HomeMy WebLinkAboutPOTTER HIGHLANDS PH 2 BLK 3 LT 4Potter
Highlands Ph 2
Block 3
Lot 4
#020-281-75
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: OSP161090 PID Number: 020-281-75 ❑✓ New ❑ Upgrade
Name:
Potter Creek Development LLC
ABSORPTION FIELD
❑ Deep Trench[7] Shallow Trench E] Bed L] Mound
Address
Potter Highlands Drive
I ❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
-
4
4GPD/SF
7 F
LEGAL DESCRIPTION
Depth to pipe invert from original grade
- 3,0 Fl
Gravel depth beneath pipe
4.0 Ft
Subdivision Block Lot
Potter Highlands Phase 2 3 4
Fill added above original grade
0 Ft
Gravel length
20.0 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
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
200 Ft'
1
N/A Ft.
Well "-
103.1
100.8
103.1
N/A
50+
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding D Other
Manufacturer
Anchorage Tank/ Orenco
Capacity
I 1500Ga1,
Surface Water
100+
100+
100+
N/A
Material
Fiberglass
Number of compartments
2
Lot Line
60.6
39.6
60.6
N/A
NA
Foundation
47.9
62.5
47.9
N/A
LIFT STATION
Manufacturer
Orenco
Capacity
500 Gal.
Curtain Drain
50+
50+
50+
N/A
Pump on level at
Pump off level at
High water alarm at
Remarks
43 in.
40 in.
45 in.
Pump make and model
P2005
Electrical Inspections performed by
Dependable Services
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Installer
Hagmeier Homes
Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services
BENCHMARK (Assumed elevation) 100ft
Inspecttiones: 151 11/3!16 11/3/16
Location and description
2�e
Garage FF
3 11/4/16 41"
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
.rte
. O`1
Conditional Approval: Date
...
,� ( QS �1
*_ 49 *,
r•,teven F��I�anriorae�
Approved Date
lams
���� El
Inspection Report _1-1-12.doc
/ PRIMARY / RESERVE DRAINFIELD I Uva
20LF x 5W x 4.0'ED x 7'TD_ \I STH7929
INSTALLED CLEAN OUT ANDMONITOR TUBE
,AT EACH END,��'�,
39 6-
B
4BR ) Q.� ( � /`�� SpA Ad o
LOT 41 HOUSE M1--" I \ C2�
(p) Cl— CM2 M �I
1 T1� �DCO.IZ a_ S
_ LS
'L a Aci
100.8
- FCO / 103-1�_� %
NEW 15009 A X TANK M M ��ly
WITHITH AX AX 20 POD
INSTALLED FOUNDATION CLEAN OUT C�
-AND POST -TANK DOUBLE CLEAN OUT
SEPTIC AREA (E) `� • WELL (E) 3
i
WELL (E) 3
V� ) �h
i
WELL (E)
A
L V - ABBREVI
A
H
T1 66.0
54.0
C2 103.4
75.9
LEGEND h � INS
TH TEST HOLE
W _ WATER LINE/
WELL RADIUS (P) PROPOSED
(E) EXISTING
SS NEW SEPTIC CO CLEAN OUT N0,
MT MONITOR TUBE NO.
TYP TYPICAL
NOTES: PANNONE ENG SVC LLC LC _� " uTDate
n OF A� ll 2 01
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 T
��P'.
PHONE (907) 272-8218 FAX (907) 272-82Scale
11 *
>7vY " Fi P.I.D. NO
POTTER HIGHLANDS PHASE 2, BLOCK 3, LOT 4'. % 020-281-75
POTTER CREEK DEVELOPMENT LLC / Steven 'R' 'annone j PERMIT No.
POTTER VALLEY ROAD �� PF CE 8149 ems/ OSP1e1090
PLAN ANCHORAGE, AK 9916 ���� PROFES aN' S peOF 3
90.0 NEW 1500g ADVANTEX
F.A.P. INSULATED 86.5 86 5 . cM
LORAIN ROCK
PROFILE ate{ -130
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM
NO. BEDROOM: 4(600 gpd)
TANK SIZE: 15009 ADVANTEX
AX20 POD
PERC RATE: 8.1 MPI
SOIL RATING. 4 GPD/SF
AREA ROD: 150 SF
SYS- TYPE- J'W TRENCH 4.O�ED
RIF 0.5C
MIN LENGTH: 15 LF
USED.
20 LFx5'Wx4.0' E.D.. 7.0' TD
TOTAL AREA. 200 SF
80.5
NOTES r
PANNONE ENG SVC LLC _
'
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
�� ���\\�
�..�' �F... �1,,
,/g. ��
/* */
... .. .. ... .:.. /.
