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HomeMy WebLinkAboutMOUNTAINSIDE VILLAGE BLK 1 LT 7Mountainside Village Bl ck I Lot 7 020-172-19 , .... ;¢ 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: ,.~,'~(/'q.~/:),-~'7 PIDNumber: OoqO- 172- Name: ~ ~ ~ ~ ~O ~ Wastewater System: D New ~ Upgrade A~,.,,: ~ ,~ ~e~[~<~ ~--~ r ABSORPTION FIELD LEGAL ~. ~ *Po,s, ~, I I WELL: ~New ~ Upgrade G,~e~ width:~ Num~rlof lines' ID=sta~e~nhn~: SEPARATION DISTANCES a Septic ~ Holding ~.T.E.P. Material: ~ Numar Ot Coca.meres: Sudace w,t,r I~o + I~ e '1~ * -- -- LIFT STATION I Remarks: BENCH MARK .ENGINEER'S ~EAL ~-~. :. . Inspections performed by: Dates: lsL ~ 2nd~V/~ ~ :~'. T~'.-,~ Department of Health and Human Se~ices approval c, -.",. Reviewed and approved by: Date: IZ'IO 'q~q''r~'~''::'-- / i£~¢r~: 'Jo rr ¢o¥££ $ / \ / / / / N 50 75 lO0 SCALE, 1' = 50 FT. I,Z5 1.5'0 BENCH IdARK: TOP rOUNO,~r/oN ASSUYED ELEV. I00.00 FT 203 W ISTH. AVENUE ANCH. A~ 99501 PERMIT # SVgBO£97 I I~550 STEAY BOAT DRIVE I N~UE PIB # 0~0-17~-19 SEPTIC SYSTEY DESIGN I DATE: AUG. ~?, I SHEET: 2/5 GRID: 3439 MSVOIO71.DVG REPLACEMENT TRENCH  PRIMARY TRENCH ~ X ~0 DRA[NFiEID 2 ~ ~O[AI DEPTH 0.~ ~ EFFECrWE ROCK ~ ~SAND ~ f~ COVER ~ AIRCO~PRESSOR  86.5'  * ~ff~ O~S GR~L I~ERVIOUS &OIL, .. · · ND SCALE BIOCYCIE 6000 LEGEND: L PRIMARY [REA~ENL SEPTIC ~ANK 2. AERATION TANK ~. C~RIFICAT/ON TANK ~%. 5. SOIL ABSORPTION [OBBEN SPURK~ND P.E. 205 WlSth Ave I MDUNrAINSIDDE VILLAGE BK 1 LOT 7 wASr~A~m .S~r~u SCHmA~/C Anchoroqe Ak 99~0t $IDCYCLE WASTE WATER SYSTEM DA[E: AUG. 27, ~998 ~79-T9~ ~ ' SHEET: ~/~ GRID: PERMIT ff SWg$D897 PID ff 0~0-]78-]9 MSVOlO73.BWG From : ALPIHE DRILL ~07 $45 0202 Au9.25. 1998 i1:48 PM PO1 LOCATION/SK~CH: ~~ --" WELL O~R: DEPTHS ~SURED FROM:~casinO top ~9rouna surface WELL DEPTH: _ DATE O~ CO~PL~ION ' Depth of hole'.~lt .... Material Type and Color From To ~ _ ~ top of casing ~ ground s~ace  USE OF WELL:~domesbc irrigation WELL INTAKE OPENING TYPE:~ open e~ D screened Depths of openings; to ft ~CREEN lyp[: SlotlMesh Size:-~. Length:, ft GRAVEL PACK TYPE: top: GROUT ~YPE: Depth: from u~, '~C tnn~l Itto It D~ELOPMENT M~HOD: Munlctpal~o; Ancr ~age Ducat,on: PUMPING L~L AND YIELD: /' PUMP INTAKE DEPTH: fl Horsepowe;; WELL DISINFECTED UPON COMPL~ION? ~ YES ~ NO CONTRACTOR INFORMATION: REMARKS: - U ~ uS ness I~lame -- ./ - ~/ ............ : .......... -02-1998 OG:O2PM FROM CreattuehKltchenhDesign TO 2766013 P.Ol MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Sen/ices Program 825 L Street. Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 ¢907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Aug 12, 1998 Expiration Date: Aug 12, 1999 Permit Number: SW980297 Legal Description: MOUNTAINSIDE VILLAGE BLK 1 LT 7 Design Engineer: 7 ~ g~_r~ 0_~.~_.~_~ Owner Name: Eric Bdtten I Michelsohn & Daughter Owner Address: 1088 Potlatch Circle Anchorage, AK 99503-1728 Parcel ID: 020-172-19 Site Address: 017530 STEAMBOAT DR Lot Size: 40240 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] 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 engineer must notify DHHS at least 2 hours pdor to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to Apdl 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. This permit is for a BioCycle system' . I Maximum excavation shall be 2-2.5' to reveal the SW layer and a 1' sand layer shall be installed as per attached ~design.' ', Received By: Issued By: Da,e: ,¢. / Z . 