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Home My WebLink AboutELMORE #2 BLK 10 LT 2a xY Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Number: OSP221055 PID Number: 018-173-08 Page 1 of 2 ng: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade ROBERTS 4650 EAST 145TH, ANCH AK of Bedrooms 14 LEGAL DESCRIPTION Subdivision Block Lot ELMORE #2, BLK 10, LOT 2 rownship Range Section SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Sewer Tank Line Well i on, 50f {. Surface Water Lot Line 10 of + 10'+ NA Foundation Remarks ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed NO Mound ❑Other Soil Rating Total depth from original grade 1.0 GPD/SF 0.5 Ft Depth to pipe invert from original grade Gravel depth beneath pipe 0 Ft. 0.5 Ft. Fill added above original grade Gravel length 3'+ Ft. 40 Ft. Gravel width Beds: Number of Lines Distance between lines 15 Ft, 3 5.5 Ft. Total absorption area Number of trenches Dist. between trenches 600 Ft2 Ft. TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other compartments LIFT STATION location Electrical installed by Gal Installer PIPE MATERIAL House to tank Tank to 3034 MIKE N ANDERSON, P.E. drain8eld Drainrield 3034 CO/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100.5 ft Inspectiondates: 1s, 4/2/22 4/4/22 Location and description 2rd 3t° 4th TOP OF PUMP BASIN ON-SITE WATER AND WASTEWATER SECTION APPROVAL,E,ytgQ�sSamp OF 1 Conditional Approval: Date `\ •' • `' • ,� `' ' � moi.• ;..�'<' . .... �. MICHAEL Septic System �� e N. At.Dt hSG;� �. .. . Approved c�- .,' • Date 7 aDa �} s1;•. •�( 2: , p+ Note: this approval does not include well permit requirements. �v PR6.s (Rev 05/02118) Permit No. OSP221055 Page 2 of 2 Municipality of Anchorage 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 Legal Description: ELMORE #2 BLK 10 LOT 2 PID No.: 018-173-08 MARK A B C MT1 67 73 I \ MT2 45 36 MT3 35 40 MT4 60 74 \ ff7 \ I I 100 RA \ MTI —1uIT1 II ® I �MT2 OLD FIE I \ x -X -X -X 9 \ B NCH, T P OF PUMP BASIN \ —X / \ \ SCALE: 1"=50' MT MT 103.5 TOP SOIL & SEED 103.5 ..."".111, .� DF ' P BASIN FILTER FABRIC' 1000 .2��•.•��'••'•' A•�°'.�v.. • . .... io EXISTING PU P BASIN . .. .XVINemSM/GM MIG L N. ANDERSON: �� MICHAEL •�= • % No. CE 9469 ` ..4—�2-22( �� ••♦♦,11';Vi SEErIN.TS0ON WATER 0 6 JUNE 2017 j\��.•' C ::.�••• EAST 145TH A VEUE N 89 56'17" E212.00 N8956'17"E212.0 C .49 TH s SHANE A. HOLT p% Q�P LS -6914 Wl� fessioW �Qo ASBU/LTSURVEY f" = 30` H NO CORNERS SET IS D TE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT2 SLOCK10 ELMORE2NDADD'N. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUL TURES, IMPROVEMENTS, OR FENC ELI NES. EASEMENTS OF REC0RD,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT EXIST OTHER THAN NOTED. ARE NOT SHOWN HEREON( UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS 5 TH DAY OF NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE APRIL , 2022 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOL T LAND SURVEYING THE SURVEYDATA ON THIS DRAWING IS PREPARED FOR THE OWNER OFRECORD ONLY 9309 GROVER DRIVE ANY COPYING, OR UTILIZING THE DATA HEREON IS PROHIBITED UNDER COPYRIGHT LAW ANCHORAGE,AK 99507 15383 FS 221-3 .40 223-9615 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221055 Work Type: Septic Upgrade Tax Code Number: 01817308000 Site Legal Address: ELMORE #2 BLK 10 LT 2 G:3036 Site Mailing Address: 4650 E 145TH AVE, Anchorage Owner: ROBERTS DAVID T Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date enr U , r"1 n J DepaI- tine 11t Lot Size in Sq Ft: Total Bedrooms: 3/30/2022 3/30/2023 40280 Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: -3/3!:52/0Z_ LI Ruses MUNICIPALITY OF ANCHORAGE Development Services Department = Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 018-173-08 Property owner(s) DAVID ROBERTS Mailing address 4650 EAST 145TH, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) ELMORE #2 BLK 10 LT 2 Legal description (Township, Rang_ e & Section) Lot Size 40,280 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (® all that apply) Initial ❑ Absorption Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) El (w/wo ADU) Upgrade 0 Duplex (D) ❑ Renewal ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees:1_6c75 t A 35 -7 Waiver Fees: Date of Payment: 3/11 I a Oa ',') jhpii'i2Date of Payment: Receipt Number: 011 N 5 0292W Receipt Number: Permit No. O5 oO 2Z/05- �? Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc March 21, 2022 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic permit Legal: ELMORE #2 BLK 10 LT 2 To Whom it may concern: This is a request for a new septic permit on the above referenced lot. The existing 2017 leach field has failed and needs to be replaced. Our proposal is to remove the old field entirely then add a new larger system, see the site plan S1. A smaller application rate has been designed into the new system for longevity of the system. From the MOA file the water table was measured at 6.0 feet June of 2017, this new system will raise the bed to grade or elevation zero, see the site plan. This new septic field will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221055, Deb Wockenfuss, 03/30/22 1"=200' PROPERTY LINE EXISTING DRAINAGE FIELD EXISTING WELL 100' RADIUS EXISTING HOUSE -EAST 145TH AVE- SCALE: DJRDRAWN: DATE: ELMORE #2, BLOCK 10, LOT 2 Anchorage, Alaska DAVID ROBERTS 3/14/2022 -EAST 147TH AVE--TETON PLACE-SEPTIC FIELD SECTION DESIGN CRITERIA: 1.0' EFFECTIVE 4 BDRM X 150 = 600 GPD SOILS = 600/1.0 = 600 SQ FT REQ'D 600/15 = 40' 15.0' WIDE 40' LONG (1) BED +1' DEEP DRAIN ROCK 2.0'15.0' -1.0' +0.5 MOUND OVER MAX FILTER FABRIC & SEWER ROCK 3,3(+2/(6# 3:1 SLOPE, TOPSOIL & SEED INSULATION-4.0' MOA FILTER SAND EXISTING GRADE 2.0' MOA FILTER SAND REMOVE ALL OF THE CONTAMINATED SOIL, BACKFILL WITH CLEAN MOA FILTER SAND TO NATURAL SOIL DEPTH MIGHT BE DEEPER THAN 4' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221055, Deb Wockenfuss, 03/30/22 1"=50' EXISTING ADVANTEX SEPTIC TANK & POD TO REMAIN MT TH#1 EXISTING DRAINAGE FIELD TO BE REMOVED AND A NEW 15X40 BED INSTALLED, TOP OF FIELD TO BE ELEVATED 2' ABOVE EXISTING, MOUND W/ 3:1 SLOPE, TOPSOIL AND SEED 30' WELL DRIV E W A Y EXISTING HOUSE EXISTING WELL 100' RADIUS ELMORE #2 BLOCK 10, LOT 2 SCALE: DJRDRAWN: DATE: ELMORE #2, BLOCK 10, LOT 2 Anchorage, Alaska DAVID ROBERTS 3/14/2022 -EAST 145TH AVE- EXISTING FENCE ELMORE #2 BLOCK 10, LOT 3 ELMORE #2 BLOCK 10, LOT 11 ELMORE #2 BLOCK 10, LOT 12 ELMORE #2 BLOCK 10, LOT 10 ELMORE #2 BLOCK 10, LOT 1 ELMORE #2 BLOCK 8, LOT 11 ELMORE #2 BLOCK 8, LOT 12 ELMORE #2 BLOCK 8, LOT 10 MT MT MT MT MAINTAIN 10' FROM PROPERTY LINES, TYP. PROPOSED CONTOURS OF 12" AROUND NEW MOUND TYP. MAX 2-3% SLOPE MAX 2-3% SLOPE MAX 2-3% SLOPE MAX 2-3% SLOPEMT WITHIN 1' OF PIPE CORNER. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221055, Deb Wockenfuss, 03/30/22 Municipality of Anchorage On-Site Water and Wastewater Program •(907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171131 PID Number: 018-730-18 Dwelling: ❑■ Single Family(SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New ■❑ Upgrade Name: Adrian Jaime ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench ElBed ❑ Mound 4650 E. 145th Ave. Anchorage, AK 99516 [' Other Phone Number of Bedrooms Soil Rating Total depth from original grade 727-6989 Four (4) 2 GPO/SF 3 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 2.5 Ft. .5 Ft. Elmore #2 10 2 Fill added above original grade Gravel length Township Range Section 2-3 Ft. 20 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 15 Ft. 3 5 Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line 300 Ft? Ft. Well >100' >100' >100' N/A >25' TANK ❑ Septic ❑S.T.E.P. ❑Holding MI Other Manufacturer Capacity Surface Water >100' >100' >100' N/A Existing Advantex/Anc. Tank 1500 Gal. Material Number of compartments Lot Line >5' >10' >5' N/A Steel 2 NA Foundation >5' >10' >5' N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Orenco/Anchorage Tank 500 Gal. Remarks Pump on level at Pump off level at High water alarm at Lift Station Added and Absorption Bed Replaced. - 42 in. 38 in. 44 in. Pump make and model Electrical Inspections performed by OSH P2005-11 MOA PIPE MATERIAL House to tank D3034Tank to D3034 Installer drainfield Denali Excavating Drainfield D3034 CO/MT D3034 Inspector MEA BENCH MARK (Assumed elevation) 100.0 ft Inspeection ction 1st 6/19/17 2nd 6/21/17 Location and description 3rd 4' Garage Slab COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's �►7� OF A4114, lf Conditional Approval: Date ., 17-. ' '•"/'S /#, *; 49� •'-t 61M0 ,J,:.:Hap:E1:0:E.E4As3:81:::::....f* � W' � ? • i - :-Appro Date P � f / `, •• .... A Inspection Report_9-1-12.doc Municipality of Anchorage Page 2 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 Permit Number: 0SP171131 PID No. 018-173-08 ELMORE NO. 2 LOT 2, BLOCK 10 40,280 s.f. E. 145th AVENUE w 0 0 N 89'56'17"E 212.00' 7 . • THA ASPHALT DRIVEWAY WELL .__ l z 00 :231 . IM Mil 1 I C LS/MH C3 0 ' /EMH1 pMH ' 43.0 4► (i) Lot 3 Lot 1 LS MHEES47.5' In M1 Ma41.8' FCO�� 00 co M2 65.8 63.8' O 0 C4 21.9 45.1' o lir o m CCD Contaminated Soil 0 O Burial Area 0 10' UTILITY CHAIN-LINK FENCE EASEMENTS S 89'56'17"W 212.00' Lot 12 Lot 11 Lot 10 ., P� _ , „A�. *. LEGEND f. Si — Septic Vent i c-) ..• ' ..j..- 'Y .0., TH - Test Hole i 49th 1‘ ..* ` M1- Monitor Tube ,, C4 - Clean Out lt 7ot r — j (.1+--�r� FCO - FoundationDClean le Clean t Out MICHAEL E. ANDERSON t�4 1, No. cE-43ei .1.1,; PLAN AS BUILT ioj,;rf �SSINP+��. SCALE 1' = 50' Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 -343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP171131 PID No. 018-173-08 102.5 I U U) U U 2 Ori!inal 8 Finished Grade 6,iiiiir, 1,500 Gallon Advantex Tank 97.95 9 .4� 500 Galion Lift Station Advantex Tank was Existing. Lift Station and Absorption Bed Placed Under This Permit. 101.5 i- / = I- 99.5 Finished Grade Original Ground Geotextde Fabric 97.25—"' 1"PVC Drainfield Rock \ 96.75-11 MOA Approved Sand 96.75—'1 97.25 Groundwater @ 92 5' 6/26/15 20'(Total Bed Trench Length) I z-89.5 3-1"PVC Laterals w110-3116"Diameter Holes at 2'On Center. Existing Absorption Bed Removed in its Entirety. Contaminated Material '��r'+`ilifvili,, Placed at Location Shown on Site Plan. Excavated Material Replaced ••4E T ' .Q t.1 with Clean Gravel and 2'of MOA Approved Sand. 4.�� 0.••'• -'•:;s 14, �° �i_ v� 4xi .• 49th �. '*�S .; 74–'1-41 PROFILE AS-BUILT % MICHAELE. ANDERSON •f••• NO. CE-1381 �ti No Scale 4-4,::•••• �,4." MUN IC I PA TY OF ANCHORAGE DEVELOPMENTLISERV CES DEPARTMENT �•••-C2 ,4%, 4700 BRAG AW STREET ANCHORAGE, AK 99519-6650 ar • 49th * *# SOILS LOG - PERCOLATION TEST :14/k1-41 E•12:Anti :MICHAEL E. ANDERSON ifmr LEGAL DESCRIPTION: LOT 2, BLOCK 10, ELMORE NO. 2 ��, No. CE-4381 PERFORMED FOR: ADRIAN JAIME �I''� DATE: 6/19/2017 PROJECT No.: •,41� �5m� ••• PARCEL ID#: TECHNICIAN: J. MILLETTE Professional Engineers Stamp: DEPTH TEST HOLE A (feet) OB/OG SLOPE SITE PLAN 1 2 3 4 d 5 SEE SITE PLAN 6 ° 7 a • d. SILTY GRAVEL .d WITH SAND 8 ° SM 9 10 ° d BOH @ 10' WAS GROUND WATER ENCOUNTERED? 7.5' IF YES @ WHAT DEPTH' DEPTH OF WATER AFTER MONITORING: 7.0' 2% 1 1 DATE OF MONITORING: 6/26/17 12 GROSS TIME NET TIME DEPTH TO NET DROP 13 DATE READING (MINUTES) (MINUTES) WATER (INCHES) (INCHES) 14 TEST HOLE PRESOAKED PRIOR TO TESTING: 15 1 16 2 30 3 17 4 30 18 5 19 6 30 20 PERCOLATION RATE: (MIN/INCH) PERC.HOLE DIA. (INCHES) TEST RUN BETWEEN: FT. and FT. COMMENTS: TEST PERFORMED BY ANDERSON ENGINEERING. I,MICHAEL E.ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 6/26/17 M -W Drilling, Inc. oP.O. Box 110378 #Anchorage, AK 99511t *907-345-4000 & 907-345-3287 Fax+ Job No.: 02-161 Project No.: N/A Permit No. SW020319 Groundwater Well As -Built & Lova * Well Owner. Prestige Homes +Use of Well: Domestic +Legal Description: Elmore No. 2, Block 10, Lot 2 4650 East 145' Avenue- Anchorage, AK +Hole Depth: 121' s, Casing Size. 6" tCased To: 120-15' sMaterial.- A 53 Steel +Dr111jVet1zod.- Air Rotary Perf. Well Completion- Open end X Screen Perforated Method. *Screen/ Perforation description: None +GroutNoies: (7) Sacks- No. 8 bentonite granules * Notes: + Well Development: Method. Air surge Notes: *Static water level (SWL) 59.5' (ab~) (below) top of casing (TOC). + Well yield test at 10 gallons per minute (GPM)16-_-.Y'_-ffS Pep h~-(GPH) for I hours with 100% of drawdown (DD)from static level (SWL). *Method. Airlift 0 Date of completion: 04 September 2002 0 Pump Install: well Eno Depth in feet from to of casing. Details or formations penetrated, size of material, color and hardness. 0 TO 3 Casing sticku !I-1-11111-- 3 TCS 5 Topsoil ............. 5 TO 91 Gravel: inter -bedded cl4y 91 TO 94 Small water aravel. zone 94 TO 115 Inter -bedded cia� and gravel 115 TO 121 Water zravel: coarse ver clean -- _ ----------- TO - ------------- - T O ------ TO ----------- --------- - ------------ - --- TO --- - - --- - ------ ------ TO To TO ............ . ...... .. ....... . _-Ago ------- TO ........ ... ........ TO ---- - ------ ......... ....... TO Cextifical?,a NoW. 814 & 972 0N``"AL MUNICIPALITY OF ANCHORAGE On-Site Water& Wastewater Program ��rcnr i. PO Box 196650 4700 Elmore Road v . Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http:!lwww.muni.orglonsite c•partn �NOM1 On-Site Wastewater Disposal System Permit Permit Number: OSP171131 Effective Date: 6/19/2017 Work Type: Septic Upgrade Expiration Date: 6/19/2018 Tax Code Number: 01817308000 j„ /I�/i1 (So F-\ Site Legal Address: ELMORE #2 BLK 10 LT 2 G:3036 Site Mailing Address: 4650 E 145TH AVE, Anchorage Owner: JAIME ADRIAN & CARRIE A Lot Size in Sq Ft: 40280 Design Engineer: ANDERSON ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ET Disposal Field ❑ Septic Tank ❑ Holding Tank 0 Privy 0 Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The Engineer needs to do groundwater confirmation prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As-built Inspection Report. If the results require a design change, construction of the system will stop pending On-Site review and approval. CO ( /Zk77 "k-J " °Le -ID hy,ker 3r« d Water Received By: &Oil//J 7J �� Date: 0/09��? Issued By: J((io►r � Date: 67;9//7 6189 10 7 MUNICIPALITY OF ANCHORAGE 73 Rifaff• JUN 0 9 2017 li 8 9- • IC tiCommunity Development DepartmentrIll4 .�u " ,' �� "hone: 9( 443-7904 �Ac Development Services Division ' "� ■ Fax: 907- - •s ; 1,9 On-Site Water& Wastewater Program � j ,_. i7 3 ON-SITE SEWER/WELL PERMIT APPLICATe Parcel I.D. 018-173-0l k,' 8 e 1 Property owner(s) Adrian & Carrie Jaime Day phone 727-6989 Mailing address 4650 E. 145th Avenue Anchorage, AK 99516 Site address Same Legal description (Sub'd., Block & Lot) Elmore #2, Block 10, Lot 2 Legal description (Township, Range & Section) Lot Size 40,280 Sq. Ft. Number of Bedrooms Four APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ❑ Upgrade E Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 74c_i-.1 E („2t,i__ c\\Ch (Signature of property owner or authorize. :•e. Qat 4',3I� 'lam' Permit/Rush Fees: 4 5/ 9 + 3H HD aiver Fees: 2.i 6 Date of Payment: 6L?ii Date of Payment: 6/Z(7 7 Receipt Number: ©u w! Receipt Number: Q40K3 6-- Permit Permit No. QSP«aas/ Waiver No. O'311 17 /off 7 Permit App_9-1-12.doc co 4,e\ ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) June 9, 2017 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 2, Block 10, Elmore Subdivision No. 2 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The absorption system on the subject lot has failed and must be replaced before a COSA can be issued for resale. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the four-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic systems. The existing Advantex Treatment Tank has been recently serviced and will be reused to serve the new absorption bed. The existing absorption pit bed be removed in its entirety with all remnants buried at the location shown on the site plan and in conformance with Municipal Code. Also identified on the plans are the locations of the existing well this lot and adjacent lots. No conflicts exist between the proposed septic system and the wells on adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The ground surface fronting the area of the proposed trench is virtually flat. The drainage patterns will be maintained after construction. The test holes placed on the lot prior to construction of the existing system indicated Silty Gravel and Sand (GM) in the absorption zone of the bed. The percolation rate was determined to be 20-30 minutes per inch. Groundwater was encountered during the placement of the test holes at 7' to 10' below the surface and rose to 6' to 9' during the monitoring period. A recent test hole indicated the groundwater level at 7.5' below the surface. The groundwater rose to 6.0' the following day and has stabilized at that level. The groundwater level at this time of year is higher than the May 15 date due to colder temperatures and the late runoff from the watershed area. Test holes placed on recent projects has confirmed this observation. In addition, the new Municipal Code governing septic systems allows a less than 4' separation to groundwater with the use of an__pro�IoSt I advanced treatment system. We have designed the Sed with an application rate of 2 gallons per day per square foot which is conservative for the soils encountered. We are proposing to reuse the existing 1,500 gallon Advantex Treatment Tank with a 500 gallon add on lift station and a new W long by 15' wide absorption bed with a .5' effective depth. The bed will be constructed approximately)2' above the elevation of 2.0iv)5' 1,7' Oat/ per MO' Lot 2, Block 10, Elmore #2 CO I June 9, 2017 Page Two the existing bed. MOA approved sand will be used to replace any contaminated soil removed beneath the bed and to raise the bed to the design location. It is thought the owner of the property utilized a large amount of olive oil in the maintenance of the household and much of it has found its way to the absorption bed resulting the plugging of the absorption bed. We are hereby requesting the use of proposed AMC 15.65.310.H2a which allows a separation distance of 2' from the bottom of the absorption bed to groundwater when used in conjunction with a Nitrate Reducing Advanced Treatment System such as the Advantex Treatment System with an AX-20 Filter Pod currently in use on the site. The ground surface on the lot in the area fronting the bed trench is flat. The bed will be placed parallel to the contours of the original existing ground as much as possible and in conformance with design criteria. A minimum of 100' will be maintained between all components of the septic system and the proposed well and from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, 744,„4.1, � •S.• ... Michael E. Anderson, P.E. •w* .• 49 TH •.� �� . : %1ttt:.--��. --a... Attachments i r •MICHAEL E. ANDERSON : or ♦ `�•. CE-4381 '_`"� If IFS pROFESSION�'� �� LAT 12 Q Q LAT 10 LOT 11 VACANT 1 1 ICabrI WI 4. war 1 t 145th AVENUE / -' j N arerrr E 21207 .` iCArry I I ' J f . •.• ii Lal I r' \ g gl hi __(-•_,JLOT 1 1 . Z -_ " ' / LOT 3 I L _ U 1 — N. 971r C 212.07 — — — — � PI w r ; am Mit c.w I w 1, 1 LOT 12 LOT 11 LAT 10 10 ELMORE NO . 2 SUBDIVISION LOT 2 , BLOCK 10 �.•`..