/
Steven 'R"Pannone' j
P� . CE 8149
_
�l���K�PPpFES90N��-�
Date
11/17/2016
RECORD DRAWNG
Scale
it
m RIGID INSULATION
POTTER HIGHLANDS PHASE 2, BLOCK 3, LOT
POTTER CREEK DEVELOPMENT LLC
POTTER VALLEY ROAD
ANCHORAGE, AN 99516
o
p - FILTER FABRIC
xo
DESIGN DETAILS
w
wo
0
0
4" m DRAIN PIPE
= v
z
x
ww
p
00
J
U r-ORAN ROCK b"
nBOVE PIPE wv
o
-
pp
TH-929
AX20
I I
Jr
93 5—
oR
90.0 NEW 1500g ADVANTEX
F.A.P. INSULATED 86.5 86 5 . cM
LORAIN ROCK
PROFILE ate{ -130
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM
NO. BEDROOM: 4(600 gpd)
TANK SIZE: 15009 ADVANTEX
AX20 POD
PERC RATE: 8.1 MPI
SOIL RATING. 4 GPD/SF
AREA ROD: 150 SF
SYS- TYPE- J'W TRENCH 4.O�ED
RIF 0.5C
MIN LENGTH: 15 LF
USED.
20 LFx5'Wx4.0' E.D.. 7.0' TD
TOTAL AREA. 200 SF
80.5
NOTES r
PANNONE ENG SVC LLC _
'
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
�� ���\\�
�..�' �F... �1,,
,/g. ��
/* */
... .. .. ... .:.. /.
/
Steven 'R"Pannone' j
P� . CE 8149
_
�l���K�PPpFES90N��-�
Date
11/17/2016
RECORD DRAWNG
Scale
it
POTTER HIGHLANDS PHASE 2, BLOCK 3, LOT
POTTER CREEK DEVELOPMENT LLC
POTTER VALLEY ROAD
ANCHORAGE, AN 99516
0. NO
020-281-75
PERMIT NO.
0SP161090
DESIGN DETAILS
SheetOF 5
Permit Number:
On -Site Wastewater Disposal System Permit
OSP161090
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
Tax Code Number: 02028175000
Work Type: Septic Initial
Permit Effective Dates: May 25, 2016 to May 25, 2017
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: POTTER HIGHLANDS PH 2
Site Legal Address: POTTER HIGHLANDS PH 2 BILK 3 LT 4 G:3638
Owner/Address: POTTER CREEK DEVELOPMENT LLC
2525 C STREET #100 ANCHORAGE AK 995030000
Site Mailing Address: 19260 POTTER HIGHLANDS DR, Anchorage
This permit is for the construction of:
Lot Size in Sq Ft: 64379
Total Bedrooms: 4
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Phone:
Fax:
ON-SITE SEWER/VVILL PERMIT APPLICATION
Parcel I.D. 020-281-75
Property owner(s) Potter Creek Development -LLC Day phone
Mailing address 3230 C St., First Floor, Anchorage, AK 99503
Site address NSN Potter Highlands Drive
Legal description (Sub'd., Block & Lot) Potter Highlands Ph2, Block 3, Lot 4
Legal description (Township, Range & Section)
Lot Size 64,379 Sq. Ft. Number of Bedrooms 4
iAm
MAY 0 2016
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑x
Initial ❑X
Single Family (SF)
❑X
(w/wo ADU)
Septic Tank
Upgrade F-1
Duplex (D)
❑
Holding Tank
❑
Renewal ❑
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.
property owner or authorized agent)
Permit/Rush Fees: 4 50.0%
Date of Payment: 5I41 go
Receipt Number: G)R-BG
Permit No. 0-5 a (all
Permit App_:: :'_. c,
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Pannone Engineering Services uc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve(ftaneneak.com
May 3, 2016
Subject:. Potter Highlands, Phase 2, Block 3, Lot -4
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 system will serve a proposed four (4) bedroom house. Currently the lot is undeveloped, with the
exception of the existing well. The system will utilize a new 1500g advantex tank system. This lot and the
surrounding lots are served by private wells. 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 Louis Butera in October 1999, and
groundwater was monitored for at least seven days. Ground water was not observed to a depth of
13.0' below the surface in the test hole monitor tube in October of 1999 or May 2016. Bedrock was
encountered in the test hole at 13.0'. Based on the results of the percolation tests and overall soils
appearance; an application rate of 4 gallons/day/square was used for a CAT III wastewater system in
the area of these test hole.
