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HomeMy WebLinkAboutTHOMAS L BOYLE BLK 1 LT 12BOnsite File Thomas L Boyle Block 1 Lot 12B #015-283-06 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201402 PID Number: 015-283-06 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: W New ❑ Upgrade Name PAUL CARSTENS ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed © Mound Site Address NHN WAGNER STREET ANCHORAGE, AK 9923 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-345-0371 4 3 GPD/SF +1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade +1.5 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot THOMAS L BOYLE SUB 1 12B Fill added above original grade 3.9 Ft. Gravel length 40 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches 1 Dist. between trenches From Tank Field Tank Line 200 Ftz N/A Ft. Well >50' >50' N/A N/A >25 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ®❑ Other Manufacturer ORENCO (ADVANTEX) Capacity 1500 Gal. Surface Water >50' >50' N/A N/A Material FIBERGLASS Number of compartments 2 Lot Line >5' >5' N/A N/A NA Foundation >1 0' >1 0' N/A N/A LIFT STATION Manufacturer O RE I ^' V CO Capacity 250 Gal. Remarks 2" FOAM INSULATION INSTALLED OVER FIELD Campbell pitless adaptor installed by Red Dog Masonry at 10' burial depth Alarm location GARAGE Electrical installed by FRONTIER ELECTRIC PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer RED DOG EXCAVATING Drainfield D3034 CO/MTD3034 Inspector J. MILLETTE BENCH MARK (Assumed elevation) 100 ft Inspection15` 3/31/21 4/7/21 Location and description dates: 2"d sd 4/7/21 4,,4/8/21 BOTTOM OF SIDING AT SW CORNER OF HOME ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date .cp Benjan Schiller Septic 125 'sr' Approvedstem��: Date (,/10 X021 .0 6/10/292•.•'����� �l pROFESSibNA��` Note: this approval does not include well permit requirements. (rtev ub/u«i d) 1"=50' 40' LONG x 5' WIDE x .5' EFFECTIVE DEPTH ABSORPTION TRENCH 4-BDRM HOME CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE PV - PUMP VAULT TH - TEST HOLE LEGEND PERMIT # OSP201402 PID # 015-283-06 THOMAS L BOYLE SUB, BLOCK 1, LOT 12B A B FCO 33.5 MH1 42.3 MH2 47.6 A B PV1 44.6 MT1 63.7 MT2 91.6 21.0 31.7 38.2 41.9 100.5 118.4 WAGNER STREETFEET 0 50 100 TH1 TH2 ALTERNATE SITE EXISTING WELL WELL 1500-GAL ADVANTEX TANK W/ AX20 POD & PUMP VAULT MT1 MH2 PV1 MH1 FCO 280 285 TOE OF 3:1 SLOPE NOTE: WELL MUST BE A MINIMUM OF 25' FROM ANY SUBSURFACE DRAIN. TH3MT2 5/20/21 PLAN AS-BUILT PROFILE AS-BUILT (NO SCALE) AX-20 POD AND MANHOLES 98.6 FINISH GRADE TH#387.2 GROUNDWATER 4/7/21 85.2 94.7 ORIGINAL GRADE PERMIT # OSP201402 PID # 015-283-06 THOMAS L BOYLE SUB, BLOCK 1, LOT 12B 6/2/21 96.2 95.7 93.8 96.2 95.7 93.1 94.5 89.6 95.0 98.9 FINISH GRADE DRAINFIELD ROCK MOA APPROVED SANDMT2 MT140' 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 3 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) THOMAS L BOYLE B1 L12B 3/30/2021 l. TIDWELL DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING: IF YES @ WHAT DEPTH? 1.04 6 3 4 015-283-06 Colony Builders 1 2 3 OB Professional Engineers Stamp: NO SM CL 4 5 6 1:35 4:13 0-6 6 6 6 6 6 6 0-6 0-6 0-6 0-6 0-6 5:47 6:20 6:23 6:13 6:15 1:42 1:50 1:58 2:05 2:12 N/A 7.5 4/7/21 6/10/21 Permit Number: #SW201402 Rate of Issue: 10-05-20 Parcel Identification Number: 01528306000 Date Started: 10-29-20 Date Completed: 10-30-20 Is well located at approved permit location? x Yes ❑ No Legal Description: Thomas L. Boyle Block 1 Lot 12 B Property Owner Name & Address: Colony Builders 9420 Vanguard Unit A Anchorage, Alaska 99507 Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Method of Drilling x air rotary El cable tool Casing Type: steel stick-up 0 2 Wall Thickness: .250 inches sandy ,silt sandy gravelly silt 2 23 23 25 Diameter: 6 inches Depth: 141 feet Liner Type: Diameter: inches Depth: feet silt 25 77 Casing stickup above ground: 2 feet Static water level (from ground level): feet gravelly silt 77 81 silt silty gravel silt 81 93 109 93 109 130 Pumping Ievel: 140 feet after 5? 