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Home My WebLink AboutRABBIT CREEK VIEW & HEIGHTS BLK 3H LT 13AOnsite File Rabbit Creek View & Heights Block 3H Lot 13A #020-541-21 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201307 PID Number: 020-541-21 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: 9 New ❑ Upgrade Name Wilco Contractors LLC ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed F Mound Site Address 16361 Diane Drive ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 632-1907 3 2.0 GPD/SF JTotal +1.3 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade +1.8 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot Rabbit Creek View & Heights 3H 13A Fill added above original grade 5.5 Ft. Gravel length 30 Ft. Township Range Section Gravel width 7.5 Ft. Beds: Number of Lines 2 Distance between lines 3.5 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 225 Ft2 Ft. Well >50' >50' >50' N/A >25' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding 0 Other Manufacturer Infiltrator Capacity 1060 Gal. Surface Water >50' > 50' > 50' N/A Material Plastic Number of compartments 1 Lot Line >5' >5' >5' N/A NA Foundation >1 0' 1 >10, I >10' I N/A LIFT STATION Manufacturer Infiltrator Capacity 540 Gal. Remarks +3.2This is a Quanics System Alarm location Inside Garage Electrical installed by Kunder Contracting Installer PIPE MATERIAL House to tank D3034 Tank to D1785 drainfield Wilco Contractors Drainfield D1785 CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspdection 1S` 5/25/21 6/4/21 Location and description 2nd 6/4/21 Threshold of garage mandoor 3rd 4`h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date "' • cs� 49 TH "•` Benjar Schiller Septic System �F� •, CE 12592 Approved Date 2 2 .202 / 'spy• • , 9/21/21 , •'*2 , Z"OpROFESSI6*X��' Note: this approval does not include well permit requirements. kmev u5iuu_1 ut FCO 1"=50' 3-BDRM HOME CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT IP - INSPECTION PORT MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP201307 PID # 020-541-21 RABBIT CREEK V&H SUB, BLOCK 3H LOT 13A A B FCO 31.1 MH1 30.0 SV 24.3 A B C C 2CO 21.4 MH2 19.2 MT1 21.3 38.6 CO1 20.5 37.7 21.5 29.8 36.1 39.4 42.2 FEET 0 50 100DIANE DR IVE LITTLE RABB IT CREEK GREENBELT10' UT IL ITY EASEMENT TH1 TH2 EXISTING WELL w/ 50' & 100' RADIUS 30' LONG x 7.5' WIDE ABSORPTION BED EXISTING WELLS w/ 50' RADII 1190 1185 IM-1060 SINGLE COMPARTMENT INFILTRATOR TANK NS-500 AEROCELL POD MH1 MH2 TOE OF SLOPE SV IM-540 INFILTRATOR TANK/LIFT STATION EXISTING WELL w/ 100' RADIUS CO1 CO2 MT1 MT2IP2 IP1 CO3 CO4 MT3 MT4 2CO MT2 17.1 CO2 17.8 POD 22.8 32.2 33.6 37.2 IP1 19.2 IP2 26.8 MT3 47.3 35.6 39.2 54.9 CO3 46.8 54.0 MT4 44.7 50.1 CO4 45.8 51.6 PLAN AS-BUILT ALTERNATE SITE: 3,000 GALLON HOLDING TANK 5' FROM PROPERTY LINE & 10' FROM FOUNDATION Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEERSeptember 16, 2021 PROFILE AS-BUILT (NO SCALE) IM-1060 PLASTIC SEPTIC TANK94.2 90.6 95.1 98.4FCOMH SV2CO94.0 IM-540 PLASTIC SEPTIC TANK 90.5 98.4 2" INSULATION MHMTTH#1NO GROUNDWATER ON 7/2/20 & 5/26/21CO 84.7 DRAINFIELD ROCK MOA APPROVED FILTER SAND 30' 101.2 FINISH GRADE 97.0 95.7 ORIGINAL GRADE COMTPODCO CORETURN TO TANK 2" INSULATION 97.5 94.2 97.0 97.5 94.5 PERMIT # OSP201307 PID # 020-541-21 RABBIT CREEK V&H SUB, BLOCK 3H LOT 13A 94.9 RETURN FROM POD MOUND IS NO STEEPER THAN 2:1 & IS VEGETATED FOR SOIL STABILIZATION September 21, 2021 Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEER93.9 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE 2 SLOPE SLOPE SITE PLAN DATE READING GROSS TIME(minutes)NET TIME(minutes) DEPTH toWATER NET DROP PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) RABBIT CREEK V&H B3H L13A 6/26/20 L. Tidwell DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING: IF YES @ WHAT DEPTH?- -- -- 020-541-21 Wilkenson 6/29 1 2 3 4 5 6 1.5' OB Professional Engineers Stamp: NO NONE 7/2/20 GM GC - BLUE CLAY 5/26/21 UNABLE TO COMPLETE PERCOLATION TEST DUE TO IMPERMEABILITY OF SOILS. Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEERSeptember 21, 2021 ® DOC CO dba BILL % COLE WIVAN WATER WELLS P.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Travis Wilkinson ADDRESS: 16361 Diane Drive, Anchorage Bore Hole Data Depth From To LEGAL DESCRIPTION Rabbit Creek V&H Block 3H Lot 13A DATE: 8-28-20 0 2 Casing Stickup PERMIT NUMBER: OSP201307 DATE OF ISSUE: 8-26-20 TAX IDENTIFICATION NUMBER 02054121000 Is well located at approved permit location: ®Yes ❑No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 84 Casing Type: Steel wall thickness .250 inches Diameter: 6 inches, depth 84 feet Liner type Static Water Level: 23 feet Recovery Rate 30 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ® open end ❑open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: 2 4 Overburden 4 6 Peat 6 17 Silty Sand & Gravel 17 44 Silty Sand & Gravel w/ Clay 44 46 Tight Sand & Gravel Wet 46 52 Silt & Sand w/ Gravel 52 59 Silt Sand & Gravel Water 59 75 Hardpan & Cobbles 75 84 Sand & Gravel w/ Clay 9821 Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. Received Date/Time 09/08/2021 14:09 09/08/2021 12:23Collected Date/Time 1215825001 Matrix SGS Ref.# Client Sample ID Rabbit Creek V&H B3H L13A Client Name Project Name/# Printed Date/Time 09/17/2021 8:51Forge Engineering Inc. Technical Director Stephen C. Ede Rabbit Creek V&H B3H L13A Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS DSD09/15/21EP200.8ug/LArsenic 09/09/21ND5.00 (<10)B Waters Department EBH09/09/21SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N ND 0.200 (<10)C Microbiology Laboratory M.A09/08/21SM21 9223B100mLE. Coli Negative 1 A M.A09/08/21SM21 9223B100mLTotal Coliform Negative 1 A Page 2 of 5 MUNICIPALITY OF ANCHORAGE ent 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 Departinent On -Site Water & Wastewater System Permit Permit Number: OSP201307 Effective Date: 8/26/2020 Work Type: WellSeptic Initial Expiration Date: 8/26/2021 Tax Code Number: 02054121000 Site Legal Address: RABBIT CREEK VIEW & HEIGHTS BLK 3H LT 13A G:3241 Site Mailing Address: 16361 Diane DR, Anchorage Owner: WILKINSON TRAVIS & HALEY Lot Size in Sq Ft: 20490 Design Engineer: FORGE ENGINEERING Total Bedrooms: 3 ot vxy) C This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 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 Special Provisions: Onsite staff observed groundwater at 5 ft below original grade on August 19, 2020. A groundwater reading shall be taken and recorded prior to construction. (-QA'l S P d TC � �v�,o 'V 1 ►meq , Uj (0/312-1 Received By: Date: Issued By:,y"O" Date: la aw PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) FORGECIVIL.COM June 2, 2021 g MOA Development Services, On -Site Water & Wastewater Program, Thi 4700 Elmore Rd Anchorage, AK 99507 ' Benda in Schiller CE 12592 ••c`� �� /�rF • . 6/2/21 . • N Subject: Rabbit Creek V&H 13311 L13 — Diane Drive ��`��pROFESSiQ��`��°� Category III system request Dear On -Site Services Engineer: The owner of the above lot is pursuing a septic permit for the new construction on his lot. Due to the layout of building and driveway, he cannot fit the original field configuration on the property. In addition, we would like to demonstrate that, with the trench profile, this system can be accepted as a Category III treatment system. While the Quanics tank and pods themselves treat the effluent to a Category II standard, our revised bed design includes a bottom layer of sand to act as a filter and provide additional treatment. Sand filters are widely accepted to provide this additional treatment through the pore spaces in the sand, which allows for better aeration of the bacteria. According to available engineering documents, the upper 6-12" of the sand filter forms the biomat, which houses the bacteria needed to break down the wastewater particles. The sand filter we propose for this system is 2.5' thick. It is not used as part of an ERS system or to provide separation from groundwater, as the system already has the required separation. It is there beneath the bed to act as the additional treatment needed to consider this Quanics system as a Category III system. We appreciate your consideration of this proposal. Sincerely, Benjamin Schiller, PE PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 25, 2020 M.O.A. Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Rabbit Creek View and Heights, Block 3H, Lot 13A – NHN Diane Drive Septic System Design Dear On-Site Services Engineer: The owner of the above lot intends to build a 3 -bedroom home on the property. We are submitting this permit application for the construction of a new well and septic system. The attached site plan identifies the location of the home and the proposed well, septic location and alternate site. No conflicts exist between this proposed system and any other well or septic system on this lot or adj acent lots. The ground surface on the lot slopes to the northeast at grades approximating 7%. There are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site. Ground contours are shown on the site plan indicating the grade and direction of flow. Stormwater drainage will not impact this septic system. The new bed will be constructed parallel to the slope as much as possible. A Quanics Category II Treatment System will be constructed on the lot. The lot is small with little surface area for the absorption system. The top of the mound will be 4’ above grade. The side slopes of the mound will be 2:1 to minimize the footprint of the mound. The mound will be topsoiled and seeded and landscape matting will be placed to prevent erosion. The alternate site for the septic system will be Category III as shown on the Site Plan. Wells on this and adjacent lots are shown along with the 50’ radii which are allowed by Municipal Code for Category II Systems. The new system will be a minimum of 50’ from all surface water and more than 5’ from the septic tank. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201307, Rebecca Carroll, 08/26/20 Please refer to the attached test hole log and plan and profile sheets for the septic design. If this design is followed, there will be no adverse impacts to adj acent properties. Sincerely, Michael E. Anderson, PE 8/25/20 SPECIAL NOTE: EFFLUENT MUST BE !� DISTRIBUTED FROM THE CENTER OF ,� \ THE BED. DO NOT TIE DISTRIBUTION \ {% PIPES INTO THE END OF THE BED t \ LOT 12A VACANT / G � \ i LOT 13A X' \ / IM -1060 SINGLE C COMPARTMENT l INFILTRATOR TANK ✓ J 'Lj IM -540 INFILTRATOR �TANK/LIFT STATION ,gas' PROPOSED.WELL NS -500 AEROC`ELL UNIT w/ 50' R ,biUS FCOtl J -- _ ; 30' LONG x 7.5' WID MT` C• 1H IP v MH / \ ABSORPTION BED j i ~� n1r TOE OF LOPE� cr BL K _ . ✓ , / \ , EXISTING WELL w/ ®%---rt9 1 �. ---100' RADIUS LOT 14A CONFIRMATION PERCOLATION TH2 \ \ TEST FOR ALTERNATE SITE \ / TO BE DONE PRIOR TO `-✓ / rFCONSTRUCTION EXISTING WELLS' \ r1` .w/ 50' RADII , ✓ __ / \ � ALTERNATE SITE - CAT.,III SYSTEM APP RATE 0.5 GPD/SF: 2.0'x 45' ABSORPTION BED r BLOCK 2H \ / ENGINEERING NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE LEGEND PROPOSED SEPTIC SYSTEM CO - CLEANOUT 4� iFi ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2C0 -DOUBLE CLEANOUT PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC FCO -FOUNDATION CLEANOUT — • . •; ... SYSTEMS. IP -INSPECTION PORT Benja In Schiller p 50 100 MH -MANHOLE CE 12592 •,o MT - MONITORING TUBE 611/21? FEET SV - SEPTIC VENT �� pR4FESS10NA -�. 1"=50' TH - TEST HOLE DESIGN FACTORS: SYSTEM REQUIREMENTS: �41 450 GPD PEAK FLOW RAISED BED SYSTEM PERK RATE: 32 MIN/IN QUANICS TREATMENT SYSTEM - CAT II APPLICATION RATES: 4 GPD/SF - CAT 11 (SEWER ROCK - SAND INTERFACE) 2 GPD/SF - CAT III (SAND - INSITU SOILS INTERFACE) 450 GPD / 2 GPD/SF / 7.5' WIDE = 30 LF BED REQUIRED (30 LF SPECIFIED) BOTTOM OF BED: V ABOVE GRADE FLOW LINE ELEVATION: 1.5' ABOVE GRADE TOP OF BED: 4.0' ABOVE GRADE 7.5' 1 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE T OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY E N G I N E E R I N C'. ®' co -TH � Senja in Schiller CE 12592 'o DEPTH (feet) 1 - 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SOILS LOG AND PERCOLATION TEST E N G I N E E R I N G LEGAL DESCRIPTION: RABBIT CREEK V81H 135H L15A PERFORMEDFOR: WILKENSON DATE: 6/26/20 PROJECT No.: PARCELID#: 020-541-21 TECHNICIAN: L. TIDWELL TEST HOLE 1 1.5' OB GM I ` GC - BLUE CLAY w; SLIGHT COLOR CHANGE GC - GRAY CLAY SLOPE COMMENTS: DATE WAS GROUND WATER ENCOUNTERED? NO NET TIME (MINUTES) DEPTH To WATER (INCHES) IP YES rI WHAT DEPTH? - L 1 DEPTH TO WATER AFTER MONITORING: NONE 0 1 II BOTTOM OF HOLE DATE OF MONITORING: 7/2/20 P 3-315- 16,t 5/26/21 E 30 3-315 16'i COMMENTS: DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) 6/29 1 10:55 - 11:25 30 3-4-1 1 II 2 11:27 - 11:57 30 3-315- 16,t 3 11:58 - 12:28 30 3-315 16'i 4 5 6 PERCOLATION RATE: 32 (MIN/INCH) PERC. HOLE DIA, 6 (INCHES) TEST RUN BETWEEN: 2 FT. and 3 FT. CC) # 1 SOILS LOG AND PERCOLATION TEST E N G I N E E R I N G LEGAL DESCRIPTION: RABBIT CREEK V&H 1331-1 L13A PERFORMED FOR: WILKENSON DATE: 6/26/20 PROJECT No.: PARCEL ID#: 020-541-21 TECHNICIAN: L. TIDWELL DEPTH TEST HOLE 2 I (feet) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS: SLOPE Ce1ul GC - BLUE CLAY WAS GROUND WATER ENCOUNTERED? NU GROSS TIME (MINUTES) IF YES a WHAT DEPTH? - L 6/29 DEPTH TO WATER AFTER MONITORING: NONE 0 DATE OF MONITORING: 7/2/20 P 2 5/26/21 E DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) 6/29 1 2 3 4 5 6 PERCOLATION RATE: - (MIN/INCH) PERC. HOLE DIA. - (INCHES) TEST RUN BETWEEN: - FT. and - FT. RAN MUNICIPALITY OF ANCHORAGE Development Services Department `� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-541-21 1. GENERAL INFORMATION Expiration Date:Z�ZZ I Complete legal description Rabbit Creek V&H B3H Ll 3A Location (site address) 16361 Diane Dr Current property owner(s)Wilco Contractors Day phone 632-1907 Mailing address 17040 Jacqueline Circle, Anchorage, AK 99516 Real estate agent 2. TYPE OF DWELLING: ❑■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Al 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 $ 75 + ci rWaiver Fee $ Date of Payment gz2.3A 11 1 Date of Payment Receipt Number Q_59 -Z70 Receipt Number COSA #.0_'�)C, 2 I / 6'72 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 9/21/21 49 TH 6. DSD SIGNATURE _ System #1 Approved for bedrooms / BenjamxnySchiller System #2 Approved for bedrooms �j��rF ..0 9 2;/292. •��`� Disapproved t�iF�pROFESSIO�P Conditional approval for bedrooms, with the following stipulations: SOF Arlo 4�(r V `J 0 - W� AND �o WAST`-"v;'ATE o:z JJI�i�FNT SER��G 1`�,`� By: Original Certificate Date: � z The Municipality of Anchor 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 Legal Description: Rabbit Creek V&H 133H Ll 3A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 8/28/20 Total depth 84 ft Cased to 84 ft ❑® Sanitary seal is functioning correctly ®❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 8/28/20 Static water level at beginning of test 23 ft. Comments B. TANK DATA Age oftank(s) <1 years Tank type/material Quanics / Plastic Measured operating fluid level in septic tank N/A Fm -1 Standpipes/foundation cleanout per record drawing Date of pumping Tank installed on 5/25/21 D. ABSORPTION FIELD DATA Mound System Which system tested (date installed) 6/4/21 Fil ALL standpipes present per record drawing Total measured depth from grade 4.2 ft (max) Measured depth to pipe invert from grade 3.7 ft (min) ❑ N/A — pressurized field R Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 020-541-21 Structure served by this system Well production at time of test 30 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No FE -1 Coliform bacteria is Negative Nitrate mg/L ❑® Nitrate less than MRL (ND) Arsenic ug/L ❑® Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 9/8/21 C. LIFT STATION 0 Required maintenance completed Age of lift station <1 years Lift station material Plastic Comments: Adequacy test date New Septic Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in 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 N/A gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft 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 ft 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. 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 �%� Day of of 201A, by and between Uita ��` i , 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 Quanics Advanced Trestment Septic System located at (legal description) Rabbit Creek View & Heights B3H Ll 3A 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adiustment(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 AWViTTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfreld replacement. (rev. 05/18/2018) Page 1 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 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 O-wner 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. Severabiliiy. 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 Date: (32?/ -wZ.% G�.71 7A _ c: . ., STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) 4 The foregoing instrument was acknowledged before me this X! day ofS e4 ke mke.; 20 Zt , by PnA 0,1 Y-, NOTARY PUBLIC FOR ALASKA. NICK VONGVICHITH tti My Commission expires: /q,�, j , 20 zq Notary Public State of Alaska My Commission Expires Mar 17, 2024 MUNICIPALITY: By: �� (signature) Date: Zg 2 (print name) Title: (rev. 05118/2018) Page 3 of 3