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SOUTHPOINTE BLK 3 LT 4
outhpointe Block 3 Lot 4 #020-311-62 Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131221 PID Number: 020-311-62 ❑� New ❑ Upgrade Name: ABSORPTION FIELD Crown Pointe Inc. ❑ Deep Trench ❑� Shallow Trench ❑ Bed ❑ Mound Address P.O. Box 112313 Anchorage, AK 99511 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 229-1886 4 4GPDlSF 2 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1 Ft. Greve/ depth beneath pipe 1 Ft. Subdivision Block Lot Southpointe 3 4 Fill added above original grade 3-4 Ft. Gravel length 1 27 Ft. Township Range Section Gravel width 5Ft. Beds: Number of LinesDistance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 155 Fe 1 Ft. Well >100' >100' N/A N/A >25' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank/Orenco Capacity I 1,500Gal. Surface Water >100' >100' N/A N/A Material Steel Number of compartments Two Lot Line >5' >10' N/A N/A NA Foundation >5' >10' N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain None Noted Pump on level at Pump off level at High water alar at RemarksFinal Landscaping and Vegetation by 7/1/2014. in. in. in. System is an Advantex Treatment System with Gravity Flow to the Absorption Bed. Pump make and model Electrical Inspections performed by PIPE MATERIAL Housetotank D3034 Tankto D3034 drainfeld Installer Sanders & Sanders Drainfield HDPE C01MT D3034 Inspector W Roberts BENCH MARK (Assumed elevation) 100.011 Inspection„ 1 11/18/13 11/19/13 Location and description 2nd dates: 1Garage Slab. P 11/20/13 4” COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL �Eqpo� q11' Conditional Approval: Date 3—� 7 l ' ao� = �� , �♦ .,.j ® • 4, TH rI 0VLIV -t e-e,i2Gk In / 7-1 `7 /p ��, •MICHAEL •E.AND€RSON Q ? Z'r . �\ ®®044kfR Approved % Date E oma_ Inspection Report_11-1-12rd011 4 07 jar Liz me •�%�/I =on^oa o Vim: m `�e •�% X004$°' \\ ti zi dr v \ A \ V \ M \\\ I \\ \\ J 4V �- O " r y N = I z I I V) ° I v M I rri D / a�c� o a c \ °' /^�C O ^ \ 3 z �100 Cl m / q0 /rn� �v O I two V N w W m N g m D I. N m /t0 IQ W t0 M CO TrUJa I � C ^ I I/ / `TTJ U V) / \ O / \o 0 F— __�No 1W53'3 X8'1.5 / V I I I M I (� ,00'OLZ=2J °N°Q0 o o 3 I^ ad 394Ib 31NlO(3 0 G 0 O M N N —5.3. J C lD O <D O J O c 3 CDZ c 3 m O m N 0 S s Wo m < o CD Z -� D(nw mZ o <o d5D D m0 S >00 AM@ �OD� (p g mZ A W co A Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit No.: OSP131221 PID No. 020-311-62 mvs x Finished Grade Existing Grade `97.3 1,599 Gallon Advantex Tank 98.7 99.0 98.5 Finished Grade 3 95.7 95.7 x 3 Geotextlle Fab " Existing Grade Existing Grade r Drain Field Rock 1 93.7J 94.7 27' Trench Length 87.7 No Bedrock No Groundwater 7-23-13 PROFILE AS-BUILT Scole: NONE 49th`: ...:...../ / /.....:................................... • .MICHAEL E. ANDERSON No. CE-4381 J' • ESSI MEMORANDUM DATE: July 29, 2014 TO: Jeff Poet FROM: Mike Anderson, P.E. SUBJECT: Southpointe, Block 3, Lot 4 Conditional Certificate of On Site System Approval We recently inspected the septic tank and absorption bed area on the subject lot. The ground surface is revegetated with grass. Sufficient coverage has been attained to prevent erosion. We hereby request the conditional status of the COSA be removed and the inspection report be approved without conditions. DEPENDABLE SERVICES ELECTRICAL PO BOX 4357 Palmer, AK 99645 To Whom It May Concern, March 19, 2014 This tetter is to confirm that the lift station at South Pointe, Lot 4 Block 3, has been wired according to N.E.C. standards. Sincerely, Andrew Wessel (907)317-9954 office (907)677-1372 fax akdependableservicesL7a gmail.com Alw,ne Drilling & Enterprit.4s Well Log Permit Number:#SW131221 Date of Issue: 7-25-13 Parcel Identification Number: 02031162000 Date Started: 8-19-13 Date Completed: 8-20-13 Is well located at approved permit location? x Yes ❑ No Legal Description: Southpointe Block 3 Lot 4 Property Owner Name & Address: Crown Pointe Borehole Data: Depth (ft) Method of Drilling x air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing type: steel Stick-up 0 2 Wall Thickness: .250 inches Organics & silt Gravelly silt 2 3 3 32 Diameter: 6 inches Depth: 40 feet Liner Type:lrvc Diameter: 4 inches Depth: 18 to 58 with bentonite bedrock 32 346 chips exterior of the pvc and bedrock feet Casing stickup above ground: 2 feet Static water level (from ground level): 41 feet Pumping level: 346 feet after b hours pumping 4 gpm Recovery Rate: 4 gpm Method of Testing: air li Well Intake Opening Type: ❑ Open End x Open Hole y ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite granules Volume: 1 Depth: Start 0 feet Stopped ? feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? x Yes ❑ No Method of Disinfection: chlorine tablets Comments: Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage AK 99511 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 MarkBegieh Anchorage, AK 99507 s° a r r Mayor - w .muni.ora/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW 131221 Date of Issue: 712512013 Parcel Identification Number: 02031162000 Legal Description Block 3, Lot 4 Southpoinle Pump Installation Date: 1124/2014 Pump Intake Depth Below Top of Well Casing: 335 feet Pump Manufacturer's Name: Goulds Pump Model: 10GS15412CL Pump Size 11/2 hp Pitless Adapter Burial Depth: NIA feet Pitless Adapter Manufacturer's Name: NIA Pitless Adapter Installer: Well Disinfected Upon Completion? 