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HomeMy WebLinkAboutNORTH WOODS BLK 4 LT 4 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater DiSposal System and/or Well Inspection Report Permit Number: .5 ~,/~ E)~ C~'~ PlO Number: (2~'/- ~3/- ~ Name: ~-/d ~-~'7 ~ ~0~/ WastewaterSystem: ~New DUpgrade ~dd,.,: ~>. ~ ~'~ // ,t ABsORpTION FIELD Phone= ~ Z~- ~ C,' Z~ ~,o.o, BeSoms: 0 Deep Trench 0 Shallow Trench ~ Bed ~ Mo,nd 0 Other Total Depth from original grade: LEGAL DESCRIPTION so, Ratings, ,~ GPO/Sq. Ft. ' Subdivblon: Oepthtootnehn,~frnmnrinln~larade: ~ Graveldeplhbeneathplpe ~ ~ '- ~, 0 ~t. ~,. Number of lines: Dist~ce belw~en lines: WELL: U New U Upgrade erave~ width: J~ Ft, ~ ~ Ft. Class~ication/4Z~/~(Private, A,B,C): ~Ft.T°tal Depth:~ _~o: Ft. Total absorption~area: ~ SQ. Ft. I Pipe~ ~ ~ ~J ~ materiah x Driller: ~ ~ Date Drilled: Static Water Level:Ft. Installer:.~ ~ ~ Date~lnstalled:_ ~ ~ Pump Set at'.I ~ing Height Above Ground:! TANK GPM Ft. Ft. SEPARATION DISTANCES ~ s~pti~ ~ Ho~Oi.~ TO Septic Absorption Lift Holding ~ubllc/Private Manufacturer: ~ ~pacity in gallons: From Tank Field Station Tank Sewer Lines Material:~,~ Number of Compadments: kot ~ Si2oin ~allon~: Manu[a~turer: t I"Pump on" level at: "Pump off" level at: High water alarm at: Fo..d.t~o, ¢ + ~2' /*~ ~ .... ~ ~.~ ~' /'7, ~' ~//-J': ~ ~ump Make ~ Model Electrical Inspections pedormed by: Drain I Remarks: ~/r~c ~c ~e-' ~z~z~ /~sz~zz-~ B~NCH MARK t Loc~tlon and Desorlpflon: Assumed Elevation: ENGINEER'S SEAL 17~4 ~g~ River L~ R~d, ~ ~ Inspections pedormed · Dates: lsl?-~ ~ Department of Health.and Human Se~ices approval ~.~ CE,Sa01 .,, Reviewed and a~roved by ~ 72-013 (Rev. 9191) MOA 25 PERMIT NO. swg80203 PAGE 2 oF 3 . MuQicip..o,!,i~y_.o.? Anchorac~e DEPARTMEN/ uP H~AL/H AND HUIvTAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 eAnchoraoe, A_[ask~ 99519-6650eTe[ephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 4, NORTHWOODS S/D P.I,D. NO. 051-751-09 -- NORTON COURT-- LOT 5 LOT 4 NEW 4 BDRM HOUSE [OCYCLE UNIT /-NEW /__ MT1 [ I · TH #2& JTH #1 SITE LOT 8 LOT 9 I KEY BDX LOT 5 15' UTILITY ESMT. SCALE 1' = 40' P~.RUIT ~o..Swg80203 PAGE. 3 O~. 3 Municip~Lit o? Anchor~Qe DEPARTMENT OF HEA~_THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 eAnchorage, A[ask~ 99519-6650eTetephone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 4, NORTHWOODS S/D P.I,D. NO. 051--731--09 A B FCO 20.3' 20.,3' BIO 16.5' 40,8' MT1 75.0' 96.0' MT2 79,0' 66,4' FINAL GRADE \ 102.0' MT2 \ MT1 /.~....'--:iL,, ,.."' · WATER FOUND 95.0' 83.0' B.O,H. $EP--25--98 ~EB 9 ~ 28 P. 02 CARCEL ELECTRIC INC. 10410 FINLEY CIR. · ANCHORAGE, AK, 99518 907-346-4030 · ~07-34§-403Z ~ Ou['. company Carce[ Electric [nc, wi~-ed the ~iOcycle septic Z~ you have any questions please give me ~ call. '?~ ~ ~ //.'ac. 3- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 15_NCHORAGE, kLASKA 99519-6650 PAGE 1 OF I ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT ~ER:SW980203 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NORTHWOODS INC OWNER ADDRESS:3111 C STREET ANCHORAGE, ALASKA 99503 PARCEL ID:05173109 DATE ISSUED: 6/25/98 EXPIP~ATION DATE: 6/25/99 LEGAL DESCRIPTION: NORTH WOODS BLK 4 LT 4 LOT SIZE: 20500 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 ALL THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 A/qD 15.65 AND THE STATE OF i~LASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) ~ DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED /LND CLOSED ON THE SAME DAY B. COVERED, SEALED ~ HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: ROBERT C. COWAN, P.E. June 2,1998 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE DepartmentofHe~thand Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 4, Block 4, North Woods Subdivision Request you issue a permit to install an innovative (BioCycle) system to serve the proposed four bedroom house on the referenced property. One test hole was excavated and a percolation test was performed. The approximate location of the test hole is located on the attached site Plan. At the time of excavation, ground water was encountered in the test hole at 8 ft. After seven day groundwater monitoring, the monitoring tube was checked and the ground water level was found to be at 4.0 feet. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on adjacent properties. This subdivision is serviced by a Class "A" water system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jlm Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 L moo I I~1 ~ o~ ·~ I ~ 0 ~ ~ I I ~mo ~ 0 ~oo N.T.S.scALE PROFILE DETAIL ~ Y ~ ~ ~ .... ;-. ~ =l i i:.' I~111 (~ ~ (1850mm) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 7 8 10 14- 17 1@- 20- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop ,,/" 'Z-~-- 2 o ~u,~Iz " I" ~ /~ ~/~ //~/a ~ ~ * TEST RUN BETWEEN __ (minutes/inch) PERG HOLE DIAMETER FT AND _ ~ FT COMMENTS S&S ENGINEERING ,~/~.,~,~/.~.~ i CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ~;'~,~,~ F..g;. Fiver Loop Road No, 204 (, /',.~ ~/' ~ ~ ACCORDANCE WITI~ii~.JLe~AI~JB-~I~II~J~I~/[II- GUIDELINES IN EFFECT ON THIS DATE, DATE: 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL. DESCRIPTION: ~- ~ t¢~z:: /~/'//¢/'¢'¢¢C~04/' Township, Range, Section: (EN~ , PERFORMED: DATE 1 2 3 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? I Depth to Water Alter Monitoring? __ X 0 E Gross Net Depth to Net Reading Date Time Time Water Drop 2. ,?o ¢ ~¢" ~/¢" .7 ~ o lO "' '~/t ' ~ /o ~ ~/~ ~ ,, PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER __ FTAND *,~ FT COMMENTS PERFORMED By~7034 Eaale R,ver Loo~ Eaad Ne. g~ l' ~/~ ~ CERTIFY THAT. THIS TEST WAS PERFORMED IN Ea. le RD;r, Alaska 99~77 ' - DATE' ~ /~ / ~ ¢ ACCORDANCE WI~ ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. . , 72-008 (Rev. 4/85) ROBERT C. COWAN, P.E. CIVIL ENGINEERS HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 4, Block 4, North Woods Subdivision June 5, 1998 GENERAL: The scope of this project includes the installation of an "innovative" Biocycle Wastewater Treatment System and a drainfield bed to serve the four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, M.O.A. certificate with any special provisions or conditions, and all applicable State Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. o Contractors installing wastewater disposal systems must be familiar with construction practices in this area and either certified by the Municipal Health Department or have been previously certified under the D.E.C. certification program. Owners installing their own systems must also receive prior approval from the M.O.A. PRESSURIZED MOUND SYSTEM INSTALLATION: Any peat or organic matter must be removed from the elevated mound site. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. The side slopes of the top layer of the mound system must not be steeper than 33% (3:0. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 Page Two Lot 4, Block 4, Northwoods Subdivision June 5, 1998 The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. The distribution pipes are to be embedded in sewer rock. Care should be taken to back- fill in such a way as to prevent damage to the piping system. Silt barrier material must be installed between the final gravel layer and the native soil back-fill. Ensure the silt barrier covers the entire gravel surface before placing back-fill. o Back-fill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the depth is less than thirty-six (36) inches above distribution pipe. ABSORPTION BED/DRAINFIELD INSTALLATION: Excavate the proposed bed to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the side walls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. OnCe the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil back- fill. Ensure the silt barrier covers the entire gravel surface before placing back-fill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Back-fill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfield depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Lot 4, Block 4, Northwoods Subdivision June 5, 1998 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: T_vpe of Pipe perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. o Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). ° Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). o A permeable non-toxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil back-fill. o All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. ° When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page Four Lot 4, Block 4, Northwoods Subdivision June 5, 1998 The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other back-fill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER PROPERTY OWNER AGREEMENT FOR ~ MAINTENANCE OF AN ON-sITE WASTEWATER DISPOSAL SYSTEM This agreement, dated~ 199__~, is made between the Municipality of Anchorage Depm:hnent of Health and HUman Services (DHHS) and the property owner(s) of: ,~7 '~/ ~t~ 4t ,,'~a,~Y,~.~v'~O.0~ ?,/f_D This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree to th, e following: Submit to the Municipality of Anchorage, on an annual basis, an inspectiOn and operation statement from a registered professional engineer. This inspection and operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Signature) (SignatUre) (Printed Name) (Printed Name) (Notarize Here) Subsoribe~t and sworn to before me this.~.~ day 0f~19 m CY) �� mCY) coIT Iq cy') W, ►N N O N N ti � Y J Y � J � m � �/U U) t- 0 U O z O O I— O O z Z d N0 N N Q � U � U) a) a) a 70 co J CO .!-s N O 0 a a) ho 0 0 0 - CL a3 (0 O 0 C: O Aw E O AG AC I A., O`` =O O ^ CL L a) Q. a O 3 t r•d V N (a _L V •� N L +�+ � :3 � Q C C t C ~ U) O ~ m 'a U C O O p 0 C •� N N V � 0 C Q •V Q > O �► Q)U Q > Q •�Cl).o � N — a) c0 .V a) O ��' 3 0 a O .N z Q OL O O Q. .Q CL N U) U o U EX 0 '5 0 C M L O N U) co o a) � w�, •a N O U) N W E 'a_ O Q O Q > OL Q N Q) — D) a) O cn > O N > +' o Q ^, W R Q N -C c oa) v O N FN- Q - Q ` :r= N cm cu W cm z v0i c �_ 0 N "Cc "Cc = Q F— O 0O N V N Q O U Q H LU o LLLL V -C 0 2 V Z LL :; t 0 Q 5 U — E V) V Q(D Z � � � W co -1C-� W C Q O Z a) Cl) CL 00 TMI a) //W� V/ U O a O U a U) C 7 E O U El Y c F- C O 2 El U) U) co m FL cn m L) O N O U ❑ a) U O LL cn El O > C/)co El () Y � `Z r U N d a) W cm U) Q TE d () 0) cu a) () U) El L U C a) a) Ll t U c a) 0 a) m LiVI Q 6 J W LL Z O p a w U) m Q 7-; W m m LL m _ 1 C a) >, co C O a) >_ co o � U U) � C 7 O I C O v > N J O7 � Q OE O a a NU) 0) c()) E U cm C N U a) 0- � NU a) a) ❑ o m U cna M a) U) cn U o ❑ O >O O' C0 m — a) cm C/) >_ 0.. oN o cm a) a -a Co a) o cn c 0 > a) 0 Q It IL N W ,H ^ cn cn LV a w I- �. O .L (� cn w Q w CO LL O E U co �' U N O a H a H N M d a) //W� V/ U O a O U a U) C 7 E O U El Y c F- C O 2 El U) U) co m FL cn m L) O N O U ❑ a) U O LL cn El O > C/)co El () Y � `Z r U N d a) W cm U) Q TE d () 0) cu a) () U) El L U C a) a) Ll t U c a) 0 a) m LiVI Q 6 J W LL Z O p a w U) m Q 7-; W m m LL m _ 1 C a) >, co C O a) >_ co o � N/A N/A N/A Benjamin Schiller, P.E. (907) 522-7773 I I�o� YC E"Alaska j/U7 Arctic nivel ;Fjlj Anchorage AK 99503 Email: crbioak@gmail.com (907)274-0314 2nd Inspection Report 2024 Customer Name: Andrew Johnson Address: 22444 Norton Ct. Homeowner Info Tank#: 41 Install Date: July 1998 Initial Inspection: Area: Chugiak Alarms Tested: Air 0 High Water 0 Battery Tested: Yes ❑ No ❑ N/A (Please make sure alarm is on "normal", not "mute") Does system have a septic tank ? No 0 Yes ❑ (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes Repaired ❑ Yes R1 Repaired ❑ Strong ❑ Mild ❑ None [J System Inspection Primary Chamber Inlet plumbing in working order? Solids pillow normal? Yes 171 Replaced ❑ Yes 9 Requires Pumping ❑ Are all aerators functioning? Yes 9 Replaced ❑ Clarification return system operating? Yes 171 Adjusted ❑ Effluent testing result pH Reading: {pH of 6-8 is ideal) 7.0 Discharge Charnbe Pump float operating? Yes V Replaced ❑ Filter cleaned? Yes FV1 N/A ❑ Comments: Inspected By: Chris Dissolved Oxygen PPM (2-5 is ideal) 3.5 Alarm float functioning? Yes R1 Replaced ❑ Any buildup of solids? Yes ❑ No A Any buildup of solids? Yes ❑ No [Y Turbidity of discharge (in FTU) (Under 35 FrU is considered compliant.) 8.92 Any buildup of solids? Yes ❑ No A Discharge line condition: Good 1/ Replaced ❑ Has emailing or mailing of form been requested? Yes No Ell 07/16/office 024 (contact oce to request. ) MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day ofof 20,2q, by and between p j.Z'e--� C,�_M,��+�, 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 Biocycle located at (legal description) North Woods Block 4 Lot 4 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) PDX 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. PJA 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). P.,M, 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. M 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 1 of 3 PA Owner 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 AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Pin Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 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 or unauthorized means shall be void. 6. Jurisdiction: Choice of Lara. 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 of en 0 a� Q. W O N DO 0 0 MUNICIPALITY OF ANCHORAGE Development Services Department ° Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-731-09 1. GENERAL INFORMATION Complete legal description Expiration Date: _ _�(''S - 2,02-2 NORTH WOODS BLK 4 LT 4 Location (site address) 22444 Norton Ct Current property owner(s) DEMBOSKI Mailing address Real estate agent Noelle 2. TYPE OF DWELLING: F-1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 376-7653 Day phone 376-7653 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic El 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 $ 560 Waiver Fee $ Date of Payment °i a d2 Date of Payment Receipt Number D `7 0 3 1 D Receipt Number COSA # 05C 9 111 � 1 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shoti%,n 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. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 3/4/20 OF ar :49TM.. *�s 6. DSD SIGNATURE 10 System 41 Approved for bedrooms 444" s25s' Ar System 42 Approved for bedrooms 4 �'� e 3•i4%21 Disapproved Conditional approval for bedrooms, with the following stipulations: B tom, Original Certificate Date: r P2 The Municipality of Anchorage Development Seniices Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent proless onal civil engineer registered in the State of Alaska. The Nlunicipahty 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 COSA Checklist Legal Description: NORTH WOODS BLK 4 LT 4 Parcel ID: 051-731-09 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 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) 23 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 7/8/98 Which system tested (date installed) same ❑ ALL standpipes present per record drawing Total measured depth from grade 3 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 Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate— mg/L El 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 23 years Lift station material Fgls Comments: Biocycle inspect 3/2/21 Adequacy test date 4/8/21 Results Q✓ 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 well) Septic Tank/Lift Station on Lot > 100' Yes Community Sewer M,,::inhole]Cleanout > 100' ftIf absorption field is under driveway comment below [] Yes if No ft M Yes if No ft Neighboring Tank > 100` M Yes if No ft Private Sewer/Septic Line > 25 F-1 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' D Yes if No ft Neighboring Absorption Fields > 100' ft Animal Containment > 50' ❑ Yes if No ft M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' El Yes if No ft El Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' F/� Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No It Private Wells > 100' Q Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' F./I Yes if No ft Water Service Line > 10' Q Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances it less than required) Building Foundation > 10' Yes if No ftIf absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots-, Water Main > 10' P-1 Yes if No ft Private Wells > 100' 21 Yes if No It Water Service Line > 10' 21 Yes if No ft Community Wells > 200' Rv Yes if No ft Surface Water > 100' El Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of h4unicipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Ar A0 Stwe Eng CE -62M IM -1 3795 -Arctic :Blvd .#313 .Anchorage AK'.9.9503 _Email: crbiciiikogmail.com (907) 274=03'14 -Homeowner Info Bon Amy y Demb-oski Tmi­k#_.4' :Install Dtite: duly 19,98 Address: 22444 -Norton Cowl A= Chugiak InIffal Inspedion- Alarms1ested: Air High' ater Batter, -Tested V. : Yes No F� N/A E Does system .havea septic tank? No R1 'Yes F-] (Recommend -pumping tank every 2 years) Is Systembd Locked? Lid hardware in working,Drdee? ]s there -any noticeable odor? --A .1–A Yes Repaired D Yes IV] 'Repaired ❑ -Strong � 'Mild F_J None'r-A IV, System Inspection -Irllet_OlUmbinp'inworking order? Solids . pillow -normal? —A -laced El Yes Rep Yes'� Requires Pumping El Are --all aerators furictionine. Anybuildup of.mi&? Yes 'Replaced M Yes T1 -No J71, Clarification return system operatine Any.buildulp of solids? Yes Adjusted Yes F No :OH :Reading: Dis5-61ved 0)�y en'P.?M Turbidity .6f:,dischar ­fi,n-.FTU) gL (PH ri Sr8 is ideal) J2,5' is idEml) 7.8 31 Pum.p,_flozftoperatirye. Alarm�float.`funttioninei Any buildup of solids? -yes YJ Replaced 'Yes Replaced F-1 -Yes ftf;�J Filter -tie -an -ed? Dis6hange'line rondition- g/ 'Replaced F Yes h/ I N/A F Zood - Comments: Has-emailiMmmailin cfffnnn'beenre-quested? .Inspected By: Chris -Date: D3/02/21 M Yes *(cuntadt 6ffice to request...) DigiSign Verified: 1CACC351-3EA4-45ED-A17B-D4CFB752950C MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 12th Day of April of 20 21, by and between Andrew Johnson 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 pennission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description) 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) —tom`- 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). jOwner 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) Pagel of 3 DigiSign Verified: 1CACC351-3EA4-45ED-A17B-D4CFB752950C _W Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. 4zOwner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. a( Owner agrees that any sale or transfer of title of the property will not occur without anew Certificate of On -Site Systems Approval. _� Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 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 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 DigiSign Verified: 1CACC351-3EA4-45ED-A17B-D4CFB752950C OWNER: By: 4swLfiw r I,k,,, (signature) Andrew Johnson (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this 20_, by NOTARY PUBLIC FOR ALASKA My Commission expires: MUNICIPALITY: Wt Date: 04-13-2021 day of (signature) Date: (print name) Title: (rev. 05/18/2018) Page 3 of 3 PA A CN 70 0) 0. 9) z -Z :LLJ o ©4 � Z 0 m O 0 0 -C E o S E I- < 0 0 X 00 0 a 00 CL U- :3 E 0.0 0 r 0 0 r- 25 o 0-00, 10 E 0 C 0 -Z rt, Iloq It 00 > 0 0 a m (D C 3 -S E1 1 02tnmoo < C*l N , r- 5 o 03 0 to Ul) r-0 0, 0.0 zo o r, r., 0 0 o ,t R 1 0 ' E 0 POO 0 r- 9 ) o) > a 0 0 0 0-0 cy) o .0 :3E I- c , V) D C a- (D 0 0-6y La- E 0) zo -t o x (4 m»-0} 'O ®® o r -0 CD a- 0 o o 0 (D Z 0 > 0 0 0 :03 5 0 M LJ -4— c a -j 0 m E — 0 0 0 0 < "0 0 -Y 0-0 >, cn 0 . .r - C) I)oo— t — 0 0 < 0 r- 0 :3 S, a 0 x —J e R iE t' 0 > "0 V) o L.j -C 0— 0 0 r- c ill > Z 0 0 M 0 0 4) o— :5 -0) 0.0 0 'r CE r 0 : LL' ID 8d L) o o '0' c 0 W o a o :rl 0 — 0 r 0 tmw o o" ..- LO. ul V) L- 0 m .0 F- -C 0 0 9 0 U) 0 .0 > 0 0 0 z F UJ 0 ,00*9z Lij x .00-90Z HIHON --77 — — — — — -- -/7 —77 z C� x 0 'n En. Q ptz 04 - S En a- z LL NU < ui m F— ,6 Z9 24.2' 4.: R 0 Lli (-) 0 CD Z z 0 C14 'C-4 0 W C 6 Z w 0 p 0) 04 W LJ CL U>j V) 24.2' O < C) 9 1 Z -oz 00*90Z HDJON z uj 0 Ix z 1 z I w 3 PA A CN 70 0) 0. 9) z -Z :LLJ o ©4 � Z 0 m O 0 0 -C E o S E I- < 0 0 X 00 0 a 00 CL U- :3 E 0.0 0 r 0 0 r- 25 o 0-00, 10 E 0 C 0 -Z rt, Iloq It 00 > 0 0 a m (D C 3 -S E1 1 02tnmoo < C*l N , r- 5 o 03 0 to Ul) r-0 0, 0.0 zo o r, r., 0 0 o ,t R 1 0 ' E 0 POO 0 r- 9 ) o) > a 0 0 0 0-0 cy) o .0 :3E I- c , V) D C a- (D 0 0-6y La- E 0) zo -t o x (4 m»-0} 'O ®® o r -0 CD a- 0 o o 0 (D Z 0 > 0 0 0 :03 5 0 M LJ -4— c a -j 0 m E — 0 0 0 0 < "0 0 -Y 0-0 >, cn 0 . .r - C) I)oo— t — 0 0 < 0 r- 0 :3 S, a 0 x —J e R iE t' 0 > "0 V) o L.j -C 0— 0 0 r- c ill > Z 0 0 M 0 0 4) o— :5 -0) 0.0 0 'r CE r 0 : LL' ID 8d L) o o '0' c 0 W o a o :rl 0 — 0 r 0 tmw o o" ..- LO. ul V) L- 0 m .0 F- -C 0 0 9 0 U) 0 .0 > 0 0 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-731-09 HAA # ;'-~.~ ~, ~' ~'" '~'; '. '~ \, 1. GENERAL INFORMATION Complete'legal description Lot 4, Block 4, Northwoods S/D Location (site address or directions) NHN Norton Court Property owner ' Ben & Amy Demboski ,/ Mailing address /- C ,i~ ×' (,: '7,?//v ¢ ~'~ ~c,, '?/ Day phon~94-2388/Target Lending agency Day phone Mailin. g address Agent D~rk ~-n~,m,/m~g=f' ~ley Day phon~gz~-P'~RR Address17034 North Eagle River Loop Road, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well xxx Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fror~t MOA f~21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING 17034 Eagle River Loop Road No. 2~34 Eagle River, Alaska 99577 Phone Date DHHS SIGNATURE )/"/ Approved for FO/_..,//O.. bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOAi~21 Municipality of Anchorage DEPARTMENT OF HE.~.LTH & HuM,~I SERV CE ~.,e^~n, ~ ^~.. Env ronmental Services Division 825 L Street, Room 502 · Anchorage Alaska 99501 · (907) 343-4744 Health- Authority Approval Checklist LegalDescription: /--0~ ~ "~Loc,~ Z(, ~/0A.7-f/~v0o,o~ PamelI.D.: A. WELL DATA Well type c..~,~.~ ,( Log present (Y/N) IfA, B, orC, attach ADEC letter. ADEC water system number "3~/i ~'00 ! Date completed Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SA~: Coliform~ eD~of Sample: g.p.m, g.p.m. Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed -//~'/cf ~ Foundation cleanout (~)~1) Date o! Tank size ) 5"0 (3~ Number of Compartments /'// Cleanouts (Y/N) /,~Wrc~ ~-~ £ Depression (Y/~ /~J ~ High'water alarm ~/N) : 'Y'~Y Date i~t~tdirec~:' ;:? ~/7"{'~' {' '~'; Soil rating ~r ~Fodrm) O. ~ System type Lengt~.~ ~,.G -7 width.' ~ 5- ' Gravel thickness below pipe g. 5" / Total depth ~ ' Effective"a~bsorption area ' ' '~ ! 0 O- ~- ~ MOnitoring Tube presentd[~/N) 7,~/' Depression over field (Y~ Date of adequacy test ~'//4 - ~a~ Results (Pass/Fail) For z~ bedrooms ed (in.): Fluid depth in absorption field before test On Fluid dept~h . . (ins) Min : Absorption rate = i q.p.d. Peroxide treatment (past 12 months) (Y/H) If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access ~/N). High water alarm level at* ¥1. ,1.>- 'f Cycles tested Size in gallons "Pump on" level at* '~ (, · ?£ · Datum ~g ~ .7 ?, ~,~ E. SEPARATION DISTANCES F. "Pump off" level at* I '/~ ?~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot ~ On adjacent lots Public sewer main ~ Public sewer manhole/cleanout Se Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~- ~ 5- -/- Property line Absorption field Water main/service line / 0 '~ Surface water/drainage /'0 e ~J-- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /b -~ Building foundation / o -/- Water main/service line Surface water I ~) 0 r_/._ Driveway, parking/vehicle storage area Curtain drain ,.u e.~ ~_ ~ ~, ~ ~v ~ Wells on adjacent lots / / leo ~ ! ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and revie~ in conformance with MOA HAA guidelines in effect on this date. Engineer's Name //~0,~ 4~,~ ~ C. ~ Date '¢1,/~ 3 / ~' are HAA Fee $ ~ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number