HomeMy WebLinkAboutPOTTER HIGHLANDS PH 2 BLK 4 LT 3Onsite File #020-281-82 ®-_ Municipality of Anchorage Af� On -Site Water and Wastewater Section • (907) 343-790 E Page '' ON-SITE WASTEWATER INSPECTION REPOR MAR ® 3 202® Permit Number: OSP191449 PID Number: 020-281-82 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family - Project: ❑® New ❑ Upgrade Name Potter Creek DEvelopment LLC ABSORPTION FIELD ❑ Deep Trench [0 Wide Trench ❑ Bed ❑ Mound ❑ Other Site Address NHN Potter Highland Drive Phone Number of Bedrooms Soil Rating Total depth from original grade 4 5.0 GPD/SFJ 8.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.0 FL Gravel depth beneath pipe 3.0 Ft. Subdivision Block Lot Potter Highlands Ph2 4 3 Fill added above original grade 0 Ft. Gravel length 20 Ft. Township Range Section Gravel width 5.0 Ft Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station jHolding I Tank Sewer Line Total absorption area 172 Ftz Number of trenches 1 Dist. between trenches n/a Ft. Well 100'+ 100'+ n/a I n/a 25'+ TANK M Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity 1500 Gal. Surface WaterAdantex 100'+ 100'+ n/a n/a Material Number of compartments Lot Line 5'+ 10'+ n/a n/a NA Fiberglass 2 Foundation 10'+ 10'+ n/a n/a LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer Red Dog PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 100.5 ft Inspection ection vt 1/21/20 Zed 1/23/20 3rd 1/23/20 4"' 2/12/20 Location and description Garage FF ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date 0. co l Steven R. Pannone � �l . c 81 4P s1F� D� Septic System ��'�i Approved ii Date 4/ % �'U,2Ci Note: this approval does not include well permit requirements. nmoc-)^^-ID �cnc�00--a: 0 rn m - �-rrl O r0' 1>r O> NCO D m 0 CD rnU,�x>xxxm x � z cl).70 f m \ 'W : r, r' r' 0 -P m D -;umQ 111 rq n � D D. v z q�z@ZN1'OD ON m C) c r (/) D m 0 :E 0� (T 1 O 0 x U? W m Z r z o m 0 -1 0 rr I V, m;u0Z0 (!i O a m� OZ TO z m rm Ft \ m � cn 0 m nr o O - n Z cm LO " -ilv Ic K ;7 w D w-0* -I z -D Oo z�U) rnO;�z- 0 rn m - �-rrl O r0' 1>r O> NCO D U) rnU,�x>xxxm x � z mUl �moz>IOm�\z m O D� _ 0..0�0 m \ 'W : r, r' r' 0 -P m D -;umQ rVv c) 'o to �-., < m �0 Do rn D. z 00 Lo m 0 rn m C) m 0o w m Q n (T 1 O 0 x U? x -1 0 U) m O K m D C) x Z / UFO o \ o S W \ > x \ nx>- MOFn rTi r OID Z t -4r- r- 0 I D roo D O O O \ o �\ m Z C ' ----T' I ID MID> \ Nz 1 ox n n I o N \ \ no O f o o - m O, O n D / \ r A / \ -� -. ji— / r,_ \ y 21 A;u 0 m A / o s o<z / s = co m \ O .p '� ou D '0 0 \C0 z n z rr*i � / \ M m ` \� � A Z� �-4' r �\ tE \ o cc 0 J S / _70' T&E EASEM NT / /✓_// NOTES: PANNONE ENG SVC LLC \REVISIONS DATE RECORD DRAWING P.O. 80X 1807 PALMER, AK 9645!aLystl. 2/14/2020 PHONE (907) 745-8200 FAX (907) 745-8201 SCALE j''4q y 1" = 60' POTTER HIGHLANDS PH2 134 L3 ."' "", �/ P.I.D. NO DRAWN ACP POTTER CREEK DEVELOPMENT LLC ~ �� teven $PaDn'none j pERM1T2 O1-82 SITE PLAN SITE: NHNANOCHORAGETTER ,HAKNDS DRIVE �1�i1 ,•'' S EET 29 \\ z \ -i N W iqM az m \ 'W : y / rro m0 x \ /,� m� r- ry O A g'r 11 x r >mw D a O L4 m D \ m � cn 0 M 0 - ;u a - D C) x Z / UFO o \ o S W \ > x \ nx>- MOFn rTi r OID Z t -4r- r- 0 I D roo D O O O \ o �\ m Z C ' ----T' I ID MID> \ Nz 1 ox n n I o N \ \ no O f o o - m O, O n D / \ r A / \ -� -. ji— / r,_ \ y 21 A;u 0 m A / o s o<z / s = co m \ O .p '� ou D '0 0 \C0 z n z rr*i � / \ M m ` \� � A Z� �-4' r �\ tE \ o cc 0 J S / _70' T&E EASEM NT / /✓_// NOTES: PANNONE ENG SVC LLC \REVISIONS DATE RECORD DRAWING P.O. 80X 1807 PALMER, AK 9645!aLystl. 