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 on the front portion of the lot is nearly flat with a knoll that
the house will sit on in the center of the lot. 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
/ / 1 � WELL (E)
I /
i 500g ADVANTEX TANK WITH 1
ui \
AX20 POD (P).
INSTALL FOUNDATION CLEAN-OUT i
AND POST -TANK DOUBLE CLEAN OUT -
/ r- • L ` m /PRIMARY / RESERVE-DRAINFIELD (P)
r ' 20LF x 5'W x 4.0'ED x 7'TD
t a } o - - INSTALL CLEAN Oh+T AND MONITOR TUBE
)�AT EACH END
ro `
/ �S
fdfTH-929
4BR M M o
�o.J /
HOUSE �. ;o
I DRIVEWAY x
� 1
II , LOf 4152.4 121.5 p
s
41
) ,
SEPTIC AREA (E)`�. j�� . �L (E) \
h
>
X
DESIGN PARAMETERS ,I /
h�
PRIMARY/RESERVE SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)\
TANK SIZE: 1500g ADVANTEX IV,
WELL (E) � Z
AX20
D
PERC RATE: 8.1 MPI � � � ��- W .
'• SOIL RATING: 4 GPD/SF
(AREA ROD: 150 SE LEGEND ABBREVIATIONS
SYS. TYPE: 5'W TRENCH 4.0'ED
RE: 0.50 W WATER LINE/TH TEST HOLE
MIN LENGTH: 15 LF�� WELL RADIUS /(P) PROPOSED
(E) EXISTING
\USE: ',SS NEW SEPTIC CO CLEAN OUT NO.
20 LFx5'Wx4.0' E.D., 7.0' TD \ - MT MONITOR TUBE N0.
TOTAL AREA: 200 SF W TYP _ Y ICAL
IAINOTES: PANNONE ENG SVC, LLC —�aF A ��>, Date
FOR CONSTRUCTION P.O. BOX 100217 -ANCHORAGE, AK 99510 i '(� •• .�q'Ah 5/n/zots
PHONE (907) 272-8218 FAX (907) 272-8211 �y*�/ Sc'le o
... ... .. ... P.I.D_ NO
POTTER HIGHLANDS PHASE 2, BLOCK 3, LOT 4 / 020-281-75
POTTER CREEK DEVELOPMENT LLC /1 Steve R, onn ne/PERMIT No.
CE 8149 OSPI61090
POTTER VALLEY ROAD J
PLAN ANCHORAGE, AK 99516 ���D' "p sheet
r
ll" �011sl = t OF 2
�xxlll`
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 AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: INSTALL NEW ADVANTEX AND SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 13 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 13 FEET
BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE .ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. _
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE. PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE
ENGINEER, THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF
EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE
ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN
DEFECTS BY THE CONTRACTOR. -
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
no
TITLE:
NOTES:ENG `�����\ Date
FOR CONSTRUCTION rp,pVgQXOj010217 ANCHORAGE, CK 99 L0 r'��OFA�'gsli, 5/11/2016
PHONE (907) 272-8218 FAX (907) 272-8211%g�p �y+�1 Scale
NTS
... . ... ... ...... P.I.D. NO
POTTER HIGHLANDS PHASE 2, BLOCK 3, LOT -281-75
POTTER CREEK DEVELOPMENT LLC Steven'R. 'Pannone PERMIT NO.
1 9 CE 8149 .'
POTTER VALLEY ROAD �+ cs .^ OSP161090
DESIGN DETAILS ANCHORAGE, AK 99516til FRpP"OFE"S9'Np Sheet
2 OF 2
it
1'.
is
15
14
15
16
17
18
19
20
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
FOR: �iE'�� /w--yFZcY3tI' L C' DATE
UPTION: —,7;V J Township, Range, Section:
)MMENTS
'73P-4vC- ♦<OVcF�C�N
GM
S/L� SgNOy
/PJ`vy�/ Ti"TI.Sc fiQL�P
?.XML GE�✓� � aG C7P
$p L, jw rf2lpgRfEtl
WAS GROUND WATER
ENCOUNTERED? ND
S
IF YES, AT WHAT - L
DEPTH? 0
P
E
Depth to Water Atter
Monitoring? LW# Date: A0-22-49.
PLAN
Reading
Date
Gross
Time
Net
Time Depth to
Wate��N�
Net
Orop /Nf//
/
✓`
"
/G: 35
PERCOLATION RATE / - Iminutes, inch) PERC HOLE DIAMETER 61,
TEST RUN BETWEEN FT AND FT
RFORMED BY: E/2ZZ> A I — CERTIFY THAT THIS TEST WAS PERFORMED IN
CORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.