203 W 15th. Avenue, Suite 203 ANCtIOP, AGE, ALASKA 9950 I (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 7 BLOCK 1 MOUNTAINSIDE VILLAGE MICI/ELSOIIN AND DAUGIrrER Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 June 26,1998 August7,1998 We are submitting an application for the installation ora well and septic system for this lot. The submittal consists or, three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet i/3), the proposed improvements of the lot, of which only the well and septic system are subject to this permit application, (sbeet 2/3), and a scbematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: Testholes and soil identification performed by James Williams P.E. on Oct. 17, 1997 indicates high groundwater levels in both testholes and impervious soil at 9 feet in testhole #1 and at 5 feet in testhole #2. Tasthole #2 is still accessible and the ML material was retested on August 5. by me. The attached "SOIL LOG" shows the result of our test, which clearly indicates that the ML layer is permeable. Donna Meats and Jeffrey Poet from DtlSS happened to be at the site while this test was conducted, and they agreed with the conclusions of the test. Mr Williams recommendation that an innovative system should be installed is still a valid recommendation due to seasonal high groundwater. Ground Water at 7.5 ft. Impervious soil at 9 ft Soil Rating. From Testholes by James P. Williams/Gamess <1 mirffin = 1.2 x 2= 2.4 gal per sq.tVday No. of Bedrooms 4 Requlred Area per Bedroom: 150/2.4 =62.Ssq.ft. Total area required: 62.5 x 4 - 250 sqft Use Standard 5-wide with 6 inches of rock Required Length: 250 /5 = 50 ft SYSTEM CONFIGURATION STANDARD 5-WIDE TRENCII TOTAL LENGTtl 50 FT TOTAL WIDTH 5 FT TOTAL DEPTH 2 FT FILTER SAND I FT ROCK DEPTil 0.5 FT COVER 3 FT BIOCYCLE 6000 TANK The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoffwill not result from this installation. N I[OBSEN SPURI<LAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 (907) 2Z9-5916 PERMH # SV~aOOXX r~tlOUN1YANSIDE VI£LdGE Et'7 I 17550 STEAM BOAT DRIVE I NAME PID # YY I SEPTIC SYSTEM DESICN I DATE: JUNE 5, 1998 I SHEET: I/5 GRID: 5459 NSVOIO7I. DWG / S~'ANDARD ~R£NCH L£NCTH: 50 WIDTH: 5 D£PDI: SAND FILTER COVER $ J[OBBEN SPU£KLAND P.E. 203 W 15TH. AVENUE ANCH. Al(. 99501 PERMIt # SV9800XX / / N 50 75 I00 SCALE: 1' = 50 £T, IIIOUNTiANSIDE VILiAGE LT7 BLK1 17550 STEAM BOAT DRIVE NAME PID # YY 125 15'0 BENCH MARK: ASSU~ED ELEV. I00.00 F[ SEPTIC SYSTEM DESIGN DATE: JUNE $, 1998 SHEET: 2/$ OR/D: 3439 HSVOIOTI. DWG REPLACEMENT TRENCH 4-INCH INSU~4TION  PRIMARY TRENCH $ X $0 DRAINFIELD 2 FT TOTAL DEPTH 0.5 FT EFFECTIVE ROCK I {'[SAND $ FT COVER I -- ~ C~ AIRCOI4P£E~O/~ SAND ~CgrItL ~. ~, ~ *.' :~=~ ~]ll:ll~ .I 4 BAR~IE~ ~ : ~..-~ ~a SC~E I ~OCYCZC ~000 Z. P~/~A~Y rREAr~ENZ, SEPrZC rANK 5. C~RIFICATION 4. DISCHARGE TANK ~ : 49~h ~ ~ ~ XOBBEN SPURK~ND P.E. 20~ WlSth Ave NOUNTAINSIODE VILLAGE BK 1 LOT 7 WAST~AXER SYSTEg SCHEgATIC Anchoroqe Ak 99501 BIDCYCLE VAGUE VATEg SY~[EH DATE: JUNE 8, 1998 279-.