2/14/2020 PHONE (907) 745-8200 FAX (907) 745-8201 SCALE j''4q y 1" = 60' POTTER HIGHLANDS PH2 134 L3 ."' "", �/ P.I.D. NO DRAWN ACP POTTER CREEK DEVELOPMENT LLC ~ �� teven $PaDn'none j pERM1T2 O1-82 SITE PLAN SITE: NHNANOCHORAGETTER ,HAKNDS DRIVE �1�i1 ,•'' S EET 29 \\ Alpine Drilling & Enterprise. Well Log Permit Number: HSW I91449 Date of Issue: 10-11-19 Parcel Identification Number: 02028182000 Date Started: 10-28-19 Date Completed: 10-29-19 Is well located at approved permit location? x Yes [] No Legal Description: Potter Highlands Phas 2 Bl 1 C; ocr4Lot3 Property Owner Name & Address: Potter Creek Development LLC Hagmeier Homes Borehole Data: Depth (ft} Method of Drilling Soil Type, Thickness & Water Strata From To b x air rotary ❑cable tool stick-up 0 2 gravelly silt 2 11 silty gravel. 11 36 grcnlelly silt 36 64 bedrock 64 206 WATER QUALITY TESTING C011frirm AbsQA+ C01/100mL. Nitrates `i, i 9 mg/L Arsenic 1.0 /L y z 2020 Casing type: steel Wall Thickness:.250 inches Diameter: 6 inches Deptli: 66 feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 70 feet Pumping level: feet after 2 hours pumping S gpm Recovery Rate: S gpm Method of Testing: air Zi Well Intake Opening Type: ❑ Open End x Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bent_ o_?i -- anules Volume: 2_ bgs Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? x Yes ElNo Method of Disinfection: Comments: Well Driller: Alpine Drilling & Bnterpr•ises PO Box 110496 Anchorage AK 99511 11111 q 111!q1 I I FOR lip Liffl Development Services Department Phone: 907-343-7904 fir - On -Site Water & Wastewater Section Fax: 907-343-7997 =00.1 Well Drilling Permit Number: 191449 Date of Issue: 10 -11 -19 Parcel Identification Number: 020281821000 Legal Description Potter Highlands Phase 2 Block 4 Lot 3 Property Owner Name & Address: Hagmeier Homes 2204 Cleveland Ave. Anchorage, AK 995127 Pump Installation Date- 02 -06 -2020 190 Pump Intake Depth Below Top of Well Casing: feet Goulds Pump Manufacturer's Name: 7HS07 Pump Model: 3/4 Pump Size: hp Pitless Adapter Burial Depth: feet Manufacturer's Name: mcozc� Pitless Adapter Installer: Pitless Adapter Well Disinfected Upon Completion? Yes 0 No Method of Disinfection: Chlorine tablets Comments: PLEASE SAVE FOR COSA. Pump Installer Name: AAROW PUMP & WELL SERVI(1, Company: P.0, Box 110496 Mailing Address: Anchorage, State: AK 99511 City: _Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 0 LO 0 N 0 z a 7 R w W w M Y UN OW JU m Q CV 00 O J 1�6 ,2L'LLZ 3 .90,01.00 N mod bi N II 0 ZQ Q U D m pZ8g5 L za 00< Z Q W w oo zo Z o Z p >Qz3 =NQz0J Q cn 0� X O} V 2S F V U= N p a F< 3 m 0� w H > Q w w O� N N w o w 2>XowgoW0p fA Q o � t Z U_ w U U w Q� Q Q N J W O Q x Q x LLJ Z } m ~ U OW LL- p } U Z Ix W Zo w x W o W =o wW. U XWwN=oM�� Z W p m WF- U z } W )--UwzZOZmN -- mwww SII zm = w WE a.o�� 6xomU _ w U N� O d Z W N Q Z - d W L p 0 0 0= W 00 U J j � No J z�WN � o Z �QCL LO W N m Q r) O 0 Z H Z Q N m ~w(D 3ww 00 0 O 0 z r) /n meg_ N Q V/ W o N 04 c z °° N Q 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: OSP191449 Work Type: WellSeptic Initial Tax Code Number: 02028182000 Site Legal Address: POTTER HIGHLANDS PH 2 BLK 4 LT 3 G:3638 Site Mailing Address: Owner: POTTER CREEK DEVELOPMENT LLC Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Q Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: ,�l„ent .” t epai-tmei,t 10/11/2019 10/10/2020 60212 Q 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: A J (l n Issued By: l oltJilt,� �Y Date: I/ G Date: 10 4 E10L4A/S MUNICIPALITY OF ANCHORAGE Community Development Department tea. Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERMlELL PERMIT APPLICATION Parcel I.D. 020-281-82 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 2, Block 4, Lot 3 Legal description (Township, Range & Section) Lot Size 60,212 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: Date of Payment: (N all that apply) Receipt Number: Permit No. 05 P191 ILM Waiver No. Absorption Field ❑X Initial R Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ 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: 226 Waiver Fees: Date of Payment: 1010 Nq Date of Payment: Receipt Number: LIL226 Receipt Number: Permit No. 05 P191 ILM Waiver No. Permit App__- : Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191449, Rebecca Carroll, 10/11/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191449, Rebecca Carroll, 10/11/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191449, Rebecca Carroll, 10/11/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191449, Rebecca Carroll, 10/11/19 MUMC AU7 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. 020-281-82 Expiration Date: d w I 1. GENERAL INFORMATION Complete legal description POTTER HIGHLANDS PHASE 2 BLOCK 4, LOT 3 Location (site address) 19161 POTTER HIGHLANDS DRIVE, ANCHORAGE, AK 99516 Current property owner(s) JAMES & JENNIFER LEGG Day phone Mailing address 19161 POTTER HIGHLANDS DRIVE, ANCHORAGE, AK 99516 Real estate agent Day phone 2. TYPE OF DWELLING: ® 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: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .550 Date of Payment &k Az_ ) Receipt Number -6-11 %2 5 COSA# 05G2� 11Q_, Date: Waiver Fee $ Date of Payment Receipt Number 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 FIRST WATER CONSULTING Phone 907.350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE Date 4/21/2021 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 ,aaa�®�y® system and maintenance. The operational life of all well and septic systems are subject to ft these various and dynamic characteristics and are outside the control of the evaluator of the •�• ""'�j well and septic system. Therefore, any estimate of how long a system will function satisfactory g*`Q: • .. �,p, $�� for current or future occupants or guarantee that no unseen encroachments, deficiencies or _ discrepancies exist can be given by First Water Consulting & FRGS • . TH ..... �� 6. DSD/SIGNATURE Curtis Huffman System #1 Approved for bedrooms �t♦¢�F��s•, CE 128991 .���'® �4 •.4/21/ 1•'<�� System #2 Approved for bedrooms ��� '°ROFESS0 Disapproved Conditional approval for bedrooms, with the following stipulation ��`��0 QEF(( ((( TER AND J� KV SERv�',S, 7/,?J By:99 �`vL r ����-�C Original Certificate Date: 7 % 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 Legal Description: POTTER HIGHLANDS PHASE 2 B4, L3 Parcel ID: 020-281-82 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 10/29/2019 Total depth 206 ft Cased to 66 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA NA - <2 YRS Static water level at beginning of test *70 ft. Well production at time of test *5 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.21 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 4/15/2021 Comments *PER MOA RECORDS - COSA RENEWAL – NEW WELL & SEPTIC <2YRS OLD. B. TANK DATA Age of tank(s) 1.5 years Tank type/material ADVANTEX / FIBERGLASS Measured operating fluid level in septic tank NA Standpipes/foundation cleanout per record drawing Date of pumping SEE AX MAINT. REPORT C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 2/12/2020 ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 5 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date NA – NEWER SYST. <2 YRS Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: 3” OF FLUID OBSERVED IN FIELD MT ON 4/15/2021 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 Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I 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. 4/22/21 05/14/2020 17:32 8686770 APLUS 0511312020 10:28 Ani: torage Tank ¢N)907 277 3715 392 660 som miss a ■emmr■ memo ■e■ er■ m ■i ori t tar � el of agerm■ m Boom a r m ■m■ 4!�qvanW! Pe Field MabilO ance Report Stark -Up SU nmary Report James Legg Larry Betts 19161 Potter Hi;i lands Drive, Anchorage AK 99616 .. pennita Mese ee hens rkrmWr 4 (904) 869-3619 OSP191,W Mode 1A Pannone Engines ring Services, LLC Tank I,Inc. Phone Aullarkea lnelelbr (907) 272-8218 Red Dog Masonry, Inc. (907)272-3543 Primary T oontmem If using a 2blaia PMOAA Ing lank, npinplots the following: ❑ Processing Tank Septic volume (_- _901.) Itociro Volume l gal.) Conetructim ❑Cortotass ❑F1110MI3aa ❑Other Menufectumn,.. if using a 2MACM Sol Io Tank and Pl Ion Tank, Complete the Following: ❑ SeptleTank (-- _9aW Conutmcdon ❑Conclata ❑F OVIass ❑char MxnufecNMr_. ❑ Reciro Tank (_.. —901.) Construction ❑ Coocrela ❑ Fldarglass ❑ Other Msnufactuser._- ❑ Pump Model: ❑ Flcata sat Proper • at -m. ^M. -Fn. Secondary Treat lent RSV setting: y�.- �__-in. ReaMual head m asulrmantt Ped at _6V_ - -in. Pod 6212` -in. Pod 09 _Y13L-in. C1 0laoher9s Tank,1 961111( _90L) .construction ❑Concrete ❑Flhemgiass ❑PVC(B"1011 Manurhoturer.–. ❑ Pump Model! -_ ❑ Floats set Props yet -In. ❑ Dlsoharge puml now mo (drawdown test). ( gPm) ❑ Dlechar9e Pum{ do0esnluMAt (galJdcss) Vj Comments^ �'' Control Panel PAGE 09 P.0011001 AnchorageTank 907-272-3543 T d oat0/20 p Ogle 4/20 ncy dm1 /20 "M. 907-522.6603 Panel ID{RTU or U4 O) "On"Timer Setting "Dln'T7mer 9etting RTU141734 Fllter Peds Ped e1 s"ll No. Pod 02 Serial No. Pod M3 asnm No. 433104 Othar System Components. ❑ DMinfoellon equipment (manufaCuraj ❑ Dispersal eyetem (type Or Deola (Initial) • a Srar up Prooadura -a followne. Ildssrsaapured. �CIroWt araakom are on and control Parcel Is 19fthad. For Sart/lca Cell" label with phony a was afgxsd to canal. Homeowner Package was mulowed wm: ❑ Builder on(daty (data) The system la ready for use PY6a ❑ No (exPlain) r. rr'ZIWIPPF1M signature Dots" �-- ax corfnpleled form to 1-888-884-7404 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 ZZ Day of —A p,-; I of 20 2-1 , by and between —J-05L�v,a. hx 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 AN ADVANTEX SYSTEM located at (legal description) POTTER HIGHLANDS PHASE 2, BLOCK 4, LOT 3 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) ' TW 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. S W 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). Srw 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. XT W 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 3"U 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. �w Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. sTW Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. ssw 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. 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 OWNER: By: (signature) Date: yz ZdZ] VA Lt 6e S (print name) STATE OF =+ice:. ,W 1 The foregoing instrument was acknowledged before me this 'Z2. -day of 20 by =LV&— ' r Pt}r 1� aty !i}} 1291$50 :a NOTAV PUBLIC FOR AiAls� T"� � ''� of �}D�- ` E;<trif M4. Decemb�r'�, My Commission expires: g -Lj 2-1 MUNICIPALITY: y�i By: /� (signature) (print name) (rev. 05/18/2018) Date: Title: Page 3 of 3 I I I [1� * 0 1 MEZZO Expiration Date: JUL U010 0� Complete legal description Potter Highlands Ph2 134 L3 Location (site address) Current property owner(s) Hagmeier Homes LLC Day phone Mailing address Real estate agent 2204 Cleveland Ave Ste 201 Anchorage, AK 99517 F1 Single Family (w/wo ADU) F-1 Duplex FI Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4, TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for Day phone Private Septic RX Holding Tank 171 Community n Public Sewer 171 Distance: Date: fl4Z-7— 0 / I COSA Fee $ 26: Waiver Fee $ Date of Payment aWall-96 Receipt Number COSA# 65C Date of Payment Receipt Number 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 MCA 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date ?�©'gO0o OF A/-�Sfilt TH 9$+ 6. DSD SIGNATURE • #1 Approved for bedrooms 4System / Steven •R� ­Poiniiorie CE 5149 System #2 Approved for bedrooms �� �sr Disapproved Conditional approval for bedrooms, with the following stipulations: 0 k�Y OF gMnr��/r,. lu r WATER AND WASTE ,11. R o `n Q BY: g UA Original Certificate Date: 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 0111 Fill, I i Legal Description: Potter Highlands Ph2 134 L3 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/29/19 Total depth 206 ft Cased to 66 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18°+ in. Date of flow test for COSA 10/29/19 Static water level at beginning of test 70 ft. Comments B. TANK DATA Age of tank(s) 1121/20 years Tank type/material Ad° !" jF,b�, Measured operating fluid level in septic tank n/a ❑ Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 1/23/20 On ALL standpipes present per record drawing Total measured depth from grade 8.0 ft (max) Measured depth to pipe invert from grade 5.0 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 020-281-82 Structure served by this system 1 Well production at time of test 5.0 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes R No ❑ Coliform bacteria is Negative Nitrate 4.19 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Services Date of Sample 4/1/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date n/a Results IJ Pass For 4 Fluid depth prior to test _ Water added gal New depth in Elapsed time min bedrooms in ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced 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' M✓ Yes if No ft F✓ Yes if No ft Neighboring Tank > 100' M✓ Yes if No ft Private Sewer/Septic Line > 250 Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' 0 Yes if No ft Water Main > 10' Animal Containment > 50' 0 Yes if No ft M Yes if No ft Q Yes if No ft Water Service Line > 10' Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' M Yes if No ft M 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' R 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' Q Yes if No ft Community Wells > 200' Q 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' 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' ✓/ Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / 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. Z,6& tj67 6 COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE Qk"-' '"" "-- " MI., N."I 6-A. moi THIS MAINTENANCE AND REPAIR ACRE MENT, herein the "AGREEMENT" made and entered into as of this 19th Day of of 20by and between herein the "OWNER," and the Municipality of Anchorage, herein the " 14 CIPALITY", 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 f A f Iocated at (legal description) 2. Maintenance, Repairs and Alterations. ----�, (Owner is required to read, understand and initial each section) , JL Throughout the teen 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. JL 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). JL 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. JL Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 JL Owner acknowledges that the Municipality may request records of maintenance and repairs frorn the manufacturer's representative or maintenance provider. ji. Owner acknowledges that the fine for failing to maintain and -repair an AWWTS may be assessed in accordance with AMC 1.4.60.030. JL - Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. JI, Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site System,, Approval. Ji,— 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. JI, Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval, 3. Term. The tetm 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 -frorn 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 pat -ties 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 ature) Date: ��� G�{ 2 name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) TIie foregoing insmiment was acicnowlggcd before me this ji day of WJy 7c/n , 2025, by c� _I P � 0 N 1 _ N1 6TARY PUBLIC FOR ALASKA ' "Official Seal" My Commission expires: Notary Public Lakiesha Pleasant - " C¢mmisifm State Of Alaska E1 011 1 391 6 Explraa 7t 13 YJ23 MUNICIPALITY., By:/� '� (signature) Date: q1? O pl,e-b,OCCS pro C (print name) Title: (rev. 05/18/2018) Page 3 of 3