44 ` 2 hoursum in 50 �W11 I p p g — l�Pm clr; iter Recovery Rate: 50 gpm Method of Testing: airlijq silty gravel 130 137 Well Intake Opening Type: water sand & gravel 137 141 x Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite granules Volume: 1 bg Depth: Start 0 feet Stopped ? feet Pump: Intake Depth feet MATER QLWJTY TESTING IPump size hp Brand Name C41/100ML Well Disinfected Upon Completion? x Yes ❑ No Method of Disinfection: chlorine tablets Comments: Well Driller: Alpine Drilling & .enterprises PO Box 110496 Anchorage AK 99511 02/07/2021 03:35 907-345-0202 ALPINE DRILLING PAGE 01/01 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Pump Installation Log Well DriIIing Permit Number: 201402 nata nf roattip. 10.05 .7020 Parcel Identification Number: 015 283:6mo Legal Description Blocks Lot Property Owner Name & Address: Colony Builders Thomas Boyle Sub. 1 12B 9420 Vanguard, Unit A Anchorage, AK 99507 Pump Installation Date: 3 .20 -2021 Pump Intake Depth Belovr Top of Well Casing: 132 feet Pump Manufacturer's Nagoe: Goulds Pump Model: 1 OS1307 314 Pump Sine; hp Pitless Adapter Burial Depth: N/A feet Pitless Adapter Manufacturer's Name: NIA Pitless Adapter Installer: NIA Well Disinfected Upon Completion? W Yes C7 No Method of Disinfection. Chlorine tablets Comments: PLEASE SAVE FOR COSA. Pump Installer Name: Company, Alpine Drilling & Enterprises Mailing Address: P.O. Box 110496 City: Anchorage State: AK Zip. 99511 Attention: The putup installer shall provide a pump installation log to On-site within 30 days of pump installation. �tir.�l�c+ur MUNICIPALITY F ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section ` www.muni.org/onsite Well Decommissionina Lo Legal Address. Subdivision 7 Block d Lot a > T R Section Lot, On-site Water & Wastlewater Section certified contra _r perforating the well deocmmissiordng: t / Signature: Company.- Well ompany: 907-343-7904 Fax: 343-7997 Well deommissiodrig date I 0—A fr�t? Method of decommissioning: AMC 15.55.0601-1 a. ❑ b. ❑ e Liocation: Use the space below to provide a drawing of the prop" showing the following items: • North arrow Decommissioned well location • Location of other water was on the property Two separate swing -tie distarms far each well shorn an the drawing Note: The swirgKm distances shM be measured from etcher permanent structures or the property corners. G,Mevelopment ServicesSuiltting SafWOn She Water and f=Ldoc O 0 Lo co w 0 0 to 0 0 0 PIA 111=40' PLAT NO. P-2446 BOYLE SUBDIVISION LOT 12B, BLOCK 1 49,500 S.F. N 89059'00"E 300.00' 60.8' 80 co ori ori Lo WELL SEPTIC SYSTEM •�• GRAVEL DR. � EXISTING BUILDING SEPTIC SYSTEM N Lo N 89'59'00"E 300.00' I LT I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO -AS-BU GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC IT IS THE RESPONSIBILITY OF THE OWNER TO JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, 2000 E. DOWLING RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR GRID DATE SW2734 5/14/2021 ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA F.B. JOB NO. NOTE: NO CORNERS SET THIS DATE 2021-01 BS12131 0 F 4 4 1♦ ♦��P � ........ ♦'�:' •:s'� ♦i *: 49TH 0 0 C � .0 ;;:, � w Jeffery A. Gastaldi •: • - M . •. LS -6091 �� AV ♦ � •. 5/14/2021 • iJ pr0fe5sion0� o" BUILDING DETAIL SCALE: 1 "=20' 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 hftp://www.muni.org/onsite Permit Number: OSP201402 Work Type: WellSeptic Initial Tax Code Number: 01528306000 Site Legal Address: THOMAS L BOYLE BLK 1 LT 12B G:2734 Site Mailing Address: 11840 Wagner ST, Anchorage Owner: CARSTENS PAUL Design Engineer: FORGE ENGINEERING This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: "*0 0 � s llepar nient 10/5/2020 10/5/2021 49500 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 orevent freezina Co #I : o bsore-�on ©Uj'51 ! e ' a) ro -4- A a O0 C'n d Na M -ed S b LA-�N U 0-� P -M C `Ill l.2 oa 1 1I -V �e Received By: F Date: Issued By: �- ayuwj Date: 4 PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) October 4, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Thomas L. Boyle, Block 1, Lot 12B – NHN Wagner Street Septic System Design Dear On-Site Services Engineer: The owner of the above lot intends to build a 4-bedroom home on the property. We are submitting this permit application for the construction of a new well and septic system to serve the home. The attached site