Alpine Drilling & Enterprises
Well Log
Permit Number: #SW 111112 Date of Issue: 6-20-11 Parcel Identification Number: 02028150000
Date Started: 2-17-12 Date Completed: 2-18-12 Is well located at approved permit location? x Yes ❑ No
Legal Description: Viewpoint South Tract A Well # 2 / Potter Highlands Phase 1 Lot 21
Property Owner Name & Address: Potter Creek Development LLC
3801 Centerpoint Dave Suite 104
Anchorage: Alaska 99503
Borehole Data:
Depth (ft)
Method of Drilling x air rotary ❑ cable tool
Soil Type, Thickness & Water Strata
From To
Casing type: steel
Stick-up
0 2
Wall Thickness::M inches
Organics & silt
Cobbly silty gravel
2 4
4 66
Diameter: 6 inches Depth: 79 feet
Liner Type:
Diameter: inches Depth: feet
silt
66 69
Casing stickup above ground: 2 feet
Static water level (from ground level): 77.7 feet
bedrock 69 306
Pumping level: 272 feet after
24 hours pumping 71.2 gpm
Recovery Rate: 11.2 gpm
Method of Testing: pummp test
Well Intake Opening Type:
Q Open End x Open Hole
❑ Screened Start feet Stopped _ feet
Q Perforations Start _ feet Stopped feet
Grout Type: bentonitegranules Volume: 2 GPs
Denth: Start -0 feet Sto ? feet
Pump: Intake Depth feet
Pump size hp Brand Name _
Well Disinfected Upon Completion? x Yes ❑ No
Method of Disinfection: chlorine tablets
Comments:
WellDriller: Alpine Drilling & Enterprises
PO Box 110496
Anchorage AK 99511
0 7 / 15, 0 16 0 5, 9 � 5 - 3'? 0 2 ALPINEDRILLIINC:i PAGE 0'2' 02
Development Services Departmen-t
Bufldihq Safety ivision
on-site Water & Wastewater Program
Q'00 Elmore Road
P.O. Box196650
A6dioroge , AK 99507
Mayor EW—WAV-Ti&tC4-/
f907) 343-7904
Pump Installation Log.
") 1
tit I !
Date of Issue- ao, ,� 0 1,
Well Drilliut Pernik 3,117,111her. S
Pareel Identification
I reC-f ��
.-PHter
C) 1/77 —7
Punip bitakz Deptli ROOWTOP of NNell C3SiU9-,;/iZbk feet
Pump Manufacturer's Namet
/; .i"
Pump Mo0 dch fr cJ
Pump Size I by
Fitless Adapter Burial Dept4, "i i!A, .,
f�
Pitless Adapter MawAachirer's Nanle, A,) j
Witless Adapter Installer.
I i
W0110islarctted UpDa cojup!etialt�, C.t Yes L-1 No
I
U*hoA AfTlisinfection:
pomp Installer Name,
Aw�)w Nmp a W61 SCMJI-Ci,'
P.Q. Sol L10496
AK 1-0496
Prqp rt.'V Iner ddress;
A
Attention: The I)wIT illstalW shail pj-,)vjdc a ptimp is',stallation to to flhe D-ol", within 30 da1v
F6MOD
/a
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: OSP111112
Tax Code Number: 02028150000
Work Type: Well Initial
Permit Effective Dates: June 20, 2011 to June 19, 2012
Design Engineer:
Subdivision: VIEWPOINT SOUTH
Site Legal Address: VIEWPOINT SOUTH TR A4 G:3638
Owner/Address: POTTER CREEK DEVELOPMENT LLC
3801 CENTERPOINT DR STE 104 ANCHORAGE AK 995030000
Site Mailing Address: 6520 ENGLAND AVE, Anchorage
This permit is for the construction of:
N Disposal Field N Septic Tank N Holding Tank
Lot Size in Sq Ft: 3525267
Total Bedrooms: 1
N Privy Y Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued
Date: i0/ — Y —(
Date: Cy/T
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. 0 U- ZS I -_0 - 600
Property owner(s) &8 c&e k Deve gw&.�(-� C -LL 5
Day phone 7G Z' 77
Mailing address
Site address 6
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range &
Lot Size q3 ACM SR -ft,
THIS APPLICATION IS FOR:
IS all that apply)
Absorption Field ❑
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well
Water Storage
❑
Number of Bedrooms
THIS APPLICATION IS AN:
Initial
X
Upgrade
❑
Renewal
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
3
P e'
3 last✓✓,L
Svvl Loi Z /�
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.
Trac, . 'ir®wt'4&
(Si nature of property owner or authorzed agent) 3�S 016 d '
?y7-�O?1a
fush Fees: aco —
Receipt Number:
Permit No. P)JP 1 1 11 t a
Waiver Fees: _
Date of Payment:
Receipt Number:.