~9x~ SHEE~' 3/J GRID: 34J9 PERMIT ~ ~W~SXXX PID g YY NSVOIOT3DWG Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street. Anchorage. Alaska 99502-0650 SOILS LOG m PERCOLATION TEST 'E A' OESCR,PT,ON:. '/, BV-- I 1 2 3 4 5 6 7 10- 1'1- '12- 13- '14- 15- 16- '17- 18- 19- 20- Township. Range. Section: WAE GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Oepth to Water Alter Idonitodno? Oate: SLOPE SITE PLAN Net Drop PERCOLATION RATE · ~ ~ (m,nute~'mch) PERC HOLE DIAMETER __ TES.I* HUNEETWEEN .~--~ FTAND ~' FT PERFORMED BY: I CERTIFY T~T T~IS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE. DATE: ~/~/~ · ..,.~,.~ Municipality of Anchorage ~.~. DEPA.R.T, .MENT OF HEALTH & HUMAN SERVICES PERFORMED FOR: LEGAL 0~S/mPTION: L?,al, ~m~.9~ ~,~ ~TOwnship, Range. Section: Reading Date Gross Net I DePth to Net Time Time Wate~ Drop ////~ I;~/~ - ~,, -- 14- 161 17- '~. 18' 20' PERCOLATION RA~+/Z-I (mmutes/,nch) PERC HOLE DIAMETER ._ TEST RUN BETWEEN~-- [.~' FTAND~.~['~T ACCORDANCE~,,~ :LL ,,A,, ANO MUNICIPA, GUIDELIN~N EF,ECT ON THIS ;ATE, DAT~ Municipality ol Anchorage '"' ~_~'/,~..~' ' DEPARTMENT OF HEALTH & HUMAN SERVICE.'~-~," 49T1~ 825 'L" Street. Anchorage. A,aska 99502-0650 ~.~i so~Ls .oo - ,E.cou~T,O. T£ST/~,%;-.. ~ ~,~:.. PERFORMED FOR: LEGAL DESCRIPTION: L'~/'~::)~ !//~/R/'~,~'~: ~///(Z.'I~' ~W~Ship. Ra.ge, "''~: =': S~tion: 2 /~4L. 4 7- 8- 9- 10- 12- 13- 14- 15- 16- 17- 18- 19- 20- SLOPE WAS GROUND WATER ENCOUNTERED? ~,~' SITE PLAN Reading Cate Gross Net Depth to Net Time Time Water Drop : ~ ~ ~ ~ ,~ ~ ~l s ' . ~ . PERCOLATION RATE ~"'"~t,.~ (m,nutes,'mch, PERC HOLE DIAMETER ~ ~/ / (/ ' ~1 . / //~., ~ ~' ~ L.~ ~o ~ ~..~. AUG-OS-98 WED 12:S1 PM fiDEC DRINK griT/SOL 14RSTE FflX NO. 907 269 7655 P. 02 TONY KNOWLE$, GOVERNOR DEPT. oF ENVIRONMENTAL CONSERVATION DIVISION OF ENVIRONME~"TAL HEALTH DRINKING WATER and WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, AK 99501 htr o://www, state.A.k.usldec/homc/htm Telephone: (907} 269-7519 Fax: (907} 269-7650 August 4, 1998 Ivlr. Tobben Spu~kland, P.E. 203 W. 15' Ave., #203 Anchorage, Alaska 99501 Re: Lot 7,.Block 1; Motmtalnside Village ADEC # 9821-WW-175-275 RECEIVED AUG 5 1998 Municlpalay ut ~.,~not ago Dept. Health & Human Services Dear Mr. Sp~kla~d: On Wednesday, July 29, a meeting between DEC staffand Mtmicipality of A~chorage stafftook .place. At tl~t meeting, a future consistent approach to ~e u~e ofn~wer technology systems, such as the B?cycle 6000 you have proposed, was discussed. As further meetings will take some time to work out. the details to r~viewing and approving sknila~ projects, I suggest that yot~ agai~ approach the Mtmicipality w~th a plan that does not. - requi~e a waiver for the development on Lot 7, Block 1, Moanta;-<ide Village. Our e~closed letter to you o£June 29, 1998 and the altered drawing of the system design, allow you to meet our ~qu~'ements whhout the need for a waiver. I have discussed *dais site with Ms. Meur at ~e Municipality. Please ~ee her for the authorizations needed from ~heir build~g department as she will have copies of this correspondence. Respectfully, ' William R. Rieth, P.E. Environmental Engineer WRRkf Enclosures: As Stated cc:' H$. ~e~rs, MOA~ -IIN\.-' 1a 9 di /N r'': toga ;I • ' Municipality of Anchorage a. I, �, ei On-Site Water and Wastewater Program ° < (907) 343-7904 ` 4,, SLI i ,-. lrir bi `� Certificate of On-Site Systems Approval Parcel I.D. 020-172-19 Expiration Date: l © ` (0 —( 1. GENERAL INFORMATION Complete legal description Mountainside Village Block 1 Lot 1 7 Location (site address) 17530 Steamboat Dr. Current Property owner(s) Jon & Mlndl Sinclair Day phone Mailing address 17530 Steamboat Dr. Anchorage, AK 99516 Real Estate Agent Day phone 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: Individual Well 0 Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received : _— Date:1 l l 1 (tea COSA to be released to the engineer,unless otherwi 1g uested •j - engineer. COSA Fee $ 52b 00 Waiver Fee $ Date of Payment 7 13 ISMS Date of Payment Receipt Number 07 10384 4 Receipt Number COSA# OSG IK13J'7 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. 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 sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 7/2/18 0 Aikt• 1 O*•49 TM /\ *' 6. DSD SIGNATURE """ • 'TL.13 System#1 Approved for 1( bedrooms •Steven R.•`annone• A �� �. CE-8149 System#2 Approved for bedrooms f • •• Disapproved � PNOFESSIO• t�' '� Conditional approval for bedrooms, with the following stipulations: ON-SITE yccx, WAFER AND WASTEWATER o PROGRAM G 15> B : Original Certificate Date: 7-4 e `( 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 COSA blue sheet_f c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Mountainside Village Block 1 Lot 17 Parcel ID:020-172-19 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 08/21/1998 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 61 ft. Cased to 61 ft. Casing height(above ground) 29 in. FROM WELL LOG AT INSPECTION Date of test 08/21/1998 06/27/18 Static water level 7 ft. 24.4 ft. Well production 6 g.p.m. 5'S g.p.m. WATER SAMPLE RESULTS: A Coliform 1NL, el colonies/100 mL Nitrate 2-5' mg/L Arsenic N1) ug/L Date of sample: 06/27/1998 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Biocycle/Fiberglass Date installed 08/24/1998 Tank size 1600gal. Number of Compartments 4 Cleanouts (Y/N) N Foundation cleanout(Y/N) N Depression over tank(Y/N) N High water alarm (Y/N) Y Pumper SEE MAINTENANCE REPORT Date of pumping N/A C. ABSORPTION FIELD DATA Date installed 8/24/1998 Soil rating (g.p.d./ft2 or ft2/bdrm) 2.4 GPD/SF System type Shallow Trench Length 50 ft. Width 5 ft. Gravel below pipe 0'5 ft. Total depth 2.5 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test 06/27/2018 Results(Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 5 in. Elapsed Time: 240 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? 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 10+ 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 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. G. ENGINEER'S CERTIFICATION ~ OF Aqq l I certify that I have determined through field inspections and /r' p>'..