HomeMy WebLinkAboutPOTTER HIGHLANDS PH 1 BLK 1 LT 4Potter
Highlands Ph 1
Block 1
Lot 4
#020-281-56
Municipality of Anchorage
Community Development Department Page 1 of 3
Onsite Water & Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • httpJ/www.muni.orglonsits • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number. OSP151111 PID Number: 020-281-56 0 New ❑ Upgrade
New.
SHAWN &MICHELE O'FALLON
ABSORPTION FIELD
❑ Deep Trench ■ Shallow Trench ❑ Bed ❑ Mound
Andress:
12641 LUPINE ROAD, ANCHORAGE, AK 99516
❑ Other
Phone: No. of Bedroom:
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TOW ewe kacaakkwarka�
(907) 250-0893 4
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LEGAL DESCRIPTION
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POTTER HIGHLANDS PHASE #1 1 4
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SEPARATION
DISTANCES
150
1
To
Septic
Absorpawi
LIE
Holding
PuerdPrkw
Fran
Tank
FNM
Station
Tank
wear Lkea
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wait
too'+
100'+
100'+
25'+
TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑Other
arwlh u
INFILTRATOR TANK
CSPWW.
1060 ce.
Surface water
1004
1001+
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-
Lot Lim
5'+
104
51+
-
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PLASTIC
X
LIFT STATION
Foundation
8+
1&+
51+
-
Curtain Drain
NONE KNOWN
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INFILTRATOR TANK 540 e,.
wear w.r.e
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Remarks: 'THIS IS A CAT III QUANICS AEROCELL SYSTEM
TIMER
TIMER
38'
"2 FEET OF MOA SAND FILTER BELOW TOTAL DEPTH.
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PSE -41T
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MUNICIPALITY OF ANCHORAGE
PIPE MATERIAL
D1785/
House to tank D3034 Tank to D2885
drainfield
Installer
SANDERS &SANDERS
Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd.
BENCH MARK (Assumed elevation)
99.70 R
Inspection
fo°04 mc! °Ntl1p `
Dates: 1St 8/31/2015 2nd 813112015
3rd 8/31/2015 4th 2!1712016
TOP OF MANHOLE
EMM BEAL
Community Development Department Approval
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PERMIT NUMBEK:
080151111
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19.7
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18.7
19.8
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24.1
22.0
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29.4
25.1
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33.0
28.3
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35.2
29.8
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39.6
34.9
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42.5
38.6
MT1
45.1
42.5
CO2
71.7
66.5
RECORD DRAWING
(
PARCEL ID NUMBER
020-281-56
\
\ NEW
\ 4BEDROOM
\ HOUSE
NEW 1060 GALLON SINGLE
COMPARTMENT INFILTRATOR SEPTIC
TANK FOLLOWED BY 610 GALLON
INFILTRATOR PUMP TANK WITH
AEROCELL PUMPICONTROLS.
(MOA CAT IS TREATMENT SYSTEM) -
NEW 850 AEROCELL UNIT WITH
DANDY VALVE BASIN (MOA CAT
RESERVE SITE
(5' BY SO•-150SO.FT.)
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GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
PREPARED FOR: PHONE NUMBER
SHAWN & MICHELE O'FALLON 250-0893
LEGAL DESCRIPTION:
POTTER HIGHLANDS PHASE #1; BLOCK 1, LOT 4
TYPE OF WORK:
� RECORD DRAWING
PAGE NUMBER
20F3
DRAWN BY:
J.L.M.
DATE:
5/18/2016
20
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nSP151111
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PARCEL ID NUMBER:
020-281-56
IM -1060 GALLON SINGLE /
COMPARTMENT INFILTRATOR TANK)
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06/22,2015 21:00 907-345-0202
ALPINE DRILLING
Alpine Drilling & Enterprises
Well Log
PAGE 01/01
Permit Number: #SW 1511 I I Date of Issue, 7-21-15 Parcel Identification Number: 02028156000
Date Started: 10-13-15 Date Completed: 10-13-15 Is well located at approved permit location? x Yes ❑ No
Legal Description: Potter Highlands Ph 1 Block 1 Lot 4
Property Owner Name & Address: 010on Michelle D & Shawn T Alaskan Homecrafters
WATER QUALITY TESTING
Colrtnrrn (\Le9— c011100mL
Nitrates I. M rriglt.