0 Yes ✓❑ No Method of Disinfection: Comments: Pump Installer Name: Aarow Pump & Well Service, LLC P.O. Box 110496 Anchorage, AK 99511-0496 Property Owner Name & Address: Crown Pointe P.O. Box 112313 Anchorage, AK 99511-2313 Please save for your engineer. This is needed for ,your COSH,. Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Engineer: .egal Description permit: report Type: Municipality of Anchorage P.O Box 196550 4700 Elmore Road Anchorage, Alaska 99519.6650(907)343-7904 Fax(907)343.7997 htto:llwww.mu ni.oralonslte Planning and Development Services Department On -Site Water and Wastewater Program On -Site SewerMeli Submittal Comment Sheet ANDERSON ENGINEERING SOl3THPOINTE Blk 3 U4 OSP131221 WellSeptic Completed By: As Built Review -he attached paperwork has been reviewed and is being returned for the following reasons: 3/27/2014 J. Poet 1. Extra C.O. on survey to west of trench? The additional pipe is an old test hole. It will be removed. 2. Elevations have bust plus only 5 feet separation from bottom test hole to bottom of trench. Correct elevation Is now shown. Corrected prof lie Is attached. On -Site Water & Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131221 Tax Code Number: 02031162000 Work Type: WellSeptic Permit Effective Dates: July 25, 2013 to July 25, 2014 Design Engineer: ANDERSON ENGINEERING Subdivision: SOUTHPOINTE Site Legal Address: SOUTHPOINTEBILK 3 LT 4G:3738 Owner/Address: POTTER CREEK LAND COMPANY 50% & POTTER CREEK LAND PARTNERSHP 16420 ST JAMES CIR ANCHORAGE AK 995165340 Site Mailing Address: 6436 SOUTHPOINTE RIDGE DR, Anchorage Lot Size in Sq Ft: 78741 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: Date: Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 hftp://www.muni.or_q/Onsite Development Services Division On -Site Water and Wastewater Program went �, N P Department **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP131445 COSA#: Permit#:OSP131221 PID#: 020-311-52 Legal Description: Southpointe, Block 3, Lot 4 Engineer: Anderson Engineering Applicant: Potter Creek Land Company & Potter Creek Land Partnership Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the 25% or greater slope has been approved. The approved separation distance is 25.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. .......................... .... ..................................... ........... I Waiver is Granted: X Waiver is not Granted: Date: l l d5 13 Approved by Name of Reviewer ............................................................................. Rec#: 02867G Amount: $200.00 Date Paid: 11/18/2013 **** VARIANCE/WAIVER REVIEW **** ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX November 15, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4, Block 3, Southpointe Subdivision Absorption Trench to Slope Waiver Dear Onsite Services Engineer: Lot 4, Block 3, Southointe Subdivision has limited area for construction of a septic system due to a steep slopes to the west and the presence of bedrock. The developer of the lot has located the house on the flattest area of the lot further reducing the area available. We have located an area with acceptable soils, but it is situated slightly more than 41' from a break in grade greater than 25%. The alternate site is 25' from the break. We are therefore applying for a waiver allowing placement of the absorption trench at this location. The soil encountered in the test holes is clean well graded sand (SW) which is very good for the absorption of septic effluent. In addition, an Advantex Nitrate Reducing Treatment System is installed on the lot. No migration of effluent is expected to occur to the steep slope. The 25% slope when extended downward from 2' above the proposed distribution line does not daylight. Sincerely, Michael E. Anderson, P.E. 49th MICHAEL E- ANDERSON Attachment o—I gouaa1 uoi}diosgy ° z ° c .O > , .aro ,,, •CO v•A N. V' .•�j ° w � b w W V V q, AV �� s5• moi' �' u s �0 ifl z ,— a}is a}ouaa}ly C W Ln w / n V n o mo m cn / n m Lo W L zF-m r'l o cnO N O N Ln O Ln O O Ln O Ln O Ln O N N N 1 1 9 7 W 1 I i i N N s �1 1 1 I I I i gouaa1 uoi}diosgy ° z ° c .O > , .aro ,,, •CO v•A N. V' .•�j ° w � b w W V V q, AV �� s5• moi' �' u s �0 ifl z ,— a}is a}ouaa}ly C W Ln w / n V n o mo m cn / n m Lo W L zF-m r'l o cnO N O N Ln O Ln O O Ln O Ln O Ln O N N MUNICIPALITY OF Community Development Department Development Services Division 6 On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 RUSH! / cH! ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 020-311-62 r RUSH! Property owner(s) Crown Pointe, Inc. Mailing address P.O. Box 112313 Anchorage, AK 99511 Day phone 229-1886 Site address 6436 Southpointe Ridge Drive Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Southpointe, Block 3, Lot 4 Legal description (Township, Range & Section) Lot Size 78,741 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (S all that apply) Absorption Field El Initial El Single Family (SF) Q (w/wo ADU) Septic Tank E Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Q Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Dis tance: 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: %30 (A3 I 1044 aiver Fees: Date of Payment: �7 �3 ��J C Date of Payment: Receipt Number:D�ia �lQl (A Receipt Number: IF Permit No. 05 ` 12) aa� Waiver No. Permit App_9-1-12.doc July 22, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4, Block 3, Southpointe Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer The owner of Lot 4, Block 3, Southpointe Subdivision intends to construct a four- bedroom home on the lot. We are therefore requesting a permit be issued for construction of a new well and septic system to serve the new home. The size of the septic system and the proximity of bedrock to the ground surface in the subdivision limit the available area for the sewage disposal system and make it difficult to place a conventional septic system. We have therefore decided to place an Advantex. Treatment System on the lot in conformance with subdivision plat notes to provide the most effective treatment of the septic effluent prior to discharge into the surrounding soil strata. The location of the absorption system is shown on the attached Site Plan. Drainage patterns are also shown on the plan and will not be modified as a result of the proposed construction. The test holes placed on this lot revealed silty sand with gravel soils with some sand (SM/SP) underlain by bedrock. The percolation rate in the materials encountered in the area near the new system was 2 minutes per inch. No groundwater was found and no bedrock to 8'. Our design provides for the bottom of the absorption trench to be as shallow as possible. We are therefore proposing to place a four-bedroom Advantex Treatment System. The absorption trench will be 27' long x 5' wide with a 1' effective depth. The distribution line in the trench will be placed at 1' below the existing ground level. The total depth of the trench will be 2'. A minimum of 3' of fill will be placed above the trench and 4' over the septic tank to meet Municipal Code and prevent freezing. Insulation with 2' of fill may be placed instead of the total 3' of cover. The ground surface of the lot slopes at 15% to 20% to the northwest near the location of the primary absorption trench site. The trench will be constructed parallel with the contours of the slope as much as possible in conformance with Municipal requirements. Lot 4, Block 3, Southpointe Page Two July 22, 2013 All components of the new septic system will be constructed a minimum of 100' from any surface water and 1 00'from the well currently on the lot. No conflicts exist between the proposed well and septic system and those in the area. All adjacent lots are vacant. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, -W1.� F - Michael E. Anderson, P.E. Attachments .' 49th •? MICHAEL E. ANDERSON No. CE -alai 0 oi0 N z SOUTHV,OINTE DRIVE / x.338.46' R=270.00' / ESM /— T � \ 0 N I / I / to •- / I I I I / I N m �•/ L3 a / �I I �Eow \ / m 00 E r�r` of Il I I ds\ L2 t �9. �1 0 ina I I O v \x uc I I 1 �z y � ..., I J� OW \ _- I I N x F\ N-4! \ OSS \ n o £9 \ c 6 0 1 \ 0 9s��xo`\\\ c 0 F \ O.. OOL p O \ a C c 00= 5 �= U N O O c O c O L,0ao00 Z U� - MUl W I I I I 1 I W ool-=o=> J �U:2H N:2U1 MA O Z M (J Q 0 H oU OO 0-w V J 0 0- 0d 4i L6w w> ; E 0 0 0 a ~oto �o Z N�CO�J *I O ���• J AT 4i L6w LOT 4, BLOCK 3, SOUTHPOINTE SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS Four Bedroom Home 5' Wide Trench System Perc. Rate: 2 Min./Inch 4 Bedroom Advantex Treatment System Application Rate: 4 GPD/SF 1' Drainfield Rock 4 Bedrooms * 150 GPD/Bedroom = 600 SF Absorption Area 600 SF/4 GPD/SF/5 SF/LF*.87 (Red. Factor) = 26.1 LF Trench Length THEREFORE: Construct a 27' Long x 5' Wide x1' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 1' Below Original Ground Surface. Total Depth to be 2' Below Existing Ground. Provide 3' Cover Over Trench and 4' of Cover Over Tank. 0 CII 1'0" Revegetate Outer 6" of Mounded Area Natural Backfill 5' 3' Cover (Minimum) Geotextile Fabric 4" Perforated PVC (Holes Down) Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) ���� NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. ■: Minimum 4' Separation From Groundwater. • y Minimum 100' Separation From Wells in the Area. ....`. Minimum 100' Separation From Surface Water or Streams: MICHAEL E. ANDERSON No. CE4381 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: Lot 4, SOuthpointe Subdivision PERFORMED FOR: DATE: 7/16/13 PROJECT No.: PARCEL ID#: TECHNICIAN: JB DEPTH TEST HOLE 1 (feet) 1 2 READING OB/OG NET TIME (MINUTES) 3 NET DROP (INCHES) 7/17/13 4 SM/SW 10:02 10 SAND W/SILT 5 2 6 10 5.50"/10.63^ 7 3 8 10 B.O.H. 5.00" 4 No Bedrock Encountered 9 5.50"/10.50" 5.00" SLOPE 1 O WAS GROUND WATER ENCOUNTERED? No C IF YES @ WHAT DEPTH? 11 DEPTH OF WATER AFTER MONITORING: None DATE OF MONITORING: 7/23/13 1 1 1 1 1 1 1 ' 49th AEL E. ANDERSON No. CE -4381 DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) 7/17/13 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 10:02 10 5.50'/10.75" 5.25" 2 10:13 10 5.50"/10.63^ 5.13" 3 10:24 10 5.75Y10.75" 5.00" 4 10:35 10 5.50"/10.50" 5.00" 5 10:46 10 5.25^/10.251, 5.00" 6 10:57 10 5.50"/10.50-, 5.00" PERCOLATION RATE: 2 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 3 FT. and 4 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 7/23/13 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENVON-SITE WATER AND WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST PROJECT #: PERFORMED FOR: John Berggren DATE PERFORMED: 5/2/2003 LEGAL DESCRIPTION: Lot 4 Block 3 The Villages West Subdivision 9 17 49th - MKMREL E. RNOERSOM No. EE -4301 READING DATE GROSS TIME 39 SLOPE NET DROP SITE PLAN 10:15 TEST HOLE # 1 10:25 10 Dry 8.75" OG/OL 10:26 2" 2 10:36 10 Dry B.5" Recharge I 2-- _. .Silty Sand _ - ----- with SomeGravel - \ 10:47 10 Dr SP/SM 3 Lo -46: 7 R 9 1 8 Bed Rock Oo B WAS GROUNDWATER No S ` \ ` (a ENCOUNTERED? - X L2 k 10 IF YES, WHAT DEPTH? 0 P DEPTH OF WATER None E AFTER MONITORING: DATE: 5/15/2003 12 •�p��agp �•cF- OF A/ #& TO/I512003 9 17 49th - MKMREL E. RNOERSOM No. EE -4301 READING DATE GROSS TIME NET TIME DEPTH TO WATER NET DROP Start 5/5 10:15 1.75" 1 10:25 10 Dry 8.75" Recharge 10:26 2" 2 10:36 10 Dry B.5" Recharge 10:37 2" 3 10:47 10 Dr PERC RATE: 1 MIN./INCH - PERC. HOLE DIAMETER: 6" TEST RUN BETWEEN 3.5 FT. AND 4.5 FT, COMMENTS: Test Hole Pre Soaked Prior to Test. TEST PERFORMED BY: AH I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 9/7/2003 Performed For. Legal Description: 1 21 (Test Hole Nu L Bottom of Hole OF W L. -JI: -.y •,� . 491H . * Municipality of Anchorag11 e"" "' I ........... ...........« Department of Health & Human Services / ,o : MICHAEL I- ANDERSON = 4 825 L Street, Anchorage, AK 99502-0650 �j '•, Cf - 4381 �r SOILS LOG - PERCOLATION TEST # r��9•.-7-LJ' -/� .•�y�= Was Groundwater 9 Encountered? No If Yes, What Depth? 10 Depth to Water After Monitoring 11 Date: 13 14 15 16 17 18 Perc. Rate: Perc. Hole Diameter: Test Run Between Comments: Visual Soils/ No Perk Test Performed By: JDN/ TLK I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: ® Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 S .,I E T� Certificate of On -Site Systems Approval Parcel I.D. 020-311-62 1. GENERAL INFORMATION: Expiration Date: O V a a a oa 1 Complete legal description SOUTHPOINTE: BLOCK 3. LOT 4 Location (site address) 6436 South Point Ridge *Anchorage Current Property owner(s) Jennifer Dickinson Mailing address Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 301-2131 Day phone 3. NUMBER OF BEDROOMS: Received 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: istance: Distance.- Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment a I Z 1 IT'�' o '� l Date of Payment Receipt Number y`I y7G Receipt Number COSA # S CZ (�)o Waiver # 0 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: (fv 21 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other. person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE V System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, #AECC884 1Y (OF(AVcr with the following s t�tionSON-SITE�m� WATER AND r_1 IAIA `.. mSTEY!'PCIZI'- O � J PROGRAM T SER��G���`�� By: - Original Certificate Date: 'FIR 3 020 a The Municipality of Anchorage Development 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: v COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: SDUTHpOINTE;BLOCK 3.LOT 4 if more than I septic system on lot: COSA Checklist # _of A. WELL DATA �� Well log is filed with Onsite (or attached) � Date drilled o�o ed `�,"^x, Total depth 348 ft Cased to 40 ft * Sanitary seal is functioning correctly ��Wires are properly protected Casing height (above ground) 18+ in. Date offlow test for C{)SA 8/13121 Static water level at beginning of test 46.8 � Comments B. TANK DATA Age oftank(s) / years Tanktype/mah»ha| ~~~~~ Measured operating fluid level inseptic tank 4/" [VStandpipes/foundation cleanout per record drawing Date ofpumping SEE ATTACHED MAINTENANCE REPORT