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POTTER HIGHLANDS PH 2 BLK 3 LT 3
Potter Highlands Ph2 Block 3 Lot 3 #020-281-74 Inspection Re _t-1-12.doc 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: 0SPI51126 PID Number: 020-281-74 0 New ❑ Upgrade Name: ABSORPTION FIELD Colony Builders ❑ Deep Trench [Z] Shallow Trench ❑ Bed ❑ Mound Address 16071 Mountain Air Drive Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 4.0GPD/SF 8.9 F1. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.9 Ft, Gravel depth beneath pipe 4.OFt. Subdivision Block Lot Potter Highlands No. 2 3 3 Fill added above original grade 1.5-2 Ft Gravel length 17 Ft. Township Rarge Section Gravel width 5FL Beds: Number of Lines Distance between livres I Ft. SEPARATION DISTANCES To Septic Absorption Holding Se'mr Total absorption area Number of trenches Dist between trenches From Tank Field Uft Station Tank Line 170 Fe One I Ft. Well >100' >100' >100' >75' >25' TANK O Septic ❑ S.T.E.P. ❑ Holding ❑+ Other Manufacturer Advantex/Anchorage Tank/Orenco Capacity I 1,500Gal. Surface Water >100' >100' N/A NIA Material FAP/Fiberglass Number of compartments Two Lot Line >5' >10' N/A NIANA Foundation >5' >10' WA N/A LIFT STATION Manufacturer Capacity Gat. Curtain Drain None I Noted Pump on level at Pump off level atHigh water alarm at Remarks in. in. in. Pump make and model Electrical Inspections performed by MOA PIPE MATERIAL Housetotank D3034 Tankto D3034 dminfieW Installer Red Dog Excavating Drainfield F810 COIMT D3034 Inspector MEA BENCHMARK (Assumed elevation) 100.Oft ins dffieosn 1# 6/13/15 8/13/15 Location and description 2w Back Deck Northeast Comer. 3" 10/20/15 a" COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp ��gatttt, .•'�E OF.. i�q Baa Conditional Approval: Date ��P •� "' +: baa. = ••• P• 49th 1�`S IAICDER50. 4381 2i ••t•C t Approve Approve Date ! �� ��••- Inspection Re _t-1-12.doc oR\�� �n NOS Woeo d to g4/Fg? o g In oc O aC� Z 0 Ew N N \\\ •SS. �' I I I l O l b \ o• N \\\ Q � g m w M m o dl z J o �D F o �g Q(9 M w �aW W r�, M Q ;N; O U zo zo ' w � LO _ W U w Y O' n �yJ�y--j� o ' U j Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 Page 3 of 3 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP151125 PID No. 020-281-74 n 81.1 n n n 79.4 74.5 4-1 Dwinfield Rock il I -I[— 74.5 70.5 IT (Trench Length) 63.4 No Groundwater 5-12-15 PROFILE AS -BUILT Scole: NONE Development Services Department Building Safety Division On -Site Water & Wastewater Program l 4700 Elmore Road r P,O. Box 196650 Anchor Mark Hspich a9e, AK 99507 Mayor vvlww muni.oro/onsite (907) 343.7904 Pump Installation Log Well Drilling Permit Number: SW 11111 Date of Issue: 6120/2011 Parcel Identification Number: 02028150000 Legal Description Property Owner Name & Address: Viasvpoiot Sou3h Tract W Potter Highlands Phase 1, Lot 20 Colony theidera 9420 Vanguard Dr., Unit A Anchorage, AK 99807 Pump Installation Date: 5125118 Pump intake Depth Below Top of Well Casing: 382 feet Pump Manufacturer's Name: Grundfos Pump Model: 10SOE-18.330 Pump Size 1.5 hp Pitless Adapter Burial Depth: NIA feet Pitless Adapter Manufacturer's Name: NIA Pitless Adapter Installer: NIA Well Disinfected Upon Completion? © Yes ❑ No Method of Disinfection: I Comments: Pump Installer Name; Aarow Pump & Well Service, LLC P.O. Box 110495 Anchorage, AK 09511-0495 Please save for your engineer. This is needed for your COSA. Attention: The pump installer shell provide a pump Installation log to the DSD within 30 days of pump installation. 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: OSP151125 Tax Code Number: 02028174000 Work Type: WellSeptic Initial Permit Effective Dates: May 18, 2015 to May 17, 2016 Design Engineer: ANDERSON ENGINEERING Subdivision: POTTER HIGHLANDS PH 2 Site Legal Address: POTTER HIGHLANDS PH 2 BLK 3 LT 3 G:3638 Owner/Address: POTTER CREEK DEVELOPMENT LLC 3230 C ST FIRST FLOOR ANCHORAGE AK 995030000 Site Mailing Address: This permit is for the construction of: Y Disposal Field Y Septic Tank Lot Size in Sq Ft: 76998 Total Bedrooms: 4 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 Municipality of Anchorage Ment S J rL L a '., epartment **** VARIANCEIWAIVER REVIEW **** Waiver#: OSVI51036 COSA#: Permit#:OSPI61126 PID#: 020-281-74 Legal Description: Potter Highlands Phase 2 Block 3 Lot 3 Engineer: Anderson Engineering, Applicant: Colony Builders Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 0.0 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; R The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property." ®'Adjacent properties are not affected by this waiver. Waiver is Granted: X" Waiver is not Granted: Date: g / : / � Approved by: —'�.� Name of Reviewer **** VARIANCEIWAIVER REVIEW **** im MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907 a4 - _ I ON-SITE SEWER/WELL PERMIT APPLICATION BUSH! i Parcel I.D. 020-281-74 ' RUSH! MAY 13 2015 Property owner(s) Colony Builders Day phone 4 Mailing address 9420 Vanguard Drive Anchorage, AK 99507 s e t 11 Site address NHN Potter Valley Road Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Potter Highlands No. 2, Block 3, Lot 3 Legal description (Township, Range & Section) Lot Size 77,014 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field E] Initial 0 Single Family (SF) Q (w/wd ADU) Septic Tank El Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well F Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Trench to Slope Waiver Dis tance: 0 I certify that the above information is correct. 1 further certify that this is in accordance with applicable Municipal Codes. L of property owner or authorized agent) Permit/Rush Fees: 631 , L-( O Waiver Fees: Z I S 6a Date of Payment: 50 3A r, Date of Payment: /I S Receipt Number: X5116 Receipt Number: _ Permit No. dS F I SI 12 S Waiver No. OSV I S 1 O3 Permit App_9-1-12.doc ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX May 13, 2015 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 3, Block 3, Potter Highlands Subdivision No. 2 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 3, Block 3, Potter Highlands Subdivision No. 2 intends to construct a new four-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new septic system to accommodate the home. The attached Site Plan and backup documentation identify the location and configuration of the existing well and septic system along with the alternate site. Also identified on the plans are the existing well on surrounding lots. The subdivision was only recently platted and recorded and this is the first lot to be developed. A well is in place on the lot which was used during the design phase of the subdivision for the aquifer test. It will be utilized to provide water to the new home. A four-bedroom Advantex Treatment System will be placed on the lot in conformance with the subdivision plat notes. No conflicts exist between the proposed septic system and well or septic systems and wells to be developed on adjacent lots. Drainage arrows and ground surface contours are shown on the site plan showing the grade and direction of flow on the lot. The drainage pattern will not be changed as a result of this project. Two test holes were placed on the lot in the area of the absorption trench and alternate site. The logs indicate silty gravel (GM/GP) with sand in the zone specified for the absorption trench. The percolation rate of the soil was determined to be 2-3 minutes per inch. No groundwater was found during the placement of the test holes and none was noted during the monitoring period. An application rate of 4.0 gallons per day per square foot was used in the design of the absorption system. We are proposing to place a new 1,500 -gallon Advantex Treatment Tank and a 15' long by 5' wide by 4' effective depth absorption trench to treat and dispose of the effluent generated in the house. The elevation of the distribution line in the absorption trench will be 6' below the surface and the total depth will be 10' to compensate for the steep slope on the lot. A Lot 3, Block 3, Potter Highlands Subdivision No. 2 May 13, 2015 Page Two minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the absorption trench and 4' over the septic tank. The ground surface on the lot in the area of the septic system slopes to the west at a steep grade. A trench to slope waiver is attached for review and approval. The new trench will be constructed parallel with the contours of the slope as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 100' from all wells and any surface water and 10' the proposed and existing water services in the area. 