Arsenic N D ug/L
Well Intake Opening Type:
❑ Open End x Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped _. feet
Grout Type: bentonit pules 'Voh: me: lbg
Pump: Intake Depth feet
Pump size hp Brand Name
IIWell Disinfected Upon Completion? x Yes ❑ No `
Method of Disinfection: chlorine tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
PO Box 110496
Anchorage AK 99511
7497 Tyre Drive
Anchorage, Alaska 99502
Borehole Data:
Depth (£t)
Method of Drilling x air rotary ❑ cable tool
Soil Type, Thickness & Water Strata
From To
Casing type: steel
Stick-up
0 1
Wall Thickness: ,250 inches
Gravelly silt
2 29
Diameter: 6 inches Depth: 46 feet
Liner Type
_.29- -----33-_
--i-
T)iameter: inches Depth: -_feet
gravelly silt
33 43
Casing stickup above ground: 2 feet
Static water level (Prom ground level): 87 feet
bedrock 43 286
Pumping level: 286 feet after
se
111,wr. ua . i 4 sin r p r,'. g _ gt
Recovery Rate: 4 gpm
Method of Testing: air Ii
WATER QUALITY TESTING
Colrtnrrn (\Le9— c011100mL
Nitrates I. M rriglt.
Arsenic N D ug/L
Well Intake Opening Type:
❑ Open End x Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped _. feet
Grout Type: bentonit pules 'Voh: me: lbg
Pump: Intake Depth feet
Pump size hp Brand Name
IIWell Disinfected Upon Completion? x Yes ❑ No `
Method of Disinfection: chlorine tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
PO Box 110496
Anchorage AK 99511
Pump IustaBation Date: 2/16/2016
Pump Intake Depth Below Top of Well Casing: 272 feet
Pump Manufacturer's Name: Givndloe
Pump !Model: 16$QE1533a
Pump Size 1 1/2 hp
Pitless Adapter Burial Depth! N/A feet
Pitless Adapter Manufacturer's Name: NIA
Pitless Adapter Installer: N/A
Well Disinfected Upon Completion? W] Yes ❑ No
Method of Disinfection: chlorine tablets
Comments:
Installer Name: Aarow PUMP & Well service, LLC
P.O. Box 110496
Anchorage, AK 99511-0496
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
ID
Received Ti_me'� un, 'J 9.
i
2016 4:53PM No,1374
J
Development Services Department
Building Safety Division
On -Site Water Al Wastewater Program o *og '$`.'e
4700 Elmore Road
P.O. Box 196650 "
Mark Begich
Anchorage, AK 99507 F" `7
Mayor
www.muni.org/onsite
- (907)343-7904 - -
Pump Installation Log
Well Drilling Permit Number: SW 151111 Date of Issue:: 7-21-15
Parcel Identification Number: 02028156000
Legal Description
perty Owner Name &Address;
Potter Highlands Ph 1 Block 1 Lot
ellon Michelle D & Shawn T
rAn
41 Lupine Bond -
-
horage, ak 99516
Pump IustaBation Date: 2/16/2016
Pump Intake Depth Below Top of Well Casing: 272 feet
Pump Manufacturer's Name: Givndloe
Pump !Model: 16$QE1533a
Pump Size 1 1/2 hp
Pitless Adapter Burial Depth! N/A feet
Pitless Adapter Manufacturer's Name: NIA
Pitless Adapter Installer: N/A
Well Disinfected Upon Completion? W] Yes ❑ No
Method of Disinfection: chlorine tablets
Comments:
Installer Name: Aarow PUMP & Well service, LLC
P.O. Box 110496
Anchorage, AK 99511-0496
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
ID
Received Ti_me'� un, 'J 9.
i
2016 4:53PM No,1374
J
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: OSP151111
Tax Code Number: 02028156000
Work Type: Welseptic Initial
Permit Effective Dates: July 21, 2015 to July 20, 2016
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: POTTER HIGHLANDS PH 1
Site Legal Address: POTTER HIGHLANDS PH 1 BLK 1 LT 4 G:3638
Owner/Address: O'FALLON MICHELE D & SHAWN T
12641 LUPINE RD ANCHORAGE AK 995163224
Site Mailing Address: Lot Size in Sq Ft: 80106
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:bZ — (Z I- __ _ - Date: 2 �S
MUNICIPALITY OF
Community Development Department
Development Services
On -Site Water & Wastewater Program
ANCHORAGE
Mayor Dan Sullivan
Phone: 907-343-7904
Fax: 907- 343-7997
On -Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 020— Zgt- 6l*
Property owner(s) ALASKA HOMECRAFTERS LLC
Mailing address 7497 TYRE DRIVE, ANCHORAGE, AK, 99502
Day phone 9D7-349-2454
Site address NHN, GREECE DRIVE, ANCHORAGE, AK, 99516
Legal description (Sub'd, Block & Lot ) POTTER HIGHLANDS PHASE #1;
BLOCK 1, LOT 4
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms
4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DEWELLING:
(®all that apply) Initial ®
Single Family (SF)
Absorption Field ®
❑
(w/wo ADU)
Upgrade
Septic Tank ®
❑
Duplex (D)
❑
Renewal
Holding Tank ❑
Multiple 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.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Date of Payment:
Receipt Number: t 660(Ol G Receipt Number:
Permit No. c5rn t 'St W I Waiver No.