D. ABSORPTION FIELD DATA SHALLOW TRENCH Which system tested (date installed) 11«*113 [WALL standpipes present per record drawing Total measured depth from grade 033 ft (max) Measured depth topipe invert from grade 40 (min) ElNA\—praasuhfield F-01 Monitor yWonitortubes go to bottom of effective. If not, state depth into effective____ FE] Code -required soil cover over fie|d FlSystem presoaked (Required ifvacant for greater than 3Udays prior to date oftest) Gallons introduced N/A gallons Comments/Deficiencies: CO8xChecklist yellow sheet Parcel ID: 020-311-02 Structure served hythis system Well production attime oftest 4.5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? F-1 Yes �� No XColiform bacteria isNegative Nitrate 1fK9 mg/L [:] Nitrate less than MRL (ND) Arsanioug/L �� Arsenic less than MRL (ND) Collected by GE6.LTD. Date ofSample 8/5/21 C. LIFT STATION VN Required maintenance completed Age oflift obati7on years Lift station material Comments: ADVANTEX Adequacy test date 8/13/21, Results [Z)Poss For 4 bedrooms Fluid depth prior Lotest 1 in Water added 622 gal New depth 11 in Elapsed time 120 min Final fluid depth 5 in Absorption naba 600+ gpd Any rejuvenationtreatment (past 12month s) NONE |fyes, enter date N/A From Private Well on Lot to: (Please enter distances if less than required or if COMMUnity well) SeoticTsnk/Lift StatiomonLot—> 100' 1-71 Yes 50'+ Community Sewer Manhole/Cleanout >1OO' ifNoft Yea if No ft 7,( Yes ifNoft Neighboring Tank >10O' M,/ Yes ifNoft Wells onAdjacent Lots: /A Private Sewer/Septic Line >25'EZ] Yes ifNoft Absorption Field onLot >1OO' MYes ifNo50'+ ft Holding Tank >1O0' MV ifNoft Neighboring Absorption Fields >1OO' ifNoft ifMoft Animal Containment >5O' Yes ifNoft Yes if ifNoft ifNuft |fseptic tank iaunder driveway � Surface VVmter>iOO' 171 Manure/Animal Excretal Stonage> 100' if No Community Sewer Main >�75' ��Yea ifNoft rVJYea ifNoft From Sepbo/Hm|din0Tank cnLot to: (Please enter distances if less than required) Building Foundations >1O' 1-71 Yes if No *54' ft Surface VVabar>107 [lYes if No 501- ft Property Line >5' QYea ifNoft ifNoft Wells onAdjacent Lots: Wells onAdjacent Lots: /A Absorption Field >5' Fvj Yes ifNoft Private Wells > 100' E] Yeo if No 50'f ft Water Main >10' ��Yes ifNoft ifMoft Community Wells >20O' [Z] Yes ifNoft Water Service Line >1O' 0Yea ifNoft ifNuft |fseptic tank iaunder driveway comment below From Absorption Field onLot to: (Please enter distances if less than required) Building Foundation >10' UYea ifNoft ifabsorption field ksunder driveway comment below Property Line >1O' [771Yes ifNoft Wells onAdjacent Lots: /A 13 VVaberW1ein>10' �� Yes ifMoft Private VVe||o>10O' ��Yes ifNo�[�~rft Water Service Line >1O' FqYea ifNuft Community Wells >2OO' Yeo ifNoft Surface VVmter>iOO' 171 Yes if No 50/f ft F.ENGINEER'S COMMENTS *MET CODE 8JTIME (lFINSTALL G. ENGINEER'S CERTIFICATION /certify that / have deteminpdthrough field inspections and mvievv ofMunicipal records that the above systems are /nconformance with MCA CO3A guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 13 #AECC884 08/18/202115:25 8686770 �— ine"11VI abler t NIK, APLUS PAGE 01 NOV 277 3715 P.0011001 tt� ■■■ ■a■■a■ goal a■ss■ma■l■ tt� a■ ■ a ■■ a ■ a a r no ■ �■ a ■ a ■ ta~ ug ■w ■ al■ ■a■ ■ ■ ■a■ long ■ ■i g ■ a■ ■ o ttttm Annul In 3pectlon AnchorageTank PioFMiHYawrav/Track6tl 4 ....--,..`-- 9t/7^2//^354 Jennifer Lomb, no— SrtcAMrdma .,� _..___�-.__-Larry Betts 6436 Southpoi to Ridge Grive, Anchorage AK 99516 -- AX Sfi5 ra N Coun,y ID !� AX -133879 Nnn gSP'I31221 417873 %triav8 OAA In :a Noy flew- — Recirc railo Amer s.ttinp,: This is a =c a inspection P01"form Fields SM tplirtg observations (i5, iVl11sJ pts T87) Odor of Semple — --- - TYplcnt /]N1 Isty L-ERrlhy ❑r4oldy Nen-ryt a+ K-, % IFidr,� C OehbAge [—,, tienrry Cts- film in PVUQ Yeo i Nc Foam bt tank I—)Yes fkN,, Check Control per rsl Rectirr AntAg tAaCNtu•gC Arnpg Audiih: and vKuai t7 rms (CK Did tong (tefa:ttetfy •dy) _]Yter No hnspeoUClem Pum :i System Inspect Ciean Ri4ar/Lid......... ........... i Clean Sprite Box........ (� 7 Intake vent Float Cords Pump ................. . .. clean 7 F Biatuf*'t ttPr........... .... (_ fj BtgtubePu:tapvatt ............. fiocircutatip� ''IN Spfrlter' ..... .' ; c:mmer rmono _ (907) 555 5555 FTI! ME, p M- 4f Lerl Is +Mpactlan RTU127795 08!24/2020 Measure sludgelseum slurtge _ SCum tst0ompttrtrrenk —T ttini f,� �--_ Prcviaus Currertl� 4 Previus 2ndComperiman 'Current Previous Curtvnl Previ6u3 Inspect3Clean AdvariTTer Fitter — ^ Coot y!Nomnof ❑Pungent Eiomcrt; Nnrrnat f_i EXCe.:.3lve ©ridging/Ponoing! None/6rttnor L_1 Excessive lmopecVClean Discharge p'ttntp ` rsterht lnspatt R3er/Lid spliew err, Fiost o6rtls r Inspeevser•vice Other System conv"Jents i}isWeaupn Equipment Inspecf clean Inspeat Clean rte• y, Drrpersat Latemhforifices/ Clhsrrvstlarrs / Additional Service% ganndereti -- -� -�—� �) C#etvtcd textila shftt&? r � Rapi4Cc*d!1'! iterrtS'l Repleced/ttaed othsr hems? PtrtS used: W a Warranty, F3 = 6plahle (✓ aPprbpri�tta scicatiortl W a /ism Numborr veseril twn FinaUSQ" Inopection SY re nstnil�tl 1;40 t,ottetl on 16 Mrynlfotp n?connerfov; flush VfltVL_'y C#osetl C(Irtrol porttN mrrCtivatcy Sur'ttMaryfR uaamn*ndatians i, $Yst" pertorming; nm hrrthr;r action neerlGu F- yrtk'nCe*1s pumpatA n Call tot ItAmAt•,o _ C++* Cate .