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Home My WebLink AboutMOON #2 LT 38AOnsite File Moon #2 Lot 38A #018-182-29 Formerly T12N R3W Sec 33 L38 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221396 PID Number: 018-182-29 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name MOON ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 3640 EAST 142 AVE, ANCH ❑ Other Phone Number of Bedrooms Soil Rating ITotal depth from original grade 5 1.25 GPDrsF 0.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade +0.5 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot MOON LT 38A Fill added above original grade 4.0+ Ft. Gravel length 40 Ft. Township Range Section Gravel width 15.0 Ft. Beds: Number of Lines 3 Distance between lines 3 Ft. SEPARATION DISTANCES 0 Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 600 Ftz Ft. Well 1041x- 100'+ 100++ 50'+ TANK X Septic S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity ANCH TANK 3000 Gal, Surface water 50'+ 50'+ 50'+ Material Number of compartments Lot Line 101+ 101+ 10'+ NA STEEL 2 FoundationLIFT 10 10'+ 10 STATION Manufacturer Capacity I Remarks ANCH TANK 250 Gal' Alarm location GARAGE Electrical installed by RISING SUN Installer PIPE MATERIAL House to tank 3034, Tank to 3034 drainfield MIKE N ANDERSON, P.E. Drainfield 3034 CorMT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection 1-' 9(25/22 9/28122 Location and description 2nd TCP 4F MANHOLE 3rc 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp =�° •'� `' 3 Conditional Approval: DateAw 49 T+i 'J �- V:1 MICHAEL N. ANDERSCN Septic Syste__�_____-- f CE-9469 .•,..•w Approved 1 V�-.,��_ ®_., . Date �$� �=•101iV Note: this approval does not include well permit requirements. ,��aR OFFSz's�tR'� kRCv VUIVL( IOJ Permit No. 05P221396 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: MOON U2 LOT 38A PID No.: 018-182-29 MARK A B CO1 61 21 TC01 40 18 TCO2 38 30 33 MMPOD 238 MT2 37 78 MT3 40 92 MT4 48 101 BENCH, GARAGE II II /I II II MI \ TCO2 DRIVEWAY s — —\ T3 /m 3000 GALLON STEEL TANK WITH TWIN ADVANTEX PODS � ASBUILT / \\ SCALE: 1"=50' 1 cc DF )RG a 49 RL ................................. \) :MICHAEL N. ANDERS( No. CE 9469 e 'CO 0-11-22 o♦'!.��SS\� S Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section .a,�. 4700 Elmore St, P.O. Box 196650 Anchorage, AK 99519-6650 www_muni.orq/onsite (907)343-7904 Soils Log - Percolation Test .� I611.4 R. 1�k t �� D O � Date Performed: k`(� 3<Sc+i�3� Legal Description: F Township, Range, Section: I V '. • MICHAEL N, ANDERSON • . IF YES, AT WHAT DEPTH? t VV Depth to Water Atter 11- Performed For: t �� D O � Date Performed: k`(� 3<Sc+i�3� Legal Description: WAS GROUND WATER Township, Range, Section: T�4 �a z_ s reez1 /p 2- 3- 4- 5- C? 6- 7- 8 - Date Gross Time 9- Depth to Water WAS GROUND WATER ENCOUNTERED? E'„sj 10- IF YES, AT WHAT DEPTH? t VV Depth to Water Atter 11- tr Sit Monitoring? 12- Date: Z. 13- So 14- 15- 16- 17- 18- 19- 20 - COMMENTS Site Pian 09 Reading Date Gross Time Net Time Depth to Water Net Drop m tr Sit U So t( , R 'c WL_+InJry MA1r_ L. (mnutesAnch) PERC HOLE DIAMETER t t TEST RUN BETWEEN Z, qFT AND �FT PERFORMED BY: "xAt I CERTIFY THAT THIS TESJ WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ! L L _L, MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Well Log Permit Number: # 211245 Date of Issue: 7-7-21 Parcel Identification Number: Date Started: 1-13-22 Date Completed- 1-14.22 Is well located at approved permit location? Yes IN No ❑ Legal Description: T1 2N R3W SEC 33 LotW G:3035 Property Owner Name & Address: CoUrlrtey Moon Borehole Data: Depth (f}) Soil Type, Thickness & Water Strata From To Casing stick up 0 2 gravel 2 4 wet peat 4 12 wet gravel 12 30 silt & gravel 30 105 clay layer 105 115 silt & gravel 115 135 silt & gravel w/ H2O 135 138 coarse gravelw/ H2O 138 140 Water Sample Results: f I! z 4 4 Arsenic: N p _ ug/L Nitrates: d J) mg/L Total Coliform Bacteria:. .1 VA colonies/100mL Method of Drilling ® air rotary Q cable tool Casing type: steel Wall Thickness: -250 inches Diameter -6--inches Depth: 140 feet Liner Type: Diameter inches Depth: feet Casing stickup above ground: feet Static water level (from ground level): 45 feet Pumping level: feet after hours pumping _.gpm Recovery Rate: 24 gpm Method of Testing: airlift El Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet : 20 Start 0 feet StnnnM 20 Well Disinfected Upon Completion? Yes No Method of Disinfection: tabs Comments: Well Driller: Johnny Kay ❑ ❑ Company: Hefty Drilling, Inc. Mailing Address: po box 112130 Anch. AK 99511 Attention: The well driller shall provide a well Iog to the On-site Water and Wastewater Section within 30 days of completion. Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road 4 P.O. Box 196650 a Mark Begich Anchorage, AK 99507S A e T IV,&O Mayor www.muni.oro%nsite (407) 343-7904 Pump Installation Log Nell Drilling Permit Number.,SW A(.7,45 Date of Issue: r7-7—c 1 Parcel Identification Number: Legal DescriptionProperty Owner Name & Address: T 1d N �3 it/� -r � 33 GAt 38 C..�c� C�00 n 5 Pump Installation Date: I - A , Pump Intake Depth Below Top of Well Casing: )'�o feet Pump Manufacturer's Name: �rtar d ��5 Pump Model: /0 cj oj�; o q? - ...?00 Pump Size 314 f hp Pidess Adapter Burial Depth: 1() feet Pitless Adapter Manufacturer's Name: CAW6 Pitless Adapter installer: bict orc, Well Disinfected Upon Completion? M Yes E] No Method of Disinfection: Comments: Pump Installer Name: Johnny Kay Hefty Drilling, Inc. Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE Onsite Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 httpl/www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221396 Work Type: Septic Renewal Tax Code Number: 01818229000 Site Legal Address: MOON #2 LT 38A G:3035 Site Mailing Address: 3640 E 142ND AVE, Anchorage Owner: MOON COURTNEY & JESS Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: ',ienr lot S q V cpar-in ent Lot Size in Sq Ft: Total Bedrooms: 10/10/2022 10/10/2023 45566 Q Disposal Field Q 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 B) Issued By: Date: Date: 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. 018-182-'261 Property owner(s) MOON Day phone Mailing address 3640 EAST 142ND ANCH, AK Site address SAME -P2 Legal description (Sub'd., Block & Lot) MOON LT 38A Legal description (Township, Range & Section) Lot Size 45566 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) El Septic Tank 0 Upgrade ❑ (w/wo ADU) Holding Tank ❑ Renewal EDDuplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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) {ijc�, Permit/Rush Fees: 145 Fees: Date of Payment: r_ Date of Payment: Receipt Number: 64x33 Receipt Number: Permit No. _ ()S ea o) I __�q Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Sept 27, 2022 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Septic permit renewal Legal: T12N R3W SEC 33 LT 38 (Proposed Moon #2, Lot 38A) To Whom it may concern: This is a request for a renewed septic permit. The well has been installed but the septic was delayed due to heavy rain delays. Nothing has changed from the original design perimeters. This renewal permit will not impact any of the neighboring properties. The slope across the site for the mound is less than 5percent to the south east, see the site plan. 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 OSP221396, Deb Wockenfuss, 10/10/22 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 Water & Wastewater System Permit Permit Number: OSP211245 Work Type: WellSeptic Initial Tax Code Number: 01818203000 Site Legal Address: T1 2N R3W SEC 33 LT 38 G:3035 Site Mailing Address: 14210 IDA RD, Anchorage Owner: MOON COURTNEY & JESS Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date ��ren.t e, r; r U Department Lot Size in Sq Ft: Total Bedrooms: 7/7/2021 7/7/2022 1:•11 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage 4'+ 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 JS tial Provisions: An additional percolation test is required at time of construction. Percolation test shall omply with all requirements of AMC 15.65, including taking readings for at least 1 hour if 10 minute readings are taken. Results shall be submitted with the inspection report. U 1 pe,VlSe�OS0ra�"on b2c C 1112-1ZOZ1 V / Received By: Date: Issued By: � �yZ1Uca Date: Y 4W,`( UNIMPALITY 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. 018-182-03 Property owner(s) COURTNEY MOON Day phone Mailing address 3910 E 142ND AVE, ANCH AK Site address 1 y.) 1 O -L80- Rood Legal description (Sub'd., Block & Lot) T12N R3W SEC 33 LT 38 Legal description (Township, Range & Section) Lot Size 108900 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: (N all that apply) Absorption Field Fx_1 Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well 0 Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial 0 Single Family (SF) 0 Upgrade (w/wo ADU) 1-1 Renewal F-1Duplex (D) ❑ 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: 1319, �Lt SI -i Date of Payment: e-49, ©a 1 Receipt Number: 0 O Ll Permit No. c-bP q 1 �),; 5 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc June 17, 2021 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic & well permit Legal: T12N R3W SEC 33 LT 38 (Proposed Moon #2, Lot 38A) To Whom it may concern: This is a request for a revised septic permit on the above referenced lot. A test hole was excavated on the lot and found GM (Silty Gravels) with water at 5.2 then raised to 3.0 feet after the 7 day monitoring period. Over the past year the water table has been monitored and -3 feet is the max high water elevation. A new perc test will be done prior to installation. The old perc rate was measured at 2 minutes per inch. Due to the 5-bedrooms we are proposing a 2500 gallon steel tank and dual pod system per the Anchorage Tank requirements see the site plan. The tank will be ballasted with concrete per the design. A pump basin will also be installed to lift the effluent up to the proposed mound system. This new system will not impact any of the neighboring properties. The slope across the site for the mound is less than 5percent to the south east, see the site plan. 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 OSP211245, Rebecca Carroll, 07/07/21 DESIGN CRITERIA: 5 BDRM X 150 = 750 GPD SOILS = 750/1.25 = 600 GPD 600 GA/15 = 40' (1) MOUND +0.0' DEEP 0.5' EFFECTIVE 15.0' WIDE 40' LONG (TH�#1)#1) 2.0 (f ORG GM 91 WATER @ 5.2' MAY 2020 WATER @ 3.0' MAY 2021 INSTALL SOIL MATT - TO STABILIZE SLOPE OR USE 3:1 SLOPE r \ i� 15' DRAINAGE I \ j EASEMENT I \\ r WELL i I ` PROPOSED HOUSE—,I t rrra \` 10' T&E EASEMENT _ � II' +3.0 21 +0.5 0.0 -2.0 IN. 2' OF COVER REQ. + INSUL. .ED AND 4" TOPSOIL r -GRADE FIELD PROPOSED DRAINAGE FIELD -- SEPTIC I \ r I i / 1 I WELL i I • I I i i I ! -EAST 14? AVE- - WELL )SED NEL 1 SEPTIC �1 1 PROPERTY LINE -\ / !r ER FABRIC & SULATION '0 PIPE R ROCK R SAND wl1 Septic Design Prepared for COURTNEY MOON T12N R3W SEC 33 LT 38, PROPOSED MOON SUBD. #2 LOT 38A Anchorage, Alaska 'cae' N. Anderson, P.E. DATE: 11/1/2021 4601 NATRONA AVE DRAWN: DJR ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: 1 "=100' WELL . OFAl . . ® ® 49 TH ®.................................. MICHAEL N. ANDERS( No. CE 9469 .11/2/21 44b- SS\C M i ER FABRIC & SULATION '0 PIPE R ROCK R SAND wl1 Septic Design Prepared for COURTNEY MOON T12N R3W SEC 33 LT 38, PROPOSED MOON SUBD. #2 LOT 38A Anchorage, Alaska 'cae' N. Anderson, P.E. DATE: 11/1/2021 4601 NATRONA AVE DRAWN: DJR ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: 1 "=100' WELL . OFAl . . ® ® 49 TH ®.................................. MICHAEL N. ANDERS( No. CE 9469 .11/2/21 44b- SS\C M 1 1 I I i / L 1 / ` d d / ` ♦ • ♦ • d+.41 / �d i 1 / • +d• I ♦ d• / I f ♦ // ♦ d\ + d i ' 1 d •14 \\ PROPOSED WELL 1 00'RADIUS_, q • a + +d I J j FOOTING DRAINS MUST BE >10' FROM THE FIELD. Z, 0 Cn r- 0 O v m \ \\ PROPOSED5 \\ BEDROOM \ HOUSE - NEW 2500 GALLON STEEL TANK W/ (2) ADVANTEX PODS AND (2) 20" RISERS —TANK NEEDS TO BE BALLASTED W/ 6200 LBS OF CONCRETE TYP. MT EXTERNAL �� MT PUMP BASIN M11 ,b I M L-------------- T12N RM, SECTION 33 LOT 191 Septic Design Prepared for COURTNEY MOON T12N R3W SEC 33 LT 38, PROPOSED MOON SUBD. #2 LOT 38A Anchorage, Alaska 1"Wichael N. Anderson,P.E. DATE: 11/1/2021 4601 NATRONA AVE DRAWN: DJR ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: 1 "=30' T, 0 Cn r C Z rr i i i / / / / , / OF _744 49 TH \ ;MICHAEL N. ANDERSON; ' No. CE 9469 11 /2/21 ,.•� °�'® Municipality of Anchorage Aft Development Services Department On -Site Water and Wastewater Section 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Soils Log - Percolation Test 01 • a MICHAEL N. AND: RSCV Performed For: C () 4,4'-f r Y� V ��'r ? kn 4 t'f 0 +'t � Date Performed: Legal Description: �"I� , I9.1� Q (r 3 �i Township, Range, Section: LOA- ?, tw Slope Site Plan f)vv f LI k I- - 2- 3- 4- 5- 2 -3- 4- 5 - Cd Cd I c? 7- 8 - Date Gross Time Net Time Depth to Water WAS GROUND WATER 9- 10 ENCOUNTERED? ,j e 5 10- IF YES. AT WHAT DEPTH? L 1 G t Depth to Water After 71, O Monitoring? EP 12- Dare: r 7! 2 13-1 1 dr 14ttihtt4+- u.uI-*..j trrti J.'_ I 14- 15- 16- 17- 18- 19- 20- IA4 -L Init � Cz/d/ ! ., A Reading Date Gross Time Net Time Depth to Water Net Drop 10 G t ?ir 15'r 317 rCMt-,VLii 11UN rw.I t (n inutesfsnch) PERC HOLE DIAMETER (J TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: r\-- t -U t I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: V ,f I. t L( Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211245, Rebecca Carroll, 07/07/21 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 6 Day of Tu tH of 20a, by and between M 002 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 A -�, ` 2 D located at (legal description) Pru oo�, c -d M o on Sv L , t_u xX. 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) t l Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). �M Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, n repairs or permitted alterations to the system. t�M Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page I of 3 /104 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. 0,A Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. & Owner agrees that any sale or transfer of title of the property will not occur without anew Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: LV7 c 6*rl (signature) Comae 4vx i O-Ac>oo-, (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) Date: 7T,. it ZdZ { The foregoing instrument was acknowledged before me this�4 day of z.j 20by Covri ), V1v ;? NO RY PUBLIC FOR ALASKA JOHN MARTID8,2025 My Commission expires: 4� Notary Publi State of Alas My Commission Expires MtiNICIPALITY: By: (signature) �2Lecco'-. (print name) Date: 7� Title: (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section r Fax: 907-343-7997 Certificate of On -Site Systems Approval p Parcel 1. D. 018-182-29 Expiration Date: 1. GENERAL INFORMATION Complete legal description MOON #2 LT 38A Location (site address) 3640 E 142 AVE, ANCH AK Current property owner(s) MOON Day phone Mailing address SAME Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic 0 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 Waiver Fee $ Date of Payment Date of Payment Receipt Number 00 00 8�2 Receipt Number COSA# (JWaiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 10-12-22 By; J V,.-- R&_C f Original Certificate Date: Z0 —z0— , 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 ChecMist blue sheet ,..... m "'Ot-• , > a .: �, L.1 f' � -" . ••�°' •49Tr? 6. DSD SIGNATURE *r. ,,�. 5 ' System #1 Approved for bedrooms System #2 Approved for �tr �•• MICHAEL N. r',,NDft;SC;j r_ i bedrooms (, < CE- 94'9 Disapproved ,•> m Conditional approval for bedrooms, with the following stipt6{�tti;,�-o� By; J V,.-- R&_C f Original Certificate Date: Z0 —z0— , 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 ChecMist blue sheet Legal Description: MOON LT38A If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1113/22 Total depth 140 ft Cased to 140 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 30 in, Date of flow test for COSA NEW Static water level at beginning of test 45 ft. Comments B. TANK DATA Age of tank(s) NEW years Tank type/material """"TE Measured operating fluid level in septic tank * ❑ Standpipes/foundation cleanout per record drawing Date of pumping * ADVANTEX TANK Parcel ID: 018-182-29 of Structure served by this system D. ABSORPTION FIELD DATA new ADVANTEX system Well production at time of test b+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L OR Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 9/29/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material STEEL Comments: Which system tested (date installed) 9/26122 Adequacy test date NEW ❑ ALL standpipes present per record drawing Results 0 Pass For 5 bedrooms Total measured depth from grade 4 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade ft (min) Water added gal ❑ N/A — pressurized field New depth in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time min ❑ 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' 0 Yes Community Sewer Manhole/Cleanout > 100' r/ Yes if No ft M Yes if No ft Neighboring Tank > 100' F71 Yes if No ft Private Sewer/Septic Line > 25'71 Yes if No ft Absorption Field on Lot > 100' [D Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Q Yes if No ft r7l Yes if No ft if No >50'+ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' F✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' ❑ Yes if No >50' ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' ✓❑ Yes if No ft Water Main > 10' p Yes if No ft Community Wells > 200' ✓❑ Yes if No ft Water Service Line > 10' P- 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓Q 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 ft Surface Water > 100' ❑ Yes if No >50'+ ft F. ENGINEER'S COMMENTS ADVANTEX SYSTEM ALLOWED TO BE 50' OR MORE FROM WATER G. ENGINEER'S CERTIFICATION I 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 40TH IA -^'•. MICHAEL N. ANDERSON ' , -�•, CE - 9469 E�,'� MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND111REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day of of 202L�-, by and between (-110 P ,��--N ta) b ti3 , 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 located at (legal description) 2. Maintenance. Repairs and Alterations. (Owner is required to read, understand and initial each section) -S Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without p riY a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: (signature) Date= jo/1<T12_.CL_l'' (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) 0 The foregoing instrument was acknowledged before me this day of 00-ioLtr , 202a,by iiirisoo __�.--- NOTARY PUBLICNOTARY PUBLIC F R ALASKA NICOLE P. SQUIRES STATE OF ALASKA My Commission expires: M(ArChI7111 �rrcoM.MiS ON E%P RES Mam 12.7021 MUNICIPALITY: BY __� '''`^� (signature) (rev. 05/18/2018) Date: /0 - Z© (print name) Title: -2Z Page 3 of 3 tV 0 a'b r>— : •?, 0 CO � cr Coo�� :O ot• -n r :� z \C)AMW 0 C'I O O W C WO tV 0 a'b r>— HEI O❑ Q a 71;n o�O » �� 0 C'I O O W C ty ° > a SrR�,ti a (D m W J M x N rn N p6 CD O ^� C£'hc, N O m a : a r O Q Q Q f ryrD n (D d D O> ,r 09 m � � cu x (D i b (D nx ri (D r�-r Z3 (D O m m N Q+ = 0 N R C cn — U) (D io o in n _ 3 — (D N a- WIt 00Lilo m w — -fit /V 0 (p Drn < << n rn (D ID n W N o-(D E-' OO Z Q 3 S Z U) 0 n 0 O (D N Q A7�O0i W D e D < v a m N C O 0 D c 3 ,D (D N v+ O O �. 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