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, Michael E. Anderson, P.E. Attachments �.°•• 49th MICHAEL E. ANDERSON .. No. CE -4381 •••S �3a• • r0. * z _ (0 n /N:{R m a / Al :� u• OR ocN��Z D o� u ~ v NN 6SS O. N D ao? 5 o_ • m ,� o• o CIO3 •'c � t O0 C') M o ti r ra In m m m y x m poo rnN � I O > n m - �\ m J / co < r .\ - \ n 0 / lu 0ioin� I m n m z o-omac nW 0 \ 1s S O � \ 5,L5ta Il i POTTER HIGHLANDS SUBDIVISION NO. 2 LOT 3, BLOCK 3 DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Perc. Rate: 1-5 Min./Inch Application Rate: 4 GPD/SF 5' Wide Trench System 1,500 Advantex Treatment Tank 4' Drainfield Rock 4 Bedrooms * 150 GPD/Bedroom = 600 SF Absorption Area 600 SF/4 GPD/SF/5 SF (Width) *.5 (Red. Factor)= 15 LF Trench Length THEREFORE: Furnish and Install a Four Bedroom Advantex Treatment System with a 1,500 Gallon Steel Tank. Construct a 15' Long x 5' Wide x 4' Effective Depth Absorption Trench at the Location Shown. Distribution Line to be Placed at 6' Below the Surface. Total Depth of Trench to be 10'. Maintain 100' Separation From All Private Wells and any Surface Water in the Area. Place a Minimum of 4' of Cover Over the Treatment Tank and 3' of Cover Over the Absorption Trench. 5' TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) 4 NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. ■..... Minimum 4' Separation From Groundwater. 0-A Minimum 100' Separation From Private Wells in the Area - Minimum Minimum 100' Separation From Surface Water or Streams: �.`� May 18, 2015 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 3, Block 3, Potter Highlands Subdivision No. 3 Absorption Trench to Slope Waiver Primary and Alternate Sites Dear Onsite Services Engineer: Lot 3, Block 3, Potter Highlands Subdivision No. 2 has steep slopes to the south of the proposed house location. The developer of the lot intends to place a system with gravity flow. We have located an area with acceptable soils, but both the primary and alternate sites must be placed on a slope greater than 25%. The distribution lines in the trenches will be placed as 6' below the surface. The 25% slope when extended from the sidewall of the trenches does not daylight less than 50' from the trench. We are therefore applying for a waiver allowing placement of the primary and alternate absorption trenches at the location shown. The soil encountered in the test holes is silty gravel with sand (GM/GP) which is very good for the absorption of septic effluent. No migration of effluent is expected to occur to the steep slope. Sinnc�ee�rely,0 Michael E. Anderson, P.E. Attachment �0 0 0 0 0 O 0 O o Ur O O W CD O Cil O u O CP O (P Cli -TT O O m N O U) N F— F- 00 - 0O D —i z cA � U) U)frF Tl C c,r) O CT) O CA U) �. o z O n • LSI N rn 0 rn CP b Z :3 ;TIA 0 Itt , \ \ \ 0 0 \ 0 \ D \� o \\ o v -- n \ U U d d 0 0 N \\ 1 \tP N\ MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: POTTER HIGHLANDS #2, LOT 3, BLOCK 3 PERFORMEDFOR: COLONY BUILDERS DATE: 5/5/15 PROJECT No.: PARCEL ID#: TECHNICIAN: W ROBERTS DEPTH TEST HOLE 1 (feet) 1 No OB/OG 2 DEPTH OF WATER AFTER MO 3 4 5 SILTY GRAVEL WITH SAND 6 GM/GP v 10 11 12 13 14 15 16 BOH @ 16' 17 18 19 SLOPE WAS GROUND WATER ENCOUNTERED? No IF YES @ WHAT DEPTH" DEPTH OF WATER AFTER MO DATE OF M 4E° 49th MICHAEL E. ANDERSON MONITORING: NONE O DNITORING: 5/ 12/13 DATE READING GROSS TIME NET TIME DEPTH TO (MINUTES) (MINUTEWATER NET DROP S) (INCHES) (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 515 1 11:45/11:55 10 0.75"/5.50" 4.75" 2 11:56/12:06 10 0.50"/5.25" 4.75" 3 12:07/12:17 10 0.75"/5.50" 4.75" 4 12:18/12:28 10 0.75"/5.50" 4.75" 5 12:29/12:39 10 0.50"/5.25" 4.75" 6 12:40/12:50 10 0.75"/5.50" 4.75" PERCOLATION RATE:2_1 (MIN/INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN: 4 FT. and 5 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: 5/12/15 PERCOLATION RATE:2_1 (MIN/INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN: 4 FT. and 5 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: 5/12/15 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 DEPTH (feet) I- 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 — lo - II 13 14 15 16 17 18 19 I SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: POTTER HIGHLANDS #2, LOT 3 BLOCK 3 PERFORMED FOR: COLONY BUILDERS DATE: 5/5/15 PROJECT No.: PARCEL ID#: TECHNICIAN: W. ROBERTS TEST HOLE 2 OB/OG SILTY GRAVEL WITH SAND GM/GP BOH @ 16' WAS GROUND WATER ENCOUNTERED? No IF YES @ WI{AT DEPTH? DEPTH OF WATER AFTER MO DATE OF MO �• 49th /V IAEA E. ANDERSON NO. CE -4381 Ymfessio�al 26' 32' N[TORMG: NONE O NITORING: 5/12/15 P E DATE READING GROSS TIME NET TIME %EPTETo NET DROP (MINUTES) (MINUTES) (INCHES) (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 5/5 1 11:50/12:00 10 1.13"/5.38" 4.25" 2 12:01/12:11 10 1.25"/5.50" 4.25" 3 12:12/12:22 10 1.25'/5.50^ 4.25" 4 12:23/12:33 10 1.38"/5.88" 4.25" 5 12:34/12:44 10 1.25"/5.50" 4.25" 6 12:55/1:05 10 1.13"/5.38" 4.25" PERCOLATION RATE:24 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 4 FT. and 5 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 5/12/15 PERCOLATION RATE:24 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 4 FT. and 5 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 5/12/15 Alpine Drilling & Enterprises Well Log Permit Number: #SW 111113 Date of Issue: 6720-11 Parcel Identification Number: 02028150000 Date Started: 2-12-12 Date Completed: 2-15-12 Is well located at approved permit location? x Yes ❑ No Legal Description: Viewpoint South Tract A Weil #1 / Potter Highlands Phase 1 Lot 20 Property Owner Name & Address: Potter Creek Development LLC 3801 Centerpolnt Drive Suite 104 Anrhoraap Alaska 99503 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 Thirkness:.250 inches Organics & silt Cobbly silty gravel 2 4 4 58 Diameter: 6 niches Depth: 68 feet Liner Type: Diameter: ! inches Depth: feet sandy silt 58 61 Casing stickup above ground: 2 feet Static water level (from ground level): 101 feet bedrock 61 386 Pumping level: 312 feet after 25 hours pumping 10 gpm Recovery Rate: 3. 0 gpm Method of Testing: pump test Well Intake Opening Type: Open End x Open Hole ❑ Screened Start feet Stopped _ feet ❑Perforations Start_ feet Stopped feet Grout Type: bentonite granules Volume: 2 bgs e h: Start 0 feet Stopped ? fee Pump: Intake Depth 302 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 Permit Number: OSP111113 Tax Code Number: 02028150000 On -Site Water 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 Work Type: Well Initial Permit Effective Dates: June 20, 2011 to June 19, 2012 Design Engineer: Subdivision: VIEWPOINT SOUTH Site Legal Address: VIEWPOINT SOUTH TR A-4 G:3638 Owner/Address: POTTER CREEK DEVELOPMENT LLC 3801 CENTERPOINT DR STE 104 ANCHORAGE AK 995030000 Site Mailing Address: 6520 ENGLAND AVE, Anchorage This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank Lot Size in Sq Ft: 3525267 Total Bedrooms: 1 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. Receivi Issued MUNICIPALITY OF ANCHORAGE Community Development Department t Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D.QZU -Z9'l -SO - 000 Property owner(s) Ldj*- ei>re% ear ~,d- L L. C Day phone 76Z 7-5 7i� Mailing address 3$01 Cett r P;.4 -e lir Sf low% Ak 99sp; Site address Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) MA" A M& SQc-III 7 -/(Al A 1A Lot Size O, 13 cy tef Bq;*r' Number of Bedrooms SA4 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (0 all that apply) Absorption Field ❑ Initial Septic Tank ❑ Upgrade ❑ Holding Tank ❑ Renewal ❑ Privy ❑ Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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. of property owner or authorized a ermi ush Fees: a -DO — Date of Payment: - / _ Receipt Number: 0 Permit No. DZ51P I 1 h 13 �YS-olGr �� 721-63/o Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411.doc (Rev. 1/11) , l , r SLOT 28 LIPT 23 + ,' r,.. -;l 1.5 acres I 1. perq�, LOT 21' If cres it WWW r c LOT 2,9 I i ;ll If 1 l A r= LOT-36 --1 acres - Ifr-+lr+___-- I LOT 21-- 1. 