Waiver No.
G:\Building\Cn SiteTo=s\Client FormsTermit App_010411.doc (Rev. 1/11)
It
+,
1
LOT 28
It '//� Lp1.5`acres
L'O,T 1�2,' ;
It I /' j r /.: /
/ r� 1 1 'r•
LOT 2�9�
11/ i I'[ I"'
11 _ rLOT-30 "1-5 acres
i k5 acres---'
_
I i r LOT 2?---
11 1 i 1+ 1 i. s acres PROPOSED -
I I I+ I 1 I `.
I , #
+I ',PROPOSED 1 a " 57 WE 1 3 ,
WELL#2
I l
1 1 I 'III 1 I , , 1 + `�: ,c• 8Q � ,/ ; ''-=' _
+SOT 20 PRDPQg,6 ; ` nC�.
i I
\ \ L7 acres
\� •, �, , � `, t / mss;.. ,, ,,'
arc 1 ✓� I 1 /.I .. r / /_ ,' i / , �� -�_
r
4 47
1 , I f / r` _..� ••• ! ,r , / ,' , Limits of R¢od iCon..5fruction /
to 2),1 , i � �•,r1 ' -/,fir � ! r / , r r' ' _---� - l! �
I 11 1 I a �/l A; !y '•a-, If � / % r /` /_ _'- l /, 1 1' //
If
r PROPOSED WELL SITES
LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS POTTER HIGHLANDS SUED.
440 West Benson Boulevard, Suite 200 Phone: 562-5291 » ,
Anchorage, Alaska 99503 Fax 561-6626 SCALE: 1=100
OD
NT
0-) CT)
C") �
�I?
O O
0') G)
ca
O
Q
Q
Q
cn
a)
cn
a)
U)
0
O
a)
U
a�
U
M
N
O
N
M
N
iv
0
c
O
.Q
x
W
0
0
0
u /
ti
r
co
N
0
N
0
a�
U
d'
J
cy')
J
m
N
CO_
V
z
Q
w
F-
a_
C:
O
a
U
U
a)
J
LO
M
Q
L
O
L
U
ry
0
CO0
Q
C�
Of
0 -
CD O
Cfl
N
N
a)
0
c�
Un
LL
0
x
0
O
CL
Q
M
C
O
:t -_
c
O
u
E
O
A
M
M.
v
O
O
N
.O
>,
Q
OO
m
CL
m
CL
3
i,
(a
•=
L
Q
R
CL
CO
M
O
E
M
~
~
ca
O
'0
U
L
O
O
O
�O
0
C
N
W
CD •a
N
d0
n
�C
L,
O
._O
Q
>
N
o
a
U
.Np
Q
O
.0
N
LL
cu
N
cn
O
•3
a)
a
.N
z
Q
W
>
C
Q.
'a
O
O
Q
C
CL
N
v
O
E
�
i
m
L
x
0
N
�
O
N
cC
O
C/)
o
CD
�
as
�
N
o
E
Q
z
a-
0
OQ
OL
W
i•
U
O
IL
>
O
O
Q)
O
d
N
O
O
UQ
c
O
Q
Q)
v
N
O
N
o<
L
0)
W
O
-0
M
2
=
U
Q
I- O
(�
N
O
rn
O
:E
N
Q,
Q
a
0
U
ami
00
O
co
U
Q
C-
0 Q
co
O
Q
Q
W
co
J
v
i
C:
O
O
a)
U
N
WA
Z LO
0
Q 00
� N
O�
W N
Z O
T-
L/r
V /
TmT
VJ
J Qj
M
cu
Y O
U �
O U
m
N
N N
a >
CU L
^U C)
L.J..
V/ L
CU
f6 �
L
2 �
L_ O
a_
O O
N
�L N
U �
co
m m
(3)
A
0
CL
O U
U
a)
c
0
OL
co
.�
a)
0
(D
Q
O
a
Q)
A
a)
m
LL
Q
0
U
�
�
7
7
a)
I
y
IL
0)
o
N
—
CO
co
r_
CL
(L)
O
(1)
E
El
.5
0)
E
U
L
N
o
E
3
o
U
C
❑=
Q
�
"C
CV
a
O
c
:E
co
❑�
c.
.>
o
❑
❑
O
O
C
.V
N
4?
