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Home My WebLink AboutT12N R3W SEC 15 S2SE4NE4SE4 PTN E228'TI 2N R3W 5E¢ 15 $25E4N PTN EZ28' #015-291-03 Municipality of Anchorage H"__`i` • � On -Site Water and Wastewater Program_ < ` _`�- (907)' 343-7904 s 1 r ¢ T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-291-03 Expiration Date: 1. GENERAL INFORMATION Complete legal description T12N R3W Sec 15 S2 SE4 NE4 S4 Ptn East 228 Location (site address) 5721 E 1041h Ave. Anchorage, AK Current Property owner(s) Sagen H. Juliussen Mailing address Real Estate Agent 5721 E 104th Ave. Anchorage, AK 2. TYPE OF DWELLING: ® 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_ Well ❑ Public Water.System ❑ WaiverNariance request for: Received by: 3 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ `7 Z5UL�Waiver Fee $ Date of Payment o/ip /� d� U Date of Payment Receipt Number Q (0 G Receipt Number COSA # 05 C 2 6 15 Ll 9 Waiver # stance: 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 fifes 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date lelzk 2,, Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may'fluctuate during the year and the water usage of the family being served by the system. 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, - ArcTerra can not give any estimate of how long a system will function satisfactory for current or future -dP-`� occupants or can ArcTerra guarantee that no unseen ,.. OF A encroachments, deficiencies or discrepancies exist. ��,Sy Ile 4WTH 6. ;DSD SIGNATURE IT - 1f -- System #1 Approved for bedrooms.^yETH .s. I FFU9 / :NSC/.G` /r System #2 Approved for. bedrooms. /a }, �o t� r orsssto" •� Disapproved. Conditional approval for bedrooms, with the following stipulations: O�s� a y PRIG C �i�OpMl=torr SG��`,\,\�� By: tom-,, — 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doo COSA Checklist Legal Description: T12NR3W See 15 S2 SE4 NE4 SE4 PTN E22S Parcel ID: 015-291-03 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 1/18/06 Total depth 219 ft Cased to 217.5 ft ❑ Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 46 in. Date of flow test for COSA 10/2/20 Static water level at beginning of test 140 ft. Comments B. TANK DATA Age of tank(s) 15 years Tank type/material Septic/Steel Measured operating fluid level in septic tank lit'tstation IN Standpipes/foundation cleanout per record drawing Date of pumping 9/22/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 12/23/05 ALL standpipes present per record drawing Total measured depth from grade 4.5 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective 01 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: COSA Checklist yellow sheet Well production at time of test 4.9 gpm Water storage tank volume na gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Areterra Consulting Date of Sample 10/2/20 C. LIFT STATION Required maintenance completed Age of lift station 15 years Lift station material Plastic Comments: Adequacy test date 10/2/20 Results Q Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 500 gal New depth 3 in Elapsed time 10 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) ® Yes Septic Tank/Lift Station on Lot > 100' ft Surface Water > 100' Community Sewer Manhole/Cleanout >.100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'0 Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Community Wells > 200' Yes if No ft Animal Containment > 50' ®Yes if No ft ® Yes if No ft comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 1.0' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes, if No ft Water Main > 10' Yes if No ft Community Wells > 200' 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' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 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 yeltow sheet MUNICIPALITY 01, ANCI10RAGE 0 Community Development Department ® 011 -Site Water & Wastewater Program P: 907-343-7904 - F: 907-343-7997 - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org Intermittent Dosing Sand Filter Maintenance Log Street Address 5-72I E /01 PhoneqO E-19 7i0D Legal Desc._E,4K7z2a;'c.-r-5�isz4,lvc-4. -E40gcvi,-;-E�2�1. PID Septic Tank: -Sludge level inches -Pumping: required (yge§ no -Pumping completed IQ no Absorption Field: OAS RC1 -Liquid level nches -Flushing valves per approved design $ =-11) es- �nro -All flushing valves opened, distribution lines flushed, and flushing valves closedvt=. nr) Lift station: -Pump basket cleaned(&s n o -Biotube effluent filter cleaned es no -Timer float setting-?/ inches -High level float setting inches -Reference poin t -4 -Pump on __L'�O seconds -Pump off '_^ 1 1_minutes -Cumulative lifetime cycle -Cumulative run time �3R' hours -Operation satisfactory(-q-e-�s )no Air System: -Air pump filter cleaned(yes) no -Air pressure FS) —psi ,Date of latest install or rebuild aD -Air system operation satisfacto[y not satisfactory Alarm System: -Dedicated electrical circuit (ves� no -Audible and visual alarm inside dwelling jryes�no -Float setting ro inches -Alarm system operation (s:atisfactoj �noJsatisfactory Comments: Maintenance Provider: Technician Company IUS Signature IDSF Mqinttnnqnn- I nn nAniii fqn� Date of maintenance:3"`�I� Dat e_M_ �e_ U i Z11115, Mffi� T141S MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as 01"LlIlS Day of r- of 20' 21I -LL -. by and between Acj- herein the "O'\VNER," 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: ZD Z:� Advaiice(f NV,.istelN,,Itcl-'I'i.eatiiieiit Svstenis. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as IDSF located at (legal description) Z-� T 12Bl\"W See 15 S2SF'4-NTE4SE4 PTN 228' . 572_1YE 104" Ave. Ai)cliorauc 2. iNhiijitemnice, 1�epairsand Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. 'The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. kOwner 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 of Owner aclaiowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. for failing to maintain and repair an AWWTS may be Owner acknowledges that the fine 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 a g ' rees 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. ONNrner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Terra. 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. Amcntlnne.nt. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction; Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 ( signature) l`-� (print name) STATE OF ALASKA ) ss. Date: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this '��( day of 20 ZU, by7�L ,NOTARY PUB I� My Commission expires: MUNICIPALITY: r� UCINDAYANKEY / Notary Public State of Alaska ; ASKA '0-a� , 2-0Zq By (signature) (print name) Date: l 13-Z---? Title: (rev. 05/18/2018) Page 3 of 3