HomeMy WebLinkAboutPOTTER HIGHLANDS PH 3 BLK 3 LT 9 Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage,AK 99519-6650• http://www.muni.org/onsite• (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181365 PID Number: 020-282-01 ❑✓ New ❑ Upgrade Name: Potter Creek Development LLC ABSORPTION FIELD Address E Deep Trench ✓❑Shallow Trench ❑ Bed ❑ Mound 19054 Potter Highlands Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 6 GPD/SF 8.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 4.0 Ft. 4•0Ft. Potter Highlands Phase 3 3 9 Fill added above original grade Gravel length Township Range Section 0.0 Ft 20.0 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 5.OFt. N/A N/A Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line 200 Ft' 1 N/A Ft. Well 107.3 134.0 N/A ' N/A 45.8 TANK ❑Septic I]S.T.E.P. ❑Holding Q Other Manufacturer Capacity Surface water 100.0+ 100.0+ N/A N/A Advantex 15000a1. Material Number of compartments Lot Line 27.4 15.3 N/A ' N/A NA Fiberglass 2 IFoundation 10.0+ 10.0+ N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 1 50.0+ 50.0+ N/A , N/A Gal. 1 Pump on level at Pump off level at High water alarm at Remarks __ _ in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer _ drainfield Red Dog Masonry Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100lt Inspection1= 02/12/19 Location and description dates: 2 02/13/19 3'd 02/15/19 4m 05/02/19 Garage FF COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp ..0 ` of AC� Conditional Approval: Date Y:e, • ,:4�st�) %* 49 /`ditipta01 10-- bteeve n -. •ri.riora‘e—ir ' 6-V714 -. CE 8149 e„ v Approved 1 Date S 44 �0!\\`�� Inspection Report_1-1-12.doc <3` `41 TH-961 / \� ' . _ . _ . _ . _ ./i K / PROBABLE FUTURE WELL LOT UNDEVELOPED . \. .7____, LOCATION NO WELL OR SEPTICS . _ . „ , . m s ” , N • w _ .. I a I . ..... W > � W I,, Zip o "o WELL (P) U ti yItja '�� 48R HOUSE B I i :II (NEW) / NEW 1,500g ADVANTEX TANK o . - w'`--W--f INSTALL FCO AND POST—TANK CO I \ FC )- A w DRIVEWAY a !Z 9 ss� T1 s) LS �C1 1,1, 107.3 S1 IhL CO ' M? TH-960 \ ss v- vv______.—\N)( M2 C2•• 4. I I; — 14.9 r Wi A B • I FC 10.10 "PRIMARY (NEW)/ RESERVE DRAINFIELD (P) 2OLF x 5'W x 4'ED x 8'TD T1 53.5 65.8 SEPTIC AREA (E) INSTALLED CO AND MT AT EACH END LS1 62.6 69.3 CO 66.7 72.0 Q Cl 87.1 79.8 (J O C2 92.0 93.3 M„..._.----M----___44 i M1 86.0 80.3 M2 92.0 92.0 /I\ I I LEGEND DESIGN PARAMETERS w -- WATER LINE/ WELL RADIUS PRIMARY/ RESERVE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1500g ADVANTEX SS NEW SEPTIC W/ AX20 POD PERC RATE: 1.6 MPI SOIL RATING: 6 GPD/SF ABBREVIATIONS AREA ROD: 100 SF TH TEST HOLE SYS. TYPE: WIDE TRENCH 4.0'ED (P) PROPOSED MIN LENGTH: 10 LF (E) EXISTING CO CLEAN OUT NO. USED: MT MONITOR TUBE NO. 20 LF X 5' WIDE, 4.0' E.D., 8.0' TD TYP TYPICAL TOTAL AREA: 200 SF NOTES: PANNONE ENG SVC, LLC _-_,-....... ....\‘‘, Dote RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 ,(� -4�, k 5/20/2019 PHONE (907) 272-8218 FAX (907) 272-8211 ic.D�P ..• �� y�l Scale *.• 4• I '* , 1"=50' /...'®te... .' :•• P.I.O. N POTTER HIGHLANDS PHASE 3, BLOCK 3, LO .9 / ��‘ 0-282-01 JOHN HAGMEIER HOMES LLC r Steven R. Ponnone PERMIT NO. POTTER HIGHLANDS CIRCLE Il�' • CE •8149 \<' OSP181365 PLAN ANCHORAGE, AK ,k'opi•P�gpjESS'A•.\1 Sheet ��V\\CC` 2 OF 3 °I- t- z F- m m <0 0 g o i- 1- CC U U u. U U Z Z U J Z 97'5 AX20 ` La FILTER FABRIC POD U 4•'0 DRAIN PIPE - U195.6 TH-i `` 95.6 /f[oRVNERocKs; OPSO194.0 1500g F.A.P. . ADVANTEX 91.6�T ` —91.6 TANK(NEW) CP 87.5 87.6 TRENCH SEE DESCN PROFILE -13.0 SM -16.0 GP -18.0 77.6 DRY 10/11/99 DRY 10/22/99 NOTES: 1�����.