(Rev. 01/11)
GARNESS ENGINEERING GROUP, Ltd
---- CIVIL& ENVIRONMENTAL ENGINEERS
May 4, 2015
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road,
Anchorage, Ak 99507
Ref: Septic Design for Potter Highlands S/D Phase #1; Block 1, Lot 4.
To whom it may concern:
The proposed 4 bedroom house is to be served by a private well and septic system. The platting notes for this
subdivision require that all houses be served by advanced treatment systems. We are proposing to install a
Category III Advantex treatment system consisting of a 1500 gallon S.T.E.P. tank, an Advantex AX -20 treatment
pod, an Orenco pump vault (if necessary), and a shallow drainfield. Design comments are summarized as
follows.
1. SOILS: See the attached Louis A. Butera, P.E. soil log for soils profile, percolation test results and
groundwater readings. GEG, Ltd. checked the testhole on 4/1/2015 and it was found to be dry to a depth of 15
feet. Design specs are based upon the highest listed groundwater reading (10/9/2013) by Steve Eng, P.E.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPHY: The average topography near the drainfield is between 20-25%. There is a drainage swale
installed along the west property line that has slopes of approximately 25%. We do not consider this to be a
cutbank or problematic for the proposed drainfield. The Swale has erosion control fabric and aggregate installed
and is heavily vegetated. Pictures are attached, showing the slopes and drainage improvements. In short, there
are no slope concerns.
5. DRIVEWAY AND HOUSE LOCATION: The drainfield must be installed prior to installation of driveway
and foundation. Driveway and foundation locations must be adjusted, if necessary, to accommodate septic
location.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you
have any questions, please contact meat 337-6179. Thank you for your assistance.
Sincerely,
President
Garness, P.E., M.S.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
I
I POTTER HIGHLANDS SID PHASE 1; BLOCK 1, LOT
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PROPOSED
SEPTIC SYSTEM
(SEE DESIGN,
SEE PAGE 2OF4
1 / POTTER HIGHLANDS SID /
\ PHASE 1; BLOCK 1, LOTS /
/
9 / PROPOSED HOUSE
11 �
1 /
n POSED
SEPTPROIC SYSTEM
PROPOSED j
�
HOUSEAND/ ORNEWAY
/
I /
/ NOTE: NEIGHBORING
I /
I HOUSE, WELL AND SEPTIC
/ LOCATIONS ARE BASED
/ UPON 2014 PANNONE
j
ENGINEERING SERVICES
I / DESIGNS AND PERMITS
I /
I /
I /
I /
I /
I j
I/
V
/
VIEWPOINTSOUTH;
TRACT A-5
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
:PARED FOR:
ALASKA HOMECRAFTERS LLC
I PHONE NUMBER:
907-349-2454
PAGE NUMBER:
1 OF 4
r
DRAWN BY:
POTTER HIGHLANDS S/D PHASE 1; BLOCK 1, LOT 4
J.L.M.
E OF WORK:
DATE: REV
SITE PLAN FOR PROPOSED WELL AND SEPTIC SYSTEM
7/141
1 / POTTER HIGHLANDS SID /
\ PHASE 1; BLOCK 1, LOTS /
/
9 / PROPOSED HOUSE
11 �
1 /
n POSED
SEPTPROIC SYSTEM
PROPOSED j
�
HOUSEAND/ ORNEWAY
/
I /
/ NOTE: NEIGHBORING
I /
I HOUSE, WELL AND SEPTIC
/ LOCATIONS ARE BASED
/ UPON 2014 PANNONE
j
ENGINEERING SERVICES
I / DESIGNS AND PERMITS
I /
I /
I /
I /
I /
I j
I/
V
/
VIEWPOINTSOUTH;
TRACT A-5
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
:PARED FOR:
ALASKA HOMECRAFTERS LLC
I PHONE NUMBER:
907-349-2454
PAGE NUMBER:
1 OF 4
SAL DESCRIPTION:
DRAWN BY:
POTTER HIGHLANDS S/D PHASE 1; BLOCK 1, LOT 4
J.L.M.
