HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 10H LT 28ARcibbit Creek
View & Heights
Block 1OH
Lot 28A
#020 - 571 - 56
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 020-571-56 Expiration Date: J A
1. GENERAL INFORMATION: vieo
Complete legal description RABBIT CREEK& HEIGHTS; BLOCK 10H, LOT 28A
Location (site address) 17015 Jacqueline Circle *Anchorage
Current Property owner(s) Troy Melhase & Dawn Neer — Day phone 301-8751
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
Z Single Family (w/wo, ADU)
❑ Duplex
F71 Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
N
Individual Water Storage
El
Holding Tank
0
Community Class Well
E71
Community
F]
Public Water System
❑
Public Sewer
El
WaiverNariance request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee 0
qDate of Payment _2( 0 _d
Receipt Number oqc[qS C.
COSA # 0 5 � 11 a 0 �
Waiver Fee $
Date of Payment
Receipt Number
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: Gayness Engineerinq 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: _ z
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.
6. DSD SIGNATURE � 1
System #1 Approved for I bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
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Original Certificate Date: r / 1,20:2 T
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 �_ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist
Legal Description: RABBIT CREEK VIEW & HEIGHTS; BLOCK 10H, LOT 28A Parcel ID: 020-571-56
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 7'12J10
Total depth 137 ft
Cased to 124 ft
Fk Sanitary seal is functioning correctly
❑Q Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 4/1/21
Static water level at beginning of test 32.8 ft.
Comments
B. TANK DATA
Age of tank(s) 11 years
Tank type/material STEP/STEEL
Measured operating fluid level in septic tank
49"
A-1 Standpipes/foundation cleanout per record drawing
Date of pumping 2/4/21
Structure served by this system
Well production at time of test 4.6+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes R No
R Coliform bacteria is Negative
Nitrate 1.60 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑Q Arsenic less than MRL (ND)
Collected by GEG, LTD
Date of Sample 4/1/21
C. LIFT STATION
FN Required maintenance completed
Age of lift station 11 years
Lift station material STEEL
Comments:
D. ABSORPTION FIELD DATA IDSF
Which system tested (date installed) 7/9/10
Adequacy test date 4/1/21
W ALL standpipes present per record drawing
Results Q✓ Pass For 4 bedrooms
Total measured depth from grade 5.0 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade ft (min)
Water added 753 gal
❑■ N/A — pressurized field
2
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
120
depth into effective'
Elapsed time min
Q Gode-required soil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NONE
date of test)
Gallons introduced N/A gallons
If yes, enter date N/A
Comments/Deficiencies:
�-' 'MT3 EXTENDS 2.4' BELOW TOP OF THE IDSF SAND. BOTTOM OF MT3 SHOULD BE SAME ELEVATION AS MT1 AND MT2 PER 2010 INSPECTION REPORT, IT IS UNKNOWN WHY THIS
MONITORING TUBE IS NOT SET TO THE ELEVATIONS SHOWN ON THE RECORD DRAWINGS.
COSA Checklist yellow sheet
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'
Q Yes
if No
ft
[7., Yes
if No ft
Neighboring Tank > 100' Q Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100' R Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No 75+ ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' Yes
if No ft
0 Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Q Yes
if No
ft
0 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'
Q Yes if No ft
Property Line > 5'
M Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'
Q Yes if No ft
Water Main > 10'
Q Yes
if No
ft
Community Wells > 200'
0 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' Q✓ 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' Q Yes if No ft Private Wells > 100' Q Yes if No
Water Service Line > 10' R Yes if No ft Community Wells > 200' Yes if No
Surface Water > 100' 0 Yes if No ft
F. ENGINEER'S COMMENTS
*MET CODE AT TIME OF INSTALL **WR#101001
G. ENGINEER'S CERTIFICATION a N
pit
1 certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with Qpm y'
MOA COSA guidelines in effect on this date.
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OSA Checklist yellow sheet0 Professonoo
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ft
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Jeff Garness
From: David Harper <dlharper2@gmail.com>
Sent: Friday, April 9, 2021 6:15 PM
To: Jeff Garness
Subject: 17015 Jacqueline Circle
Jeff, the conduit located on the above well at the above location has been changed and brought up to MOA standards as
of 4-9-21. Thanks
Dave Harper
Aarow Pump & Well Service, LLC
Sent from my iPhone
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REMARKS
Gallons Septic — Leach Area Holding Tank j -Standpipes -- Time
PROSLEM AREA — CALL FOR MORE INFORMATION
NEEDS TO BE DONEAGAIN IN 6 MONTHS VO. -
Good Shape Sludge buildup on bottom
Roat er on top
Jim cap rssiN or
f - Cut standpipe to 1' above ground Needs Septictn
neods replacing
THIS
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MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
CE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
as of this Day of Ar,'1 of 20,,71 , by and between
herein the "OWNER," and the Municipality of
herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
15.65.365. In consideration of the mutual covenants contained herein, the parties to this
agree as follows:
Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
located at (legal description)
A P, P, tT EE k V I F— T 5
Maintenance Repairs and Alterations.
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.
Ov ner 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!1812018) Page I of 3
Owner acknowledges that the Municipality may request records of maintenance and
or maintenance provider.
repairs from the manufacturer's representative p
V 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.
co 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.
Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev 0511812018) Page 2 of 3
OWNER:
By: h RC2
6�KA, �-
(signatur) Date: L! �)v 1
t (�
IL i2 -R N(-4 (print name)
STATEOFA.LA&A t,,,Sj'ttNCa1
) ss.
The foregoing instrument was acknouJledged before me this 2-4 day of
20 2�by N i ca ke o�Y, 'h a n,A A �5 by
f /\
1 L
NOTARY, -IP -9 IC FOR AL-A-SYs\.u0Sv x aTayj
1VIy Commission expires: 0 q��
MUNICIPALITY:
By: (signature)
R�e-c Ca- (�r r o � \ (print name)
SUDIN PAKWAN
NOTARY PUBLIC #20122352
STATE OF WASHINGTON
MY COMMISSION EXPIRES
09-08-24
Date:'{ 26 .2 0 2 1
Title:
(rev. 05/18/2018) Page 3 of 3