•• -...',°- ..yt review of Municipal records that the above systems are in *; , • I /\ ••* r conformance with MOA COSA guidelines in effect on this date. I O••1i Steven Pannone e • •. Engineer's Printed Name 1•••••Steven . snnone Date 7/2/2018 0�� yy• CE-8149 ...Ail COSA canary sheet_2-6-15.doc 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 I9 Day of S U 1-‘f of 20 ‘S , by and between Si►�-� Y MA��C PpN0E-e--50 , 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 g.• CI(' - cu-+.A.4,--k- ►%- located at (legal description) ( NtovnnAtN$10E: U%LLA-G,E t--ct 1, V5LC.1< 1) 11530 S-c-AnA3oDR-wE, ANc-Koe.Ai,E, Pok a1`15U6 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 M'!1' repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically S400 to S600). 5 Owner agrees that only maintenance and repair personnel approved by the Municipality M or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. 9'/ Owner acknowledges that regular maintenance of an AWWTS reduces the potential M failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and M repairs from the manufacturer's representative or maintenance provider. S� - Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be 170- assessed in accordance with AMC 14.60.030. S Owner agrees to grant the Municipality reasonable access to test and inspect the MCR AWWTS. The Municipality will give at least 24-hour notice. S.., Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. SrsA Owner agrees that the AWWTS installation and maintenance requirements as provided MSP 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. ` 1r-- Owner agrees to maintain remote monitoring of the AWWTS as required by the M0 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. 05/1812018) Page 2 of 3 OWNER:—I4- A- L.-- i I t`k I Z cS By: . ---- (----- (signature) Date: -/j 9 I2_C siL71-A AES - (print name) STATE •F AL-A-S1A n i 0 A ax"C' ) cot,�v1 4 M 1 S-e / ) ss. T AT. DISTRICT ) ek The foregoing instrument was acknowledged before me this til day of 5 , 201 , by 6ett, 5 . d o-Nd . Nrc,q E U Z 2 Pia% . ; r �(c NOT• R =CFOR 11; n 14 e6d-C, S� My Commission expires: 011 I ( 24.) T >' ``, SAHADEV BHURTEL 1;` NOTARY PUBLIC•MINNESOTA •' My Commission Expires,tan.31,2021 4t y. t., ,., MUNICIPALIT : By. t w�,t � (signature) Date: 7 I l s(fO J (print name) Title: (rev. 05/18/2018) Page 3 of 3 MUNICIPALIT~f 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Compl.ete'legal description Location (site address or directions) Property owner Mailing address Lending agency Mailin. g address Agent Address Day p~one Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewa, ter 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. NameofFirm "'~[,[~-~ -~,,-~.l~.~f '~- ~--., Phone ~'~c~_ .~1 /- Address ~ ~ ~ I~ ~ ~o~ Engine,s signature ~" Date I ~ DHHS/SIGNATURE A.p. proved for ~,l~'~ Disapproved. Conditional approval for bedrooms. 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 courtesy to purchasers of homes and their lending institutions in order to setisf~ 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. RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE~DEC Environmental Services Division 825 L Street, Room 502- Anchorage, Alaska 99501 · ~ ' Health AUthority Approval Checklist Parcel we, type Log present (Y/N) y Total aleph1 ~'2 /'/ Cased to Sar~w seal (Y/N) y ' · FROM WELL LOG If A, B, or C, attach ADEC letter. ADEC water system number Date co plemd ? ~ / ! Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date of test ~ '.~-I- ~ ,~ Static water level "7 / Well production " ~, g.p.m. WATER SAMPLE RESULTS: g.p.m. Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA [~) I ~) CT..'"'/~.. L. ~ Foundation cteanout (Y/N) Date of Pumping /~/A Depression (y/N) Pumper High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed ~ Soil rating (g.p.d,/fF eeft~Clt~ ~ System type '~--- ~/'~-- Length ~D ' Width .6' ' Gravel thickness below pipe' ~:). ~ Total depth ,~. ~ EffeclNe abeom~on area .~ ~ Monitoring Tube present (Y/N)__~/__ Depression over field (Y/N) /~ Da/e of adequacy test /x_~. Results (Pass/Fall) ~ _ For bedrooms Flutddep~hinabso~ptionfleldbeforetest0n.);J Immedlatalyafter '~gal. waterad(~d (in.):_ j Fluid depth / (ins) Minutes later:. '~ Abeo~on rote - "~~ g.p.d. 72-o2e (Rev. D, UFT b'rATION Manhole/Acc~_ _~_< (Y/N) High water alarm level at* Cycles tested E. SEPARAT~.OH DISTANCES Size in gallons "Pump on" level at* ~',.~' SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I Absorption field on lot I 4, ~" Public sewer main Sewer/septic sewice line 'Pump off" level at* ~ ~'~/~-' On adjacent lots On adjacent lots Public sewer manhole/cieanout Uft ~ation SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation z~ O Property line ~' ~ Absorption field Ip / Water maJn/sewice line ) ~-~ Surface water/drainage ),~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FP=1 n ON LOT TO: Building foundation ~ Water main/sewtce line Driveway, pmtdng/vehide storage ama Wells on adjacent lots ~> /~ Property line Surface water Curtain drain S Resetpt Number 72-026 (Rev. 3/96)' DEC-0~-1998 10:48 CT~E ESI AHCHORAGE ~tK CT&E Environmental Services Inc. 9075615J01 P.O2xO~ CT&E Ref.# 986058012 Client Name Tobben Sputkland P.E. Projec~ Name/// Client Sample ID Steamboat Matrix Drinking Water Ordered By PWSID Sample Remarks: ' Client PO// Printed Date/Time 12/03/98 10:40 Collected Date/Time 11/24/98 13:45 Received Date/Time 11/24/98 14:55 Technical Director: Stephen C. Erie EP300 Nitrate: The me,od blank was detectable for nitrate (0.171rog/L). Results may be biased high. lotat coliform 21 CB/lO0 ~L, NO eOLI $M18 92228 ~itrate-N 1.15 0.100 mg/L EPA 300.0 Atto~abte Prep Anaty$i$ Limits Date Cete lnlt 11/24198 10 ~ax 11/2~/98 11/24/98 PROPERTY OWNER AGREEMENT FC.R Tile bIAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This ageement, dated /c, - ~ [, 199 ~, is made between the Municipality of Anchorage Department of Health and Human S~-rvices ('DHHS) and the properD, owner(s) of: 0 ' This agreement is made for t, he purpose of maintaining an on-site wastewater disposal system on the subject prope"ty. 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 mad 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 ................................ & ...... State of On this day of , personally appeared before me, __ who is personally known to me __whoSe identity ! proved on the baeis of ~whose identity I proved on the bath/affirmation of , a credible witness to be the signer of the aboy~ document, and he/she acknowledged that he/she migned it. Notary Public My commissic,.l expires