plan identifies the location of the home along with the proposed well, septic location and alternate site. No conflicts exist between this proposed well and septic system and any other well or septic system on this lot or adj acent lots. The ground surface on the lot is virtually flat with only a minor bias to the west. There are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site. Ground surface contours are shown on the site plan indicating the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trenches will be constructed parallel to the slope as much as possible. The absorption trench will be constructed utilizing engineered receiving soils in conformance with Section 15.65.210D3c and the attached design documents. The absorption trench will be constructed in association with an Advantex Treatment System with an AX-20 pod and pump vault. The system will be 50’ from the well on this and adj acent lots Please refer to the attached test hole logs, soils lab analysis, 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, P.E. 10/4/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201402, Rebecca Carroll, 10/05/20 1"=50' 40' LONG x 5' WIDE x .5' EFFECTIVE DEPTH ABSORPTION TRENCH 4-BDRM HOME NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND THOMAS L BOYLE, BLOCK 1, LOT 12B WAGNER STREET10/4/20 FEET 0 50 100 TH1 TH2 ALTERNATE SITE EXISTING WELL PROPOSED WELL 1500-GAL ADVANTEX TANK W/ AX20 POD & PUMP VAULT. TANK & PUMP VAULT MUST BE ANCHORED FOR BOUYANCY. SEE MANUFACTURER'S⇣ RECOMMENDATIONS. PUMP VAULT MUST BE ANCHORED FOR BOUYANCY. SEE MANUFACTURER'S⇣ RECOMMENDATIONS. MT MT MH PV MH FCO 280 285 TOE OF 3:1 SLOPE NOTE: WELL MUST BE A MINIMUM OF 25' FROM ANY SUBSURFACE DRAIN. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201402, Rebecca Carroll, 10/05/20 THOMAS L. BOYLE, BLOCK 1, LOT 12 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' 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 BOTTOM OF TRENCH: 1' ABOVE GRADE FLOW LINE ELEVATION: 1.5 ABOVE GRADE TOP OF TRENCH: 4.0' ABOVE GRADE 9/23/20 DRAINFIELD ROCK 5' 6" 2'0" 6" MOA APPROVED SAND 30-3/16" DIAMETER HOLES @ 1.3' SPACING 1.25" PERFORATED PVC (HOLES DOWN) 2" DIRECT BURY INSULATION 4" TOPSOIL & SEED 3:1 SLOPE 4" TOPSOIL & SEED 3:1 SLOPE OG OG REMOVE ORGANIC MATERIAL UNDER BED AREA AND REPLACE WITH IN SITU MATERIAL.✓ REMOVE ORGANIC MATERIAL UNDER BED AREA AND REPLACE WITH IN SITU MATERIAL.✓ DESIGN FACTORS: SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 16-30 MIN/IN APPLICATION RATE: 3 GPD/SF 5' WIDE TRENCH SYSTEM w/ENGINEERED RECEIVING SOILS 1,500-GAL FAP ADVANTEX TREATMENT SYSTEM w/AX-20 FILTER POD & PUMP VAULT 600 GPD / 3 GPD/SF /5' WIDE = 40 LF TRENCH REQUIRED (40 LF SPECIFIED) 1' 1' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201402, Rebecca Carroll, 10/05/20 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 1 SLOPE SLOPE SITE PLAN DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) T H O M A S L B O Y L E B 1 L 1 2 B ⌥ 9 /2 /2 0 2 0 M a s o n J a k u b i s i n ⌥ DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING: IF YES @ WHAT DEPTH? 11' 20 -- 4 5 0 1 5 -2 8 3 -0 6 C o l o n y B u i l d e r s ⌥ 11:48 9/2 1 2 3 6 - 4 1 4 12:20 13:33 PT Professional Engineers Stamp: 9/23/20 30 Y E S⌥ 2 .5 '⌥ 9 /9 /2 0 ⌥ SM/ML CL 1 3 4 6 - 4 1 230 1 1 2 6 - 4 1 230 1 1 2 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201402, Rebecca Carroll, 10/05/20 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. 015-283-06 1. GENERAL INFORMATION Expiration Date: 10, ao 1 Complete legal description Thomas L Boyle Sub, Block 1, Lot 12B Location (site address) 11840 Wagner Street Current property owner(s) Colony Builders Day phone (907) 345-0371 Mailing address 9420 Vanguard Drive #A, Anchorage, AK 99503 Real estate agent 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 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: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_].5 -t q5 Date of Payment A I'zo f Receipt Number. Q „Z b (0 (a 1] COSA# DSC 2-1 130.6 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 6/2/21 6. DSD SIGNATURE System #1 Approved for 14 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, ,�. gCc,P !�.V �$ Benjamir Schiller CE 12592 pROFESSIONP with the following stipulations: \1 OF (ire ON-SITE WATER AND By: Original Certificate Date: G Zo 2 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 Legal Description: Thomas L Boyle Sub, Block 1, Lot 12B Parcel ID: 015-283-06 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 50 gpm Date drilled 10/30/20 Water storage tank volume N/A gallons Total depth 141 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 141 ft ®❑ Coliform bacteria is Negative © Sanitary seal is functioning correctly Nitrate 0.216 mg/L ❑ Nitrate less than MRL (ND) »❑ Wires are properly protected Arsenic ug/L © Arsenic less than MRL (ND) Casing height (above ground) 24 in. Collected by Forge Engineering Date of flow test for COSA 10/30/20 Date of Sample 5/20/21 Static water level at beginning of test *58 ft. Comments *Per Well Driller, Please note typo on well log indicates 158' B. TANK DATA Age of tank(s) <1 years Tank type/material Advantex/Fiberg lass Measured operating fluid level in septic tank N/A ❑® Standpipes/foundation cleanout per record drawing Date of pumping Tank Installed 3/31/21 D. ABSORPTION FIELD DATA Mound Which system tested (date installed) 4/7/21 © ALL standpipes present per record drawing Total measured depth from grade 2.9 ft (max) Measured depth to pipe invert from grade ft (min) ❑® N/A — pressurized field ❑» Monitor tubes go to bottom of effective. If not, state depth into effective ❑® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: NEW SYSTEM COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station <1 years Lift station material PVC Comments: Pump Vault Adequacy test date Resu ❑ Pass For bedrooms Fluid dept rior to test in Water added gal New depth i Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 mon If yes, enter date 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' 89* Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft Q Yes if No Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' [Z] Yes if No Neighboring Absorption Fields > 100' Yes Animal Containment > 50' P] Yes if No �✓ Yes if No ft ✓� Yes if No Manure/Animal Excreta Storage > 100' Community Wells > 200' Community Sewer Main > 75' F/� Yes if No ft✓❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 7 Yes if No ft Surface Water > 100' ®✓ Yes if No Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: El Absorption Field > 5' (�✓ Yes if No ft Private Wells > 100' F,71 Yes if No Water Main > 10' ✓� Yes if No ft Community Wells > 200' ✓] Yes if No Water Service Line > 10' 7 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below ft ft ft ft ft ft ft ft Property Line > 10' Fv-� Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' U✓ Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS * Advanced treatment system G. ENGINEER'S CERTIFICATION 1 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. COSA Checklist yellow sheet co ,*.-49TH* .. Benjarrrfrrl;chiller 61 592 ���'�® PROfESS10�P. MIINICIPALITY 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 20.2J, by and between } [�t7b t VL oA , herein he "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 Advantex Waste Water Treatment System located at (legal description) Thomas L. Boyle, Block 1, Lot 12B 2, Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) "I- Throughout the tern. 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 daring the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This TV-"' �v includes an annual maintenance fee (typically $400 to $600). 1 " 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) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. 2— 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. aV-- 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 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. 05/1812018) Page 2 of 3 OWN.F,R- By: (signature) Date: C�- /-Cc A (print name) STATE OF ALASKA ss. THIRD JUDICIAL DISTRICT The foregoing instrurnent,,vas acknowledged before me this !'�day or 20,,2-L, by NTOTARY PUBLIC FOR ALASKA My Commission expires: MUNICIPALITY - (signature) „A -i— V-0 < < (print name) NO TIAR� PUBLIC 11 SARA D"'N'ROVAN STATE OF ALA—SKA u Y 94 Date: 6hol2d Title: (rev. 05/18/2018) Page 3 of 3