� OF �'I i 4• 49th 1� x� czt4ji.....i T ';MICHAEL E. ANDERSONIGs f•• NO. CE-4381• •tiZ .14 •• :..' • AREA M A P SCALE 1' = 100' ELMORE NO. 2 Gd44l BLOCK 10, LOT 2 145th AVENUE lJ \ ,' N 89'56'17" E 212.00' / \._ \\, / ,} \ Existing Bed _ f O 5% Driveway THA ;co � O O _1%-2% _1%-2% ` ? ---, O M O 1 an Existing ' L NY,_ O I Well 11%-2% 5% i 1 I ?TH1 } w (V N J i 0 500 Gallon Add Existing NH ❑n Lift Station Advantex ; Op Treatment SV d r Four System, • Bedroom ' O Home / fCO LU \ _± \ /-7' TH2 /; Alternate Site O N. v r N i O O NO —, Disposal Area 1 0' Utillity Easement N 89'56'17" E 212.00' LEGEND SV - Septic Vent CO - Clean Out SCOPE OF WORK: MT - Monitor' Tube TH - Demo and Remove All Remnants of MH - MantHolee Existing Absorption Bed to Disposal Site. Construct New 15' Wide x 20' 4,7 OF 44'I% Long Absorptoion Bed at Location ��P ,..• .. .. 9 - .� Shown. ,,c0/ � •'•�yt Ai • V. � 49th r 0 7441-4-4 & .. i •#�n°.,MICHAEL E. ANDERSON :�v•j j NO. CE-43611 SITE PLAN �''•�� :•. ..... k, 4" •. • .F.PRDFESSI4NP, SCALE 1' = 40' +�111‘11"11*** ELMORE NO. 2 SUBDIVISION Co LOT 2, BLOCK 10 DESIGN FACTORS: SYSTEM REQUIREMENTS: 4 Bedroom Home Existing 1,500 Gallon Advantex Treatment System Perc. Rate: 20-30 Min./Inch Existing AX-20 Filter Pod and Gravity Flow Application Rate: 2 GPD/SF Add On 500 Gallon Lift Station Bed Absorption System 4 Bedrooms X 150 GPD/2 GPD/SF = 300 SF Absorption Area 300 SF/15 SF/LF (Width) = 20 LF Bed Length THEREFORE: Construct an Absorption Bed 20' Long x 15'Wide as Shown on the Site Plan and at the Location of the Exisitng Absorption Bed. Remove Existing Bed in Its Entirety and Dispose at Site Shown. Replace Contaminated Soil to 1.7' Above the Bottom of Existing Bed Level with MOA Approved Sand. Distribution Pipe to be Placed 1.7' Above the Level of the Existing Distribution Pipe. Total Depth as Shown on the Detail Below. Maintain 100'Separation from all Wells in the Area. Existing Ground Surface / Top 6"to Be Revegetated // 3 Natural Backfill 1 ,) N LEXISIfl9 Ground at Time of Existing Ground at Time of Original Construction Original Construction 6" 1 O O B Drainfield Rock 1" PVC Remove Contaminated Material &Replace 10-3/16" Diameter Holes with MOA Approved Sand This Area per Lateral @ 2' Spacing Construct Bed at Elevation 96.5' 2.5' 5' 5' 2.5' I I I NOTE: Grade Area Surrounding Bed to Drain Away. •••,E, \\OF "♦♦♦♦♦ Minimum 6' Separation From Bedrock. • P;••••' Minimum 4' Separation From Groundwater. 6?:' _ # Minimum 100' Separation From Wells in the Area. :' 49th i\ `•* 1, Minimum 100' Separation From Surface Water or Streams. �••••` •• •y'+••••' ••• i Minimum 10'Separation From Water Service Line. si � ""'"r (� —� •1 fi Michael • E.Anderson f i A1C%': No.CE4381 _� '3/411,,hbFESS\u.#'• Cil Pt 105.0' 102.1' THA 100.5' Driveway 99.5' 96.5' Bottom Elevation offNew Bed. TBM is Garage Slab. 94.8 Bottom Elevation Elevation 100.0 of Existing Bed. 93.5' 6/21/17 92.0' 6/19/17 OF /44,7 . N • 49th • PROFILE EXISTING BED •C. Michael E.Anderson : Lu a ° . 114...4.;:t0FLESIS-107,,*4;14.....(NO SCALE) IS� No.CE4381 '�_7 MUNICIPALITY OF ANCHORAGE CO it •�00,eriiti11 DEVELOPMENT SERVICES DEPARTMENT .•�••. .-..Y.1-... ,Ci/ a�f�♦. 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 �1�,�'�• N 49th i\ . SOILS LOG - PERCOLATION TEST 1447-41.772.21-1-1yyy, • �';MICHAEL E. ANDERSON' i LEGAL DESCRIPTION: LOT 2, BLOCK 10, ELMORE NO. 2 ��: .., NO. CE-4381 ~ %, ESS @��4 • PERFORMED FOR: ADRIAN JAIME �� .• DATE: 6/19/2017 PROJECT No.: oimwssio PARCEL ID#: TECHNICIAN: J. M I LLE TTE Professional Engineers Stamp: DEPTH TEST HOLE A (feet) 1 OB/OG SLOPE SITE PLAN 2 c d' A 3 a 4 4 . 5 Q SEE SITE PLAN • 11 6 . .a •Q 7 4 d. SILTY GRAVEL 'd. WITH SAND 8 • a SM 9 10 d BOH @ 10' WAS GROUND WATER ENCOUNTERED? 7.5' IF YES( WHAT DEPTH? S DEPTH OF WATER AFTER MONITORING: 6,0' L 2% 11 DATE OF MONITORING: 6/21/17 12 GROSS TIME NET TIME DEPTH TO NET DROP 13 DATE READING (MINUTES) (MINUTES) WATER (INCHES) (INCHES) 14 TEST HOLE PRESOAKED PRIOR TO TESTING: 15 1 16 2 30 3 17 . 4 30 18 — 5 19 6 30 20 PERCOLATION RATE: (MIN/INCH) PERC. HOLE DIA. (INCHES) TEST RUN BETWEEN: FT. and FT. COMMENTS: TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 6/19/17 Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For: Prestige Homes Date Performed: Legal Description: Lot 2. Blockl0. Elmore Subdivision SLOPE SITE PLAN F --- I North 1 3 4 IR 15 16 17 18 OG/OL Fill Material TESTHOLE NO, 1 GM Bottom of Hole South Was Groundwater Encountered? Yes If Yes, What Depth? 10, Depth to Water After Monitoring 9' Date: 9/10/00 N See Site Plan Perc. Rate: 20 Min./Inch Perc. Hole Diameter: 6" 21 1 Test Run Between 5.0 Ft. and 6.0 Ft. Comments: Test Hole Presoaked Prior to Percolation Test. Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 9/10/00 Water Perc. Rate: 20 Min./Inch Perc. Hole Diameter: 6" 21 1 Test Run Between 5.0 Ft. and 6.0 Ft. Comments: Test Hole Presoaked Prior to Percolation Test. Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 9/10/00 Municipality of Anchorage r Department of Health & Human Services /• u 825 L Street, Anchorage, AK 99502-0650 7 SOILS LOG - PERCOLATION TEST, Performed For: Prestige Homes Date Performed: Legal Description: Lot 2. Blockl0. Elmore Subdivision SLOPE SITE PLAN 1 i 1 15 16 17 1 OG/OL Fill Material TESTHOLE NO, 2 GM Was Groundwater Bottom of Encountered? Hole If Yes, What Depth? Depth to Water After Monitoring Date: North South Yes S 7- L O 6' P 9/10/00 E See Site Plan Perc. Rate: 30 Min./Inch Perc. Hole Diameter: 6" 21H Test Run Between 3.5 Ft. and 4.5 Ft. Comments: Test Hole Presoaked Prior to Percolation Test. Performed By: Mike Anderson, I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 9/10/00 July 28, 2003 Municipality of Anchorage Mark Begich, Magor Building Safety Division P.O. Box 196650 •4700 Bragaw Street Anchoragc, Alaska 99519-6650 • (907) 343-8301• Fax (907) 343-8200 h ttp: //i"nv.muni.org Kaylen LeBaron 9330 Vanguard Drive Anchorage, AK 99507 Subject: On -Site Water and/or Wastewater Permit. Permit Number: SW020319 Legal Description. Dear Kaylen LeBaron: An On -Site Water/Wastewater Permit, number SW020319, issued by this office for a single-family system, will expire on August 30, 2003. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $100.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well permit. If you have any questions, please call this office at 343-7904. Si er y, J es Cross, P.E. anager On -Site Water and Wastewater Program Enc: Copy of permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW020319 Legal Description: ELMORE #2 BLK 10 LT 2 Design Engineer: 0014 Anderson Engineering Owner Name: Kaylen LeBaron Owner Address: 9330 Vanguard Dr. Anchorage , AK 99507 - Date Issued: Aug 30, 2002 Expiration Date: Aug 30, 2003 Parcel ID: 018-173-08 Site Address: 004650 145TH AVE E Lot Size: 40280 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: Z Disposal Field 7 Septic Tank E] Holding Tank E] 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a s surfacee soil absorption system under construction during freezing weather must be either: A. Open a d closed on to ame day. B. a ed, sealed, and heated to prevent freezing. CI "4ACti Received By: Date: '17 -� - - tZ' Issued By:/ 2aw-4 t!