E OF WORK:
DATE: REV
SITE PLAN FOR PROPOSED WELL AND SEPTIC SYSTEM
7/141
OF 13EDROOMS:4
PER DAY (GPD): 600
,TION RATEIS: <1 MIN./INCH
ILE APPLICATION RATE: `6.0 GPD/FT'
:D APPLICATION RATE: `4.0 GPD/FT'
DRAINFIELD SOFT.: 150
BY III ADVANCED TREATMENT
UM DEPTH OF EXCAVATION:8 FEET
: 5 FEET
H: 30 FEET
APPROVED SAND FILTER: 2 FEET
TIVE: 0.5 FEET
'TION FACTOR: NIA
L SOFT; 200
GEG, Ltd. HAS AN 8 PAGE SPECIFICATION
LETTER THAT PERTAINS TO THIS DESIGN. TO
OBTAIN A COPY OF THE LETTER CONTACT
GEG. BY PROCEEDING FORWARD WITH THIS
INSTALLATION, THE ENGINEER, WELL DRILLER,
CONTRACTOR AND PROPERTY OWNERAGREE
THAT THEY HAVE READ THESE
SPECIFICATIONS AND AGREE TO ACCEPT THE
TERMS AND CONDITIONS OUTLINED.
NOTE: THE CONTRACTOR
SHALL HAVE THE EAST & WEST
LOT LINES, AND ALL WELL RADII
FLAGGED BY A REGISTERED
LAND SURVEYOR PRIOR TO
CONSTRUCTION.
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PROPOSED 1060 GALLON SINGLE \ \
COMPARTMENT INFILTRATOR SEPTIC
TANK FOLLOWED BY 540 GALLON
INFILTRATOR PUMP TANK WITH
AEROCELL PUMP/CONTROLS.
(MOA CAT III TREATMENT SYSTEM)
PROPOSED 650 AEROCELL
UNIT SIN (MOA AT LVE
III
BASIN (MOA CAT III J/
TREATMENT SYSTEM)
PROPOSED GRAINFIELD /
(SEE DESIGN CRITERIA) J
d PROPOSED4
BEDROOM HOUSE
(SEE GASTALDI PLOT PLAN)
j' RESERVE SITE
(5'BY 30'-150 SQ.FT.)
AT
CO
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
ALASKA HOMECRAFTERS 907-349-2454 2 OF 4
LEGAL DESCRIPTION: DRAWN BY:
POTTER HIGHLANDS S/D PHASE #1; BLOCK 1, LOT 4 J.L.M.
TYPE OF WORK: DATE: REV
DESIGN OF PROPOSED SEPTIC SYSTEM 7/20
DESIGN CRITERIA:
NUMBER OF BEDROOMS:4
GALLONS PER DAY (GPD): BW
PERCOLATION RATEIS: <7 MIN.ANCH
ALLOWABLE
PROPOSED,
MINIMUM DR
'CATEGORY
DRAINFIE
MAXIMUM OF
WIDTH: 5 FE
LENGTH: 38
M.O.A. APPR�
EFFECTIVE:
REDUCTION
ACTUAL SO.1
GARNESS ENGINEERING GROUP, Ltd
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CIVIL & ENVIRONMENTAL ENGINEERS
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PREPARED FOR:
ALASKA HOMECRAFTERS
PHONE NUMBER:
907-349-2454
PAGE NUMBER:
4 OF 4
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LEGAL DESCRIPTION:
POTTER HIGHLANDS S/D PHASE #1; BLOCK 1, LOT
DRAWN BY:
J.L.M.
TYPE OF WORK:
DATE: REVISEDf1,il
, CROSS SECTION DETAIL OF PROPOSED DRAINFIELD
7/14/2015
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907-349-2454
PAGE NUMBER:
3 OF 4
DRAWN BY:
J.L.M.
DATE
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GARNESS ENGINEERING GROUP, Ltd
`.•,',��I�� LEGAL DESCRIPTION:
"'�p�i♦ POTTER HIGHLANDS S/D PHASE 1; BLOCK 1, LOT 4
��♦ TMPE OF WORK
PROFILE OF CAT. III AEROCELL SYSTEM USING INFILTRATOR TANKS
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PREPARED FOR:
ALASKA HOMECRAFTER LLC
PHONE NUMBER:
907-349-2454
PAGE NUMBER:
3 OF 4
DRAWN BY:
J.L.M.
DATE
ISED - 7/14/2015
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
3701E. TUDDRROAD, SUITE IDI'ANGHOMGE,MNSM-PHONE(907)337A179-F (M7)3MJ248-W SITE: w.W.•.ONTe+ BH=�HB�T
LEGAL DESCRIPTION:
PERFORMED FOR: _
POTTER HIGHLANDS SID PHASE 1: BLOCK 1. LOT 4
ALASKA HOMECRAFTERS LLC
TEST HOLE #1
SOIL CLASSIFICATIONS
DATE
....
IIIIIIIII
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TEST HOLE #1
SOIL CLASSIFICATIONS
DEPTH TO
GROUNDWATER
DATE
....
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DATE
DRY
717/2015
DRY
7/8/2015
DRY
7/14/2015
6"
'
7/7/2015
1" = 100
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
7/8/2015 1
6"
'
2
-
<2
0"
61,
3
6"
"
4
-
<2
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6"
5
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7
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8
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9
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6"
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19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 5.5 FT. AND 6.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ONO
SOILS LOGGED BY: JODYMAUS PERCOLATION TEST PERFORMED BY: JODYMAUS
COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH.
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WASP ORM .DIN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: % 0
O i
�,..a�a..a ..,.
_ Municip of Anchorage �' ••,
DEPARTMENT OF HEALTH 6 HUMAN SERVICES 3�—••
825 "L" Street, Anchorage, Alaska 99502-0650 -_17 > Louis A.Butera ggs
• CE 6736
SOILS LOG - PERCOLATION TEST � �♦(�qa ,r c���
- iii ��ateG4fM�a•,r^�5�
.. M:A„4.4L��•
.R FORMED FOR: DATE PERFORMED:_ _(�:e
-GAL DESCRIPTION: Township, Range, Secti0n:
nl —"-1Z 1 SLOPE SITE PLAN
L
4
C
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
6M
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.Sr�cv/ LoRn/ i/e2
WAS GROUND WATER
ENCOUNTERED? /✓lb
IF YES, AT WHAT
OEP 7
C �..
Depth to Wrier Atter
Monitoring] —PRY ove:
Reading Date
Gross
Time
Net
Time
Depth to
Wates
Net
Drop
C K
PERCOLATION RATE (mmulmmchl PERC HOLE DIAMETER 1_
TEST RUN BETWEEN FTAND r FT
JMMENTS
9RFORMED BY; CERTIFY THAT THIS TEST WAS PERFOAMED IN
:CCRDANCE WITH ALLSTATE ANO .MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE- DATE:
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MIINICIPALITY OF ANCHORAGE
Klzrl
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
Day of (t of 2,Q f_j by and between
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 grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AW WTS), described as
located at (legal description).
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
service and maintenance provider approved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. 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 AWWTS.
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 AWWTS
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
AWWTS 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.
S. 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:
1Iature) Date: S �U
,xn uj. \ d c (c(I 19L (print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this day of�CG
2016, by O -W n O' F qct CIA 0\1111111111/
.. KLU G
NO4MMLIC FOR ALASKA = ' NOTARI(
My n expire�� l�� t. cl * ;PUBLIC
MUNICIPALITY:
By: i (signature)
Deb Woe cn Suss (print name)
Date: -71Z &
Title: C
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 020-281-56 Expiration Date: t V
1. GENERAL INFORMATION
Complete legal description POTTER HIGHLANDS PHASE 1: BLOCK 1, LOT
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
GREECE DRIVE, ANCHORAGE, AK 99516
SHAWN & MICHELE OTALLON Day phone 250-0893
12641 LUPINE ROAD, ANCHORAGE, AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
waiverNariance request for. N/A i A
Distance:
Received by: z
Date: L14,11,46
COSA to be released to the engi er, nless otherwise requested
by the engineer.
COSA Fee $ 7 F®
/ /
Date of Payment Lo'/ M!�!
Receipt Number
COSA# (OS�C/6/Z-69'
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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK, 99507
Engineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
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 Municipaliify ofAnchorage and industrypractfces. The reported results describe the
condition of the systemis on the deters of the evaluation. separation distances were measured to madilykienifbable features.