1- 1. 6 acmes •', P40POSED-_ r i i \\PROPOSED n\ WE#3 , _ v ` 57 %� .301 OT 20 WELL#i-- �\ acres f \ , V I 1 I 1 I I r ,•.Ii • +, / I i I II Ir I r ''� =' -- % ••7• I ,ijj _ 1 1 , ` ' ' I i % ,, rr ••••! fl it ,' Limits of Rod `Con.gtruction ' lure '1 /L to 2�1 r+i I X !j I / 1 + ' /f r r/� .11J ', ,` f if 2Nrltr PROPOSED WELL SITES LAND & CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS POTTER HIGHLANDS SUBD. 440 West Benson Boulevard, Suite 200 Phone: 562-5291 SCALE:1"=100' 11= 1 001 Anchorage, Alaska 99503 Fax: 561-6626 MUNICIPALITY OF ANCHORAGE Afte Development Services Department Phone: (907)343-7904 On-Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC261120 Parcel ID 020 -281-74 Expiration Date: 4/29/2027 Legal description POTTER HIGHLANDS PH 2 BLK 3 LT 3 Site address 19296 POTTER HIGHLANDS DR Current property owner(s) ODELL SCOTT & JONI X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments By: ,�%/f,."l Original Certificate Date: 5/21/2026 i This Cet-ificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE -� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-281-74 Complete legal description POTTER HIGHLANDS PH2 BLOCK 3 LOT 3 Location (site address) 19296 POTTER HIGHLANDS DRIVE ANCHORAGE, AK 99516 Current property owner(s) ODELL SCOTT & JONI Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: * Private Well serving # 1 dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑N Fiberglass Age 11 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD:❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ L / Waiver Fee $ Date of Payment ( `�' Date of Payment COSA # 0_9 C_ 7 _ L ii , , Waiver # COSA Application_Apr2025.doc COSA Checklist.docx COSA Checklist Legal Description: POTTER HIGHLANDS PHASE 2 BLOCK 3 LOT 3 Parcel ID: 020-281-74 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 2/15/2012 Total depth 386 ft Cased to 68 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 4/29/26 Static water level at beginning of test 101 ft. Well production at time of test 2.1 gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.411 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 4/29/26 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank *NA Date of pumping 4/29/26 – (Had tank pumped) Required maintenance completed, if AWWTS Comments: Advantex Maintenance - 6/25/2025 C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 10/20/15 ALL standpipes present per record drawing Total measured depth from grade 9.3 ft (max) Measured depth to pipe invert from grade 5.6 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 4/29/26 Results Pass Fluid depth prior to test 10 in Water added 600 gal New fluid depth 30 in Elapsed time 1440 min Final fluid depth 10 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 10 in Effective depth remaining 38 in Comments/Deficiencies: COSA Checklist.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No *50+ ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No *50+ ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *5+ ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No *50+ ft Wells on Adjacent Lots: Wells > 100’ Yes if No *50+ ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below. F. ENGINEER’S COMMENTS *MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATIII/II SEPARATION DISTANCE REQUIREMENTS. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 05/12/2026 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 05/12/26 06{27{2025 07:39Anchorage Tank (FAX)l 907 227 3715 P,0001/0019 512 530 IIID ■■■ 11MM21■ ■■Aa ■ ■■■11■ ■� ■■■ i on on 11 A ■e on ■ 11 ■■■ Moog 1111 ■ *vatrffLwx8 Field Maintenance Report Annual Inspection E ■ Ron 1 a soon r no ■o � AnchorageTank 907-272-3543 Pimpoty Ownerril wking A Operator Scott 00ell Af Home Services Teal Site Address Contact Phone 99296 Potter Highlands Drive, Anchorage AK 99516 307-389-7997 AX Site ID N County ID I Pod rl RTU *AJL # Data of List inSpootion AX -137804 OSP151125 422437 R•T1.1132176 07102/2024 Retrieve O&M Info Daily flow Reclrc ratio_ Timer settings; Perform Field $ampling/Observations NTU (IS x NTUs) phi (8.9) DO (2-6) Curren Previous Odor of SamTMusty Typical ❑ Earthy ❑ Moldy Nan -typical © Sulfide CabTIN? e ❑ Decay Oily film In PVV Elye's Foam in rank ❑ yes No Check Control Panel Il®circAmps Ols, hgr�ge Am` p5 Ul( Audible and visual alarms 6 OK Ciel tome (telQmetry only) [I Yes ❑ No Inspect/Clean Pump System In cot Rlser/Lid ................. ... Splice Box .................... Float cords .... . . . ........ . Floats........ ..... . . a , . Pump........................ BiotubeOl Filter . .. . ............ . Biotubo Pump Vault ............ Recirculating Splitter Valve...... . Comments Clean Measure Sludge/Somm Siedge Scum 1 st Compartment CURT Previous Curren Previous Splice Bax El Pump El E]Ri ❑ grid Ct]mpartment Curr[aQt Previous Current Previous Inspect/Service Other System Components Inspect Clean Inspect Inspect/Clean AdvanTex Filter Inslet CI Odor. v Normal ❑ Pungent LateraWOrifices Blomat: Norma! ❑ ExG969ive Pod Bottom 9ridging/Ponding: Nona/Minor ❑ ExC&ssIV9 Intake Vent - i Inspect/Clean Discharge Pump System Inspect Inspect Clean ser/I..id I7loats C3C Splice Bax El Pump El E]Ri ❑ Float cords —..-- Inspect/Service Other System Components Inspect Clean Inspect Olean Disinfection Equipment ❑ ❑ Dispersal Laterals/Orifices ❑ ❑ Observations AdVionaal Services Rendered Cleaned textile sheets? ❑ Replaced/used other Items? ❑ Roplacod UV itorns? Parts Used: W = Warranty, B = Billable (V� appropriate selection) w 8 Item Number Description Fin /Safety Inspection RSV reinstalled Manifold reconnected; flush valves closed Su�mary/Rocommenda#ions System performing; no further action needed ❑ Call for service , Llds bolted on Control panel reactivated ❑ Tank nerds pumping ❑ Other'? Signature Date L-2 Fax completed form to 1.866-384-7404 OU27{2025 07;40Anchorage Tank (FAX)1 907 227 3715 P,0002l0019 Procedure for winter freeze prevention- At regular intervals, the recirculation pump of an AdvanTex Treatment System sends septic tank effluent into the AX20 filter pori, through a manifold of lateral pipes with holes drilled into the top. An orifice shield is snapped onto the pipe and centered over each hole. During pump run cycles, this aerates the liquid as it is distributed atop the filter fabric sheets that hang beneath. Between pump cycles, water remains inside the lateral pipes and can freeze in severe winter temperatures. This procedure seeks to remedy that by drilling a drain hole in the bottom side in each lateral, at both ends. This ensures the laterals drain completely should the pod be slightly out -of -level, Orifice Shield Remove 1-5 _;.r . ; pp .... , Ste 1. Tum off the controls breaker iinside1h, a pariel j Arid open the-Ax.2a lid. Step 2, RaMoye the orif de;shields at each ncl crf sit five latOral pipes: i Step 3, U..sing ithe. hole p the pipe as a g.uitle drill into it With ano 3118"' bit -down and, through the bot- tom otEarn of.th6 pips. This creates a drain dole. step. 4. lleihsiWl the .orifice shielid0br eaC latefal, center a�g tha.sfiietds ever the i�d&i, While Wre there, onsUre the !ball valves are closed. f Step 5. Tufn can the controls breal�er in the panel, Step 6k Bump! the necire pump with Pe t' 'fe switch ' to inspect yatpr work: if eve irig l'�otcs Stop 7. Close; and secure the ped lid aria a sine I control panel is in operation mode. i s Safety inspection, Site Address: I� � &' L 9"JI'Ji _ Pod lid bolted on? Yes Q No Comment on any damage noticed; Orif ice Shield Remove 6-10 Using existing hole as a guide, drill rs"0 hole through bottom of lateral pipe Reinstall -Orifice Shields over holes Control Panel Activated? f� Yes ❑ No Circuit Breakers: Recirc: dOn [—]Off ,Discharge; [ On ❑Off Controls; 4n ❑Cif, Tec,hniclan Signature TO Cate: Co -1.3" _ Anchorage Tank, 2723 Rampart Drive, Anchorage, AK 29501 907-W2-3543 anchorageta*--cam ATTENTION: Buyers and owners of a property served by an Advanced Wastewater Treatment System (AWWTS) * * TO AVOID SEWAGE BACKUPS* Prior to using the wastewater system, contact the service provider to ensure that regular maintenance is completed. Many of the systems require remote monitoring, the provider will tell you how to provide this capability. Who to contact: • AdvanTex: Anchorage Tank at 907-343-3704 • Quanics Aerocell: Garness Engineering at 907-337-6179 • Biocycle: Biocycle Alaska at 907-274-0314 • BioBarrier: Tim Ecklund at 907-250-0100 • Intermittent Dosing Sand Filter (IDSF): contact MOA onsite 907.343.7904 Please complete the attached document, Advanced Wastewater Treatment System Maintenance and Repair Agreement. When signing this document, you acknowledge that you are required to provide regular maintenance for your AWWTS. MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this ILf Day of of 20,7 (a , by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN ADVANTEX located at (legal description) POTTER HIGHLANDS PH2 BLOCK 3 LOT 3 2. Maintenance. Repairs and Alterations. (Owner is required to read, understand and initial each section) MCS 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. Ajg 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). AV,s Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. &�:S Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page I of #Af Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Att-I Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14,60.030. µtf Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Iv4 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. .GS Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/1812018) Page 2 of OWN ER: 0 (signature) STATE OF At—,A�5" V-tjecT ) Ss THIRD JUDICIAL DISTRICT � name) Datc: 9/1 6 The foregoing instrument was acknowledged before me this 1144ay of 0, by 1A - j:: -VP 47 4L NOTAR PCTI LIC FOR NL-' +-ttlti�A— My Commission exp res, (W TAII 6 .43A U-1 u D �A Dat print name.) Title: (Tcv, 05/18/2018) Page 3 of 3 Municipality of Anc On -Site Water and Wastewater (907)343-7904 H✓ NHI *�, OCT 3 0 201la m Certificate of On -Site Systems Apprd` �s gin Parcel I.D. 020-281-74 Expiration Date:2 S/6• 1. GENERAL INFORMATION Complete legal description Potter Highlands Phase 2, Block 3, Lot 3 Location (site address) 19296 Potter Highlands Drive Anchorage, AK 99516 Current Property owner(s) Colony Builders, Inc. Day phone Mailing address 9420 Vanguard Drive Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: E] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Foul 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well FXI Individual E Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by:I/d/tUdU[LA , COS" to be released to the engineer, unless 'vu COSA Fee $%9 0 v1/00 Date of Payment Receipt Number COSA# OSGt5)�eb5 oy the engineer. Waiver Fee $ Date of Payment Receipt Number Waiver # S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal of fixed.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 Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE Ll_� System #1 Approved for _q_ bedrooms System #2 Approved for _ bedrooms Disapproved Date 10/ �C - r. � VO MICHAEL E. -ANDERSON - GE -4381 Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: `J The Municipality of nchorage Deylopment 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 Septic System Advisory Well Flow Advisory COSAbluesheetr c - Nitrate Advisory Arsenic Advisory Other 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: Potter Highlands Phase 2, Block 3, Lot 3 Parcel to: 020-28 1 -74 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 2-15-12 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 386 ft. Cased to 68 ft. Casing height (above ground) >18" in. FROM WELL LOG AT INSPECTION Date of test 2-15-12 10-27-15 Static water level 107 ft. Well production 3 9 -10 -m - WATER SAMPLE RESULTS: vwr Coliform 0 colonies/100 mL Nitrate • *1-11 mg/L Arsenic ND ug/L Date of sample: 10/21/15 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Fiberglass/Advantex Tank size 1,500 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping New Pumper Construction 100.7 ft 3.8 9-p M. Collected by: MEA Date installed 8/13/15 Cleanouts(Y/N) High water alarm (Y/N) Y Y C. ABSORPTION FIELD DATA Date installed 8/13/15 Soil rating (g.p.d./ft2 orebdrm) 4 GPD/SF System type 5' Wide Length 17 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 10.6 ft. Eff. absorption area L70 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.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons _ "Pump on" level at in. "Pump off' level at Datum Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >1 00' Absorption field on lot >100' Public sewer main >75' Sewer /septic service line >25' Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main >100' Water service line Wells on adjacent lots > 100' Manhole/Access (Y/N) in. High water alarm level at in. _ Meets alarm & circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout >100' Holding tank >75' Manure/animal excrete storage areas >10' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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. Anderson, P.E. Date 10/26/15 COSA brown sheet -1 0-10-1 2.doc >100' Absorption field >5 Surface water >100' Water main >10' Driveway, parkingivehicle storage >10' co c D r m z 0 1� � A O0 m = �Op m c C mz zb � z UD \ UI A G W o N Lto mtoA�v 0 l�/1 4 CO Zmz�onM�z;x O 0 �mmOZ2,0' m= r- 2: Z A A Z 3 D m �zrn0Z mmx 0 o m W Win= m[ �r,c�' � nomm A m O VCm;DmNrnr�� Z A 0 D z O�� m X o M S28�4_ v, Ozg'om(:)Mm � .17 f�r yyN --1 -{ MCO mm:r> O(A s_ �� pita A E: 0 � o v z -+ i m 0 DO O m • ;r O m, O v m �m m N 2S•�� � 7�89g, �t 46.5' 48.P O I x E 1 C) Z v 01 W 0 z 0 > VJ p U)0�i' o W E ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND )60t OC411 MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this Day of 0C+p JjRa/ of 20J5, -by and between SC c t�r Uch, i( , i the "OWNER," and the Municipality of Anchorage, herein the JICIPALITY." In consideration of the mutual covenants contained herein, the ies 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 Advantex Treatment System located at (legal description). Lot 3, Block 3, Potter Highlands Subdivision No. 2 2. Definitions. Alteration. Any change to the design or function of an AW WTS 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 AW WTS that were included in the original design which would allow the A W WTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an A W WTS. 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 AW WTS 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 AW WTS, 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 AW WTS 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 AW WTS service and maintenance provider approved by the municipality and the manufacturer of the AW WTS for the entire term of the A W WTS. 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: (I) 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 AW WTS. 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 AW WTS 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 wil I 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 A W WTS 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 A W WTS installation and maintenance requirements as provided by the AW WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AW WTS. 1. Owner agrees to provide and maintain a telephone connection to the AW WTS as required by the AW WTS approval. 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 ery provision hereof. Amendment. 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. 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: S cott-00-6C 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. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance 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. vncn: 7�L:� l (signature) Date: �G Ey I.25 SCU ff" 00 0( (print name) TE OF ALASKA ) ss. ZD JUDICIAL DISTRICT ) foregoing instrument was acknowledged before me this 1Wdayof Oe&Jd We— �o GNO,i;, NOTARY PUPrLIC FOR ALASKA My Commission expires: J,LH 4,4Dt *fn o OF PSP' lbv L(in !�✓GiGa✓ (signature) Date: 11 S Dab (JQrl6jgS *y (print name) Title: GE