� Date: a .?c MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW000392 Legal Description: ELMORE #2 BLK 10 LT 2 Design Engineer: 0014 Anderson Engineering Owner Name: Kaylen LeBaron Owner Address: 9330 Vanguard Dr. Anchorage , AK 99507- Date Issued: Sep 27, 2000 Expiration Date: Sep 27, 2001 ParcelID: 018-173-08 Site Address: 004650 145TH AVE E Lot Size: 40280 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: Z Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. 9 Private Well ❑ Water Storage 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 prior 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 April 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. Received By:��'� Issued By: Date: T"" lei nE;:z( Date: — 2 7-06 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 OSC251006 Parcel ID 018 -173-08 Legal description ELMORE #2 BLK 10 LT 2 Site address 4650 E 145TH AVE Expiration Date: 12/9/2025 Current property owner(s) DUNNACHIE SCOT X The On-site system(s) is/are approved for 4 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date: 1/15/2025 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, De�lopment Service Department (DSD) issues COSAs based upon representations provided by an k/dependent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other 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 Application 1. GENERAL INFORMATION Parcel I.D. 018-173-08 Complete legal description ELMORE #2 BLK 10 LT 2 Location (site address) 4650 E 145TH AVE ANCH AK Current property owners) SCOTT DUNNACHIE 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: I■❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK:®, Steel ❑ Plastic ❑ Concrete I Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑■ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ S 50 Waiver Fee $ Date of Payment 1 5 2� S Date of Payment COSA # S Waiver # COSA Application_ June 2022 COSA Checklist Legal Description: ELMORE #2 BLK 10 LT 2 Parcel ID: 018-173-08 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA N Well log is filed with Onsite (or attached) Date drilled 9/4/02 Total depth L21 ft Cased to 120.15 ft 70 Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 12/9/24 Static water level at beginning of test 60 ft. Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping 12/9/24 0 Required maintenance completed, if AWWTS Comments: "ADVANTEX, PRE-SET D. ABSORPTION FIELD DATA Which system tested (date installed) 4/4/22 9 ALL standpipes present per record drawing Total measured depth from grade 3.5 ft (max) Measured depth to pipe invert from grade ft (min) fi❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Q Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) _ If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 4+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes 0 No 9 Coliform bacteria is Negative Nitrate 0.716 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by . Date 12/9/24 MNA C. LIFT STATION N Required maintenance completed Age of lift station 2002 years Lift station material STEEL Comments: SEE MAINTENCE SHEET Adequacy test date 12/9/24 Results Q Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 1 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Q Yes if No _ ft Neighboring Tank > 100' Q Yes if No _ ft Absorption Field on Lot > 100' [j] Yes if No ft Community Sewer Manhole/Cleanout> 100' Q Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ It Holding Tank > 100' [j] Yes if No _ it Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No it 2 Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes f No _ ft rm Yes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No _ ft Surface Water > 100' F�l Yes if No _ ft Tank to Property Line > 5' F�] Yes if No _ it Field to Property Line > 10' F Yes if No _ ft Water Main > 10' ❑� Yes if No _ ft Water Service Line > 10' ❑� Yes if No _ ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' Q Yes if No _ ft 0 Yes if No _ It If tank or field is under driveway comment below G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm /moil -(S I('40'n M 1. Engineer's Printed Name art"- A COSA Checklist—June 2022 Phone 727-8864 Date t(15�25— f• .... /':.. �*I •• MICHAEL N. AKDLRS';N•• P•'�. C 94,39 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" madd and M .� f.4t�ta u of 20 , b tween entered into as of this _ Day of � Y And be 0hhbkiAL herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Cod (AMC) 15.65.365. In :onsideration of the mutual covenants contained herein, the parties t this Agreement agree as follows: 1. Advanced Wastewater Treatment Svstems. The Municipality grants permission the Owner to utilize and operate an Advanced Wastewater Treatment System (A W W/lT , described as vA%-iz /t 21 located at (legel description) 2. Mainteaaaee Repairs and Alte011981. (Owner is required to read, understand and initial each section) SL Throughout rite term of this Agreement, the Owner shall enter into a service agree4 nt with an AW WTS service and maintenance provider approved by the Municipality r the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capaole of performing as designed and producing treated septic effluent 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 pays or all repair(s), main.enance, adjustment(s), replacement costs, and inspection costs. Th' includes an annual maintenance fee (typically 5400 to $600). 1L Owner agrees that only maintenance and repair personnel approved by the Munici fity or the manufacturer's representative will inspect and make any necessary mains cc, repairs or pemr.itted alterations to the system. Owner acknov; ledges d.at regular maintenance of an AW WTS reduces the pot( failure of the system, which could include sewage backup and costly repairs or replacement. Page I of 3 (rev. 05/18!2018) Owner acknow;edges (lint the Municipality may request records of maintenance an repairs from th, manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an A W WTS m y be amsscd in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AW WTS. 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 new Certificate of On -Site Systems Approval. j Owner agrees tSat the AW WTS installation and maintenance requirements as provil ed by the AW WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AW WTS. CL- Owner agrees to maintain remote monitoring of the AW WTS as required by the AWWTS approval. 3. Term. The tern 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 centue while the AWWS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of thj Agreement sWI in no way constitute a waiver of the provisions, nor in any way aff! 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 representative the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. JutisdicHon Choice of Law. Any civil action arising from this Agreement shall bk brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. Tie laws of the State of Alaska shall govern the rights and obligations parties under 0 i Agreement. 7.ver2i i. Any provisions of this Agreement decreed invalid by a court of nom tent jurisdiction shall not invalidate the remaining provisions of the Agreement. i (rev. 05/18/2018) Pag of3 QWNER: By: -0� (signature) Date: l . YlStvjp y,tLLj (?*(print name) STATE OF ALASKA ) } ss. THIRD JUDICIAL DISTRICT ) The foregoing instmimt was acknowledged before me this cllay of 20,),j. by ` r=-- STATE OF ALASKA NOT .3LIC FOR ALASKA NOTARY PUBLIC My Commissim expires: 1-114 Natalie C. Carpenter My C wnissbn Expires Jul 24.: r f aturc) Date: name) Title: (rev. 05118/2018) Pa W3 3 479 545 I. ■m■ molls ■■■ ■■■■■ ■■ on ■■m■■ I� 3 I. ■■ ■ ■ ■mmmmm■ ■ ■■ ■ ■ ■■ ■ �e ■ on ■ ■ ■ ■■■omo■ ■ ■ on ■ ■ o �dvanTex® Field Maintenance Report AnchorageTank Annual Inspection 907-272-3543 Pmpery Owmr/Tra&M9 r _ pH (6-9) Operator Christine Calderone 9 US Services Technician bite Address Previous Caxton Pham 4650 E. 145th Ave, Anchorage AK 99516 (907) 229-2437 Ax Sib ID RCounty ID 0 Pod f RTU NUL r Date of Last Impepaon AX -100138 SW000392 200557 RTU125324 05/18/2023 Retrieve O&M Info Daily now Recirc ratio_ Timer settings: Perform Field Sampling/Observations NTU (15 x NTUs) pH (6-9) DO (2-6) PPM 338 9 2nd Compartment Odor of Sample Typical 0Musty ❑Earthy [:1 Moldy Non -Typical 08ulfide ❑ Cabbage [:1 Decay Oily film in PVu ❑ yes �No Foam in tank Dyes No Check Control Panel Rec9im Amps Discharge Amps Audible and visual alarms A!]'OK Dial tone (telemetry only) ❑Yes AN. Inspect/Clean Pump System Inspect Riser/Lid ..................... Splice Box .................... Float Cords .................... Floats ....................... Pump...................... Biotube• Filter ................. Biotube Pump Vault ............ Recirculating Splitter Valve....... Comments Clean Measure Sludge/Scum Sludge Scum tat Compartment Current Previous Current Previous 2nd Compartment Current Previous Current Previous Inspect/Clean AdvanTex Filter Odor. )F—fI Normal ❑ Pungent Biomat: Normal El Excessive Bridging/Ponding:None/Minor ❑Excessive Inspect/Clean Discharge Pump System Inspect Riser/Lid Splice Box Float cords `P Inspect/Service Other System Components Inspect Clean Inspect Clean Dispersal Laterels/Oriflc711 Disinfection Equipment Inspect Clean Laterals/Orifices Pod Bottom PodB,,,-----,,,ppp Intake Vent -{7 Inspect Clean Floats ❑ P Pump ❑ D9 Additional Services Rendered ❑ Cleaned textile sheets? ❑ Replaced UV items? ❑ Replaced/Used other Items? Parts Used: W = Warranty, B = Billable (✓ appropriate selection) W B Item Number Description Final/Safety Inspection SV reinstalled anifold reconnected; gush valves closed Summary/Recommendations ❑System performing; no further action needed ❑ Call for service Date Fax completed form to 1-866-384-7404 reLLlds bolted on t.ontrol panel reactivated ❑ Tank needs pumping ❑ Other? 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. 018-173-08 1. GENERAL INFORMATION Complete legal description Expiration Date: J �� ELMORE #2 BLK 10 LT 2 Location (site address) 4650 E 145TH AVE, ANCH AK Current property owner(s) Mailing address Real estate agent ROBERTS SAME 2. TYPE OF DWELLING: E] Single Family (w/wo ADU). ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well E Private Septic Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ a f fT leo? (guso) Waiver Fee $ Date of Payment qZ7 �OQa Date of Payment Receipt Number 00"79 D � Receipt Number COSA # Q SCS a f 1 a I 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 MIKE N ANDERSON, P.E. phone 727-$$64 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 4-4-22 40TH 6. DSD SIGNATURE .� System #1 Approved for 4 bedrooms °+ ,�• MICHAEL r,CE 9( . System #2 Approved for hedrooms �� °a^�^ •. r .,9 Disapproved �� F!?, V %N71 Conditional approval for bedrooms, with the following stipulations: OF ANC `� ER PNp o 1 By: _PjvOriginal Certificate Date: //Z /2 0 2 Q t 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 Checklist blue sheet COSA Checklist Legal Description: ELMORE #2 BLK 10 LT 2 Parcel ID: 018-173-08 If more than 7 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 9/4/02 Total depth 120 ft Cased to 120 ft ❑ Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24"+ in. Date of flow test for COSA 2/15/22 Static water level at beginning of test 62 ft. Comments B. TANK DATA Age of tank(s) 2002 years Tank type/material ..." Measured operating fluid level in septic tank 34" 0 Standpipes/foundation cleanout per record drawing Date of pumping ADVANTEX, SEE LOG D. ABSORPTION FIELD DATA NEW SYSTEM Which system tested (date installed) NEW 9 ALL standpipes present per record drawing Total measured depth from grade 4 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 Well production at time of test 4+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes [9 No 9 Coliform bacteria is Negative Nitrate 0.718 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 9 Arsenic less than MRL (ND) Collected by MNA Date of Sample 2/25/22 C. LIFT STATION 9 Required maintenance completed Age of lift station 2017 years Lift station material STEEL Comments: SEE MAINTENANCE RECORD Adequacy test date NEW Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added NEW gal New depth _ in Elapsed time _min N Code -required soil cover over field Final fluid depth _ in ❑ System presoaked Absorption rate _ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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 if No _ ft Community Sewer Manhole/Cleanout > 100' Yes ❑✓ Yes if No _ ft 0 Yes if No _ ft Neighboring Tank > 100' ❑� Yes if No _ ft Private Sewer/Septic Line > 25' 0 Yes if No _ ft Absorption Field on Lot > 100' EJ Yes if No_ ft Holding Tank > 100' ❑✓ Yes if No _ It Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No ft E)Yes ifNo_ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No _ ft 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' Q✓ Yes if No ft Property Line > 5' Absorption Field > 5' Water Main > 10' Water Service Line > 10' 0 Yes if No _ ft ❑ Yes if No ft ✓❑ Yes if No ft 0 Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' Ov Yes if No _ ft 2✓ 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' [a Yes if No _ ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No_ ft Wells on Adjacent Lots: Water Main > 10' Water Service Line > 10' Surface Water > 100' F. ENGINEER'S COMMENTS 0 Yes if No ft Z Yes if No ft v❑ Yes if No It G. ENGINEER'S CERTIFICATION Private Wells > 100' ❑✓ Yes if No ft Community Wells > 200' ❑D Yes if No ft / certify that 1 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. COSA Checklist yellow sheet � �•• MICHAEL N. AADL"(N . 