- Fax COMPlated farm to 1.866-384-7404G In9pecl Clean LetterEWOrificog 7 Pod Bottr -n / ,, (� 7 Intake vent +;J/{� Inspect clean Floats i= (_ Puri)p F Inspeevser•vice Other System conv"Jents i}isWeaupn Equipment Inspecf clean Inspeat Clean rte• y, Drrpersat Latemhforifices/ Clhsrrvstlarrs / Additional Service% ganndereti -- -� -�—� �) C#etvtcd textila shftt&? r � Rapi4Cc*d!1'! iterrtS'l Repleced/ttaed othsr hems? PtrtS used: W a Warranty, F3 = 6plahle (✓ aPprbpri�tta scicatiortl W a /ism Numborr veseril twn FinaUSQ" Inopection SY re nstnil�tl 1;40 t,ottetl on 16 Mrynlfotp n?connerfov; flush VfltVL_'y C#osetl C(Irtrol porttN mrrCtivatcy Sur'ttMaryfR uaamn*ndatians i, $Yst" pertorming; nm hrrthr;r action neerlGu F- yrtk'nCe*1s pumpatA n Call tot ItAmAt•,o _ C++* Cate .- Fax COMPlated farm to 1.866-384-7404G MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE A_,N�DnRE-PAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this ( 7 pay of of 20.el , 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 aW and operate an Advanced Wastewater Treatment System (AWTS),n described as b 60 604A- ini– Ot&4 Q– 7QlVCf i located at (legal description) 2. Maintenance, Repairs and Alterations. caner 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 6Paccordance 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 personae) approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. (42 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) Pagel of3 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. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severabilitv. 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 OWNER: B (signature) P� (print name) STATE OF, 4LAS4Gk-- Wk/ f t�l ss. Date:1`f1 The foregotn nstrume t was ac -nowle ged before me this � day of kj 2�, by .11 _FMy 7Appointment STINTZI NOTARY P FOR AL—� - Public 11 shington My Commis s el�ires: Expires , 2021 MUNICIPALITY: By:R (signature) Date: R& C ea t_.A. f—o LL (print name) Title: (rev. 05/18/2018) Page 3 of 3 Sunned with CamScanner MUNM AUTY OF 0 Development Services Department ` u On -Site Water & Wastewater Section -- Parcel I.D. 020-311-62 Certificate of On -Site Systems Approva 1. GENERAL INFORMATION Complete legal description Southpoint B3 L4 Location (site address) Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 2-- � "_2 r v T� 6436 Southpointe Ridge Dr Current property owner(s) Mailing address Real estate agent Jennifer Lombrano 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well F Private Septic F Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received b Date: _20 10 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ '"1 u' 50 (Covib - l Waiver Fee $ Date of Payment 10/ 3012,O2 -o Date of Payment Receipt Number 0 76 O 5 C-3 Receipt Number COSA # O 5 C 2 01 � b -J 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE Date 2© GC9 Zi� OF 49 TH System #1 Approved for bedrooms ' s �: Pentcnt olT -59'- CE 8149 System #2 Approved for bedroomsgk��nl� Disapproved Conditional approval for bedrooms, with the following stipulations: llll(!!((lfrrr , Y ov� � t� ON . v r� � .ti Y Original Certificate Date: The Municipality of Anchorage Development 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Southpointe B3 L4 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA OR Well log is filed with Onsite (or attached) Date drilled 8120/2013 Total depth 346 ft Cased to 40 ft OR Sanitary seal is functioning correctly X Wires are properly protected Casing height (above ground) V in. Date of flow test for COSA 7!112020 Static water level at beginning of test 60.8 ft. Comments B. TANK DATA Age of tank(s) 7 years Tank type/material 8"""s`"" Measured operating fluid level in septic tank 50" © Standpipes/foundation cleanout per record drawing Date of pumping Advantex D. ABSORPTION FIELD DATA Shallow Trench Which system tested (date installed) 1112013 X ALL standpipes present per record drawing Total measured depth from grade 6.3 ft (max) Measured depth to pipe invert from grade 4.9 ft (min) ❑ N/A — pressurized field X Monitor tubes go to bottom of effective. If not, state depth into effective N Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: DRAINFIELD HAS 30-40% OF LIFE REMAINING COSA Checklist yellow sheet arcei-ffl -_020 311-62 Structure served by this system 1 Well production at time of test 2.5+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No 0 Coliform bacteria is Negative Nitrate 1.79 mg/L ❑ Nitrate less than MRL (ND) Arsenic Llg/L 0 Arsenic less than MRL (ND) Collected by PES Date of Sample 10`2212020 C. LIFT STATION Q Required maintenance completed Age of lift station 7 years Lift station material Steel Comments: See maintenance report Adequacy test date 7/112020 Results 2 Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 607 gal New depth 10 in Elapsed time 140 min Final fluid depth 0 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No 5+ Community Sewer Manhole/Cleanout > 100' Yes if No ft ❑ Yes if No ft Neighboring Tank > 100'✓❑ Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Water Main > 10' 0 Animal Containment > 50' ❑ Yes if No ft ❑✓ Yes if No ft Water Service Line > 10' ✓❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [D Yes if No ft ✓❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5+ ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5'✓❑ ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' f7l Yes if No ft Water Service Line > 10' ✓❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10'✓❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ✓❑ Yes if No ft Community Wells > 200' ❑Q Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I 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. COSA Checklist yellow sheet ` 22�, of q�qs�� 49 Ti -l' Ste yen? P,nnone CE fi'''r 08''24/2020 15: *3 368677Cl "PLUS PAGE ec 376 406 r ®6i mom a1liffumm R 11190M 0I1®OM MM BMW M MR mom M IS FA Im IN IN® r 9� MR ME®E MOOMMORM 0 0 0 0 0 M IRR r , ;0 Field Maintenance Repot g Anchors eTank Annual insp(--- ction 907-272-3543 Propeny CMner/rmcking 8 OpQrntor Jennifer Lombrano Larry Betts Sitc Addma p - - - Curront 1 Float Cord^ ......... .... . .... contpct phone 6436 Southpointe F dge Drive. Anchorage AK 99516 (907)555-5555 AX SRc ID ti County ID Nr4177,873 N FTU r,/UL x Datc or La;t inopocllvn AX -133879 OSP131221 RTU127795 09/11/2019 Retrieve O&M info 0a11y flour Reciru ratio, _ Timer settings; Please Call Will at X07-331-8551 Panel is locked Perform Field Sampli Ig/Observations NTU (15 x NT, Js) PF 6-9) DO (2-£) q, a Odor of Sample Typical MuatyI ❑ Earthy - Moldy Mon -typical i Suifld. ❑ Cabbage ❑f Decay Oily film in PVU [, Yes Foam In E�mk C res ItNo Check Control Paneil Rooijrc Amps Discharge Amps Audible and visual alarr s 00K Dial tone (telemniry on] ! ❑ Yea ❑ No Inspect/Clean Pump; system Inspect Riser/Lid .... _ ..... . Splice Box .......... ......... Curront 1 Float Cord^ ......... .... . .... i Floats .............. ......... ' 1 Pump.............. ......... Previous Siotube^ Filter . . ..... ......... i slotube Pump vault .. ......... _} Recirculating Splitter Va ve....... Clown Comments Signature — - Clean Measure Sludge/Scum Sluder. Srnm ist Compartment Curront 1 roious Current Previous 2nd Compartment Current ProvioVt Current Previous inspect/Clean AdvanTex Filter Odor. Normal ❑ Pungent Biomet: KNono/Wnor Normal ❑ Excn.ssivg Bridging/Ponding: LJ Excessive Inspect/Clean Discharge Pump System inspect RkrrJLld '_) Splice box ❑ Float cords Inspect/Service Other System Components Inspect Clean Inspect Clem Disinf>ction Equipment /77 Dispersal Laterals/Orltica� k" Observations Additional Services Rendered ❑ Cleaned textile Bheets? ❑ Replaced Uv items? ❑ Replaced/Used other Itorrw..? Parts Used: W d Warranty, B = Billable (✓ appropriate selection) W B Item Number Description Final/Safety Inspection fV rvinstailotl Manifold reconnected; flush valves closed sum mary/Flecommendations, ❑ System performing: no further action nesded ❑ Call for service Lids boiled on Control psnel rsacliv�ted ❑ Tank needs pumDino ❑ Other? Fax completed form to 1.866-3a4-7404 inspect Clean LatersIVOrlfIc" Pod Eottom !. I Intake Vent i Inspect Clown Floats Pump (_ ❑ Inspect Clean Inspect Clem Disinf>ction Equipment /77 Dispersal Laterals/Orltica� k" Observations Additional Services Rendered ❑ Cleaned textile Bheets? ❑ Replaced Uv items? ❑ Replaced/Used other Itorrw..? Parts Used: W d Warranty, B = Billable (✓ appropriate selection) W B Item Number Description Final/Safety Inspection fV rvinstailotl Manifold reconnected; flush valves closed sum mary/Flecommendations, ❑ System performing: no further action nesded ❑ Call for service Lids boiled on Control psnel rsacliv�ted ❑ Tank needs pumDino ❑ Other? Fax completed form to 1.866-3a4-7404 MU-NICIPALIT Y OF ANCHORAGE ADVANCED WASTE -WATER TREATMENT S'Y'STEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 23 Day of Q C.I 04&Yr of 20 ZU , by and between uC4h�GVj , 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 all Advanced. Wastewater Treatment System (AWWTS), described as �� ��,� : �U��� (�U��' {%1� j�(9— (�1/ located at (legal description) 2. Maintenance. Repairs and Alterations. (Owner is required to read, understand and initial each section) r IL 