Hidden defects or encroachments may exist that were not identified during the evaluation. The operational fits of alf wells and septic
systems depend o i a variety of variables including, but not limited to, swl conditions, groundwater levels (that may fluctuate during
the year), quality ofoonstmctfon (materials and workmanship), and the water usage of the lamily utilizing the sysfemis. These
conditions can vary, and are outside the conho(of GEG. Safisfactorylesf results do not guarantee future performance of the
sysfemrs; therefore. GEG makes no warranty (express or implied) regarding the folum performance of the wolf or septic system.
GEG makes no representation whether an alternative wetlorseptic system can be installed on the property in the a vent either of the
current systems fail. The content of this report is for the sole benefit of the personiparty who retained GEG. Reliance upon the
information provided in this report by any otherperson orpady, including but not limited to subsequentproperty purchasers, isnot
authorized. In short, GEG disavows any legal duty to anyone other than the persoNpady who paid for this report.
6.DSD SIGNATURE
M
)6— System #1 Approved for V bedrooms.
Phone
337-6179
Date %lZa(tro
Ae CC 68L�
System #2 Approved for bedrooms.
Disapproved. Q�L1TY 0r'A ^
Conditional approval for bedrooms, with the following stipula: s: ON-SITE
tVP,TERh n.
p IArn -- �i i�l rr,
PROD
Original Certificate Date: —
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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.
r,A_SfCfl:luLQW3
COSA Checklist _ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
rR,,,, inf»mi
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 #1; BLOCK 1, LOT 4 Parcel ID: 020-281-56
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 10/13/2015 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES
Total depth 286 ft. Cased to 46 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 10/13/2015
Static water level 87 ft. ft.— --- — -
Well production 4 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. Nitrate 1.21 mg./L. Collected by: GEG, Ltd.
Arsenic: ND ug./L. Date of sample: 5/18/2016
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material PLASTIC (INFILTRATOFO
Tank size 1060/540 gal. Number of Compartments 1/1
Foundation cleanout (Y/N) YES
Date of pumping
NEW
Depression over tank (Y/N) NO
Pumper
C. ABSORPTION FIELD DATA VBELOW EXISTING GRADE
Date installed 8!31/15-2117/16 Soil rating .p.d./rftlbdrm)'•4.0
Length 30 ft. Width 5 ft.
Date installed 8/31/2015
Cleanouts (Y/N) YES
High water alarm (Y/N) YES
System type SHALLOW TRENCH
Gravel below pipe 0.5 ft,
Total depth 8.15-8.65 ft. Eff. absorption area 150 fe Monitoring tube YES Depression over field NO .
Date of adequacy test NEW Results (Pass/Fail) For 4 bedrooms
Fluid depth ih absorption field before test in. Water added =gal. New depth _in.
Elapsed Time: — min. Final fluid depth = in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
"THIS IS A CAT III AEROCELL TREATMENT SYSTEM
D. LIFT STATION
Date installed 8131/15-2/17/15 Size in gallons 540 Manhole/Access (YM) YES
"Pump on" level atTIMER in. "Pump ofP level at TIMER n. High water alarm level at 36 In.
Datum BOTTOM OF TANK Cycles test NEW Meets alarm 84 circuit Fequirements
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot lar+ On adjacent lots 100'+
Absorption field on lot lar+ On adjacent lots 100'+
Public sewer main
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/cleanout 108+
Holding tank
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main
1a+
Wells on adjacent lots 100'+
Water service line lo'+ Surface water 105'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line 10'+ Building foundation 10'+ Water main 10'+
Water service line 101+ Surface water 100'+ Driveway, parking/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guldel/nes in effect on this
date.
Engineer's P;6W Na JEFFREY A. GARNESS
Date
(Rev. 10112/12)
A &cc 8by'
1R
PLAT NO. 2013-113
POTTER HIGHLANDS SUBD., PHASE 1
LOT 4, BLOCK 1
1.839 ACRES
FCf
GASTALDI LAND
SURVEYING, LLC
JEFF A. GASTALDI, R.L.S.
2000 C DOWUNG RD., SUITE 8
ANCHORAGE, ALASKA 99507
PHONE 248-5454
GRID DATE
SW3638 5/16/2016
F.B. JOB N0,
16-01 PHS141
T. do E. ESMT.
BUILDING DETAIL
SCALE: 1 "=20'
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
'PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMEM%
COVENANTS OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE
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