\\, Date PANNONE ENG SVC, LLC OF A� \� 5/20/2019 RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 r't� "••' �S l( '"�P' ' Scole PHONE (907) 272-8218 FAX (907) 272-8211 //* • TH y NTS ••• ••4,•• •••,1 P.LO. .• POTTER HIGHLANDS PHASE 3, BLOCK 3, LOT 020-282-01 POTTER CREEK DEVELOPMENT LLC. Steven R. Ponnone PERMIT NO. POTTER HIGHLANDS CIRCLE ,rt1'ccs CE 8149 . ? OSP181365 DESIGN DETAILS ANCHORAGE, AK (l�,,,,.•••••••p�`v Sheet l �OFESS+ON ANN, „.„.-...~ 3OF3 PLAT NO. 2018-10 POTTER HIGHLANDS SUBDIVISION, PHASE 3 LOT 9, BLOCK 3 55,570 S.F. S 89.49'S5"E 355.71' r I ' I I 20'CFA ROW ESMT. !10'10.1 C (2017-030855-0) ! n I WELL I I 0 I I 07.3• W rI I n .( o43 0 ! it EXI uNj 0 r BUI DING I - I 0W 1'S W r • o f • i o f 30' 15 t cr n 10.3• ! I of m r GRAVEL 0 o I Ee coca Z ', I I Z I F I I I 00 17.3• !-CWT ! I I `.21.7. ! SPIV SYSTEu I I ! eI I 24.5• ! I I 124.4' I S 89.49'55"E 385.22' BUILDING D E TA I L ELEVATIONS BASED ON 1972 NGS DATUM(TYP) SCALE: 1"=20' AS—B U I L T I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO 4.1111114* GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. OF • SURVEYING. LLC •�'�.••••••Q�q A# IT IS THE RESPONSIBILITY OF THE OWNER TO • P:' .9 JEFF A. GASTAL01, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS. 7,Uj;' • 2000 E.00wLING RD.,SUITE 8 COVENANTS OR RESTRICTIONS WHICH 00 NOT - *: 49T—H ....s, *j ANCHORAGE. ALASKA 99507 APPEAR ON THE RECORDED SUBOMSION PLAT. M t ,q•G (/ • PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR ♦o.• Je is0.6091 niei '- ESTABLISHING BOUNDARY OR FENCE LINES. �• ''^ ••• 5/2/2019 >`• • J SW3638 5/2/2019 • ,,........I °0.�.• ANCHORAGE RECORDING DISTRICT,ALASKA • os,iono F.B. JOB NO. NOTE: NO CORNERS SET THIS DATE •,�����• 111=40' 19-01 PHS393 5-AU!'41CIPALITY OF ANU-i'ORAGE On -Site 'Water & Wastewater Program? P0 u -.,9565, 47';U Efmor:, Andiomy. Alaska NSG -CN{: Phwc W WAN4 W P0713435997 On -Site Water an I-Nastevvater System Permjz' Permit Number: 0S.P181'365 Work Type: VVeflSeptic initia! Tax Code Number: 02028-2,01,000 Site Legal Address: POTTER HIGHLA,.IDS P.H 3 i�J_K 3 LT 9 G:363'8 Site Mailing Address: Owner. POTTER CREEK DEEVEI.(_-,Pl,�,,- C, [.,,_C Design Engineer: PANNONE ENGWEERCIG SERVE BS This permit is for the r_onsj.rLc- tion of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms, 10/11, 6,11*20 18 10/ 1 6,�20 19 I'D !. Dispos EZ. -Seplic Tank C1 Holding Tank 0 Privy F%Me *WU LJ 01aOr Stonge All construcibn shaH be in accobance with: L The atiacMed approved desyn, 2 AU mqWremwif.sspecifie(j it"i code Chapters 15Z5 W 1515 and Me SM, of NaAo, Wastewater Disposal Reguludws OBAAC72) an(! Dl -inking !,,Vater RegUlati0rS (18AACW) 3 The wastewater code n- .!,,quir:is in�speccijrm3 [iib installation. The engineer setas; rlotifyflie Services Depa.rtr,.-,F^nt pe r AMC 1 �5.635 . Provj�je r1c," ,ifllcati-)rl by calling („-�_7) 343-79,04 (24!7). 4. Prom OCtober 15, �a April 115, P snit absotplijor! systcfn� Lj.,,!der cQnsinjction cAhng freewng shall be either: a. Opened arid Closed on the siame (,,,iy, or N. Cu)Vered, seaied, 3itf heated to prevent free-inn 101 1 q I �6 � S c,0 I I k uAlk Von ved ReceVed B Y: Own By: s V1, 0 TN nok/ Datri o 4 �p�� ® Kcosli MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division 40 Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 020-282-01 Property owner(s) Potter Creek Development LLC Day phone Mailing address 561 E 36th Avenue, Ste 200, Anchorage, AK 99503 Site address NSN Potter Highlands Circle Legal description (Sub'd., Block & Lot) Potter Highlands Phase 3, Block 3, Lot 9 Legal description (Township, Range & Section) Lot Size 55,570 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial FX] Single Family (SF) ❑X Septic Tank 0Upgrade ❑ (w/wo AD U) Holding Tank ❑ RenewalDuplex ❑ (D) El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑X 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. (Signature of property owner or authorized agent) Permit/Rush Fees: 4 /26-v. 46 Waiver Fees: Date of Payment: 16 / it ! a Date of Payment: Receipt Number: oyq Receipt Number: Permit No. o6- Waiver No. Permit App__- : .....:c: Pannone Engineering S~rv~c~S LLC Steven R. Pannone, Principal E-mail:Registered Professional Engineer October 19,2Ol8 Subject: Potter Highlands Phase 3, Block 3, Lot Well and Septic System Install Permit Request Design Narrative This is a design narrative for a permit to install a new well and septic system to be issued for this property, The proposed systems will serve a proposed four bedroom (4) bedroom house. Currently the lot is undeveloped. Anew 3dvantexsystem and well will beinstalled. This lot and the lot tothe south are sen/ed byprivate wells. The remaining surrounding lots are undeveloped and will beserved by private wells. There are nowells within 5Q'ofthis CAT III wastewater system. l. Soils. One test hole was performed on this lot by Louis Butera in October of 1999, and groundwater was monitored for at least seven days, Ground water was not observed to a depth of 18' below the surface inthe test hole monitor tube after the 7day monitoring period. Bedrock was not encountered in the test hole. Based on the results of the percolation tests and overall soils appearance; an application rate of gallons/day/square feet was used for a Cat ||| wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet -1 of the design package 3. Surface Water: There isnosurface water within IOOfeet ofthe proposed septic tank and drain field. The proposed drain field upgrade will maintain at /east 1O0feet from all surface water and drainage ditches. 4. Topography: The existing topography generally slopes from the west to the east in the area surrounding the septic system at approximately 10%. There are no steep slopes in the vicinity. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from K4oA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. &;ai|ing: P.O. Box ", 00217,An[horSge,AK99510-0217 Physical: 332East K4ano�/\nchora�e,AK99581 Tie|2phon2:(BO7)Z7Z-8Z18 FAX:(907)Z72-8Z11 TH-961 \ /xLLruu*mu�'uZ)/-/ANN uo� / � | TH-980 IST, SEPTx�AREA([)-` ( r DESIGN PARAMETEF PRIMARY/ RESERVE SEPTIC NO. BEDROOM: 4( TANK SIZE: 1500yADVANTE, W/ AX20 D pERC RA/E: 1.5 MPI SOIL RATING: SCPD/SF AREA ROD: 100 SF - 5Y3. TYPE: WIDE TRENCH 4.( MIN LENGTH: 10 LF _ // USE: 20 LF X 5' YY|DE, 4.0' E.D, 8.0' TD TOTAL AREA: 200 SF / | / / U PR|�ARY/ RESERVE DRAwR[LD �) Y_?m F " s'w , ^'rn " n'rn ���_�__���_�� � INSTALL CO AND WTATEACH [ND . / | � '`'LEGEND ` ----vvWATER LINE/ WELL RADIUS ---- SG NEW SEPTIC /'| / ABBREVIATIONS \. / WELL (E) NOTES: PAMONE ENG SVC, LLC CHANCE ORDER P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 POTTER HIGHLANDS PHASE 3, BLOCK 3, LOT POTTER CREEK DEVELOPMENT L.L.C. POTTER HIGHLANDS CIRCLE PLAN | ANCHORAGE, AK TH TEST HOLE (P) PROPOSED (E) EXISTING CO CLEAN OUT NO. MT MONITOR TUBE NO. TYP TYPICAL OF Ak,� Date 10/19/2018 CE 8149 020-282-01 PERMIT NO. el PROFESSO*'- Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181365, Rebecca Carroll, 10/16/18 or_ R a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESc `, 825 "L" Street, Anchorage, Alaska 99502-0650 n o L9t:'ta A. uteea A SOILS LOO ® PERCOLATION TE sT Qvm�.�����, ER FORM ED F0R:7Z�' �EZ�. Zt-i,-y�,t��� ZZ C, DATE PERFORMED: 999 EGAL DESCRIPTION: %ZI LD To` 2 0D o 3 0.0. 00 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Gf' G-cY�.Sc'/ TJ/�l G4s�c'7L.5 ova S4n/O /Af7 5=� F_7 l DMMENTS vnship, Range, Se SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? __9 Date: l0— tion: SITE PLAN s L O P E Reading Date r Net Time cG Depth to Wa tje r S.y . -SL��J�5.4rti/rJ - "_7 •4 p12-e'l n �po DMMENTS vnship, Range, Se SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? __9 Date: l0— tion: SITE PLAN s L O P E Reading Date Gross Time Net Time cG Depth to Wa tje r Net Drop PERCOLATION RATE /�/-f/ (minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN -5-5 FT AND FT ,RFORMEO BY: `2� I CERTIFY THAT THIS TEST WAS PERFORMED IN ,CORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: .nna rcae„ n,aF. Carroll, Rebecca M. From: Tobish, Thede G. Sent: Friday, October 12'2O189:22Ak4 To: Carroll, Rebecca M. Subject: RE: Potter Highlands Ph 3 Blk 3 Lt 9 HiBecca plat note #11Ogoverns and gives guidance, sofollow the plat boundary. The plat lines represent the results of afield delineation. Thede From: Carroll, Rebecca K4. Sent: Thursday, October 1l,2O184:I0PM To: TVbish,Thede G. <thede.tobish@anchnnageak.gov> Subject: Potter Highlands Ph3B|kSb9 Thede, The GIS map for Potter Highlands Phase 3 Block 3 Lot 9 (020-282-01) shows undesignated wetlands on the east portion ofthe lot. The plat for the subdivision (18-l0)does not show wetlands onLot 9. Should |gowith the wetland boundaries identified unthe plat oronthe GIS map? Thank you, BcocoCunn|| Onsite Water and Wastewater Municipality ofAnchorage 343-7908 1 4 S� j Development Services Department � On -Site Water & Wastewater Section Certificate of On -Site Systems Approval Parcel I.D. 020-282-01 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: It—1q—?_02!C7 Complete legal description POTTER HIGHLANDS PHASE 3 BLOCK 3, LOT 9 Location (site address) 19054 POTTER HIGHLANDS DRIVE, ANCHORAGE, AK 99516 Current property owner(s) SAHMON & WHITNEY FALLAHIAN Day phone Mailing address Real estate agent 19054 POTTER HIGHLANDS DRIVE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -g 6 / 1/;?, 6 0 Date of Payment 2020 Receipt Number. ev07 0 9Z, COSA# 0SCa013a'7 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/3/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to �llt these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q'•' . for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting &9 TH FWCS ' *• •�* .. ........ 6. DSD SIGNATURE ' • " • • "' v'~" / . • Curtis Huffman System #1 Approved forbedrooms ����F�s•,• CE 128991 _Y_ /l�c� .,7/3/20�0•���r System #2 Approved for bedrooms �e�F�PROFESsioNP Disapproved Conditional approval for bedrooms, with the following stipulations: IN Original Certificate Date: / -1'/— 2— 6) The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: POTTER HIGHLANDS PHASE 3 BLOCK 3 LT 9 Parcel ID: 020-282-01 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 11/21/2018 Total depth 326 ft Cased to 146 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 6/30/2020 Static water level at beginning of test 240 ft. Well production at time of test 4.7 gpm Comments B. TANK DATA Age of tank(s) 1.5 years Tank type/material ADVANTEX / FIBERGLASS Measured operating fluid level in septic tank * ® Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) 2/13/2019 ® ALL standpipes present per record drawing Total measured depth from grade 10.2 ft (max) Measured depth to pipe invert from grade 6.2 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Structure served by this system Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 3.44 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FW=[; Collected by NES Date of Sample 6/30/2020 C. LIFT STATION ® Required maintenance completed Age of lift station _ years Lift station material Comments: *SEE AX MAINT REPORT Adequacy test date 6/30/2020 Results M Pass For 4bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 1 in Elapsed time <5 min ® Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: FWGS 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 Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No 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' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® 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' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l 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. TH �. .. ....•...� .. .... ....�...... • Curtis Huffman ��� °'Fc�•.. CE 128991 •,•���� �� ���c�,• • 7/10/2020 •��� �e©pROFESSI4H�AMP' MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREA'T'MENT SYS'T'EM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this ��.:-Day of ��"�%� -of 20'Zr. by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.36.5. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater, Treatment Systems. The .Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description) 2. Maintenance, Repairs and AIterations. (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 ofperforming as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay -for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. xh� 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. 05/1812018) Page 1 of 3 AOwner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. (tfliV� Obvner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. iAL�& Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at Least 24-hour notice. W, Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. "I/ 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. _PkNOwner 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 Municipatity. 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 shalt 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. Severabilitv. Any provisions of this Agreement decreed invalid by a court of competent .jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNS i By: '— (signature) (print name) STATE OF AS IA ��k1, n -o 15 ) ss. T-IiIR-D TUDI-C—T-kL—ISIS-TRIC—Ta�� The foreggintr instrument was aclalowledged before me this 20 0, by' ovine C �--� t )n. (\1 , a it NOTARY PUBLTC FOR ALA CA My Commission expires: 0' a- MUNICIPALITY: By: ,( (signature) name) Date: Cd�a� ay of J� , J Date: Title: 011-EICIAL SEAL PAMELA A LITTMANN NOTARY PUBLIC -STATE nF 11 HN 1S MY COMMISSION EXPIPp Y103 . v .t,ryhr (rev. 05/18/2018) Page 3 of 3 05. 14, X020 '1,..32 8686; o APLUS ® 368 336 117 Is IN I Ron so *vanTeii'-, Field Maintenance Annual Inspe Ntion Property ownarrnaeking a Sam & Whitney Fall Chian site Addree; •' 99054 Potter Highl;. ids Drive, Anchorage AK 99516 aX Ska 1D 4 Canty 10 8 Poo g AX -146577 I OSPI81365 1 430891 Retrieve O&M Info Dally flow Reoirc ratio --,- Timor 5ottings: Perform Field Sampd ng/Observations NTU (15:t LATUS) odor of Sample Typical Mu:: r ❑ Earthy i1 Moldy Non -typical Sul li e ❑ Cabb:39e ❑ Decay Oily film In PVU ] Yes No Foam to tank i,Yes No Check Control Pani: Reoirc Amps Discharge Amps Audible and visual 91: ins OK Dial tone (telemetry , dy) ❑Yes ON. Inspect/Clean Purril System Inspect Clean Rlser/Ud ......... ........... spliceBox ....... ........... !—' Float Cords .... . .. ........... Floats .......... • . _ _ ...... f - Pump ............ ........... SlotubeA Filter..... .......... Biotube Pump vault ....... ... 7 Recirculating Splitt<i� Valve....... Z �iCf7L` Comments ._ Signature—„—._ G IIII s IN III2 operator Larry Betts RrU P/VL d RTU139290 Measure Sludge/Scum er...r..o PAGE 0.. AncharageTank 997-272-3543 contact Phone (801) 668-9555 Date at last In'Pletion 0611 a/201 9 Scum 1StCompartmont Current Previous Current Previous 2nd Compartment Current Previous Current Previous Inspect/Clean AdvanTex Filter Inspect Clean Odor. Normal Pungent Latrlrals/Orifice+' / C Biomat: Normal ❑ Excessive Pod Bottom BridginglPonding:{ None/Minor ❑ Excessive Intake Vent ( /J inspect/Clean Discharge Pump System Inspect Inspect Clean Riser/Lid n Floats U n Splice Box. ❑ Pump ❑ U Float Cords u Inspect/Service tither System Components Inspect Clean Inspect Clean Disinfection Equipment' Dispersal Laterals/Orifice 0lbservatlons Additional Services Rendered ❑ Cloaned textile sheets? ❑ Replaced UV items? Replacod/Wed cthcr Items? Parts Used: W = Warranty, S = Billable (.l appropriate selection) w R Itam Number Description FinaalfSafety InSPOction i.n PSV reinstalled Az bolted on ZManifold reconnected; flush valves closed !— Control panel reactivated Summary/Recommendations ❑ System performing; no further action needed E] Tank needs pumping Call for aeraice ❑ Other? nc (.4 Date 1 I Fax completed form to 1-866-384-7404 EPtfrMs 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 ;r� -� Parcel I.D. 020-282-01 zS Expiration Date: `��5 -17 1. GENERAL INFORMATION Complete legal description Potter Highlands Ph 3 B3 L9 Location (site address) 19141 Potter Highlands Drive Current property owner(s) Hagmeler Homes LLC Day phone Mailing address 2204 Clevland Ave Suite 201 Anchorage, AK 99517 Real estate agent Day phone 2. TYPE OF DWELLING: O Single Family(w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic 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 $ T.5 Waiver Fee $ Date of Payment 67g2//q Date of Payment Receipt Number Oq,`j 3 (a Receipt Number COSA# (3509/19'8 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 Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 c• Engineer's Printed Name Steven R. Pannone P.E. Date QJ• . / / C�OFAL4 k 6. DSD SIGNATURE System#1 Approved for l bedrooms Steven R. P,nnoree j �? CE Sl�-9 System #2 Approved for bedroomsflta Disapproved \\\`��. - Conditional approval for bedrooms, with the following stip`l�ti ( (((f(rr' Wry '1/4 Otis s F -73r pRat; �'�TFR „ RA41 oma` is00- l/ICES�,N``,\`` >>»)►►)>>"�i By: – _- Original Certificate Date: i —2-k2 –)? 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: Potter Highlands Ph3 B3 L9 Parcel ID: 020-282-01 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system 1 A. WELL DATA ❑Well log is filed with Onsite(or attached) Well production at time of test 5 gpm Date drilled 11.21.18 Water storage tank volume gallons Total depth 326 ft Well disinfected for coliform test? ❑Yes ❑✓ No Cased to 146 ft Coliform bacteria is Negative El Sanitary seal is functioning correctly Nitrate 3.00 mg/L ❑ Nitrate less than MRL (ND) CI Wires are properly protected Arsenic ug/L U Arsenic less than MRL(ND) Casing height(above ground) 24 in. Collected by PES Date of flow test for COSA New Date of Sample 5-13.19 Static water level at beginning of test 142 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) 0 years ❑ Required maintenance completed Tank type/material Age of lift station years Measured operating fluid level in septic tank New Lift station material ❑Q Standpipes/foundation cleanout per record drawing Comments: Date of pumping New " FAP Advantex/Fiberglass D. ABSORPTION FIELD DATA Shallow Trench Which system tested(date installed) 2/13/19 Adequacy test date New ALL standpipes present per record drawing Results Q✓ Pass For 4 bedrooms Total measured depth from grade 8.0 ft(max) Fluid depth prior to test in • Measured depth to pipe invert from grade 4.0 ft(min) Water added gal ❑ N/A—pressurized field New depth in ❑� Monitor tubes go to bottom of effective. If not,state Elapsed time min depth into effective 0Code-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) If yes, enter date Gallons introduced gallons 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' Community Sewer Manhole/Cleanout> 100' []✓ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line>25' 0✓ Yes if No ft Absorption Field on Lot> 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields> 100' Animal Containment> 50' 0✓ Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' 0 Yes if No ft Surface Water> 100' 0 Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells> 100' ✓0 Yes if No ft Water Main > 10' El Yes if No ft Community Wells>200' 0 Yes if No ft Water Service Line> 10' 0 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' 0 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' 0 Yes if No ft Private Wells> 100' 0 Yes if No ft Water Service Line> 10' 0 Yes if No ft Community Wells>200' 0✓ Yes if No ft Surface Water> 100' ✓l Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review -...10-.••. of Municipal records that the above systems are in conformance with *: •••49TH 1\ •.* MOA COSA guidelines in effect on this date. •••• •t,` $even "anriowe CE 8149 COSA Checklist yellow sheet i ADVANCED WASTEWATER TREATMENT SYSTEM {{' MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND Sahmon Fallahian THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this 3 Day of May of 2019 , by and between Sahmon Fallahian s 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 1500 • located at(legal description). Lot 9 Block 3 Potter Highlands P 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 1 • 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 s 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 • fi and orders for the AWWTS. C. Upon request by the Municipality,the owner agrees to provide the Municipality a j` is written schedule of routine maintenance and repairs which have been performed I' 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. • I 1 C. Any attempt to amend,modify,or change this contract by either an unauthorized 1 representative or unauthorized means shall be void. i 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance I 1 and Repair Agreement shall be brought in the Superior Court for the Third Judicial E I District of the State of Alaska at Anchorage. The laws of the State of Alaska shall 1! govern govern the rights and obligations of the parties under this Maintenance and Repair i } Agreement. ti 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining 1 i i .provisions of the Maintenance and Repair Agreement. E l OWNER: 4 • r.'By: �, (signature) Date: E cDA'nn. n c A cx- N Gc r1 (print name) E fk f K i STATE OF ALASKA ) g ss. r THIRD JUDICIAL DISTRICT ) Hca The forego' g instrument was acknowledged before me this 3 `day of , 20 161 , by(Gti)(X1)( S71'Lniti ki: N TARY PUBLIC FOR ALASKA ;i,41.,. "orctoial scar" 0,31 r 43r, Notary Public p My Commission expires:S 2 1 og a l S f, 1 ,, e-� Gebricllc Smith 1i;.•- �r'' State of Alaska Commission P190328003 Expires 0328/2027 F llx f' • MUNICIPALITY: q s By: t-v, / _(signature) Date: Z2—I E' E (print name) Title: s 4 F 1 E f Alpine Drilling & Enterprises i Well Log I Permit Number: fiSW181365 Date of Issue: 10-16-18 Parcel Identification Number: 02028201000 Date Started: 11-18-18 Date Completed: 11-21-18 Is well located at approved permit location?x Yes ❑ No Legal Description: Potter Creek Highlands Phase 3 Block 3 Lot 9 Property Owner Name&Address: Potter Creek Development LLC 1 Borehole Data: De th I ft { P ) Method of Drilling x air rotary ❑cable tool Soil Type,Thickness&Water Strata From To Casing type:steel stick-up 0 2 Wall Thickness:.250. inches siltysandygravel 2 30 Diameter: 6 inches Depth: 146 feet Liner Type:. boulder 30 32 Diameter:_ inches Depth: feet silty gravel 32 37 Casing stickup above ground:2 feet : gravelly silt 37 96 Static water level(from ground level): 142 feet silty clay 96 139 Pumping level: 326 feet afterii 2 hours pumping 5 gpm bedrock 139 326 Recovery Rate: 5 gpm • Method of Testing:air lift Well Intake Opening Type: ❑Open End ` x Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet eGrout Type: betonite chips i (,U4r4/ - ` Volume: 4 Depth: Start 10 feet Stopped 30 feet g Pump: Intake Depth feet • Pump size hp Brand Name Well Disinfected Upon Completion?x Yes❑ No I WATER ITY TESTING Method of Disinfection: chlorine tablets Conform el Cta1/100mL Comments: Nitrates -00 mg/L Arsenic N 17 ug/L Well Driller: Alpine Drilling&Enterprises • PO Box 110496 Anchorage AK 99511 t i • t i 4 1 i U C P L YY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water& Wastewater Section Fax: 907-343-7997 Pump installation Log • Well DrillingPermit Number: 181365 10 16 18 Date of Issue: - i Parcel identification Number: 02C-28 _01 (Legal Description Block Lot Property Owner Name&Address: Potter Creek Highlands 3 9 • John Hagmeier Co. Phase 3 2204 Cleveland Ave.,Suite 201 Anchorage,AK 99517 Pump Installation Date: 02 -21 _2019 Pump Intake Depth Below Top of Well Casing: 312 feet • Pump Manufacturer's Name: Goulds Pump Model: 7HSI 0 Pump Size: hp • Pitless Adapter Burial Depth: N/A feet Pitless Adapter Manufacturer's Name: N/A Pitless Adapter Installer: N/A Well Disinfected Upon Completion? 0 Yes 0 No • Method of Disinfection: chlorine Tablets Comments: • PLEASE SAVE FOR COSA. Pump Installer Name: Company: Alpine Drilling & Enterprises Mailing Address: P.O. Box 110496 City: Anchorage State: AK Zip: 99511 Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.