HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 8
"
~ DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION
,~ ENVIRONMENTAl. ENGINEERING DIVISION
825 I. Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl_ INSPECTION REPORT
LJ L3PGRADE
~ DISTANCE TO: IWel~t~ ~ Absorptioe~r~.o ' Dwell3--/ P~N~__~
~ ~Z Manufactur~e¢~ Material%~ No. of c~ments
I Liq' ~2t~' "ali°ns~____~ IF HOMEMADE: Inside length Width Liquid depth
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ~ Manufacturer Material Liquid capacity in gallons
~:,- DISTANCE TO: We,~~ Foundatio.?
i l ~j~ No. of lipe~ I ~Lenq~'.°f each liQe,_¢. /¢ To~¢t, of lines Tr~th inches TotaIDistance:~bsorption~tW~en lines
= I - Top of tile t~ finish grade _ ~. / ¢ Material beneath tile
area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MAT~IA LS
A ~ ~ DATE .LEGAL
72-013 IRev. 3/7 ~)
L OC:F:~T ]: F' h,i
L El:":: F;:. L t._ :.E':E;3 NOF::THHCiOE:,
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GF?.OL!HE:, FIHE:, THE: E',O'i"TOH Ol::' T.HE~: E::-:;CR'v'F!T:[Ohl ,::]:N FEET).
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'T'HE GF~:F:!',,,'EEL. £)E:F"FH l L:.; "FHE H :',.' !'-,l I HUH DEP"f'H OF' GRFI',/EL. E:E:'T'P.IEEN THE C.~UTF:'RL.L F'i F'E
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TH[:',.'T THE
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..........................i c:iFi. .FFF'T ........ F'OFi: lq F:'F~::[',,,'F!T.(E HEL..L O~:.-:: -1 F;~T1 TI'"i :;;::i:19 F'E.~:,., F~'"r't ,~::~, F'UiF.$L.~'"',... !,!f:'i ...... ".c.~:-'*,:., ~:. ,,r",r' -' ....
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.h!):N]:,~'il:JH t:::'Z~STFINE:E: FI:;;:OH Fi F'[;:i',/Ff'I:'E {.,.il:;( ..... TEl F! F'F:'.']:VR'T'E :~:':E!,.IEi~: L 'J'HE' ]:5 ;25 [:'F_'I.~:T Fi.ND
T'" R CFmli'.!f!ht'rT'¢ c" iF'?, L..:[HE ID; 75 FEET.
- TF.I..'F:'[q' .............................. i:4:I:.'.~:L.qLiZ.r.;;:EHE,KF['~5 HFCT' FtF'F!._'.r'. ': F'E'- TF"!' '",~:'T'T '" '-?~ F!i'.,tE:, CF'~Ki:E;T,C-':'I Ir":T T F$,i ~..~' "'"..h .a ........ :h,' ,:::" .FF;'E: .....
..q'-.,'~ ij ._RE LtE 't ...... r .',!':_:;L Ri.::: F'Fb:)F'ER :[ F,?}.'i;'TF!LL..FI".f' Z EIN.
:[ C:EF:'T).' F'~" TH. FIT
'J.: Z F~i"J F'RH:[L.:[F!F: H:[TH 'T'HE REQL.IZF:EHENT:5 FOR ON-...SZTE 5EF!E.r.~:S FINE:, i.,iELL. E; RS 'SET
F'OF:TH E',? "FHE HLiI'-.!:£C:!:F'F!L.:[T"/ OF F:INCF'!OF:FI(.:ilE.
2: ]: I,.!..T.L.L. ZN'_:?FF!L.L THE :5'¢.':STEH :IN FIC:COFt['.:'FiNCE H:[TH THE
:l:: :[ I..t?,i[){:Ji[;.:ST[:!?,![) 'TH,¢::I'.T TPI,;.E: !.3N-'-f.~i;'[T[~: SE!.,][.:.".~? ':'.:;'.?":~;"rE'i',l i'"lF¢-r' i:;?F'f:)tlZ~)i;:
Dale Greiner
Lugene Lane
Eagle River, AK
January 4, 1982
99577
825 "L" STHEET
,~NCHOR/',,GE ALASI<A99501
(907) 264 4't 11
(;FORGE M. SULLIVA]V,
Permit ~ 811150
Subject: L 8 Blk 3 Northwood
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Sewer and Water Program
Enclosure: Copy of Permit
F'EF:~:i I 'F NO.
· 'qPPJ ]' 'J' F. NT
L C F.' FiT I ON
LEGF~L
E:,E::F'F:IFNi'MENT ' HEF¢_TH RN[:> E'NV__, RONHENTFIL ':[:OTECTION
~ ": T' E; i ::2E
HF!F','iMUM I',,!U?E~ER 3F' EEr':,I:?OOM'E; = 2.1:
/'Vuo
:501 ' RFFF i NG ,-',: c
....... r::T .'F- ~' ": .... :1.25
THE REQUIREE:, SIZE OF' THE SOIL !:aE',SOF.:F'TZON SUSTEH IS:
THE LENGTH B, IMENSION IE; THE L.ENGTFi <iN FEE:T) OF T'F!E TRENCH OR [:,RF:flh~F!ELD.
THE DEPTH OF F:I TREI",!C:H OR F'!.T Z% THE Di?"RNCE E',ETNEEN THE E;URFRCE: OF' THE:
GROUND RND THE BOTTOM OF TFtE E:::.:;CRVR"F;[ON (IN F'EET>.
THE ....~r*.~"q ....... r:b E:'E:F'TH ]:S THE MZh~ZMUH E:,EF'TH QF GF?FI~ E',F'T~.,.~F~:N THF' OUTFFtL. L PZF'E
RI",!D THE BOTTOM OF THE ENCR',,,'RTZON (IN FEET).
F'EF:H I 'T' FIF'F'L. I E:FdqT FiF~'::; ................... THE Iq:E~;F'Cd'..!:5 i B I L. l T? Tt3 l NF'ORM -tH i E; [:,EPFII:;?THFN-' .,_'"' ..~ ,~:. ~'r ,,,~'.~ _,'~ THE
I.N':'.;TRLLFIT I ON I NE;F'EC'T' '[: t',l,:j: OF' RI',! ~-' f,.!EL L.F; FIDJ'RCENT TO TH Z ::::.: I='F.' L' F'EF'T? FIND THE
,~'-.~, ... ,h'IFFF..: ............ nF tq:EE;IE:,E:F,K:::ES THF!T T'HE I,.!E:I ~ N!LL. ,=F.'?,,'F,_...., .....
BRCI<F:[L. LING OF::' Hl',!'T"' '.?;'~.'E;TEM !.,.!ITHOUT FiNF!L If',!::~:F ~.l_."--' I..h~ 'F:¢.iE:, F~":',.','"".,":II_:FF R...,-,I' .... E:"?
F;,EF'FhF-.tTMENT !.,]_T_L EE :.E;UB..:FEC:'I" Tf'.' PF:O:.~;EE:UTICIBL
MINIMLIM £:,ISTFINC:E BE'T!4EEJ',! Fi i,lEI_ FINE:, F!!'.,i'¢ 3F.!-.E;'ITE SEI.,.IF!GE E:,ISF'OSFIL 'Z';'.¢STEM
:t..GC1.FEET F']R FI F'RIVFITE NELL OF: "J. SP3 TEl 2Fl[:l .PEET. ,- R,..-, ~= '" "m .... FI F'UEE_IC: !4ELL
UF'ZN THE "F'¢F'E OF F'JBL'J'f'Z: NELL.
I"!INIMUM [:,!STFINC:E FROM FI F'RZVR'T'E !4ELL 'TO R F'RIVRTE 'SEi.,.iEF: LINE
'T'O F! COMMI...1NIT'T' ':~=IIE'!;'. .. . . LINP' ......... 1":', ';:'P~ FEET. " :
OTHER F:E Z! ... ! F:E:MEHTS MR'¢ FIPF'L'¢. E;F:'EE: Z F Z CFYF ION'S ~F,tE:, Z:C ~.,iE;T~'UC:T i Z
R',/FIZLREd_E TO INSURE: F'F:OF'EF: Z N'/:TFILLFtTZON.
! CERT!F'? THF!T
i.: ! i::!!"! F'!:::tMiL.!RF-'. NI'FH THE RE:QUIRE:MENTS FOR Ot'.,!-S-ITE E;ENERS FIND !.4ELLE; RS SE:"['
FORTH Dh' THE MUN!C!F'FILIT:¢ OF R.NE:HORRGE.
2: I NIL J_ tNSTRL. L THE: S'~.'E;TEM iN RCCORDF!NCE i,.IiTH 'T'HE COE:,EE;.
--::: Z LINE:,ERSTFIND Tt..iFIT THE ON-SiTE SENE:F;: E;"r'STEM MR'T' REQUIRE ENL.RRGEMEi"~T IF' THE
RES!DE'NCE iS REMO[:,ELE[:, TO INE:LLIDE MORE THRN 3: BEE.',ROOM%.
qPF'! TF'F/4'.,tT' E:,FI!/_E CiF.:E[NER /
IF'F:,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: ~ ~
LEGAL DESCRIPTION: ~"
[] SOILS LOG
PERCOLATION
TEST
1
2
3
4
§
6
7
8
9
10
11
12
13
14
15
16
17
18
19
SLOPE
SITE PLAN
WAS GROUND WATER ~-/~, ~
ENCOUNTERED? , ~ ~ ~
DEPTH~ ~.~/Z
Gross Net Depth to Net
· Reading Date Time Time Water Drop
/
20 ~.~_5-~U ~ ~ ~ ~'~ERCOLATION RATE (minutes/inch)
/ TEST RUN BETWEEN ' FT AND/
PERFQRMED BY: CERTIFIED BY: DATE:
72-008 (6/79)
~. APPLI( IT FILLS OUT UPPER HAl 3NLY
Pmpe~r~ty dw'ner~ ,i;[ 0 ~' ~ Phone
Address ~- l Zip Code
Lendinglnstitution ~]~k~ ![~(A' ~t Phone
I Phone
Address Zip Code
Legal Description L ~z~ 8 /~/3
S,ree,'ocat,o ltl Ill
Type of Residence
~] Single Family ms'~
[] Multiple Family No. of Bedroo
[] Other
Water Supply
[] Individual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
~L Community For wells drilled prior to that date, give well depth (attach Icg if available).
[] Public Utility
Sewer Disposal ~ ~l
~ Indi¥idual Year Indivk~ual Installed:
[] Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE ~NSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date
Date
Inspector Inspector Inspector Inspector
Field Notes: ~~ ,,~ [2'~-- ~ ~ ~~ ~ ~
~ ~ ~...ow~ ~.oo~s 'co.~mo.s o~ ~...ow~
( ) DISAPPROVED
( ) CONOmO.,~
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
72-023 (3182)
Pat wi lmoth
SP, A Box 76C
Anchorage, A~ 99507
subject: Lot 8 Block 3
~ e
Ap!?rovat for tn.. in~3~ivi¢~ual se~r an~-~ water .,~cll~_tle~ cannot
be granked until the following item, s have been cora}?lete~:
° ?,ne sewer lin~ un~'ter the driveway will nee~3 %0 be insu!~.ted
to prevent freezing.
Please notify this Departtaent for a reinspection when
noted, diacrepancies have been correcte~.0 If there are any
further questions, please call this office at
S incere.t¥,
Rober% C. Pratt
Associate Environmental Specialist
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Section
Certificate of On -Site Systems Approval
Parcel I.D. 051-731-32
1. GENERAL INFORMATION
Expiration Date
Phone: 907-343-7904
Fax: 907-343-7997
3-19-2-3
Complete legal description NORTH WOODS BLK 3 LT 8
Location (site address) 22604 Mc Manus Dr
Current property owner(s) SECRETARY OF VETERANS AFFAIRS Day phone 240-0034
Mailing address
Real estate agent Shane Day phone 240-0034
2. TYPE OF DWELLING:
0 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:
Private Well
❑
Private Septic
F
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
FX_1
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ $550 Waiver Fee $
Date of Payment Ct -2 Date of Payment
Receipt Number m ('L Z_D Receipt Number
COSA # OSC211123 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm NorthRim Eng.
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
6. DSD SIGNATURE
System #1 Approved for __q_ bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 694-7028
Date 3/4/20
+�.09E OF "4
Ir C.,'�P
* :49
LFL*
Stave. -Eng,
(� re=G2SS _+A
3/4%21+
Conditional approval for bedrooms, with the following stipulations:
1:,
/
X.,_ Original Certificate Date: 4 "23 -.2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: NORTH WOODS BLK 3 LT 8
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) 8 years
Tank type/material Fgls
Measured operating fluid level in septic tank na
❑ Standpipes/foundation cleanout per record drawing
Date of pumping na
D. ABSORPTION FIELD DATA 6/13/13
Which system tested (date installed) same
❑ ALL standpipes present per record drawing
Total measured depth from grade 4.5 ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 051-731-32
Structure served by this system
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes FOR No
❑ Coliform bacteria is Negative
Nitrate mg/L [:]Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station 8 years
Lift station material Fgls
Comments: Biocycle inspect 3/17/21
Adequacy test date 3/18/21
Results M Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 0 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 600 gpd
Any rejuvenation treatment (past 12 months) no
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community weil)
Septic Tankil-ift Station on Lot > 1001
EJ
Yes
Community Sewer Manhole/Cleanout > 100,
[]Yes
ifNo_ft
Yes if No It
rl Yes
if No - ft
Neighboring Tank > 100' El Yes
if No
ft
Private Sewer/Septic Line > 25 ❑ Yes
if No ft
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' Yes
if No It
Neighboring Absorption Fields > 100'
Yes if No It
Water Main > 10'
Animal Containment > 50' ❑ Yes
if No it
El Yes
if No
It
Yes if No It
Water Service Line > 10'
Cj
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' F1 Yes
if No
It
n Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
EJ
Yes
if No
It
Surface Water > 100'
Yes if No It
Property Line > 5'
Yes
Yes
if No
ft
Wells on Adjacent Lots:
El,
Absorption Field > 5'
F-11
Yes
if No
ft
Private Wells > 100'
Yes if No It
Water Main > 10'
ft
Yes
if No
ft
Community Wells > 200'
Yes if No It
Water Service Line > 10'
Cj
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
EJ
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
El
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
El,
Yes
if No
ft
Private Wells > 100' Yes if No It
Water Service Line > 10'
Q
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Surface Water > 100'
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ 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.
co
49 TH
Steve Eng
tj CE -62W
-3/ 4 */ .2 1
To Whom It May Concern,
On March 18th I performed an inspection on the advanced waste water treatment
system at 22604 McManus Dr. All necessary components were there and in working order.
There was no visible earthquake damage and the discharge was tested by pumping
approximately 50 gallons of water into the system. I certify that this system is functioning and in
working order.
Christopher J. Worden
Biocycle Alaska
3705 Arctic Blvd #313
Anchorage, AK 99501
(907)274-0314
MUNICIPALITY OF ANCHORAGE
�i
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this / 7 Day of
Melvin C. Dillen
March
of 20 21 , by and between
herein 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 Bioeyele Wastewater Treatment System
located at (legal description)
L3 B3 !North Woods Subdivision Plat 79-245
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 $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page I of 3
1,-16,0 Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
,^✓1tjO Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 1.4.60.030.
/. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
,41fZ.,Z 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.
,Arz Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
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 ur 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. SeverMhility. 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
O"ER-
By:� (signature)
Melvin C. Dillen (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT }
The foregoing instrument was acknowledged before me this
202A, by��/11Q �'�1 Y -\/C. C)i 2�
NOTARY PUBLIC FOR ALASKA
My Commission expires: �LlII I�cy'�'�
MUNICIPALITY:
By r" ( (signature)
(print name)
Date: S, /, • Z l
ICI day of" ,
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OF AL
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Date: -3-2-3 _Z
Title:
(rev. 05/18/2018) Page 3 of 3
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Section
Certificate of On -Site Systems Approval
Parcel I.D. 051-731-32
1. GENERAL INFORMATION
Expiration Date
Phone: 907-343-7904
Fax: 907-343-7997
3-19-2-3
Complete legal description NORTH WOODS BLK 3 LT 8
Location (site address) 22604 Mc Manus Dr
Current property owner(s) SECRETARY OF VETERANS AFFAIRS Day phone 240-0034
Mailing address
Real estate agent Shane Day phone 240-0034
2. TYPE OF DWELLING:
0 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:
Private Well
❑
Private Septic
F
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
FX_1
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ $550 Waiver Fee $
Date of Payment Ct -2 Date of Payment
Receipt Number m ('L Z_D Receipt Number
COSA # OSC211123 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm NorthRim Eng.
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
6. DSD SIGNATURE
System #1 Approved for __q_ bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 694-7028
Date 3/4/20
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Conditional approval for bedrooms, with the following stipulations:
1:,
/
X.,_ Original Certificate Date: 4 "23 -.2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: NORTH WOODS BLK 3 LT 8
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) 8 years
Tank type/material Fgls
Measured operating fluid level in septic tank na
❑ Standpipes/foundation cleanout per record drawing
Date of pumping na
D. ABSORPTION FIELD DATA 6/13/13
Which system tested (date installed) same
❑ ALL standpipes present per record drawing
Total measured depth from grade 4.5 ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 051-731-32
Structure served by this system
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes FOR No
❑ Coliform bacteria is Negative
Nitrate mg/L [:]Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station 8 years
Lift station material Fgls
Comments: Biocycle inspect 3/17/21
Adequacy test date 3/18/21
Results M Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 0 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 600 gpd
Any rejuvenation treatment (past 12 months) no
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community weil)
Septic Tankil-ift Station on Lot > 1001
EJ
Yes
Community Sewer Manhole/Cleanout > 100,
[]Yes
ifNo_ft
Yes if No It
rl Yes
if No - ft
Neighboring Tank > 100' El Yes
if No
ft
Private Sewer/Septic Line > 25 ❑ Yes
if No ft
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' Yes
if No It
Neighboring Absorption Fields > 100'
Yes if No It
Water Main > 10'
Animal Containment > 50' ❑ Yes
if No it
El Yes
if No
It
Yes if No It
Water Service Line > 10'
Cj
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' F1 Yes
if No
It
n Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
EJ
Yes
if No
It
Surface Water > 100'
Yes if No It
Property Line > 5'
Yes
Yes
if No
ft
Wells on Adjacent Lots:
El,
Absorption Field > 5'
F-11
Yes
if No
ft
Private Wells > 100'
Yes if No It
Water Main > 10'
ft
Yes
if No
ft
Community Wells > 200'
Yes if No It
Water Service Line > 10'
Cj
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
EJ
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
El
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
El,
Yes
if No
ft
Private Wells > 100' Yes if No It
Water Service Line > 10'
Q
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Surface Water > 100'
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ 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.
co
49 TH
Steve Eng
tj CE -62W
-3/ 4 */ .2 1
To Whom It May Concern,
On March 18th I performed an inspection on the advanced waste water treatment
system at 22604 McManus Dr. All necessary components were there and in working order.
There was no visible earthquake damage and the discharge was tested by pumping
approximately 50 gallons of water into the system. I certify that this system is functioning and in
working order.
Christopher J. Worden
Biocycle Alaska
3705 Arctic Blvd #313
Anchorage, AK 99501
(907)274-0314
MUNICIPALITY OF ANCHORAGE
�i
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this / 7 Day of
Melvin C. Dillen
March
of 20 21 , by and between
herein 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 Bioeyele Wastewater Treatment System
located at (legal description)
L3 B3 !North Woods Subdivision Plat 79-245
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 $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page I of 3
1,-16,0 Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
,^✓1tjO Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 1.4.60.030.
/. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
,41fZ.,Z 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.
,Arz Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
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 ur 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. SeverMhility. 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
O"ER-
By:� (signature)
Melvin C. Dillen (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT }
The foregoing instrument was acknowledged before me this
202A, by��/11Q �'�1 Y -\/C. C)i 2�
NOTARY PUBLIC FOR ALASKA
My Commission expires: �LlII I�cy'�'�
MUNICIPALITY:
By r" ( (signature)
(print name)
Date: S, /, • Z l
ICI day of" ,
�pP.LENA C �,
CU
OF AL
�a
Date: -3-2-3 _Z
Title:
(rev. 05/18/2018) Page 3 of 3