1 /a17
Date of Payment
Receipt Num
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 4/14/2014
l 1'
6. DSD SIGNATURE
V System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved. �l two,
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date:
The Municipality of Anchorage Devlopment Services Division (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA blue sheet 9-1-12.doc
X Nitrate Advisory
Arsenic Advisory
Other
D. LIFT STATION
Date installed g,�Z 2
"Pump on" level at 41 in.
Datum 0+1
Size in gallons /5616 S it=s Manhole/Access (YIN)
"Pump off" level at 32 in. High water alarm level atin.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOTTO: 4U,( -(C, &J,fT.ER
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO
Building foundation /6 iF Property line OD Absorption field If -6 Ile-
Water
fWater main / O 1& Water service line /O 't Surface water /"J ff 'r
Wells on adjacent lots 20Cf
ABSORPTION FIELD ON LOT TO:
Property line Z re Building foundation /Q p r� Water main /e �t
Water Service line 1D 0"t Surface water /6O 'f' Driveway, parking/vehicle storage
Curtain drain Wells on adjacent lots 2 G a ',I-
F.
>`
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name 17S Tom% f= AJC
Date _y
COSA brown sheet_10-10-12.doc
0
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: 24, T li 0- e? c -wZ 97 Z// Parcel ID: D 5140 '_70
A. WELL DATA PUaue, W^R
Well type
If A, B, or C provide PWSID #
Date completed Sanitary seal (Y/N)_
Total depth ft.
Date of test
Cased to ft.
FROM WELL LOG
Static water level ft.
Well production g,p,m,
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material i 0(tlrl .11;ew
. Tank size / S60. gal. Number of Compartments Z
Well Log (YIN)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
71
Collected by:
Date installed zll?z D 6
Cleanouts (Y/N)
Foundation cleanout (Y/N)4
Depression over tank (Y/N) .A//
High water alarm (Y/N) X-/
Date of pumping
Pumper GTS � 9 rcc
-
C. ABSORPTION((j,�/�
FIELDD��yATA
Date installed V17 Soil rating (g.p.d./ft2 orflzlbdrm) System type 10QUAr
Length %00 ft. Width Z ft. Gravel below pipe ft.
Total depth 3 ft. Eff. absorption area ZOO ft . Monitoring tube 4 Depression over field
Date of adequacy test 41-114 - Results (Pass/Fail) Forbedrooms
YL
Fluid depth in absorption field before test �_ in. Water addedd!;�� gal. New depth_ in.
Elapsed Time: o min. Final fluid depth __�_ in. Absorption rate >_ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) AIG If yes, give date
07/17/2013 15:03 8686770 APLUS PAGE 07
same no N on Sol
Sam ■ So
•RRs ■SRn K S S
205 488
■ool on
[�vanTex® Field Maintenance Report
Annual Inspection
Garth Thompson
Slro Addreea
22409 Sambar Loop,
AX -108094
Retrieve O&M Into
Daly flew
Reciro ratio—
Timor settings:
tolak AK 99567
A'.ymr
SWO50297
perrieres Field Sampling/0boomsticns
NY))U (16 x NTUQ pH (&0) DO (2-6)
Odor of Sa111P1a
typical 4Musty ❑ Earthy ❑ Moldy
Nonaypical WSulgde ❑ Cahp.�a/g�a ❑ DOGGY
ally flim in PVu ❑Yes ,Y,....,(tic
Foam in tank ❑Yea LSI No
Check Control Panel
Rec((llIyd Amp3
Dlarycy�harga Amps
Audible and visual alarms
2QOK
Dial tone {telemetry only)
['Yes ❑No
Inspect/Clean Pump System
Currant
Previous
Inspect
Riser/Ud .....................
�r
Splice Box ....................
Float Cords ............... . ..
.
Floats ........................
Current
Pump. . .......................
Current
Previous
z/1
motubee Filter .................
&otube Pump Vault ... • • • • • • •
• • (>,,,,{{.
Recirculating splitter valve.......
LA
Comments
Sionature
Clean
■ ■a8 ■ til
11 no
son an r re
AnchorageTank
907-272-3543
Mike Blakeslee
Pad# ant ML
206169 1 RTU106647
Measure Sludge/Scum
Cenmct Pa..
(907)688-8829
Dna W L.et nepeetron
05/28/2012
Scum
lstcomp. mart
Currant
Previous
Current
Prevloue
�r
Intake Vent ®.
2md compartment
Current
Pravlous
Current
Previous
z/1
lnspect/Clese AdvanTax Filter
Odor. 161 Normal ❑ Pungent
Blomat: +Omtal ❑ Excesslve
BridgingManding: Lg)�ona/Minar ❑ Excessive
Ingmct/Clean Plachlirge Pump System
Inspect
Rlsm/Lid
Splice Box
Float cords
Inspect
Crean
Latersla/Odflces er
k
Pod Bottom i
Intake Vent ®.
Inspect Clean
Floats
Pump
(nape Servlee other System Components
Inspect Clean inspect Clean
Dn, nfectl Equipment ❑ ❑ Dispenal Lateralamrmcaa ❑ ❑
Observations
Addkietlsl Sere ea Rendered
❑ creanad textile oats? ❑ Replaced UV Items?
❑ Replaced/Used o r- s?
Parts Used1 W = ty, S = Billable (✓ appropriate saledlon)
W e item N mbar Description
Final/Safety inspection
gr�PSV reinstalled
[! Manifold reconnected; flush Valves closed
Summa ry/Recommendations
XSystom performing; no further action needed
❑ can for servlco
Dote
Fax completed form to 1-866-384-7404
Z&Llds bolted on
XComrol panel reaetiValed
❑Tank nestle pumping
❑ Other? —
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair 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 Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNER:
By:A't/ (signature) Date:
1�iAL(Y ,k -MC -d Tf-Y % (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this,�,� day of t` s
20 4,bY,k\Gzk,�. i�ry„e;iwcuj
ivOTA-RY rU L1C FOR ALASKA
My Commission expires -�7/C t - It',
I
MUNICIPALITY:
BY: _ (signature) Date:
name) Title:
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
KIWO]
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
Day of
of 20 , by and between
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS), described as
(�1/a a is ?4
located at (legal description).
7 L--1
2. Definitions.
Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design.
Certificate of On -Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit. An On -Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations, Installation and Removal of Additional Equipment. Prior to
performing any alterations to an AWWTS, the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
service and maintenance provider approved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay
for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement
costs, and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules
and orders for the AWWTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor, the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
H. 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.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof, or the right of such party thereafter to enforce each and
every provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a writing, executed by authorized representatives of the parties, with
the same formality that this Maintenance and Repair Agreement was executed
with, and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement, the only authorized representatives of the parties
are:
a. Owner:
b. Municipality: Director, Community Development or designated authority
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
��!5
Municipality of Anchorage
Development Services Department
/ Building Safety Division ,
On -Site Water and Wastewater Program `
4700 Bragaw Street "
P.O. Box 196650
t Anchorage, AK 99519-6650
www. 7) 343-7904 ite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0 F/— it 0 1 ^ '7,D COSA # O 017:7
1. GENERAL INFORMATION Expiration Date:
Complete legal description Wf_ 77?64r4e4r16 r -Z &ork --T
Location (site address) — c' 4419.41? i no P
Current Property owner(s)Z/< (2 Qj 70 4 ,L M e)ddE f' Day phone - 0
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
�it/4t/ ki7"7 C Day phone
_rZ4ryir.*YAEZ-,ssi►>>=irtPmwllrly%=
Urdess otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
— q
TYPE OF WASTEWATER DISPOSAL:
❑ Individual On-site
❑ Individual Holding Tank ❑
❑ Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work.
4. 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 Onsite Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm _AhT01&11A Ed Phone A0_`��/' 7(g
Address / 7-2 3 7 ,SE -42 )%0 GR61 F
Engineers Printed Name S VC;h Date /oro
5. DSD SIGNATURE
Approved for
Disapproved.
X Conditional approval for
°F..:Aqs tze
Steven Vng"
PE 62556 .'.:
bedrooms.
bedrooms, with the following stipulations:
At the time of title transfer, the new property owner shall sign .
the attached maintenance agreement which shall be returned to this
Attachments:
COSA Checklist X
.Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By; Original Certificate Date:
in". 11105)
Municipality of Anchorage
' Development Services Department
Building Safety Division
Onsite Water b Wastewater Program ,
4700 Bragaw Street
P.O. Box 198850
Anchorage, AK 99519.8850
www.muni.org/onsfte
(907) 343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Th7F_ 7-AR1& Aire c 11�.P 1340c1c ? LOT // Parcel ID: _0-6 /- 901- 70
A. WELL DATA Pv 6L (G W AT!c Ot
Well type — If A, B, or C e PWSID # _ Well L (YM)
Date completed _ San' ry seal (YM)_ Wires pro rly protected (YM)
Total depth ft. ed to ft. Casi eight (above ground) In.
FRO ELL LOG AT SPECTION
Date of test
Static water level
Well prod g.p.m.
g..m.
WATER E RESULTS:
Coliform oolonies/100 mL Nitrate mg1L Other bact colonies/100 mL
Arseni . mgA Date of mple: Collect
B. SEPTIC/HOLDING TANK DATA
Tank Type/MaterialAPV'*A/iE),/i_ Date installed 4/Z22/0Or
Tank size ISO a gal. t Number of Compartments 2 Geanouts (Y/N) y
Foundation cleanout (Y/N) --y— Depression over tank (Y/N) -AL High water alarm (Y/N)
Date of pumping AICMl Pumper
C. ABSORPTION FIELD DATA
Date fnstailed�l/zea SWI rating (g.p.d /ftp or Illlbdnn) �_ System type,&4CIAM
Length ---'o ft. Width �Z ft. Gravel below pipe �_ ft.
Total depth -_%__ ft. Eff. absorption area 2VO ft' Monitoring tube _:?L_ Depression over field,/_L
Date of adequacy test Al ect,J Results (Pass/Fall) For -4— bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ In.
Elapsed Time: _ min. Final fluid depth _ in.
Any rejuvenation treatment (past 12 mo.) (YM d type)
Absorption rate >= g.p.d.
If yes, give date
D. LIFT STATION
r e 1 S C kAR CE &4 1/.V
Date installed 411 -0 -2 -LO -0 Size in gallons / SO O Manhole/Access (YM)
'Pump on' level at 4L in. 'Pump off level at 3Z in. High water alarm level at !,(X in.
Datum rW AIP R O r"/yr Cycles tested Meets alarm ti circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WEAL ON LOT TO: pd8L/e w Arlr4
Septic tank/Iift station on lot
Absorption field on lot
Public sewer main
Sewer /septic s line _
Animal conte' ant areas .
On adjacent lots
On adjacent lots
Public sewer m
Holding ta
excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /D �* Property line /4's Absorption field CP o �+
i r
Water main / a f Water service line f Surface water / a O
Weiss on adjacent lots ZOO '*'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation 40 '* Water main
Water Service line /0'* Surface water. /Q6 � Driveway. pamnio ehicie storage lea t
Curtain drain - Wells on adjacent lots 200
F. COMMENTS
OF
G. ENGINEER'S CERTIFICATION ����, •"•• :INS"Ir
1
1 certify that I have determined through (veld inspections and
review of Munkoal records that the above systems are in �, �`' ..
conformance with MOA COSA guidelines in effect on this date. j
Engineer's Printed Name 'Sr505 tali is r0 . s eae�} fE 6 zss `•
!rr i
Date _ SILO 1G 6 v�>`
COSA Fee
14/
Date of Payment - I / - O
Receipt Number o t)
(Rev. 111)5) ,
Waiver Fee $ r Z
Date of Payment- I /- c 6
Receipt Number 3 S
3--/t-o& �!/�
I I II I /
S27 3212E ; - / s
Iml18.76'/y
••+ I I ' I I i:: 15• TELECOMM.
ELEC. EASEMENT i
QI I X15' TELECCMM. & LEGEND
, N
ELEC. EASEMENT / /' / / / V
2' CL ALCAP
O �5�
/pe'� (RE
E4B
ARN000S40WN89'56'06"E 331.61
11.60'I 27.8BSEOWx RSE
MANHOLE MCNITORI
SEKCR TUE"tPMY.HCLE OF q
1 1 0,9.4 OUT
CEANOLI
.1 11 1 SEE FOUNDATj6N�s%
1 DETAIL 5 oma'? 49/T"
L2(��ia�1 e G
R=210.00' ! Rei. 5. 0................................�
L=277.10' \ z5' ECETA E
BUFFER EASEMENT j L=gg 8�• DO c .RichOrd L. Besse 0
/ , / ;O
p 'o 0
DEE, P'�000G�
OR6s x -x,\o\�\ �,yy SURVEYOR'S C RT1FI CATION
t
' \
t----- - ;,, �.. ` R=20.00
*30.�I'
k �
NOTES
1. IT SHALL BE THE RESPONSIBILITY OF THE BUILDER OR OWNER TO VERIFY
THAT BUILDING LOCATION SHOWN MEETS ALL SUBDINSION COVENANTS
AND ZONING ORDINANCES.
2. IT IS THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONS
WITH RESPECT TO ALL UTILITIES.
3. THIS AS -BUILT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW
TAKEN FROM THE RECORDED PLAT DESCRIBING THAT PARCEL.
INSTRUMENTS RECORDED PRION TO OR AFTER THE FILING OF THE RECORDED
PLAT ARE NOT SHOWN ON THIS AS -BUILT.
4. THE INFORMATION SHOWN ON THIS AS -BUILT IS FOR THE USE OF LENDING
INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING
STRUCTURES AND PLATTED LOT LINES OR EASEMENTS. THE AS-BVILT IS
NOT TO BE USED FOR P09TIONING ADDITIONAL STRUCTURES OR FENCES.
5. THERE ARE NO OVERHEAD UTILITY LINES LOCATED ON THIS PROPERTY.
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
i PROPERTY DESCRIBED ON THIS AS -BUILT AND THE
/ IMPROVEMENTS SITUATED THEREON ARE LOCATED
/ AS SHOWN ON THIS AS -BUILT.
DATED THIS 8 DAr OF ar . 7 00
5/8/06 1
l' -TDD' THE
WITHIN
801-25A ,.{1
TABL1187.DWG BCS -r^—
Br: MLK 1890 Jaime Marie Circle
WaSilla. Alaska 99654
I
\
o
I
1
'•,��
�• EXISTING
CONCRETE BLOCK
FOUNDATION
I:
I
I
I 1 1
y
2.4 3.0' o.
30'I 30
2.0'2.8' 2.5'
'--J—�
1 1
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I
I
2.5'
j
I I
FOUNDATION DFTAII
1"=30'
I I II I /
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Iml18.76'/y
••+ I I ' I I i:: 15• TELECOMM.
ELEC. EASEMENT i
QI I X15' TELECCMM. & LEGEND
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R=210.00' ! Rei. 5. 0................................�
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NOTES
1. IT SHALL BE THE RESPONSIBILITY OF THE BUILDER OR OWNER TO VERIFY
THAT BUILDING LOCATION SHOWN MEETS ALL SUBDINSION COVENANTS
AND ZONING ORDINANCES.
2. IT IS THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONS
WITH RESPECT TO ALL UTILITIES.
3. THIS AS -BUILT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW
TAKEN FROM THE RECORDED PLAT DESCRIBING THAT PARCEL.
INSTRUMENTS RECORDED PRION TO OR AFTER THE FILING OF THE RECORDED
PLAT ARE NOT SHOWN ON THIS AS -BUILT.
4. THE INFORMATION SHOWN ON THIS AS -BUILT IS FOR THE USE OF LENDING
INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING
STRUCTURES AND PLATTED LOT LINES OR EASEMENTS. THE AS-BVILT IS
NOT TO BE USED FOR P09TIONING ADDITIONAL STRUCTURES OR FENCES.
5. THERE ARE NO OVERHEAD UTILITY LINES LOCATED ON THIS PROPERTY.
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
i PROPERTY DESCRIBED ON THIS AS -BUILT AND THE
/ IMPROVEMENTS SITUATED THEREON ARE LOCATED
/ AS SHOWN ON THIS AS -BUILT.
DATED THIS 8 DAr OF ar . 7 00
5/8/06 1
l' -TDD' THE
WITHIN
801-25A ,.{1
TABL1187.DWG BCS -r^—
Br: MLK 1890 Jaime Marie Circle
WaSilla. Alaska 99654
WR#: 060018 PID#:051-801-70
Date Received: 5/16/08
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
HA#:060177 Pennit#:050297
Legal Description: The Tablelands #2 Block 7 Lot 11
Waiver Requested: 2 foot separation distance absorption field to DroDertv line
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
...............................................................................
Waiver Is Granted: t/ Waiver Is not Granted.
List Conditions or Reasons for above:
Date: r - / C - 0 ! By: �
... a e f Reviewer
............................................................................
Rec#: 5-16-06 Amount: $175.00 Date Paid: 5.18-08
Mayor Mark Begich
Municipality of Anchorage �•
•
• o
V0.Ip1sLNN:MI•.lnchllm!;.,,\lllam!Y.LiI!1•(il:ill•larphlme(!Nli)a3:4KNll•lilx(!Nli):Nati:NNl
47M 111n(,nnc Swat • 1\nd longe, Alu.kn !1.007 •S A�J
Nlm..11111111.111'j(
I3uilding Safety D osion
5/17/2006
NORTEIRIM Engineering
17237 Bear Paw Circle
Eagle River, AK. 99577
Subject: Waiver Request for The Tablelands #2 Block 7 Lot 11
Waiver Request #WR060018
Parcel ID #051-801-70
HAM 060177 Permit # 050297
Dear Engineer,
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to the property line has been approved. The approved separation distance
is 2.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Jeffrey W. Poct
Engineering Technician
On -Site Water & Wastewater Program
Community, Security, Prosperity