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, adjustiment(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 �J or the manufacturer's representative will inspect and snake 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 drainfe d � replacement. (rev. 05/18/2018) Page I of 3 '-V,�1� Owner acknowledges that the Municipality may request records of maintenance and i - J� repairs fi-om the manufacturer's representative or maintenance provider. J Owner acknowledges that the fine for failing to maintain gild 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 1 AWWTS- The N/Tunicipality 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. J) Owner agrees that the AWWTS installation and maintenance requirements as provided J by the AWWTS vendor/installer and approved by the Municipality are the governing Dguidelines 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 7Ylunicipality 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 Lata. 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. SeverabilitSt. 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 Ii ------------- ®NV- -NI✓R• irehIll; D}Z`�C�tG, �t:� �i ':��,-7clme) By: / (signature) Date: /0 t (print name) STATE OF ALASKA ) THIRD JUDICIAL DISTRICT ) ss. The foregoing instrument Nvas acknoNvledged before me thisZ' day of QC jCj�e(- 202U, by_ .()�7 �� CIGi �isr�n =1n�� �Ie n 11 e D,cLc On NOTARY PUBLIC FOR ALASICA My Commission ex Tres: E:M:j 1� �:i�(�i1 �� 2Cz�} MUNICIPALIT (signature) S int name) (rev. 05/18/2018) Date: / -2- r2. r Title: Page 3 of 3 Parcel I.D. 020-311-62 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: - -2 7 -- Complete legal description Southpointe, Block 3, Lot 4 Location (site address) 6436 Southpointe Ridge Drive Anchorage, AK Current Property owner(s) Crown Pointe, Inc. Day phone 229-1886 Mailing address P.O. Box 112313 Anchorage, AK 99511 Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System WaiverNarlance request for Received bv:z Well Four Day phone UBP411Tci-A L IVI`R 1235 2014 TYPE OF WASTEWATER DISPOSAL: Q Individual FX1 ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 6C1.S(D D-'19 CcnA P&v' Waiver Fee $ _ Date of Payment ?JI 'DLS I iii Date of Payment Receipt Number c o: otC,' Receipt Number, COSA# (')SC 14`\�), 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Phone 522-7773 Engineer's Printed Name Michael E. Anderson, P.E. `r- DI. ate 6. DSD SIGNATURE System #1 Approved for bedrooms Y PP — `i System #2 Approved for _bedrooms Disapproved �i y�ry�r4 Conditional approval for bedrooms, with the following stipulations: j/ By: ��u ;'" y r� ZZ" , J G Original Certificate Date: % if The M/ni t of A, ro age Development 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r _, c i 49 6. DSD SIGNATURE System #1 Approved for bedrooms Y PP — `i System #2 Approved for _bedrooms Disapproved �i y�ry�r4 Conditional approval for bedrooms, with the following stipulations: j/ By: ��u ;'" y r� ZZ" , J G Original Certificate Date: % if The M/ni t of A, ro age Development 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r _, c 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: Southpointe, Block 3, Lot 4 A. WELL DATA Well type P If A, B, or C provide PWSID # Date completed 8/20/13 Sanitary seal (YIN) Y Total depth 346 ft. Cased to 40 ft. FROM WELL LOG Parcel ID: 020-311-62 Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 18 in. AT INSPECTION Static water level 41 ft. . Well production 4 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate mg/L Arsenic N/D ug/L Date of sample: 3/20/2014 Collected by: ft. g.p.m. JA B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel/Advantex Date installed 11/18-20/13 Tank size 1,500 gal. Number of Compartments 2 Cleanouts (Y/N) _ Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) Date of pumping New Pumper Construction C. ABSORPTION FIELD DATA Y Y Date installed 11/18/13 Soil rating (g.p.d./fe or ftz/bdrm) 4 GPD/SF System type 5' Wide Length 27 ft. Width 5 ft. Gravel below pipe 1 ft. Total depth 2 ft. Eff, absorption area 155 ft2 Monitoring tube Y Depression over field N Date of adequacy test New Const. Results (Pass/Fail) For_ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (Y/N) in. "Pump off' level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100, On adjacent lots >100, Absorption field on lot > 100' On adjacent lots >100, Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTICIHOLDING TANK ON LOT TO: 5'' Building foundation >51 Property line >5 Absorption field > Water main N/A Water service line >10, Surface water >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation > 10' Water main NIA Water Service line > 10' Surface water > 100' Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that f 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 Michael E. 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