D
LL
V
M!)
nn)
IL0)
U)rv'
W
G
O
Ela
O
W
/
m
o
❑
.N d
N
A>
—
CL
2
C
C
m
o
❑■
El
coo
o a
m
N
U
J
❑
a) L
❑
Q
O
j
co
N
U
O
fn M
IL
a
On
o
w
El
CL
co
a)
uo_
El
El
N
a
W
0
Elw
a)
o
Q
N
N
U)
co
0
(D
d
❑
a)a)
W
N v
W
W
H
U)
:
a)
�
1
Q
a)
� R
c
n
W
U.
LL
H-
a
a)
a� m
F-
O
O
U
c_
vi
a
a
i=
O
L
0
H
W
m
>
N
M d
O
Fes-
fn
Q
Q
cu
Q
>
N
M
ui
w
W
m r
a)
m
LL
Q
0
w
Z
CO
FollZ
c_
Z
z
N
O
J
J
o a>
a
O
O
E
c
O
O
}
U
(B
y
n O
C: t-
N
D1
o
CL
❑
d
U
cn
�
�
O
U
N
N
C:
L
O
N
cC.
V)>
O
c
0
a
O
?�
E
�
m
z
aN
d`
c
'a,
O
E
o
O❑
Z
c
o
W0
W
0
0-U)
E
o
U)
~ U
0
N
w
>
U
L
J
cn
-,
L
c6
C:
cu
0
a)O
N( O
I.0
E
O
LL
O. N
a
c
g
0
%u
•n
LO
'(
114'
N
S
0
E
d
>,
Q rn
O
c
o
N
L
N
0
O
N
cn
4—U
Lo
Q
L
O
O
U
Q
'E
U
'D
O
~
N
w
CO
c_
N
O
o a>
a
O
O
U
c
C0
n O
C: t-
N
o
o
CL
:30
d
•� O
�
�
O
U
cnn
L
O
N
Oco
O
cn
O
U
p •�
�O
CN
O OIc
O
O
W
CD
N
c
�_
rn
0
UUcn
d ❑�
o
~ U
0
Of
Z
O
P
H
LL
J
LIE
N
a
U
U
c
ca
c
c
a
c •�
o �
U)
N
d
E
U
a>
v
c
f9
C
N
c
c E
CL
E
CL c
r cr N
aa) E
E
0 U
C
N
N
O
N
(D
c
Mn
U
L
U
a
001
�
C
W
C
N
Oco
O
U
"I
CN
O OIc
c
C
Ui
o O I
c
cu
~ U
CD
I
�
OCU
C
N
a)O
N( O
I.0
O
CO
n I
O. N
a
N
E
N
'(
-o CO
.0
N
0� C-
L
=
Q
0-0U
'II '_O
'D
O
~
N
o
�
cU
0Q
N
�
N
CL
�
Q U
U
U
N
C
N
'S z
(B
C
iZ
N
Q
W
F
W
W
LL
W
w
E
p
N
E
o
Q
c
O
z
Z
C0
E
t0
_0
f`
CONin
C
(A
Q
r_�-
cu
N
N
�O
C
C
(
c
aa) U
E
w
�
m
0
cn
C:
(N
N
r
a)
O
p
O
,�-
O
>
:,
w a
L .
c6
)
~ cn N
C
O
O
E
N
0 0
0 G Q
o c
E
O
w
O
c
Q
°_w
-O
m
o
�cv
�`
Z
N
c
-0W
_oc
>N
• --$
m
o
U) Oo
ccoca
aa�
o)(na�
ao aO
i
.c_a-
N
=N
0
L
t= E .a
a
o a
0
.o
m
y
M
Opp
yo>
p
U
OU
OUi
cn EnZn
E
N
c-
M
O
>
.�J
c
Q v d
Fv
❑
❑o
�
�
d � --cC�
m
�,
>,
"-
o o��
M
o
1:1Q
N
N
O
N
(D
c
Mn
U
L
U
a
(907) 522-7773
Benjamin Schiller, P.E.
To
Page: 2 of 8 2023-09-30 00:01:09 GMT 19073086608
460923
will I a 5 songs Mason own a 8 5 is 6 a a 2 Wo 6
no 5 0 0 0 Mason a IN no MW
am man noun a IN Noun 0 1 max all low 6;
From Wes Anderson
AdvanTexio Field Maintenance Report
AnchorageTank
Annual Inspection 907-272-3543
Mike Newcomer
rtAddress
260 Potter Highlands Drive, Anchor
FT-- 00=b M 4
A 14074 OSPI61090
Retrieve O&M Info
Daily
Recirc
Timer sefthg$;
Perform Field Sampling/Observartitsms,
AK 99516
I Roo rare
424428 RT
Measure Shudge/Scurn
Sludge
Current
I-)
2nd Compartment Current
A* Home services Tech
(907) 250-9345
US,
FT� �15t NTLJs)
PH (6-0)
DO (2-6)
Scum
Inspect
-7
Pungent
Odor of SarNpB
Excessive
Typical i- Musty L'
Earthy 0
moidy
JCkbag-
Non -typical Sulfide (7
— rt�'.Y
ORY film in PVU 77yes
No
Na
Foam In tank L - Yes
No
Check Control Panel
ecurn, Ana; Discharge
Amps
Audible and visual alarms
`.";0K
Dial tons (telemetry only)
Svoq
EINO
InspectlClean Pump System
In Spent
Clean
Riser/Lid ....
I
rloal:0005
Floats ...........
Pump
Satuce- Filter,
Biotube Pump Vault
Redirdulatnut sputter Valve........
I Roo rare
424428 RT
Measure Shudge/Scurn
Sludge
Current
I-)
2nd Compartment Current
A* Home services Tech
(907) 250-9345
U133666
D.v, I L.,A In -P -di -A
09/20!2022
Scum
Inspect
clear)
Pungent
Inspect/Clean AdvanTax Filter
Oder:
Biomat:
Bridging/frionding: one/Minor
Inspectu'Clean Discharge Plural
Inspect
Riser/Lid
Splice Box
Float cards
Inspenctu'Service Other System
Inspect
Disinfection Equipment L-1
observahuns " --41-
Additional Services Rendered
Cleaned textile shears?
i_.) Replaced/Used other items?
parts Usaidt W- Warranty, 0 - BilL
W e Item Number
FinuallSaffaty Inspection
reinstalled
manifold rmonnecbdflush us
Summary/Recommendations
1�- I
,ktlysuna periorming; no further
Call for service
!,el
opmen, IIiPrevious
Inspect
clear)
Pungent
Laterals/Orifices'x-�'
Excessive
I
Pact Bottom
Excessive
Intake Vent
Im
Inspect Clean
Floats
Pump
'amporients
sea Inspect Clean
'N, Dispersal Laterals/Oriftirs
El Replaced UV items?
lo (V appropriate selection)
Description
D'Ilds bolted on
closed "Rcontrat panel reactivated
needed Tank needs pumping
Othed' __—
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
TIES MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of I Z U IAI of 20Zjby and between
erein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65,365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
located at (legal description)
Southfork North Tr D
2. Maintenance, Repairs and 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 S600).
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.
ner acknowledges that regular maintenance of an AWWTS reduces the potential
C T failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
wner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AW WTS may be
assessed in accordance with AMC 14.60.030.
G^wner agrees to grant the Municipality reasonable access to test and inspect the
AW WTS. The Municipality will give at least 24 -how notice.
-7 wrier agrees that any sale or transfer of title of the property will not occur without a new
G .��, _ Certificate of On -Site Systems Approval.
/'o /Owner agrees that the AW WTS installation and maintenance requirements as provided
by the AW WTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AW WTS.
wner agrees to maintain remote monitoring of the AW WTS 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 AW WTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: (sii/gnature) Date:
�O
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this _ day of
20� by
l
NOTARY PUBLIC FOR ALASKA CA Ac�no►i'ervienl
My Commission expires: VV
MUNICIPALITY:
By: (signature) Date:
name) Title:
(rev. 05/18/2018) Page 3 of 3
;
r
A
Q
H
Rl
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of San Mateo
On June l3 .2o2a before me, Carlos Garcia, Notary Public
(insert name and title of the officer)
personally appeared J oP. I V brown e //
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
CARLOS GARCIA
WITNESS my hand and official seal. n Motayvuerc-Ca norma
^ < } - San Mateo County i
Commission p 2175381
/ My Comm. Espires Oct 15, 2025
Signature ��✓�J (Seal)
Title or Type of Document: MvaiiceJ WASfe WcJ-¢C 1re,, Men 1 Syj 1 em
1AWllertatlee oAj Repair "VeerAeA4—
3 � 3/ 5
• Municipality of Anchorage,
On -Site Water and Wastewater Program i� l r 9 20;5
(907)343-7904 la<
Certificate of On -Site Systems Approvals,
Parcel I.D. 020-281-75
1. GENERAL INFORMATION
Complete legal description
Expiration Date: 2 -2--17
Potter Highlands Phase.2, Block 3, Lot 4
Location (site address) 19260 Potter Highlands Dr.
Current Property owner(s) John Hagmeler Homes LLC Day phone
Mailing address
Real Estate Agent
2204 Cleveland St. Ste 201 Anchorage, AK 99517
2. TYPE OF DWELLING:
Fx� Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:.
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 6 Q q6 Waiver Fee $
Date of Payment ll�'p2 Date of Payment
Receipt Numberd T a7 Receipt Number
;
COSA # OIC/6 /rWaiver #
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, ful-66nal 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.
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 system under 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 water usage of the family being served by the 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 sale benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Alk. 99510
Engineer's Printed Name Steven R Pannone
Phone .(907)272-8218
Date 11/23/2016
OF,
6. DSD SIGNATURE j, -
System #1 Approved for bedrooms Steven R. Pannone
System #2 Approved for bedrooms ��9s, CE -8149
Disapproved
Conditional approval for bedrooms, with the following stipulations:
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 engineer's work.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheet � ..,
If more than 1 septic system is on the lot:
COSA Checklist #'of 1
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Potter Highlands Phase 2, Block 3, Lot 4Parcel ID. 020-281-75
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N)`Y
Date completed 2/18/2012 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 306 ft. Cased to 79 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 2/18/2012 !! 6Z66 0 (
Static water level 77'7 ft.
Well,production 11.2- g.p.m.
WATER SAMPLE RESULTS:
Coliform h*colonies/100 mL . Nitrate 1-33 mg/L'
Arsenic VLug/L Date of sample: /I/;LS1.201(e
p1V(ft.
O. C) g.p.m.
Collected by: P >
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Adyantex/Fiberg lass Date installed 11/4/2016
Tank size 1,500 gal. Number of Compartments 2 . Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping New Pumper N/A
C. ABSORPTION FIELD DATA
Date installed 11/3/2016 _ Soil rating (g.p.d./ftz orft2/bdrm) 4 GPD/SF System type. Shallow Trench
Length 20 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 7 ft. Eff. absorption'area 200 fe Monitoring tube "Y Depression over field N
t
Date of adequacy test New ' Results (Pass/Fail) Pa$s 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.
No
Any rejuvenation, treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 11 All 2016 Size in gallons 500 Manhole/Access (Y/N) Y
"Pump on" level at 43 in. "Pump off" level at 40 in. High water alarm level at 45 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 100+.
Sewer /septic service line 25+ Holding tank 100+
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, parking/vehicle storage 1 O+
Curtain drain 50+ 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 COSA guidelines in effect on this date.
Engineer's Printed Name StevenPannone
Date 11/23/2016
COSA canary sheet_2-6-15.doc _ ,
BUILDING DETAIL
SCALE: 1"=20'
GASTALDI LAND
SURVEYING, LLC
JEFF A. GASTALDI, R.LS.
2000 E. DOWLING RD., SURE 8
ANCHORAGE, ALASKA 99507
PHONE 248-5454
GRID
SW3638
F.B.
16-04
DATE
11/9/2016
JOB NO.
PHS243
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY DEPICTED,ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
R IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
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
'o *ssuto
OF A4
r: 49TH :9
.................... ;
•.
..Jeffery A. Gost°Idi o N
' •. LS -6091 of
'�� pl0fessional�°�o��
115-10
SUBD.,
_OCK 3
RES
111=40'
PHASE 2
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNWIPALITY OF ANCHORAGE.
THIS MAINTENA1NCE AND REPAIR AGREEMENT made and entered into as of this
) Day of 1 n�l0 VeMfQ.&1'_ of 20* 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
(AWWTS), described as
2. Definitions.
Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design.
Certificate of On -Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that
the systems are adequate for the homes that they Support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an 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 term of this Maintenance and Repair Agreement, the Owner shall
maintain their AWWTS in a satisfactory condition capable ofproducing treated
septic effluent in accordance with the cquipmenCs 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 AWWTS for the entire term of the AW WrS. 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.
R. Owner agrees to comply with all applicable ordinance, laws, regulations, Hiles
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 tine 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.
H. Owner agrees that the A W WTS installation and maintenance requirements as
provided by the AW WTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction, maintenance and repair of the
Owner's AWWTS.
1. Owner agrees to provide and maintain a telephone connection to the AW WTS as
required by the AW W'fS approval.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof, or the right of such party thereafter to enforce each and
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 terns and
conditions of this agreement, the only authorized representatives of the parties
are:
a. Owner:
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 covet of compelentjurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWN
By./ e0/ Tt7/I f signature) Date:
(print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoi tg instrument was acknowledged before me this3 day of `J.(hA/e VA-
2o� by jCACIAXUne Lohr,
NO"(ARY PUBLIC FOR ALASKA '''� T^�
My Commission expires: y q — 2b2-2b2
MUNICIPALITY: /
By: �t/ (signature)
STATE OF ALASKA w
NOTARY PUBLIC
Tatyana Farkas
Mp Conrrisalon E*W —y-- 2.0
Date: 12'2, -
name) Title:
