HomeMy WebLinkAboutPOTTER HIGHLANDS PH 2 BLK 4 LT 5Sep_20.2022 04:49 PM At 9075686770 P 9/12 446 801 rlirrl on ■rt ■■■if ■■■ on ■ Ir rrrr ■ ■ ■ 111111111 ■ ■ ■ ■ ■' no INS ■ ■■■N ■ on ■ *vanTexs Field Maintenance Report Annual Inspection ■ ■ ■ ■ ■ ■ wilt ■ ■ Iii ■ ■ tIs .� AnchorageTank 907-272-3543 Property Owned400kfng R Currant tk Openitor Jessica Dawkins Float Corda . ................ . Floats ........................ Larry Betts Site Addreee Previous Oantstl Phone 19087 Potter Highlands Drive, Anchorage AK 99516 (406) 565-0444 AX 8Ro 10 b Ccunly It P N Pod 4 nTU O)UL A Bat* of Lppt Inopoatlon AM 54582 OSP 11078 ORD514082- RTU145342 Retrieve O&M Info Daily flow Racirc ratio,,,,,,, Timer settings: Perform Field NTU NTt1sl p9) o0 2-B) Oder of Sample Typical Kvuaiy ❑ Earthy ❑ Moldy Non -typical ❑ Suffido ❑ Cabba e ❑ decay Oily film In PVU ❑Ye%i a Peam In tank ❑ you No Check Control Panel Reciro Amps " hlachar a Amps Audlblo and vlaual alarms K Dial torte (telemetry only)Yee ❑ No Inspect/Glean Pump System Ina oat Olean Rlsar/Lid ..................... Currant tk $plioe Box ..................... Current Float Corda . ................ . Floats ........................ 2nd Oompartment Pump........... a,.......... Previous Biotubew Filter . . .............. . Previous Biotube Pump Vault ............ Recirculating Splittor Valvo....... ` Comments Mansura Sludge/Scum $1000 Scum latCvmpartment Currant tk Previous Current Previous 2nd Oompartment Cuntit Previous Current Previous Inspect/Clean AdvanTex Filter Odor; �lormal ❑ Pungant Biomat: Iorrnal ❑ Excessive Bridging/PondingN.Nonc/Minor Excessive Inspect/Clean Discharge rump System Inspect Blear/Lid ❑ spllco Bax ❑ Float cords ❑ Inspect/Service Other System Components Inspect Clam Laterals/Orifices Pad Bottom �k_ — Intake Vent Inspect Clean Floats ❑ ❑ Pump ❑ ❑ Inspoct Clean Inspect clean Disinfection Equipment ❑ ❑ dispersal Laterals/Orifices ❑ 0 Observations 'F Additional Services Rendered ❑ Cloanod tUxtilo shoots? ❑ Roplaaod VV Itoma? ❑ Repinced/Used other items? t Parts Used: W m Warranty, B m Billable (v'r appropriate selection) w B Itam Numbar D000ription Final/Safety Inspection S�RSV reinstalled '-Sapaanlfoid roconnocteci; fivan valvas closed Summary/Recommendations 15*stem performing; no further action noodod ❑ call for service Signature -LF , II ]/ —��. pate Fax complotod form to 1.866.384.7404 ".lode bolted on c ontrol panat reaCtivated © Tank noods pumping ❑ outer? Onsite File Potter Highlands Ph 2 Block 4 Lot 5 #020-281-84 Municipality of Anchorage On -Site Water and Wastewater Section < (907) 343-7904 Page 1 of2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211078 PID Number: 020-281-84 Dwelling: Q Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: N New ❑ Upgrade Name John Hagmeier Homes, LLC ABSORPTION FIELD ❑ Deep Trench 0 Wide Trench ❑ Bed ❑ Mound Site Address 19087 Potter Highlands Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 G•0 GPD/SF 4.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.5 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot Potter Highlands Phase 2 4 5 Fill added above original grade 0 Ft. Gravel length 30 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES To Septic I Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank + Field Tank Line 150 Ftz 1 n/a Ft. Well 100'+ 100'+ 25'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding 9 Other Manufacturer ADVANTEX Capacity 1500 Gal. iii Surface Water 100'+ 100'+ Material Number of compartments Lot Line I 5'+ ( 10'+ NA HDPE 2 Foundation 10'+ 10'+ ( LIFT STATION Manufacturer Capacity Remarks NEW ADVANTEX M1500 Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to3034 drainfield Red Dog Excavation Drainfield 3034 CO/MT3034 inspector PES BENCH MARK (Assumed elevation) 100.0 ft Inspdecctiiosn im 12/10/21 d 12/11/21 Location and description 2 31° 12/13/21 41, Southwest Garage FF ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF • ''Co THy *k� even R. ..an aa— CE 8149 Septic System 41Date 1,2� Z2 Approved 9 Note: this approval does not include well permit requirements.�`�� kf\Cv uuluel IOC uc"�0 c>0 00Is K2-<>xOm,DZOm 00cC/) 2-<�OmDDO�m o CO 31 Z�m—�\Z• cn --Arrn Z�m_�pz• MITI CD y £ D- .. r' Dr C)D T m DX C) r• D (I<'5 CO D � �OK-o0m -o - m C7 CA C� i (� m D�" z -C XD > I� �� m �'O Z�o>, DZ �p n OK rx r*t I N -P W N C7 7O 0-00-i DN N � O N A o Z� ori D y £ D* = m m 0 O m D� = rrn r -{i x m a C") Z r�v�0C)mo—1 " o �-v- K-0 0 �o ,� -_-U-m rOc m r .p �! �! �.! �Cn Np O� AO Cn•• -t -'Cn N�O� \�.. n Z mz O > O!,� �m00 p0I'0 0!� Om DOI' m fTi n Z in J W N in (IJ N J O (n K Lo - O (n x�^ (n m�m0 m mD cf). �,��j _qG) •_D 0 (�� r,�� �0 -DN O -< p Z r- f�r1 ,.,,, i .� TI "p m -0 O � -17-p. z O Obi 0) W rn W c° I O 0 \ o m n N o c, f Tl o Z Cn co o� p -Ti m OD CD D a p O 0_ (TI C r*t _ O z O to 4. cn m Ln CIO j m x p m 0/ 2 W 0 c z�z>-9 D p xPOTTER o cn 14IGI W_C0fO.x_ D Z w O x C cn c-� l Mr- 0� D F- @Dp U -D Z D N m - -MMM D02 Z mem _-Ci;:D--n m r xmn n 0 p (n D p0 m�Z �mjO0 A r� N� N iii I I a I11 1 i A m m—mtD o-) III 1 ZmZ D —I ornZ Z ;;o O W vox ANDS DRIVE 70a � / I -i I I Cn O W -�UlD am l 10' T&E EASEMENT NOTES: PANNONE ENGSVC LLC (C.1. 1088)llll RECORD DRAWINGS P.O. BOX 1807 PAL4ER, AK 99645 ' �6.,OF A<gs'+" PHONE (907) 745-8200 FAX (907) 745-8201 = C,�P. !ry y POTTER HIGHLANDS PHASE 2 BLOCK 4 h DRAWN std . LOT 5 st- R. o� .....' JOHN HAGMEIER HOMES CE -Brag SITE PLAN 19087 POTTER HIGHLANDS DR.= 'h 'ssta: ANCHORAGE, AK 99516 Z Z 0 N c un Z p 'D D0 p Z c N On c m D m Z r r p D z REVISIONS JUAIr. 02/21/2022 2/21/2022 CrAir 1" = 50' J.D. NO 020-281-84 ERMIT NO. OSP211078 HEET 2OF3 n SOD D m 0 D m z cpm DOA c m m ASA � 0m 00 Ot^y y z O co 0 v v$ 0 ;u N _ m o O r rn p DZS`—yam O�=m O J m Va O_ N A � r m n O TI m ODT 'S -00 -< 0 OCO Z'a m Z �N trait -- m O� ;uz Oi N +ldd O � = Op r T M m O m D D —nIZ� o m i O N ( G) Znm n X Z D Z =0� or I m DO A n D .< Z d mnD = m CL K I.D^ U m m, m 0�= m (n A �nI m 0 CO0 O1 gym O Zrn �A - m N Gl Cpm Ocn �� DU mT>N a p zr�QmD Z ZO wAcc �D n C Z D =�— O cn n � D r �? .n NOTES: F'ANNONE ENG SVC LLC (C.1. 1088) PHOP.NE BOX 907)0�9�482A8CHFORAAX (907)K29958211 _ Gi�PCF. " """ �F A(gs�''4 REVISIONS DATE RECORD DRAWINGS SCALE POTTER HIGHLANDS PHASE 2 BLOCK LOT 5 JOHN HAGMEIER HOMES 4 seven . aannone "%,'. ce-site �= NTS P.I.D. NO 020-281-84 DRAWN 14Efa3 PERMIT No. SOIL LOG 19087 POTTER HIGHLANDS DR. a = �` OSP211078 ANCHORAGE, AK 99516 """" SHEET 3 OF 3 n SOD O O N 0 D m z cpm DOA c m m ASA 0m 00 Ot^y z 0 v v$ Alpine Drilling 1Enterprises ��F ]Peinz.xi NTu_zzzber•: 9SVY29907 OZo- Z81 -?q Date of 3-25-27 Parcel Idezatification Number: =V#295wo Date Started: 7-21-29 Date Completed! -27-29 Ts -%yell located at approved. permit location? x yes ❑ No Legal Descripfiion: POTTER hIGHLANDS Phase I BIOck 4 Lot 5 Property Owner Name & Address: Potter Creek Developmetzt LLC ,Rorelzole Data: Depth (ft) Soil Type, Thickliess & Water Strata From To stick 2 -gyp sc ne4c gravel gravelly silt sill grm,ellj silt beclrock 0 2 26 5.1 SS 63 WATER QUALITY TESTING Cc>1lfarm Nem Call?OOrrtL Nitrates y.3, ArseftN D ug/- -)-/-7IZZ Faffilso Method of Drilling x air rotary ❑ cable tool Casing type. steel 2 Wall Thickn.ess:. 280 hiclies �6 Dizuneter: 6 iilcb.es Deptb.: 66 feet 51 Liner Type: — Diameter: incites Depth: _ feet 55 Casing stickup above ground :.2 feet 63 Static'Wfttez• leNyel (From ground level): 6y.feet 186 Pumping le;Tel: 185 feet after hours pumping 5 gpm Recotiezy -Rate: 5 gpm Method of Testing: gtr li • Well Intake Opening Type.- El yle:❑ Open Did s'. Opetl .Hole ❑ Screened Start feet Stopped. feet ❑ Perforatioti.s Start _ feet Stopped feet Grout Type: be7gorz4e t,Trartul Volume. r bg Pump: Intake Depth feet Pump si.Ze • hp Braad Dame Well Disinfected Upon Co.mpletion? x yes ❑ 1\To Method of Disinfection: clrlrritze to%lets Comments: Well. Driller: Alpine Drilling &yater.j�r ices PO Box 110496 Anchotage ,4.7i 9 SSI I Development Services Department Phone: 907343-7904 On --Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well drilling Permit Numbelr: 21 107® Date of Issue: 03 -26 -21 Ll Parcel Identification. Number: 020 - - 2g � -� Legal Descxaipxlon Block Lot Property Owner Name & Address: Pptter Creek development LLC Potter Highlands, Phase�2, 4 5 John Hagmeier Homes Pump Installation Date: 12 -21 ..2021 Pump Intake_ Depth Below Top of Well Casing: 184 _ feet Pump Manufacturer's Name. Franklin E lectri C Pump Model: 1 0 F RD07 P4 Pump Size: 3/4 _ hp Pitless Adapter lluxial Depth: N A feet Pitless .Adapter Manufacturer's Name: N/A Pitless ,Adapter Installer.: Nf A Well Disinfected Upon Completion? k Yes ❑ No Method of Disinfection: Chlorine Tablets Comments: PLEASE SAVE FOR CASA. Pump Installer Name: Company: Aarow Pump &. Well Service, LLC Mailing Address: P.O. Box 110496 City: Artch�org e State. lip: AK 99511 Attention.:, hT&wfts r shall provide a ptunp histallatioin log to On-site witbin 30 days of pump installation. M - 7993 _931L dwmm 0 TR Ewlt P�l PLAT NO. 2015-10 ER HIGHLANDS SUBDIVISION, PHASE 2 LOT 5, BLOCK 4 1,163 ACRES S 8904W.95"F 99RAn' 198.91 EXISTING DRANAGEWAY—�,,/ PER MOA MAPPING d co o u.9 o EXISPJVG IlulL_6Q GRAVEL DR. SEPTIC SYSTEM WELL 0 .;) ou - Itty iju r_ /-ZFO.VV AS -BU I LT I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC IT IS THE RESPONSIBILITY OF THE OWNER TO JEFF A. GASTALDI, R.LS. DETERMINE THE EXISTENCE OF ANY EASEMENTS, ZOOO E. DOWUNG RD., SUITE 8 COVENANTS OR RESTRIC11ONS WHICH DO NOT ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR SW3638 1/13/2022 ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA F.B. JOB NO. I NOTE: NO CORNERS SET THIS DATE. 2021-03 PHS254 **ulkslitall OF A4 of co :.0 a * 49TH :0 0 Jeffery A. Gostaldi 10. LS; -6091 AV 1/13/2022 professional 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 http:/kfww.muni.org/0nsite Permit Number: OSP211078 Effective Date: 3/26/2021 Work Type: WellSeptic Initial Expiration Date: 3/26/2022 Tax Code Number: 02028184000 Site Legal Address: POTTER HIGHLANDS PH 2 BLK 4 LT 5 G:3638 Site Mailing Address: 19087 POTTER HIGHLANDS DR, Anchorage Owner: POTTER CREEK DEVELOPMENT LLC Lot Size in Sq Ft: 50660 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: 9 Disposal Field M Septic Tank 11 Holding Tank El Privy 2 Private Well El 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: Lots in this subdivision are required to have a Category III - nitrate reducing wastewater treatment system. �`%'"" Received By: Date: Issued By: Date: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211078, Rebecca Carroll, 03/26/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211078, Rebecca Carroll, 03/26/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211078, Rebecca Carroll, 03/26/21 MUNICIPALITY C EL � 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. 020-281-84-000 Expiration Date: Legal description POTTER HIGHLANDS PH 2 BLK 4 LT 5 9/26/2023 Site address 19075 POTTER HIGHLANDS DR Anchorage AK 99516 Current property owner(s) BENEDICT JONATHAN &DAWKINS JESSICA X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 6/23/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory X Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 F�1�UMUPAUTY OF AHCHORAGE Development Services Department 1J Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-281-84 Complete legal description Potter Highlands Phase 2 Block 4 Lot 5 Location (site address) 19075 Potter Highlands Drive, Anchorage, AK 99516 Current property owner(s) Jonathan Benedict & Jessica Dawkins Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑® Plastic ❑ Concrete ❑ Fiberglass Age <2yrS - See advisory if steel older than 20 years 6. ABSORPTION FIELD: 0 AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 2- 0 Waiver Fee $ Date of Payment / Z 3 / 2u Z Date of Payment COSA # Q5CC % 2J (� Waiver # COSA Application_ June 2022 Potter Highlands Phase 2 Block 4 Lot 5 020-281-84 5 7/21/21 186 N/A 66 5.47 24 7/21/21 Forge Engineering 65 6/14/23 N/A N/A 12/8/21 4 3.5 N/A N/A N/A New Installation > Benjamin Schiller, P.E.6/14/23 (907) 522-7773 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section 04�Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner ��eS;>. u� �> ��� ; C' �� Street Address Septic Tank: -Sludge level inches -Pumping: required es r -Pumping completedey s no Lift station: -Pump basket cleaned a no -Effluent filter cleaned a no -Control floats cleaned �es, no -Proper float settings confirmed V es no -Operation satisfactory es no Alarm System: -Dedicated electrical alarm circuit no -Audible and visual alarm inside dwelling ft no -Alarm system operation atisfactvry not satisfacto Manhole Riser -Ground water intrusion at riser to tank connection yes_ -Ground water intrusion around pipe penetrations yes nom -Weep hole functional a no -Manhole lid: Functional a no Insulated no Properly Secured no Other -All manufacturer required inspections and maintenance completed a no Comments: Qualified Maintenance Provider: Technician 1t , L,�4 Date of maintenance (o _) y - 9 3 Company Signature ,� Date NIUNICIPALITY OF ANCHORAGE ADVANCED w.%s,rFxv.vrER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCF AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this � Day of JjjJU ^_ of 20_7,3 , by and between SO , 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'Wastenater Treatment Svslems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex located at (legal description) Potter Hi hfands Ph2 B4 1:5 - 19075 Potter Hi hiands '.'r 2. Maintenance. Repairs and Alterations. (Ovv ner is required to read, understand and initial each section) pX 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 1dunicipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repatr(s), maintenance, adjustntent(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). ,wOwner 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 pernimed 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 drainlieid replacement. (rev, 05/18/2018) Pagel of 3 PL - `i?'" Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. 44 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 Ilse 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 pro,.ided 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 Ts 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 ofthe Municipality at any time to enforce a proNision 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 representatiNes of the Owner and Municipality. An) 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 (lie 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. Severabilitt. Any provisions of this Agreement decreed invalid by a court of competent Jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 0511812018) Page 2 of 3 i OWNER: t3y: (Signature) Date: Pak (print name) STATE OF A+: 1 -A o+, • o � ss. TitteT ) The foregoing ins(zuinem %% as acknowledged before me this 20 day of Jvn 20,U, by ,. h o- • NOTARY PUBLic i'OR At -A- lE oh o My Commission expires: `7.Lz I I z •z4- MUNICIPAixry: By- — (re -v 05118/2018) (signature) name) �y►��"mR airy yutf Of � �►•,+. i C P hy�l jAl Slott Dale Title Page 3 of Nitrate Advisory Certificate of On -Site Systems Approval # OSC231208 Subdivision: Potter Highlands Phase 2, Block: 4, Lot: 5 A water sample revealed a nitrate concentration of 5.47 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address �P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. f Ma�lirgAddress P fJBox�96650 *Anchorage, Alaska 99519 6650 *www muni org '� � � h-fifUh,11CHPAL.11TY OF Ao,\o��cHORAGE �. ..�.-[� _yam--,�-.._,�,---�--�—:.-•.:�-,-�:--:�---_- Y - .�..�..�. - - 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. 020-281-84 Expiration Date:Z 1 GENERAL INFORMATION Complete legal description Potter Highlands Phase 2 Block 4 Lot 5 Location (site address) fq() j5Potter Highlands Dr. Currentert ro s Potter Creek Development LLC. p P Y owner(s), Day phone Mailing address 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: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El 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 2,161ZZ Date of Payment Receipt Number ()q'Ll 62 G Receipt Number COSA # 0 S C,21 10 5 1 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, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. 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 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE u J System #1 Approved for I bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date 220 oF -'49 TH "'� 9 -.. 7.-'U he Conditional approval for bedrooms, with the following stipulations: • �' r �� ON-SITE ��r%- �o WATER AND rn - z; �c PROGFAAA J JJJJ��� SERV�I��I� By: 2j, dw-cl 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 .msµ COSA Checklist Potter Highlands Phase 2 Block L;; Legal Description: g � Parcel ID: 020-281-84 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. TELL DATA On Well log is filed with Onsite (or attached) Date drilled 07121/21 Total depth/66 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 NEW Static water level at beginning of test NEW ft Comments Well Is Newly Installed Age of tank(s) ""1 years Tank type/material HDPE Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW ADVANTEX D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 12/08,21 ❑ ALL standpipes present per record drawing Total measured depth from grades 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: SYSTEM NEW, <1 YEAR OLD COSA Checklist yellow sheet Well production at time of test NEW gpm Water storage tank volume NIA gallons Well disinfected for coliform test? ❑ Yes R No Ercoliform bacteria is Negative Nitrate '+3(0 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L g Arsenic less than MRL (ND) Collected by PES Date of Sample 02/07/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date n/a Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test NSA in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) 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' Z] Yes Community Sewer Manhole/Cleanout > 100' M Yes if No ft 0 Yes if No Neighboring Tank > 100' M✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No Absorption Field on Lot > 100' ✓1 Yes if No ft Holding Tank > 100' 0✓ Yes if No Neighboring Absorption Fields > 100' Yes if No. Water Main > 10' Animal Containment > 50' Yes if No M✓ Yes if No ft Yes if No. Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' ✓0 Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Z] Yes if No ft Surface Water > 100' Q Yes if No. Property Line > 5' ✓� Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' r', -/l Yes if No ft Private Wells > 100' Yes if No. Water Main > 10' ✓0 Yes if No ft Community Wells > 200' Yes if No. 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' U✓ 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' ✓V Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Q Yes if No ft Community Wells > 200' n Yes if No 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. 1� COSA Checklist yellow sheet OF A/—"4-kk��� 5teven 1- Pannor" ... 3 CE 8149 0 Ile ��arG F�'Cr�ESStOtit\�'�,�� ft ft ft ft ft ft ft ft ft ft MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and ent red into as of thi ay of _Fete of 20Q by and between .. 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 �n Advanced Wastewater Treatment System (AWWTS), j'7 described as c ` / p Pe `Gh �?�C1 � located at (legal description) Maintenance, Repairs and Alterations. �hI (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement oc with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shalt 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 (1� 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, 1� 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 d;ainfield 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 a new 5 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 tern 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 By: -� _ _(signature) Date:Qj (print name) J O�Ja{yt✓ �P�n�v`" STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoin stn went was cknowledged before me thisi day of 7�krltl�, 20ZZ, by NOT Y PUBLIC FOR L My Commission expires: 6�f ?�/� 2.-��.�_,,, � � �� �t.-�-1;'41PComm, s , NOTARY PUBLICS, William Nagpod Exp. 513112023 MUNICIPALITY: �Q A By: �,,VA_ > �5. __(signature) Date: a�v� C�e{f cc4 l�%lr rd U (print name) Title: (rev. 05/18/2018) Page 3 of 3