'lfC 9 `%j .�•�2v69 07/08/2021 04:35 8686770 APLUS PAGE 04 ■■ ■ ■ ■M■ an MINE N ISO Mongolia 0 394 342 E ■EIME ■ ■ as N ■ ■ ■ ■ SOON A�ivanTex " Field Maifdoaece Report Annual Inspe :tion Property OxnnrMacang e Shelli Roberts am nddrete 4650 E. 145th Ave, anchorage AK 99516 "She IDM Courcy 10 AX -100138 _ SW000392 Retrieve O&M Info Dally flow Recim ratio Timer settings; Perform Field Sompl ng/Observations NTU (16: NTUa) pi (6-9) DO (2-6) Odor of sample Typical 0MUM ❑ Earthy ❑ Moldy Non-typlcal y{I Sulrn 9 ❑ Cabbage ❑ Decay Oily film in E ] yes [7(({No Foam in tank Nag J[L No Check Control Pane I A mps Discharge Amps Audible and visual ala ms IZOK Dial tone (telemetry n ly) ❑ Yes I(� No Inspect/Clean Puml System / Inspect Clean Riwol-ld .......... .......... Splice Box ...... . ............ . Float Coma ........ .......... Floats ....................... E Pump ..................... ... Ez Blotube'" Filter ..... ......... 71 Siotube Pump Vault .......... Recirculating Splitter ralva....... Comments Signature ,T ■EN■ ^ $ ■MM DperMor Larry Betts Pod t RN MUL t 200557 RTU125324 Measure Sludge/Scum AnchorageTank 907-272-3543 Conte. Phone (907) 555-5555 Date ar Lot Inepemlon 06!03!2020 Scum 1 at Compartment Current It Previous Current Previous 2nd Compartment Cument Previous Current Previous inspect/Clean AdvanTex Filter Odor Normal ❑ Pungent Biomat: Normal ❑ Excessive Brldging/Pondingu Non,/Mlnor ❑ Excessive Inspect/Clean Discharge Pump System Inspect Riser/Lid ❑ Splice Box ❑ Float cords ❑ InspeCt Clean 9 ❑[ f ILaterals/Orifices Pod Bottom Intake Vent Inspect Clean Floats ❑ ❑ Pump ❑ ❑ Inspect/Service Other System Components Inspect Clean Impact Clean Disinfection Equipment /`J ,v_J Dispersal Laterals/Orifice`• z Observations 1"k! A _ Additional Services Rendered ❑ Cleanod textile Shasta? ❑ Replaced UV Items? ❑ ReplecedlUsed other Items? Parts Used: W = Warranty, B = Billable (✓ appropriate selection) W B Item Number Description Final/Safety Inspection Ly RSV E=:t..I.h valves cloeetl ns ❑ System performing; no further action needed ❑ Call for service 0Llds bolted on Control panel mactivated ❑ Tank needs pumping ❑ Other? Fax completed form to 1-866-384-7404 MUNICIPALITY OF ANCHORAGE Development Services Department�_ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Owner Septic Tank: Lift Station/Pump Vault Maintenance Log Street Address yb,5,0 6- •Sludge level inches -Pumping: requiredes no -Pumping completed &no Lift station: -Pump basket cleaned es no -Effluent filter cleanedes no •Control floats cleaned es no -Proper float settings confirmed es no -Operation satisfactory es no Alarm System: -Dedicated electrical alarm cir e no -Audible and visual alarm inside dwellin es no -Alarm system operation satisfacto not satisfacto Manhole Riser -Ground water intrusion at riser to tank connection efen -Ground water intrusion around pipe penetrations es•Weep hole functional es no •Manhole lid: Functional es no Insulated Properly Secured es no Other -All manufacturer required inspections and maintenance completed &V o Comments: Qualified Maintenance Provider: Technicianko.rr W �� J r Date of mainte Company Lf- C, 5e (-V 1& -r- Signature _ - Signature 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 5th Day of April of 2022 , by and between Scot Dunnachie , 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 4650 E. 145th Ave. Anchorage; AK 99516 Acy o -v -,Tex --F-mc- located at (legal description) Elmor #2 L2 B10 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) X 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. X 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). X 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. X 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 X Owner acknowledges that the Municip ality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. X Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. X Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. X Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. X 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. X 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/l 8/20 1 8)Page 2 of3 OWNER: By: '' (signature) Date: � � y Zo S�C�T✓'(11�.`rG(� L' (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The forlegoirkg instrument was acknowledged before me this day of /''t , OUT PUBLIC FOR ALMK ,. R � My Commission expires: Pt!*"- O�- , as h� :,•` e�• 76�` tti oh``` MUNICIPALITY: By: (signature) Date:U g4e CC C�_ oa_r rO �( (print name) Title: (rev. 05/18/2018) Page 3 of 3 ��gs97p7, • • V ., Gf B •, Municipality of Anchor , ! • � .- .° On-Site Water and Wastewater Progr.m zy wi i (907) 343-7904 111 JUN 21 2017 EYY ti 6 4, Certificate of On-Site Systems App. ;, 6 9L c3 c;\ Parcel I.D. 018-173-08 Expiration Date: q '.2-6,` 17 1. GENERAL INFORMATION Complete legal description Elmore #2, Block 10, Lot 2 Location (site address) 4650 East 145th Avenue Anchorage, AK 99516 Current Property owner(s) Adrian & Carrie Jaime Day phone 727-6989 Mailing address 4650 East 145th Avenue Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: Ix l Single Family (w/wo ADU) Duplex 7 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ix I Individual Q Individual Water Storage ❑ Holding Tank n Community Class Well I I Community n Public Water System Public Sewer ❑ WaiverNariance request for: ' Distance: Received by:-----; :' le Date: . Adi C"'� 6 ( ,' COSA to be released . . er,unless otherwise requested by th. -ngineer. r_ COSA Fee $ (2 Co 9) Waiver Fee $ Date of Payment Lo%2, — 11 Date of Payment Receipt Number G0g611)G\ Receipt Number COSA# 4`3C.f 1 2 52 Waiver# ( h (e)a(eill I (PI )0 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address PO Box 240773, Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 6/21/2017 Dom: 4gTH • 6. DSD SIGNATURE °°▪••~� System #1 Approved for 41 bedrooms 4of.,C.,MICHAEL t:.ANDERSON01; CE-4381 • ItI System #2 Approved for bedrooms �� •.6 zr-r• 7 °S7>3 Disapproved ® 010 PROFESSION ,be` Conditional approval for bedrooms, with the following stipulations: .4) CN-SITE . NATER AND m WASTE�IATER PROGRAM By: �J WI— 1 ' Original Certificate Date: b 2` l 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_C c If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Elmore #2, Block 10, Lot 2 Parcel ID: 018-173-08 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) N Date completed 9/04/02 Sanitary seal (Y1N) Y Wires properly protected (Y/N) Total depth 120 ft. Cased to 1 20 ft. Casing height(above ground) >18 18 in. FROM WELL LOG AT INSPECTION Date of test 9/04/02 6/6/2017 Static water level 59 ft. 59'7 ft. Well production 10 g.p.m. 4.0 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate .874 mg,-L Arsenic NDug/L Date of sample: 5/24/17 Collected by: And. Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material AdvanteX/Steel Date installed 9/02 Tank size 1 '5002 Number of Compartments 2 Cleanouts(YIN) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping Pumper See Maintenance Records C. ABSORPTION FIELD DATA Date installed 6/19-21/17 Soil rating (g.p.d./ft2 or ft2/bdrm) 2 GPD/SF System type Bed Length 20 ft. Width 15 ft. Gravel below pipe '5 ft. Total depth 4-5 ft. Eff. absorption area 300 ft` Monitoring tube Y Depression over field N Date of adequacy test New Const. Results (Pass/Fail) For 4 bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed 6/21/17 Size in gallons 500 Manhole/Access(Y/N) Y "Pump on" level at 42 in. "Pump off"level at 38 in. High water alarm level at 44 in, Datum Bottom of Tank Cycles tested New Const. Meets alarm&circuit requirements? Y 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 >751 Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: >5' >5' >5' Building foundation Property line Absorption field Water main >10 Water service line >10' Surface water >100' Wells on adjacent lots X100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation > Water main > 10' >1 >10' Water Service line Surface water Driveway, parking/vehicle storage Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Well Information taken from tag on casing placed by M-W Drilling. /lust m.y Vo w.+o-n o alC..4....K-0.4.10 UT. - G. ENGINEER'S CERTIFICATION #w.sd� SIA. I certify that I have determined through field inspections and ,`P;•• 1� 44 S4_b* review of Municipal records that the above systems are in �; •' T . :-r- . conformance with MOA COSA guidelines in effect on this date. ,o ';• - H ;*p Engineer's Printed Name Michael E. Anderson, P.E. 0..... •• •, • 4.. 0 6/21/17 *4.'�9..,MICHAEL E. ANDERSON w r Date 410467:-1:;... CE-4381 I4-— i¢ .4, • Zf-I7 .••� „" ,1i,'a\%WI%- COSA brown sheet 10-10-12.doc -r E. 145th AVENUE / \ w 0 /_ • N 89'56'17"E 212.00' .• 'o r / ! :' I( f ASPHALT•:.-Pt, DRIVEWAY • WELL R=1•9 PROT�CTIV RADIUS SEPTIC PIPES z ': . 69.2' MANHOLES \ p x _ x OO x 0 TREATMENT POD Lot 1 ° I w Lot 3 J SEPTIC o0 \ PIPE o p i -- x V \O-� 67.6' + 00 `moo . ' :•:A / SHED \pi' \ / �o '"'-----.,........5-. ,- cn Lot2 ,0 10' UTILITY CHAIN-LINK FENCE - 40,280 s.f. EASEMENTS , _ . _ . __ „ _____ . _ x _ . xx _ x x — x - - - S 89'56'17"W 212.00' Lot 12 i Lot 11 � Lot 10 I I HOUSE DETAIL SCALE: 1"=30' �y 5.6,ss`CONC,: " 20.2' + o "' 12.2' 12.6' a ^ N6.5' 7.2 N 1 STORY co M RESIDENCE , 1.0' r.O• a. 10.3' 0 5.9 N 48.7' CONCRETE' .DECK• PLOT PLAN AS BUILT _X SCALE 1" = 50' GRID SW 3036 Project No. 17-175/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone ,zt:.oOOOQ� (907) 522-4625 Fax o. . F A C�� Professional Land Surveyors kenOlangsurvey.com d 9 jonathanOlangsurvey.com O . S Q I hereby certify that I have surveyed the following described property: 1 49TH i'‘ '.7 Os Q LOT 2, BLOCK 10, ELMORE SUBDIVISION - SECOND ADDITION (PLAT 69-96) QD Anchorage Recording District, Alaska, and that the Improvements situated thereon are a I vA within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed �'A KENNETH G. gt premises and that there are no roadways, transmission lines or other visible p ch (fp," easements on said properly except as indicated hereon. Q CetL21L7 Q VPS' .LS-520R.••oy � Doted this the 22v Day of JQ- , -'`‘ , at Anchorage, Alaska Q AR do OQ 0�5510NAL‘"S''=7 It is the responsibility of the owner to determine the existence of any easements, �00000�4 covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND David T. Roberts THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this 16th Day of June of 20 17, by and between David T. Roberts . herein the"OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex Treatment System located at(legal description). Lot 2, Block 10, Elmore Subdivision No. 2 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On-Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code(hereinafter, "AMC") 15.65. These approvals certify that H. 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. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: t/ 'Q T, ko Et215 b. Municipality: Director, Community Development or designated authority C. Any attempt to amend, modify,or change this contract by either an unauthorized representative or unauthorized means shall be void. the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On-Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense,to pay for any and all: (1)repair(s),(2)maintenance, (3)adjustment(s), (4)replacement costs, and(5)inspection costs. B. Owner agrees to comply with all applicable ordinance, laws,regulations,rules and orders for the AWWTS. C. Upon request by the Municipality,the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance,repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. S. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Se‘erability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: By: Y‘4444( Tc (signature) Date: /1 6 ?0 - PA u JD , j7 h ATS (print name) STATE OF ALASKA ) )ss. THIRD JUDICIAL DISTRICT ) The foregoingkstrutnent wasAcknowlgdged before me this day of )O)/u... , J 20 17, by t✓AGS j b e f 5 . Notary Public NOTARY PUBLIC FOR ALASKA WILLIAM F. KURTZ My Commission expires: /02012.6 State of Alaska My Commission Expires 10/20/2020 MUNICIPALITY: By: (signature) Date: Z %(7 (print name) Title: