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Home My WebLink AboutPOTTER HIGHLANDS PH 2 BLK 4 LT 1Potter Highlands Ph 2 Block 4 Lot 1 #020-281-80 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: OSP151208 PID Number: 020-281-80 ❑✓ New ❑ Upgrade Name: - Potter Creek Development.LLC ABSORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound Address Potter Highlands Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 6 GPD/SF 6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.5 Ft. Gravel depth beneath pipe - 0.5Ft. Subdivision Block Lot Potter Highlands Phase 2 - 4 1 Fill added above original grade 0 Ft. Gravel length . 25.0 Ft. Township Range Section Gravel width 5.OFt. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1251 Flz N/A Ft. Well 111.9 133.1 111.9 N/A 50+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding [Z] Other Manufacturer Anchorage Tank/ Orenco Capacity 1500GA. Surface Water 100+ 100+ 100+ N/A Material Number of compartments Lot Line 37.0 19.7 37.0 N/A Fiberglass I 2 NA Foundation 5.8 29.6 5.8 N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ 50+ N/A Orenco 500 Gal. RemarksField was oriented to best fit the field conditions Pump on level at 43irr. Pump off level at 40 in. High water alarm at 45 in. at the time of installation. Existing ground elevations were the same across the length of the field. Pump make and model P2005 Electrical Inspections performed by Dependable Services Installer PIPE MATERIAL Housetotank 3034 Tankto drainfield 3034 Hagmeier Homes Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspectionsr dates: 1/20/16 2�d 1/21/16 Location and description Sd 1/21/16 4'" - Bottom Trim NE Corner COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp ` Conditional Approval: Date r ' ... t • .... TH even }#. *Pii' n'orae Approvz2Date f0© 49 ,t ... ispection rt_1-1-12. oc SPECIAL PROVISIONS TO SPECIFICATIONS ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. - 2. SCOPE OF WORK: INSTALLED NEW 1500g ADVANTEX TANK WITH AX20 POD AND SOIL ABSORPTION- SYSTEM. 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 17 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17 FEET BELOW EXISTING GRADE. - 1500g ADVANTEX TANK WITH AX20 POD (P)C2 INSTALL FOUNDATION CLEAN OUT M2 7AND POST -TANK DOUBLE CLEAN OUT Irr T,, LSl i DRIVEWAY APPROXIMATE BOUNDARY OF CLASS 'D' (UNDESIGNATED) WETLANDS j LOT VACANT NO WELLS OR SEPTICS TH-1 > 1 M 4BR/DCO o C1` HOUSE PRIMARY / RESERVE-DRAINFIELD I A 25LF 'x 5'W x 0.5'ED x 6'TD o (E) INSTALL CLEAN OUT AND MONITOR M M \ ¢ p C moi\ AT EACH END S Q 133.1 z LOT 1 �M� a 1\ p 3 i DESIGN PARAMETERS �I WELL (E) PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) -TANK SIZE: Oq ADVANTEX WITH AX20 POD PERC RATE: <1 MPI SOIL RATING`. 6 GPD/SF Z P EP`'� -� AREA ROD: 100 SF ABBREVIATIONS SYS. TYPE: 5'W TRENCH 0.5'ED 2\ TH TEST HOLE MIN LENGTH: 20 LE (P) PROPOSED USED: ssWW W (E) -EXISTING 25 LFx5'WxO.5' E.D., 6.0' TD / CO CLEAN OUT NO. TOTAL AREA: 125 SF - MT- MONITOR TUBE NO. 'Ki_ -TYP TYPICAL NOTES: �� Date PANNONE ENG SVC, LLC -- of A i RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 ��•'' �qsl�+ s/9/tots PHONE (907) 272-8218 FAX (907) 272-8211 �i*�49 Fy*�+ Scale D ...TH .. .... .. P.I.D. NO POTTER HIGHLANDS PHASE 2, BLOCK 4, LOT 1 / ,. -281-80 JOHN HAGMEIER /HAGMEIER HOMES teve R. anno-e/PERMIT No. P� CE 8149 ..�/� POTTER HIGHLANDS DRIVE I �� OSP151208_ PLAN ANCHORAGE, AK 99516 ++11jF0'ORoFESso a'� Sheet __ ��\\\�� 2 OF 3 -17.0' 1 81.9 A-30. 6aev A.P wAr4vL NOTES: �� \� Date RECORD DRAWING PANP.O. BOX 100217 ANCHORAGE, AK99510 .�OF.A�gs/s/2o1s l�) PHONE (907) 272-8218 FAX (907) 272-8211 NTS 1.... . .... ... P.I.D. NO POTTER HIGHLANDS PHASE '2, BLOCK 4, LOT 1 281-80 JOHN HAGMEIER / HAGMEIER HOMES Sieve � annone PERMIT NO. PFc. CE 8149 .'cam% OSP151208 POTTER HIGHLANDS DRIVE DESIGN DETAILS ANCHORAGE, AK 99516F'qP OfESS RSSIONP �� Sheet �� 2OF4 w m m z - ¢o w� - z' 00 0 0 0 0. 0 W w WW O O OPV ¢� L UU U E V FILTER FABRIC TH-1 99.4 AX20 98.9 98.9 OR/ POD4 4" 0 GRAIN PIPE -1.s PT - DRAIN ROCK 6' ABOVE PIPE INV , 95.9 1500g PRE -ASSEMBLED 93 q _ 3.4 .. ADVANTEXTANK 92.9 92'9 BRAIN ROCK. (INSULATED) - TRENCH SEE DESIGN SP/ SM PROFILE -17.0' 1 81.9 A-30. 6aev A.P wAr4vL NOTES: �� \� Date RECORD DRAWING PANP.O. BOX 100217 ANCHORAGE, AK99510 .�OF.A�gs/s/2o1s l�) PHONE (907) 272-8218 FAX (907) 272-8211 NTS 1.... . .... ... P.I.D. NO POTTER HIGHLANDS PHASE '2, BLOCK 4, LOT 1 281-80 JOHN HAGMEIER / HAGMEIER HOMES Sieve � annone PERMIT NO. PFc. CE 8149 .'cam% OSP151208 POTTER HIGHLANDS DRIVE DESIGN DETAILS ANCHORAGE, AK 99516F'qP OfESS RSSIONP �� Sheet �� 2OF4 Alpine Drilling & Enterprises Well Log Permit Number: #SW 1111 I I Date of Issue: 6-20-11 Parcel Identification Number: 02028150000 Date Started: 2-20-12 Date Completed: 2-22-12 Is well located ata ermit location? x Yes E] No Legal Description: Viewpoint South Tract A Well # 3 offer Hi s t 30 Property Owner Name & Address: Potter Creek Development LLC Cur ri 3801 CentetpointOtive Suite 04 r�o �s p�, a g qA Anchorace. Alaska 99503 Borehole Data: Soil Type, Thickness & Water Strata Depth (ft) From To a a Method o riliinro 00 — —� Casing type: steel Stick-up 0 2 Wall Thickness: M inches Organics & silt Cobbly silty gravel 2 5 5 64 Diameter: 6 inches Depth: lfeet Liner Type: Diameter: — inches Depth: _ feet silt 64 65 Casing stickup above ground: 2 feet Static water level (from ground level): 75 feet bedrock 65 326 Pumping level: 286 feet after 24 hours pumping 7.6 gpm Recovery Rate- Z.6 gpm Method of Testing:yum test Well Intake Opening Type: ❑ Open End x Open Hole ❑ Screened Start feet Stopped _ feet WADER CIPALITY TES11NG ElPerforations Start feet Stopped _ feet F. U] C1011100M' Grout Type: bentonite granules Volume: 2V is MWft M91L Ug& Doth, Start'eet 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 Departme„t Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.G. Bax 196650 MefkBegich Anchorage, AK 99807 moydrt wvw.m d_0 /1wite (907) 343.7901 Pump Installation Log Well. Drilling Permit Number: SW 1,+111 Date of l(asue: e2L Parcel Identification Number: 02024150000 towPe an Property Owner Name & Address: !mv paint SauB� Tract A LVel1 #3/ Potter Ighlands 11hasa . a AM Hagmeier Cc - Z204 ��t.2 Z204CtevelandAve,, 5*. 2U1 Potter 0-17Ala�dS Yit�y C7 Andra ege, RK 99617 Top of Well Casing: 312 feet Manufacturer's (tame: GouuB Pump Madel: TSb10422C Pomp Size 3r4 lip Pitless Adapter $axial Depth: NIA fret Pitless Adapter Manufacturer's Name: Mwienaen Pitless Adapter lustaAer. NA Well Disinfected Upon Completion,” (1 Yes [ No Method of Disinfection: cmur;ne tao+ets Comments: Pomp Installer Neme: Avow pump & Well 5eroioe, LLC P.O. Box 110490 Anchoraee,AK 4¢511-0494 Attention: The pump installer shall provide ei ptunp k stallation log to the DSD withh O drys of pomp insWlAon, M On -Site Wastewater Disposal System Permit Permit Number: OSP151208 Tax Code Number: 02028180000 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: Septic Initial Permit Effective Dates: July 10, 2015 to July 09, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: POTTER HIGHLANDS PH 2 Site Legal Address: POTTER HIGHLANDS PH 2 BLK 4 LT 1 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. Total Bedrooms: N Holding Tank N Privy N Private Well N Water All construction must be in accordance with: 48130 fee coo io: 3oI 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. Special Provisions: The well pump installation log and well water quality results shall be approved prior to approval of the septic system inspection report. Received Issued By, r� J C61 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development. Services Division QD Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-281-80 Property owner(s) Potter Creek Development LLC Day phone Mailing address 3230 C Street, First Floor, Anchorage, AK 99503 Site address Potter Highlands Drive Legal description (Sub'd., Block & Lot) Potter Highlands Ph2, Block 4, Lot 1 Legal description (Township, Range & Section) Lot Size 48,130 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (2 all that apply) - - Absorption Field ❑X Initial F Single Family (SF) (w/wo ADU) Septic Tank Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: — I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Pbrmit/Rush Fees: C1 Waiver Fees: Date of Payment: Receipt Number: Permit No. Permit App__- :- K1 Date of Payment: Receipt Number: Waiver No, e ec)l Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer - E-mail: steve(a oaneneak.com January 8, 2016 Subject: Potter Highlands Phase 2, Block 4, Lot 1 Septic System Permit Request Design Narrative This is a design narrative for a permit to install a septic system to be issued for this property. The proposed systems will serve a proposed four (4) bedroom house. Currently the lot is undeveloped. The system utilize a 15008 Advantex tank with one AX20 Pod. This lot and two of the lots to the west already have private wells installed. The remaining lots are undeveloped. There are no wells within 100' of the proposed septic system 1. Soils. One test hole was performed in the vicinity of this system by Pannone Engineering Services in June of 2015, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 17' below the surface in the test hole monitor tube in July of 2015. Bedrock was not encountered in the test hole. Based on the results of the percolation tests and overall soils appearance; an application rate of 6 gallons/day/square was used for a CAT III wastewater system in the area of these test holes. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography slopes from the southeast to the northwest at approximately 5%"in the area of the septic system. There are no steep slopes within 50' of the proposed drain field. The proposed drain.field will maintain 50' separation all steep slopes. S. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding -lots. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. SCOPE OF WORK: INSTALL NEW 1500g ADVANTEX TANK WITH AX20 POD, AUXILIARY PUMP VAULT AND SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 17 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. —APPROXIMATE BOUNDARY - OFID' (UNDESIGNATED) ' O 1 WETLANDS - - LOT VACANT NO WELLS OR SEPTICS TH-1 / <7 � —M _� PRIMARY / RESERVE DRAINFIELD (P) M 25LF x 5'W x 0.5'ED x 6'TD INSTALL CLEAN OUT AND MONITOR TUBE DRIVEWAY BR .AT EACH END HOUSE / \ / M M �- E128.6 1500g ADVANTEX TANK WITH AX20 POD (P) INSTALL FOUNDATION CLEAN OUT - AND POST -TANK DOUBLE CLEAN OUT r M LOT 1;' / �• i IN 'tqNG � i 3 WELL (E) __G DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gPd) TANK SIZE: 1500g ADVANTEX WITH ,4X20 POD PERC RATE: <1 MPI AREA ROD c100 GPD/SF �% i • 5 j�j • j/ ABBREVIATIONS SYS. TYPE: 5'W TRENCH 0.5'ED TH TEST HOLE MIN LENGTH: 20 LF '� /� '(P) PROPOSED USE: ��- W W% (E) EXISTING 25 LFx5'WxO.5' E.D., 6.0' TD - / /� CO - CLEAN OUT NO. TOTAL AREA: -125- ^>`MIT - MONITOR TUBE NO. �� TYP TYPICAL NOTES:Dote PANNONE ENG SVC, LLC —��6 OF A� /2016 CHANGE ORDER P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 A-C�- �y++ Scale - ..#�j 1•._50' .. .. .... P.I.D. NO POTTER HIGHLANDS PHASE 2, BLOCK 4, LOT 1 a20-281-80 •Steven 'f2. anno.ne / PERMIT NO. JOHN HAGMEIER / HAGMEIER HOMES P CE 8149 e� POTTER HIGHLANDS E s:r/ OSP151208 PLAN ANCHORAGE, AK99516�++�11\� O0 ss'' mfr shieoP 2 1 2 3 4 5 6 7 8 9 1a 11 12 13 14 15 16 17 18 19 TEST HOLE 1 OR/PT ORGANICS/ PEAT SPI GRAVELLY SAND SM I WITH SILT SOILS LOG - PERCOLATION TEST SLOPE X TH WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY DEPTH TO WATER AFTER BOH MONITORING? -DRY DATE: - 7/7/15 DATE PERFORMED: 6/24/15 COMMENTS: DRIVEWAY F, \4, / HOUSE \ ' (E) 7 i SLOPE TH X READING DATE CLOCK NET TIME SITE PLAN/ _ 1 6/24/15 12:40 --- 3.15 --- 2 12:44:30 4.5 MIN 9.15 6 / 12:45 c) - �Q LOT NO WELLS --- 4 12:49:45 4.75 MIN 9.15 6 5 12:50 --- 3.15 --- 6 12:54:45 4.75 MIN TH-1 6 0? WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY DEPTH TO WATER AFTER BOH MONITORING? -DRY DATE: - 7/7/15 DATE PERFORMED: 6/24/15 COMMENTS: DRIVEWAY F, \4, / HOUSE \ ' (E) 7 i SLOPE TH X READING DATE CLOCK NET TIME WATERTIME LEVEL READING NET DROP 1 6/24/15 12:40 --- 3.15 --- 2 12:44:30 4.5 MIN 9.15 6 3 12:45 --- 3.15 --- 4 12:49:45 4.75 MIN 9.15 6 5 12:50 --- 3.15 --- 6 12:54:45 4.75 MIN 9.15 6 PEROLATION RATE 0.79 (minfinch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 4 FT AND 5 FT PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PANN7�I7 N N s�� \\\ Date FOR CONSTRUCTION P�19OONE4 �ivANCHORAGE,CK 99LSL0 OF A�'gSl�) 7/9/2015 PHONE (907) 272-8218 FAX (907) 272-8211i0jrp �'y++ Scale POTTER HIGHLANDS PHASE 2, BLOCK 4, LOT JOHN HAGMEIER / HAGMEIER HOMES POTTER HIGHLANDS DRIVE SOILS LOG ANCHORAGE, AK 99516 Steven ,12,'NLr CE 8149 *!/ NTS P.LD. NO 20-281-80 ie PERMIT NO. OSPI51208 Sheet 2 OF 040.002 Client: Pannone Engineering Services Project: Potter Highlands Subdivision, Phase 2, Lot 1, Block 2 Date: June 24, 2015 Crowther Associates Particle Size Distribution Table Sample Source Sieve Size Percent Finer Percent Finer Percent Finer Percent Finer 3 inch 100 1-1/2 inch 97 '/ inch 86 #4 61 #10 46 #40 21 #100 9 #200 6 0.02 mm Classification Gravelly Sand with Silt (SP -SM) 1632 Bellevue Circle /Anchorage, Alaska 99515 Telephone (907) 349-21981E mail: crowther@alaska.net 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 Permit Number: OSP111111 Tax Code Number: 02028150000 Work Type: Well Initial Permit Effective Dates: June 20, 2011 to June 19, 2012 Design Engineer: Subdivision: VIEWPOINTSOUTH Site Legal Address: VIEWPOINT SOUTH TR A-4 G:3638 Owner/Address: Site Mailing Address: POTTER CREEK DEVELOPMENT LLC 3801 CENTERPOINT DR STE 104 ANCHORAGE AK 995030000 6520 ENGLAND AVE, Anchorage This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 3525267 Total Bedrooms: 1 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. Receivf Issued MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. OZO- 297-.-0'006 Property owner(s) 1-1-C Day phone Z6Z - 7-5"70 Mailing address J$16 Site address 6 S2 D Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Wt-l+ivr Sec/�4 7'11A,1 2360 Lot Size 043au-esscFt,— Number of Bedrooms s1r~9 /pa�pseep I.S'acrts� v THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial Absorption Field ❑ Upgrade ❑ Septic Tank ❑ Renewal ❑ Holding Tank ❑ Privy ❑ Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. A7'� (X <��/� , T/q •rna( dYtsr`><t v�� . xrle• `Izy fJu (nature of property owner or authdrized agent) 3c�� 0165'or Zy'O31D rmi ush Fees: A00 �" la Waiver Fees: te of Payment: (e - % -111 Date of Payment: Receipt Number: ) �� Q �� Receipt Number: Permit No. Os1�!� � 1 o Waiver No. GABuilding\On SiteTon \Client Forms\Permit App_010411.doc (Rev. 1/11) LbT28 a/J . , r 1.5 acres / , 17 L'Off` 1�2,/'l ; il� i i ' JL � ,uC��S r'r �`I\ •`t • • I � i ;1 - %l LOT 2,91/ ,t / ' \ t LOT --30 --r5 acres _- r,�1fr+�+ acres ,' i rLOT r l i I i i r I{+lii I �• ' 1. 6 acnes 40PQW$ - to WE4;f,3 'PROPOSED WELL,2 \ ,/ -�`-I- f LOT 20 WELL#i acres r it t � I i I I I I I �� ,/.fi ••� I j i / � / I 1 i ,` :°,��••/,! (l 1' ,` /Limits of R¢od ton:gtruction / J i • r l J , , J r lure ,' ! 1 1 f ,` 1 , ' to 21 FJ • 4 ,7tt iJ� e: /It/ i s i i l` Arm n r h PROPOSED WELL SITES LAND & CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS POTTER HIGHLANDS SUBD. 440 West Benson Boulevard, Suite 200 Phone: 562-5291 SCALE: 1"=100' Anchorage, Alaska 99503 Fox: 561-6626 /( I � /�j� 6 7 8. 9 10 E @ ' Municipality of Anchora k juN i u cUl6 ; A On-Site Water and Wastewater Program- (907) 343-7904 9 A C6 � g i 999 01 6-9 L 9 Certificate of On-Site Systems Approval;, /� Parcel I.D. 020-281-80 Expiration Date: A 1. GENERAL INFORMATION Complete legal description Potter Highlands,, Phase 2, Block 4, Lot 1 Location (site address) Potter Highlands rDrive Potter Creek Development, LLC Current Property owner(s) P � Day phone Mailing address 3230 C Street, First Floor Anchorage, Alaska 99503 Real Estate Agent Day phone -2. TYPE OF DWELLING: [71 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual ❑' Individual Water Storage ❑ Holding Tank Community` Class Well ❑ Community ❑ Public Water System.. ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by. Dater I --v COSA-to be released to the engineer,. unlessotherwise requested. by the engineer.- COSA Fee $ I i • �0 Waiver Fee $ Date of Payment (0_10_1(sl Date of Payment Receipt Number COCKO(I\ Receipt Number COSA#' QSC!' (0 1122. Waiver# 5. STATEMENTOF INSPECTION BY ENGINEER As certifiedrby my Beall,,_ Od"' to,and as of. the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate, of Sites 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 myinvestigation and inspection, the ort -site water supply and/or wastewater disposal systemis(are) in compliance with all applicable Municipal: and State codes, ordinances, and. regulations ineffect 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 systemunder 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 waterusageof the family being served bythe 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. Nalrfe of FirmPannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 06/09/2016 ��', N �>> 6. DSD SIGNATURE • System #1 Approved for bedrooms Steven onnone j System #2 Approved for bedrooms ��`�4 . CE8149 Disapproved{i,R7pF�gS4�� r Conditional approval for bedrooms, with the following stipulations: y �� °'C- Original.Certificate Date: (FJ 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 COSAbluesheet t '- :A c - - - If more than 1 septic system is on the lot: COSA Checkli§t #_of 1 Structure served by this system i Certificate of On -Site Systems Approval Checklist Legal Description: Potter Highlands Phase 2, Block 41 Lott parcel ID:020,281-80 A. WELL -DATA Well typePrivate If A, B, or C provide PWSID#. Well Log (Y/N) Y Date completed 10/13/2015 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 286 fit.. Cased to 46 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 10/13/2015 New Static water level 87 ft. New ft Well production 4` g,p.rn, New - g,p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 1.28• mg/L Arsenic ND ug/L Date of sample: 3/15/2016 Collected by: PES B. SEPTICIHOLDING TANK DATA Tank Type/Material Advantex/Fiberglass Tank size 1,500 gal Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (Y/N) N Date of pumping New Pumper N/A Date installed 1/20/2016 Cleanouts(YIN) Y High water alarm (Y/N) Y_ C. ABSORPTION FIELD DATA 1/21/2016 6 GPD/SF Shallow Trench Date installed Soil rating (g:p:d./ftz orft2 /bdrm} System type Length 25 ft. _ ... Width 5 ft. Gravel below pipe 0.5 ft. Total depth 6 fl. Eff. absorption area 125 ftz Monitoring tube Y Depression over field N Date of adequacy test New Results(Pass/Fail) Pass For 4' -bedrooms Fluid depth in absorption field before test New in. Water added -New gal. New depth-NeW in. Elapsed Time: New min. Final fluid depth New in. Absorption rate >=' 600+ g.p.d, Any rejuvenation treatment (past 12 mo) (YIN & type) NO If yes, give date .. D., . LIFT STATION. 14 J vaL w�'d Date installed 1/20/2016 Size in gallons 500 Manhole/Access (Y/N) Y "Pump`on" l0vel in. "Pump level 40 45 9't,'43 off" at in. High water alarm level at In. Datum Bottom Of Tank Cycles tested New Meets alarm & circuit requirements? Yes 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 75+ Public sewer manhole/cleanout, 1 00+ Sewer /septic service line 25+ Holding tank 10.0+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ 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 10+ Water Service line 10+ Surface water 100+ Driveway, parkingtvehicle storage 5+ Curtain drain 50+ Wells on adjacent 1lots � Q0+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through fieldinspections and review of Municipal records that the above systems are in conformance with MOA C,OSA guidelines: in effect on this date. Engineer's Printed Name Steven Pannone Date 6/10/2016 COSA canary sheet 2-6-15.doc _"1 ■ ■ POTTER 1 11=50' PLAT NO. 2015-10 HIGHLANDS SUBD., LOT 1, BLOCK 4 1.105 ACRES r r aye 0 as "Y' G�EI dR. \ t PHASE 2 I:,,1w a WELL / r / T. & E ESM(. DEVELOPMENT SETBACK H J —• Cf U I L i 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE LAND PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC IT IS THE RESPONSIBILITY OF THE OWNER TO JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, 2000 E. DOWLING RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE. ALASKA 99507 APPS ON THE RECORDED SUBDIVISION PLAT. PHONE 248-W4 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRIDDATE HEREON BE USED FOR CONSTRUCTION OR FOR SW3638 4/28/2016 ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA F.B. JOB NO. 15-05 PHS214 NOTE: NO CORNERS SET THIS DATE BUILDING DETAIL SCALE: 1 "=20' 49TH : 7 ................... efFery A. Gosrolai : o Ls -6 1 gi A .... • . °%sal°nct v°°�& • • • ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BE, MUNICIPALITY OF ANCHORAGE AND OWKJVu,r 1 i+n 17r. Awl3o� De -&rot U THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this n / Day of' of 20� by and between a..r,( L 5c, N- Cdr'ck , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality giants permission to 2. 11CIMMOHB. Owner to utilize and operate an Advanced Wastewater Treatment System (AW WTS), described as located at (legal description). 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 roan -made or natural change in a system that would inhibit the system fiom performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the tern of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AW WTS for the entire term of the AW 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; (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the 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 AWMTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AW 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 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. I. Owner agrees to provide and maintain a telephone connection to the AWWTS as required by the AWWTS approval. 6. Nonwaiver. The failure of either party at anytime to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: CLr, s+op he -r Mc.,..ctrCCaa- . Sr a ,4 Lia Oe Co-, , 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 and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: By: OE_�'—�� (signat re) Date: oQQ l^er L; sy tie Cora (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT } The foregoing instrument was acknowledged before me -this i�— day of AA1.q 201.6 ,by iFlg,pM,,�w�ti�-� L�itr.AU-n`i Li (,IM11'"' U1rrr VV)= 7ALASKA QQQ NOTARY PUBLIC FOR ALASKA NOTARYPUBLIC My Commission expires: oV ONIq FIAmur Umani ) &O"mn : c3loc�! MUNICIPALIT / 3LIly- - GI(L.V w. �✓U (signature) Date: f!� b (print name) Title: