HomeMy WebLinkAboutUS SURVEY 3202 LT 5 T10N R1W SEC 102 � d ,,.•1 � r2 :3
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Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171232 PID Number: 090-022-21
Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
Gary Mohar
ABSORPTION FIELD
❑ Deep Trench *Shallow Trench ❑ Bed ❑ Mound
Address
923 Powerline Rd. Bird Creek, AK 99540
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
850-417-1453
3
2.0 GPD/SF
+1.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
+2.0 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
US Survey 3202 5
Fill added above original grade
5.5 Ft.
Gravel length
45.0 Ft.
Township Range Section
10N 1W 10
Gravel width
5.0 Ft.
Beds: Number of Lines
1
Distance between lines
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 Ftz
Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK ❑ Septic X S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank/Orenco
Capacity
11250 Gal.
Surface Water
>100'
>100'
N/A
N/A
Material
Steel
Number of compartments
2
Lot Line
>5'
10'
N/A
N/A
NA
Foundation
>5'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Anchorage Tank/Orenco
Capacity
1250 Gal.
Curtain Drain
None
Noted
Remarks *CAT II system installed
Pump on level at
48 in.
Pump off level at
42 in.
High water alarm at
52 in.
Pump make and model
Electrical Inspections performed by
Orenco/PF2005
Capstone Electric
PIPE MATERIAL House to tank D3034 Tank to
drainfield D 1785
Installer
Wilco Construction
Drainfield D3034 CO/MT
Inspector C. Johansen, J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspeectiontes: 15f 11/13/17 11/14/17
Location and description
2nd
Bottom of 2nd from south lateral beam on SE wall
3,d 4th
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Date
OF A4
�"1�fi1�
p' ••"•
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..: ..........
Eden Schiller /
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ApprovedCa-kA Date 1
• �`4�
•.• CE 12592.0 Oiw
AW
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DPROfE5S10�
Inspection Report_9-1-12.doc
US SURVEY 3202 LOT 5 T1 ON R1 W SEC 10
PERMIT # OSP171232
/ 50' BLM EASEMENT
11� I hed
I I
Existing Well
II III I Shed
1 1
Two O
Bedroom FCO
1 Home
\ Shed Shed
JGarage—
1\ d� MT2 C0 M
H3 2
\ TH
D I Shed
D
K EXISTING SEPTIC TANK WAS
M
ABANDONED IN ACCORDANCE
WITH MUNICIPAL CODE.��
I I \
50.00 H
50' BLM EASEMENT
ptl
. .... ... ...........
Benjamin
6' ME 32592
•'�
ll►:�PROFES510NP�'�
A B C
FCO
16.2 24.2
SV1
23.6 50.3
SV2
52.2
25.7
MH1
52.3
26.3
MT1
59.1
36.6
C01
60.6
38.7
MH2
53.6
35.1
MI -13
52.0
34.7
CO2
50.1
34.4
MT2
37.8
41.8
CO3
39.6
43.2
0 50 100
FEET
1.1=50'
PID # 090-022-21
II
I
— 1500,GAL STEEL SEPTIC
TANK
36" PUMP VAULT W/
AEROCELL PUMP AND
t 2 FLOATS
'ot 45' LONG x 5'IWIDE x 0.5'
EFFECTIVE DEPTH
ABSORPTION TRENCH
650 GPD AER OCELL UNIT
I
I
ALTERNATE SITE
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
US SURVEY 3202 LOT 5 T1 ON R1 W SEC 10
PERMIT # OSP171232
PID # 090-022-21
01�— INSULATION �-p
_---98.2 FINISH GRADE jj jj 92.7 ORIGINAL GRADE
MOA APPROVED DRAINAGE SAND
94.7
94.7 94.2 - N 45 ` 94.2
raj TH *�
. • ' Benjami chiller .. ' .
WE 22692
l 111�� /'ROFESSI�NP�'~
91.2 GROUNDWATER 8/16/17
81.2 EXPOSED SURFACES OF MOUND HAVE BEEN
TOPSOILED AND SEEDED.
PROFILE AS -BUILT
(NO SCALE)
3
,1
May 3, 2018
Municipality of Anchorage
Development Services Dept- On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: US Survey 3202 Lot 5 — 932 Powerline Road
Alternate On -Site Disposal Method
Dear On -Site Services Engineer:
The owner of the above lot has installed a new advanced septic system to replace one that had
failed. The design specified a Category III septic system, a Quanics system with a Jandy valve
attachment. However, the contractor installed a Quanics system without a Jandy valve, making
this a Category II system. We would like to request approval for this system to operate without re -
sizing the drain field or retrofitting the system.
In a typical (unmounded) bed installation, the advanced treatment system would discharge to the
bed set directly on in-situ soils. The bottom of the bed would need to have a minimum 2' separation
to groundwater. A Category II system is specified as having a lower application rate than a
Category III system because the effluent does not receive quite the same level of treatment, and
therefore will plug up the soils quicker, causing the bed to fail.
In the system installed on Powerline Road, there is 2.5' of filter sand that makes up the vertical
separation to groundwater. This filter sand changes the system significantly, acting as further
treatment before the effluent reaches the receiving soils and the groundwater below. The effluent
that filters through to the bottom is effectively Category III effluent.
This analysis is supported by the EPA's "Decentralized Systems Technology Fact Sheet" as well
as regulations codified for various states. These organizations consider the system to be sized based
on the two application rates- that of the filter sand for the initial size of the system and the
permeability of the basal soils for the size of the bottom of the bed. This method of analysis
acknowledges the use of the sand layer as the initial receiving soils instead of simply a buffer layer.
Based on this accepted methodology, the initial layer of receiving sand would qualify for an
application rate of 4 GPS/SF for Category II effluent, and is significantly oversized for the system
installed on this property. By the time it reaches the slower silty soils underneath, it has received
significant filtration, and the use of the Category III application rate of 2 GPD/SF should be
acceptable.
We are confident that the system as installed meets the intent of the application rates, and
increasing the size of the absorption trench, or retrofitting the system to convert it to a Category
III system, will have no practical change to the effluent quality.
Sincerely,
Benjamin Schiller, PE
•1;BenjamiMSchiller • •:
�'F•• C 1 592 .• �`��i
1hl_PwoFEs INP
DEPTH
(feet)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650
SOILS LOG AND PERCOLATION TEST
LEGAL DESCRIPTION: US SURVEY 3202, LOT 5
PERFORMEDFOR: ANDERSON ENGINEERING
DATE: 8-3-2017 PROJECT No.:
PARCEL ID#: 090-022-21 TECHNICIAN:
TEST HOLE 1
SANDY SILT
ML
BLUE CLAY
`SCHILLER / MILLETTE
SLOPE
SITE PLAN
SEE SITE PLAN
y
WAS GROUND WATER ENCOUNTERED? 1 '4 v
READING
IF YES @ WHAT DEPTH'S -
L
DEPTH To
WATER
(INCHES)
DEPTH OF WATER AFTER MONITORING: 1.5'
0
TEST HOLE PRESOAKED PRIOR TO TESTING:
DATE OF MONITORING: 8 /16 /17
P
9:36
S/�,S O. S t
E
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
8/3
1
9:36
0"
2
10:06
30
0.75"
0.75"
3
10:07
0"
4
10:37
30
0.75"
0.75"
5
10:38
0"
6
1 11:08
30
1 0.75"1
0.75"
PERCOLATION RATE: 40 (MIN/INCH) PERC. HOLE DIA. 6" (INCHES)
TEST RUN BETWEEN: 1.5 FT. and 2.5 FT.
COMMENTS: Test Hole Presoaked Prior to Percolation Test. Silt Layer at 8' is Impervious.
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H,cIPAtITy MUNICIPALITY OF ANCHORAGE
r� • On-Site Water&Wastewater Program S<;
.a„�, PO Box 196650 4700 Elmore Road V �.
Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax: (907)343-7997
y ' �' http://www.muni.org/onsite
1 epartment
4,yckoRp°.
On-Site Wastewater Disposal System Permit
Permit Number: OSP171232 Effective Date: 9/7/2017
Work Type: Septic Upgrade Expiration Date: 9/7/2018
Tax Code Number: 09002221000
Site Legal Address: US SURVEY 3202 LT 5 T1 ON R1W SEC 10 G:4760
Site Mailing Address: 297 AURIGA LN, Indian
Owner: MOHAR GARY Lot Size in Sq Ft: 108900
Design Engineer: FORGE ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
0 Disposal Field 0 Septic Tank ❑ Holding Tank El Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: Provide signed and notarized AWWTS maintenance agreement with inspection
report/record drawings.
Received By: f i'( 1-14//e/i, /ii i Date: q 7
Issued By: // Date: qAir&
Municipalli y of Anchorage•
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV171102 COSA#: Permit#: OSP171232
PID#: 090-022-21
Legal Description: US Survey 3202 Lot 5
Engineer: Forge Engineering
Applicant: Gary Mohar
Your request for a waiver of the required 4 feet vertical separation from the bottom of the
absorption field to groundwater has been approved. The approved separation distance is 2.0 feet.
In addition, your request for a waiver to provide Engineered Receiving Soil (ERS) in the absence
of 2 feet of native unsaturated accepting soil has been approved. See engineer's letter for waiver
request and justifications.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all code requirements be met or another approval
from this department.
The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
n Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
Waiver is Granted: X Waiver is not Granted:
Date: 4/1(0201 Approved by: kiltetk (GNLe'v
Name of Reviewer
**** VARIAN C EIWAIVE R REVIEW ****
MUNICIPALITY OF ANCHORAGE
,7" :. ..)1
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 9 -34 -7997
On-Site Water & Wastewater Program 6 1 8 9 10 77
ON-SITE SEWERNVELL PERMIT APPLICATION ti1.
AUG 1b2017 t
Parcel I.D. 090-022-21 1-
Property owner(s) Gary Mohar
Day phone �``cv
Mailing address 923 Powerline Road, Bird Creek, AK 99540 69 L y
Site address 923 Powerline Rd
Legal description (Sub'd., Block & Lot) US Survey 3202, Lot 5
Legal description (Township, Range & Section) T1ON R1W SEC 10
Lot Size 108,900 Sq. Ft. Number of Bedrooms litre e (3.)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field CI Initial ❑ Single Family (SF) El
(w/wo ADU)
Septic Tank 0 Upgrade E Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Sefono 'troeN -11) ry-ou.‘c# k,ao. kr i ER,S Distance: a (* N \
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Sig ature of operty owner or authorized agent)
Permit/Rush Fees: 6105' Waiver Fees: 41 2 1 5
Date of Payment: %1 t r/t Date of Payment: 9/ri/I I
Receipt Number: QQa1(pr Receipt Number: 0(15 70 C
Permit No. 05 P l902. Waiver No. O SV fl 1 I 0 c2
Permit App_9-1-12.doc
FORGE ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
September 6, 2017
Municipality of Anchorage
Development Services Dept- On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: US Survey 3202, L5
Waiver for vertical separation to water and engineered receiving soils
Dear On-Site Services Engineer:
The owner of the above lot is replacing his failed septic system with a new Category III system
and absorption trench. Due to the high groundwater, a mounded system will be necessary to
achieve the required separation distance from groundwater.
The test hole data shows organics for the top 1', sandy silt under that down to 8' and blue clay
beneath that. The groundwater has been measured at 1.5', right near the top of the in-situ soils.
The seasonal high groundwater level is estimated to be right at the bottom of the organic layer.
Current code requires 2' of in-situ receiving soils above the seasonal high groundwater levels.
We are asking for a waiver to allow 2.5' of engineered fill (a minimum of 2' of filter sand, and
the rest can be sand or Type II soils) to be used in this case. The peat and organics will be
removed from under the trench, and the needed amount of fill placed, with the top 2' specified as
sand. The filter rock will be placed on top of that fill. There are no adverse consequences to this
proposal. The classified fill is better quality than the in-situ soils, and will provide for greater
separation to groundwater.
In addition, we are asking for a waiver to allow 2.0' separation to groundwater in this case. Since
this is a Category III septic system, it processes the effluent significantly more than a typical
septic tank. The difference in effluent quality is enough that reducing the separation by 2' to
groundwater will not cause any threat to health, either in this property or in neighboring
properties. + ..,:0� 1d4%,
Thank you for considering this request. . 44
��.;1.•°• AtVS_ 7" , 0
Sincerely,
s • ' trm.' 1 & tikes
• � o
de c
Benjamin Schiller, P.E. `#0��•�r�,5 �"��
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
August 26, 2017
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject: U.S. Survey 3202, Lot 5
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The septic system on the subject lot has failed and must be replaced prior to the
issuance of a COSA for the property. The existing system is undocumented and the
exact location and configuration is unknown. We are therefore requesting a permit be
issued for the upgrade of the septic system to accommodate the two-bedroom home on
the lot. The new septic system however is designed for a three-bedroom home. The
attached Site Plan and backup documentation identify the approximate location of the
existing system and the proposed location for the new septic system along with the
existing well. The existing septic tank and absorption system will be decommissioned in
accordance with Municipal Code. No conflicts exist between the proposed septic
system and the wells on this or adjacent lots. Drainage arrows are shown indicating the
current drainage patterns. Drainage patterns will not change with construction.
The test hole recently placed on the lot indicated Sandy Silt (ML) in the absorption zone
of the trench. The percolation rate was determined to be 40 minutes per inch. The soil
material changed to impervious silt at 8' below the surface. No groundwater was
encountered during the placement of the test hole but was recently noted at 1 .5' below
the surface. We are therefore requesting a waiver allowing the design to be reviewed
under the new Wastewater Code which allows the use of Engineered Receiving Soils
and a separation distance of 2' to groundwater with a Category III septic system.
We have designed the new absorption system with an application rate of 2 gallons per
day per square foot. We are proposing to place a new 1,500 gallon steel septic tank
and a Quanics Aerocell System along with a 45' long by 5' wide absorption trench with
0.5' effective depth. The total depth of the system will be 1.5' above the surface with the
US Survey 3202, Lot 5
August 26, 2017
Page Two
distribution line at 2' above the existing surface. This will provide a 3.5' separation
distance from the current groundwater level. The groundwater may be found closer to
the surface during high runoff periods, but it is unlikely to encroach into the organic
layer. The organic layer will be removed and replaced with MOA approved sand.
The ground surface on the lot in the area of the new trench is virtually flat with minor
sloping to the south. The absorption trenches will be constructed parallel to the
contours of the slope in accordance with Municipal Code. A minimum of 100' will be
maintained between all components of the septic system and the proposed well and
from any surface water in the area.
The previous survey on the lot indicated a small area of surface water to the east of the
house, near the existing septic tank. Our investigation revealed that it was not a natural
stream or ponding area. it was not fed from anywhere uphill, and did not flow or outfall
anywhere. It appeared to be a depression that was filling with effluent from the failed
septic system. It is possible that it is result of a partial tank collapse. The depression
has been filled in recently, and there is no surface water in it. A small rivulet or
drainage was noted on the westerly portion of the lot. The septic system will be
constructed 100' from this drainage.
If the system is constructed in accordance with our design the following statements
apply:
]. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely •'4A° :
4klb ‘3' 14110
Benjamin Schiller, P.E. y r.: ir
Attachmentsio-r
alp' '• t5104t/. 4"
1,��y�¢,/
U . S . SURVEY 3202
LOT 5
\ N 49'20'00' W 330.00'
/ \ �
/ \
/ \ 98,037S.F. \
/ 50' BLM EASEMENT \
1 � 1
1 I, 1 he 1
1 p
T ® j 1 ,
I I Existing well 1
11 he 1 f
NI \ I
1
` ` NOTE: I\ 1 r Place Foundation/
` , \ croorn
Cleonout //
l III
\ ® 1
FCO
W \ \\ W
g , . 1 /<500 Gallon Steel g
s Septic ••nk g
\ ,-....
z Garages- `` . •
__ '36`�Pump Vault
w/Aerocell Pump 650 GPO A rocell
1 and Floats ya° 7 Unit w/Jany Valve
Ae
,o• ,y k- 45' Lon x 5' Wide
° x .5' Elective Depth
%'TH1 c," Absorptipn Trench
II
mShad `-
U *4!
11
; ALTdRNATE SITE
m \
NOTE; ‘ *;
Nor
Slopes
>25X Within 50' the
GroundwaterWithin 100' of the
\ Proposed Septic System.
No Conflicts with Wells or Septic 1
50.0 _ _� Sytems on Surrounding Lots..
LA J
Decommission Septic Tank and
\ Absorption Area in Accordance
with Municipal Code. Exact Limits
+kr.
50' BLM EASEMENT and Configuration Unknown.
.,,rrt•1<K�+4%4 N 49'20'00' W 330.00'
rr ...,,'SCJ I,
alt
sv. \ *•f
1 : • •th �` •
.
i• • • i LEGEND
. ' ti SITE PLAN MT — Monitor Tube
•
*�; BENJAMI �.CHILLER
•G` " FCO — Foundation Clean Out
1--.:1'-,'-.. No, CE-12592 �,+ TH — Test Hole
vit j'•••9#41!1 P•�,�: SCALE 1" = 50' CO — Clean Out
•1�'JFES:; of
U .S. SURVEY 3202, LOT 5
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Bedroom System 5' Wide Trench System
Perc. Rate: 40 Min./Inch Quanics Treatment System
Application Rate: 2 GPD/SF .5' Drainfield Rock
3 Bedrooms * 150 GPD/Bedroom = 450 SF Absorption Area
450 SF/2 GPD/SF/5 SF (Width) *1 (Red. Factor)= 45 LF Trench Length
THEREFORE: Construct a 45' Long x 5' Wide x .5' Effective Depth Absorption Trench at the
Location Shown on the Site Plan. Place Distribution Line at 2' Above Original Ground. Total
Depth to be 1.5' above Original Ground. Remove Organic Layer Below Trench and Place MOA
Approved Sand. Maintain 100' Separation Between Wells in the Area and All Components of
the Septic System.
6" Topsoil and Revegetation
To Prevent Erosion
3
3 71
1 T 2" Insulation
Geotextile Fabri.
'0"
_ V.////// //////el
6
6„ 4" Perforated
PVC (Holes Dow
Drainfield Rock
1.6.,
MOA approved sand
1'0" MOA approved sand
5'
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE) • ..��-a.t.��
��•,P�� .........,.'♦♦1
NOTE: Grade Area Over Trench to Drain Away. •
: stn ,ON '�♦♦
Minimum 6' Separation From Bedrock.
Minimum 2' Separation From Groundwater. S.
Minimum 100' Separation From Private Wells in the Area. BENZ IN SCHILLER '�(��a-
Minimum 100' Separation From Surface Water or Streams:% •_ CE-12592 `:
♦♦A !i 7 1:1.• 4 +
'1111raaaa+**
I
MUNICIPALITY OF ANCHORAGE �"1"\ilkA.V`1
4 �[�
DEVELOPMENT SERVICES DEPARTMENT ���P x•'• 49141+
z4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 �*.49TM �` 4
VA
SOILS LOG AND PERCOLATION TEST ,
. Ben in Schiller P
LEGAL DESCRIPTION: US SURVEY 3202, LOT 5 r�'iF,j,. Cn9t6220s2 �444�• �
ANDERSON ENGINEERING 1kkZ,�PROFESSIOHP\��'
PERFORMED FOR: 1\1�\x��'��
DATE: 8-3-2017 PROJECT No.:
PARCEL ID#: 090-022-21 TECHNICIAN: SCHILLEF? / MILLETTE • Professional Engineers Stamp:
DEPTH TEST HOLE 1
(feet)
1 SLOPE SITE PLAN
2 _ - SANDY SILT
3 -..-- - ' ML
4
5 , SEE SITE PLAN
6
l
8 '
BLUE CLAY
9 ,—__—
10------^ WAS GROUND WATER ENCOUNTERED? NO
IF YES @ WHAT DEPTH
DEPTH OF WATER AFTER MONITORING: I.5.
11— ' - DATE OF MONITORING: 8/16/17
12 r----::
GROSS TIME NET TIME DEPTH TO NET DROP
13 DATE READING (MINUTES) (MINUTES) IER
CHES) (INCHES)
(INCH
14 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 8/3 1 9:36 Ott
�� 2 10:06 30 0.75" 0.75"
3 10:07 0"
17 4 10:37 30 0.75" 0.75"
18 _ 5 10:38 0" •
19 6 11:08 30 0.75" 0.75"
20
PERCOLATION RATE: 40 (MIN/INCH) PERC.HOLE DIA. 6" (INCHES)
TEST RUN BETWEEN: 1.5 FT. and 2.5 FT.
COMMENTS: Test Hole Presoaked Prior to Percolation Test. Silt Layer at 8'is Impervious.
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- ------ --lY/syn %'�'- _72 L "J
Al.( ,fvg72-ir 74
ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: /
/"=yD ..om®ay.tt0
FOLLOWING DESCRIBED PROPERTY; �.OF A( r
4,1c.5-‘1_ ,-;;---..,:,33�Z Ea DATE- // ' gv,�h .-•'• --._S k•
AND THAT NO ENC AOHMENTS EXIST EXCEPT AS 6/��j s�, . .„
ri
INDICATED. IT IS THE RESPONSI�3ILITY OF THE _ ; 4�E
TO DETERMINE THE EXISTENCE OF ANY 3RID a /4"-----
OWNEREASEMENTS, COVENANTS, OR RESTRICTIONS f/.7io il, - d
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB ,..'ae � z `y.
ANY DATA HEREON BE USED FOR CONS TRUCTI ON - ��z-Sa fi `tire ` ''
OF FENCE LINES, OR FOR ESTABLISHING BOUND- D1�4WNi 3 „ rice...'
ARY LINES. / - '`"`�"�
Gr/J
~1: Time
Date
Insp
~-~UNICIPALITY OF ANCHORAGE ~
DEPARTMEN~PF HEALTH AND ENVIRONMENTA~ ?ROTECTION
825 L Street, Anchoraa~. Alaska 99501
2:00 p.m. #2:
10-3-77 Monday
Buchholz
264-4720
Date Received:
Time #3: Time
Date Date
Insp Insp
September 30, 1977
e
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Security Pacific Mortgage Company
Mailing Address:
Property Owner:
Mailing Address:
1101 East Tudor Road, Suite 190
Robert B. Hancock
Star Route Box 8535 Indian
Phone:276-1933
Phone:653-8171
Legal Description: Lot 5 Section 10 U.S.S.S 3202
Single Family Residence: (x) Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Well System: Individual well ( ~ Community/Public System ( )
Permit ~ Depth of Well 80' Well Log on File
Construction
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System Tx)
Installed 1977
Public Utility (
Installer
Manufacturer
Soils Rate Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
~Page Two '~
~ Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 7 Section 10 U.S.S. 3202
Comments: ~L --~ LF~/~ I/~_ ~'~ .~
Affadavit Attached: ( )
Approved 1~ (~~
Department Worksheet:
Letter Attached: ( )
Da%e: - t ?
Date: f(~ --'/~--'"~ 7
( ~UNICIPAL.ITY OF ANCHORAGE ~f[~
Department of Health and Environmental Protection
825 L Street, Anchorage, Alaska 99501
264-4720
quest for Approval of Individual Sewer and Water Facilities
Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
Phone:
Lending Institution:
Mailing Address: ~/
¸5.
Realtor/Agent:
Mailing Address:
Legal Description: ~
Street Location:
Single Family Residence:
Multiple Family Residence:
Phone:
(~Number of Bedrooms:
( ) Number of Bedrooms:
Water Supply: *Individual Well
If Individual Well, well depth
If Community System, name of system
Public/Community System
( )
Sewage Disposal System: On-site System (~ Public System
If On-site System, date of installation: ~/~/~ ~
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
DAft
INDIVIDUAL
AL DEPARTMENT OF NE ~LTH AND SOCIAL'SER¥,,~eS -...
OIVISION OF P )BLIC: HEALTH LabNo
~ INDIVIDUAL AH ~SEMI-PUBLIC
:BACTERIOLOGICAL WATER ANALYSIS
.SANITARIAN'S REMARKS.,
Diameter of ~Vell\ DeoTn
Well Casing
Length al Water Deplh
Offset in
PUMP LOCATION: El n Well [~ Bosemem [~ n gosemem
BA~TJ~RIOLOGICAL WATER ANALYSIS RECORD
READ INS:i-RUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
EMg ~.
.ocloSe groth 2~4 hfs
Coliform Den~
This omo .sis indrcotes Coliform Organisms to be.
AGAR
48 hfs gram's stain
(Most Drobable No. per 100cc
Oetober 4~ 1977
Security Pacific Mortgage
1011 Esst Tudor Road
Suite 190
Anchoragev Alaska 99507
Subject: T10N PlW 'Section 10 Lot 5 US Survey 3202
The well serving ~he s%lbject residence was inspected
on October 3, 1977. The construction is not approved.
Upgrading the well to meet code requirements consist of
installing a floor drain f~m~ the well p~ to a hillside.
This department would grant a temporary approval if f%mds
are escrowed.
If there are any further q~lestions, please contact this
office at 264-4720.
sincerely,
Les No Buchholz,
Sanitarian
Robert ~ancoek
Star Route A Box 8535
Indian~ Alaska 99540
MUNICIPALITY OF ANCHORAGE
OJ
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 090-022-21
Certificate of On -Site Systems Approval
Expiration Date: 9— Z/ -2,0 2 Z
1. GENERAL INFORMATION
Complete legal description US Survey 3202 Lot 5 / T1 ON R1 W SEC 10
Location (Site address) 923 Powerline Rd, Indian, AK 99540
Current property owner(s)
Mailing address
Real estate agent
Gale & Thomas Wozencraft Day phone (918)813-9116
923 Powerline Rd, Indian, AK 99540
2. TYPE OF DWELLING:
0 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
Private Septic
RE
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 5 0
Date of Payment 7 a0Q a
i
Receipt Number_ 0 2 $�
COSA# 65CPa 1 lab'
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 (M.J.) Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 3/30/2022
TH
6. DSD SIGNATURE 3 � ��' •' ;
System #1 Approved for bedrooms r�—'.r��
Y pp Benham r Schiller /
System_#2 Approved for bedrooms 3/E 30/222592
Disapproved �i�PRO
FESSION
Conditional approval for bedrooms, with the following stipulations:
i
By ----'Original Certificate Date: 31 rZdZZ
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: US Survey 3202 Lot 5 / T10N R1 W Sec 10 Parcel ID: 090-022-21
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 Unknown
Total depth 80* ft
Cased to Unknown ft
W Sanitary seal is functioning correctly
❑® Wires are properly protected
Casing height (above ground) 12** in.
Date of flow test for COSA 3/28/22
Well production at time of test 3.2 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes IN No
9 Coliform bacteria is Negative
Nitrate 0.580 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Fg] Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 3/28/22
Static water level at beginning of test 19 ft.
Comments *Per 10/3/77 MOA approval paperwork **Met code in 1977
B. TANK DATA
Age of tank(s) 4 years
Tank type/material STEP/Steel
Measured operating fluid level in septic tank 43
Fm_1 Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA Wide Trench
Which system tested (date installed) 11/13/2017
❑® ALL standpipes present per record drawing
Total measured depth from grade 2.7 ft (max)
Measured depth to pipe invert from grade 2.4 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 0.3
C. LIFT STATION
Q Required maintenance completed
Age of lift station 4 years
Lift station material Steel
Comments: 8/13/2021 ARM Septic Services
Adequacy test date 3/28/22
Results [] Pass For 3
Fluid depth prior to test 6 -
Water added 470 gal
New depth 0 in
Elapsed time 1440 min
0
bedrooms
H
❑® Code -required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate >450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: Absorption field insulated.
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'
P/
Yes
Community Sewer Manhole/Cleanout > 100'
r7✓ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' Q✓ Yes
if No
ft
Private Sewer/Septic Line > 25' F✓ Yes
if No ft
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' F/ Yes
if No ft
Neighboring Absorption Fields > 100'
0✓ Yes if No ft
Water Main > 10'
Animal Containment > 50' [✓ Yes
if No ft
F71 Yes
if No
ft
Yes if No ft
Water Service Line > 10'
0✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' Q✓ Yes
if No
ft
-❑✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
P/
Yes
if No
ft
Surface Water > 100'
Yes if No ft
Property Line > 5'✓0
Yes
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q✓
Yes
if No
ft
Private Wells > 100'
0✓ Yes if No ft
Water Main > 10'
0✓
Yes
if No
ft
Community Wells > 200'✓0
Yes if No ft
Water Service Line > 10'
0✓
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' E✓ Yes if No ft If absorption field is under driveway comment below
Property Line > 10'✓Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'✓Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / 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
OF'.4C�` l
TM
BenjarriSchiller
�������� • , C 2
3/30/22
kk�,PROFiSSI
�t�"�®�4-ate
Maintenance Checklist- Advanced Treatfnent System
Ope��mnu|ChenkistAdvanoedTeahnen System
Legal Description:
Street Addr
Service provided on: Date: Time:
Service provided by� Company, Technician:
Date of last service: By: (��o �ul Other:
1.Type ofAe,nceUTreatment System:
[��catU-Aero ellTreatmontSystem
r-1 Cat III -AemCe||Treatment System
2.Conditions admedia filter: ptable FUnacveptable
a. Evaluate presence ofodor within lOftofperimeter ofsystem:
�None El Mild 171 Strong Chemical F. Sour
0 Source ofodor, ifpresent:
3. Manhole Risers and Pipe Caps: n<A-oeptab|o 0UnaoceptaWe
a Covens intact.- Sk7es
U. Method ofsecuring covec
o Insulation presenton all !ids? ��Yes El No \
d. Any plumbing leaks orwater mtruemn�^L��'"" ��No
' =�0�1
e ���w��������n�ne�- �� �Nu�� �
/LVenting/Air supply: ptable Unacceptable
a. Air supply unit operating properly. N]+es FlNo
b. Ventmgappears operable, [��ex ��No
��
��ed�sur�oe L���uepteb|e LJ Unacceptable
a. Giomatonourfece []Yea
b� Uniform spray pattern, &�^~s
d, Ponding in/on media E'Yes
e Plugging/clogging o/nuzz|ea. FYen
[ Media appears tobesettling. El Yes
g, Appropriate maintenance performed, N7us
h� Pest activity at surface, E] Yes
6. Effluent quality
a. Effluent odor after passing through media fiUec
b Effluent color after passing through media filter
17V]]Old Glenn
2r'm [�No
No
No
5�/vo
[:]Nn
so
;—�Mild El Strong
EY-elear 17 Brown F-1 Black
ARM Septic Services, T LLC
7. Tasks for recirculating/discharge flows: Ll Unacceptable
a. |fapplicable, Jandyvalve functioning: FYns El No N/4
b. |fapplicable, JandyValve basin dry: El Yes No FS N/4
o.Cleaned collection systnminAerone||unit: 10 Yes "No L-Ve"N'ntNeoesaary
d. Design recirculation ratio- 80 : 28
e. Actual recirculation ratio (Estimated): So -z'&?
8. Pump System: []Unacceptable
o. Control panel inAuto: Ki��s F�Nu
1\�-
b Timer settings !FS Panel (No Override timer): -!K�es
ON _~7— c^\OFF:
Override ON, Override OFF:
c. Floats in correct placement: S"Yes
d, Floats working properly,
L�<Y~^
e High water alarm operational:
[�4e"
�—
rannoouni --
[ High water ��
g Pump Run Counts-
h. Pump Run Tlme�
| Float Error Counts,
N/A
J Total Override Cnunts.LlNA\
h Effluent Filter serviced
av~.
!� 'Tank lids secured after inspection:
1R'es
no Weep hole functional-
��e"
`
No
No \ � `�u/ J/�,L
FNo
L�No
No
8. Primary Tank: FlUnaoceptab|e
e. Sludge and Scum level checked- ��< o
b Sludge/Scum |eve|ai1st u 2nd: 7 « 3
c, Tank needs to be pumped: FYes '�- No
d. Water softener backwash discharging onsystem? 0Yes 17 No
e How many people live onthe oyxtam?� -
[ Tank lids/caps Secured after inspection: s 1171No
g Last Date Tank pumped:
10. Drainfield:
o. Type ofDmmfield(circle )Oe�Tmn�
b. Deo�nE�x��ode�h: tide
~�
c Checked Liquid Levels inDramhe|d� I�Sryes FlNo
MT#1Liquid Leve[ Inches
Ml#2Liquid Level: Inches
K47#3Liquid Level: Inches
K8T#4Liquid Level: Inches
d. |sthere any surfacing effluent?� 0Yey NN ,~
179]]Old Glenn Highway
11. Is the remote monitoring system functioning? (ifno. describe in cumnnentn)[�Y�^�+N'
a. Type of Monitoring system:
b. Phone line working? Yes 17 No $i�'N/A
12. Does this system receive an advisory notice/warning? (if so, describe in comments) k Ll No
13. Is the system in satisfactory condition/pass inspection? (if no, describe in comments) 171 Yes No
Other Comments:
\�nvp ��-..
Service Provid,�r -Date:
17933 Old 6teillh�Mighway *Chugiak, AK 99567
office/fax: (907) 688-9433 Email.: ARMService5AK@outtook.coni (PAGE 3 of 3)
o
IES
INIUNICIPALITY OF ANCHORAGE
ADVANCED NN"As'rFNN7ATER TRI ATAMENTSYSTEM
MAINTENANCE, AND REPAIR AGRET":I11?NT
TI 1lSX-'IAINT1--;NANCT-` AND REPAIR herein the "AGREE MENT" made and
entered into as of this Day of ol'20'27- -, by and between
S"" -ea
Le"ei"tlie"OWNEIZ,"atidthe NILiiiicil)lity of
Anchorage, herein the "MUNICIPALITY", inaccordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
L Advanced Wastewater Trell OVI ent Sys te in s. The NItiiiicipilitygrants permission t(.)the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
located at (legal description)
9 2 S' 'Pot.) AV- Ciqs-�/o
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
CLS -7';�C Throughout the ierrn 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
'21 accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically S400 to nZf�Z
Owneraorees thatonly maintenance and repair personel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
/0 � -rW0 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
I
jtzU Owner acknowledges that the ►'v1ttnicipality may request records of maintenance and
repairs from the tnanufaclurer's representative or maintenance provider.
Owner acknowledges that the tine for failing to maintain and repair an AWwTs may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Mill, icipality reasonable access to test and inspect the
AWWTS. The Municipality will hive at least 24-hour notice.
CZJ Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
r
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendorfinstaller 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 ofthe 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 Aareement 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) Paae 2 of 3
-.,
OWNER4�,ra 5�Z-ZZ
!J (signature) Date:
St -
STATE OF4=--�
eoJUTr of. )ss.
T;4!RlI_ITT7 IGI 17 TI&Tl)i' -r-. � )
f r4 t."f-f-111aC7
The foregoing instrument was acknowledged before me this 'day of ,
20?--, by LrcLi k SoCyE £��/ �r� tic—,t v xw«,tj— orZ7t .
RGI,�r
OFFICIAL STAMP
NOTARY PUBLIC FOR,(7 6a� SEAN PATRICK CHARLTON
My Commission expires: NOTARY, PUBLIC-OREGON
COMMISSION7
_
MY COMMISSION EXPIRES APRIL 6.2024
MUNICIPALITY:
y: (signature)
name)
Date: S-
-31 -
Title:
(rev. 0/18/2018) Page 3 of 3
1a9 10 /1
• h6 7S
\r �1�1't,t� i� l A'11 rc . B�
• Municipality of Anchors ,`�'��`'
On-Site Water and Wastewater Prog ��
(907) 343-7904 0. M ,., SAFETYS
w
b
Certificate of On-Site Systems App :` '43,11 6 a 1- �
Parcel I.D. 090-022-21 Expiration Date: a 0 •
0
1. GENERAL INFORMATION
Complete legal description US Survey 3202 Lot 5 T10N R1 W Sec 10
Location (site address) 923 Powerline Rd.
Current Property owner(s) Gary Mohar Day phone
Mailing address 923 Powerline Rd. Bird Creek, AK 99540
Real Estate Agent Tracy Perryman Day phone 850-417-1453
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual EJ
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: (/i4 ZULtZ./ °Tle Date: 5/2,/ J
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ oq0,5D Waiver Fee $
Date of Payment 5430 Date of Payment
Receipt Number 0 86(2. ID Receipt Number
COSA# Of7CI 7 1l 8 a 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.
Name of Firm Forge Engineering Phone (907) 522-7773
Address POBox 240773 Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, P.E. Date 05/2/18
6. DSD SIGNATURE 0*: • TM
System#1 Approved for J? bedrooms 4111'-
enla in Schiller Q
System#2 Approved for bedrooms #,T<• F9FOp wpsi
Disapproved
Conditional approval for bedrooms, with the following stipulations:
- OF Ajvc,
: ON-SITE
: WRTER AND •
WASTEWATER o
PROGRAM
'o
„.,'��AIT c^:p\I'C‘
By: `I�A)PJCI CQJU1APP Original Certificate Date: I nd r 0 I
d
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 blue sheet_S c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: US Survey 3202 Lot 5 T10N R1W Sec 10 Parcel ID: 090-022-21
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N
Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
80* Unknown
Total depth ft. Cased to ft. Casing height (above ground) 12 in.
FROM WELL LOG AT INSPECTION
Date of test Unknown 4/10/18
Static water level ft. 19 ft.
Well production g.p.m. 3'0 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 0.481 mg/L
Arsenic 7.44 ug/L Date of sample: 4/10/18 Collected by: Forge Eng.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/Steel Date installed 11/14/17
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping Pumper New Construction/ Quantics CAT II AWWTS
C. ABSORPTION FIELD DATA
Date installed 11/13/17 Soil rating (g.p.d./ft2 or ft2/bdrm) 2.0 System type 5 Wide
Length 45 ft. Width 5.0 ft. Gravel below pipe 0.5 ft.
Total depth 4.0 ft. Eff. absorption area 225 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Constr. Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 11/13/17 Size in gallons 1250 Manhole/Access (Y/N) Y
"Pump on" level at 48 in. "Pump off' level at 42 in. High water alarm level at 52 in.
Datum Bottom Cycles tested ARM Services Meets alarm&circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100On adjacent lots �100
Absorption field on lot >100On adjacent lots >100
Public sewer main '75' Public sewer manhole/cleanout 100
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation �' Property line >5' Absorption field >5'
Water main Water service line Surface water
Wells on adjacent lots 100
ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
>10' >100' >10'
Water Service line Surface water Driveway, parking/vehicle storage
Curtain drain None Noted Wells on adjacent lots �100
F. COMMENTS
*Well depth taken from existing Muni records
4����.1>
G. ENGINEER'S CERTIFICATION OF lt�
I certify that I have determined through field inspections and �,rg'<P*• `4�.t1
review of Municipal records that the above systems are in j*; • • TH i' •.*it
conformance with MOA COSA guidelines in effect on this date. 1 IF •ey
Engineer's Printed Name Benjamin Schiller, P.E. % ••
r . Buisaurin Schiller : j
Date 5/2/18 �+��cislF9F CE •12592••��� ��
�pROFESS\O .
COSA brown sheet 10-10-12.doc
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITrY OF/ANCHORAGE f�
AND 7:644 is--& Lc d l� 12��L•tr.. TV`
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
Day of of 20 17, by and between i e•-•'(>&le 1e)o, e4cr'�
herein the"OWNER,"and the Municipality of Anchorage,herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Maintenance and Repair Agreement agree as follows:
I. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS), described as
Quanics Aerocell System
located at(legal description).
US Survey 3202 Lot 5 770 Ai )'Z,i 4"1 _cEc._j 0
2. Definitions.
Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design.
Certificate of On-Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code(hereinafter, "AMC") 15.65. These approvals certify that
service and maintenance provider approved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof, at the owner's sole expense,to pay
for any and all: (i)repair(s), (2) maintenance, (3) adjustment(s), (4) replacement
costs, and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules
and orders for the AWWTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor,the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On-Site Systems Approval.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair 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 Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Mainten• ce and Repair Agreement.
OWNER: WZ-Zeil\c*
-d.rri
By•, • � / (signs re) Date:
1 414 NO Z.ACr� (print name)
C C k,kit
STATE OF ALASKA )
)ss.
THIRD JUDICIAL DISTRICT ) l
The foregoing instrument was acknowledged before me this AIay of ft p r i 1 ,
2018 ,by Itoh•e$ o,.,.::1 X6112 wore
NOY PUBLIC FOR ALASKAjotozatAN
My Commission expires: 0 6/Q X/ boa 8, ,l
MUNICIPALITY://��
By: ` ,� CAM -Q (signature) Date: 00/1S/
R(Lk) c Ca -c o i l (print name) Title:
ARM Services, LLC
Quanics Maintenance Contract,Addendum A(2018 edition)
For the purposes of the contract, the term "owner" or "owner(s)" shall refer to the legal owner of the
system, or the authorized representative. The term "ARM" shall refer to ARM Services, LLC.
PURPOSE:
As required in the MOA(Municipality of Anchorage), the Quanics Aerocell system requires a
maintenance contract with a certified maintenance provider.ARM Services, LLC is a certified Quanics
maintenance provider. This contract covers one year of Quanics system monitoring, inspections, and
maintenance, which will start upon receipt of payment. This contract will include a minimum of one
inspection per year, which is covered under the $425 annual.fee (see"fees" for reduced rate for a
brand new system).
SERVICES:
The services currently offered by ARM for the purposes of fulfilling this maintenance contract include:
• At least one inspection and servicing of the system per year. Service work includes (but is not
limited to) fitter cleaning, nozzle cleaning, inspecting of components and observing them
functioning, checking drainfield liquid levels, and testing system operation.
• Annual report, indicating the status of the system, and any required repairs.
• Availability to respond to alarms or callouts.
• Availability to repair system, make adjustments, and technical assistance.
if any major maintenance, repairs or other items are required (other than the minimum filter cleaning,
nozzle cleaning and inspecting of the system), these items shall be completed at an hourly rate of
$105/hour+ material costs. If ARM Services, LLC (ARM) responds to any alarm conditions or call-outs (or
completes service work/ repairs or troubleshooting), whether notified by the Quanics unit via phone
line or from tenants/owners, a two hour minimum of billable time applies at $105/hour. If an alarm
condition exists,ARM shall have 48 hours to respond to an alarm. If ARM responds to alarms from
6pm-11pm, time shall be billed out at$157.50/Hr (2-hr min.). If ARM responds to an alarm from
11pm-8am, or during weekends or holidays, time shall be billed out at$210.00/Hr (2-Hr min.). If such
an alarm or malfunction situation arises, the owner(s) shall have a contingency plan which is to include
an emergency pumping of the system (via septic tank pumping service) and/or restriction of water
usage, to provide relief until the system can be inspected by ARM during reasonable hours. The
owner(s) phone number is required to be input into the remote monitoring system in the Quanics panel,
and the owner(s) are responsible for being the primary responders to any alarm conditions, whether
contacted via phone call from the Quanics, or by someone else reporting a problem or alarm. If the
owners respond to an alarm, and ARM is contacted to provide technical assistance over the phone, this
time shall be billed out at$105/hour, with a .5 hour minimum (For example, if during a peak flow
event like a Christmas party, if the Quanics system cannot keep up with a large surge of water and goes
into alarm, the system can easily be manually pumped down by the homeowner while receiving
technical assistance from ARM via telephone call or text). Should the system require pumping (via
pump truck) for emergency reasons or as part of routine maintenance, the pumping fees are not
covered under the annual. $425 fee. Should this Quanics unit utilize a RYMSYS remote monitoring
system, the annual RMSYS fee is not included (or covered by ARM) under this contract. This contract
shall renew automatically each year, unless the owner provides written notice with their intent to
dissolve the contract. Payment is due at the beginning of each 1-year cycle, otherwise this contract has
been broken, and ARM will not be providing any maintenance or monitoring services.
FEES:
• Annual maintenance contract fee: $425.00/year (A reduced rate of$225/year is provided for
brand new systems, for their first year only, as the maintenance requirements are less)
• Hourly rate (Mon-Fn, 8am-6pm): $105.00/hour
• After hours rate (6pm-11pm): $157.50/hour
• Hourly rate for weekends, night-time (11 pm-7am), and holidays: $210.00/hour
24738 Chugiak Drive*Chugiak,AK 99567
Ph: (907) 317-9433 office/fax: (907) 688-9433 Email:ARMServicesAK®outlook.com
ARM Services, LLC
OWNER RESPONSIBILITES:
The owner(s) have read and understand the Quanics installation manual and the Quanics owners/
operation manual, and agree to operate the system in accordance with those manuals (available from
Garness Engineering in Anchorage,Alaska). The owner(s) of this system are required to be trained on
how to respond to alarms, how to identify potential problems, and how operate the system.Although
ARM will be responding within 48 hours to potential alarms or problems, it is important for the owner(s)
to understand the basic workings of the system, and to be prepared to respond to an immediate
problem. This contract is absolutely contingent upon the system being maintained and kept in good
working order. In short, if at any time the owner(s) put off any maintenance (or repairs) on this system,
use the system in an abusive manor, or do not keep a working phone line hooked up to the panel (this
includes maintaining a working remote monitoring system and any renewals required), this contract is
null and void (ARM will not be providing a refund of the annual fee). See additional owner(s)
responsibilities under"Disclaimer".
DISCLAIMER:
ARM is not responsible or liable for any damages to the system or the residence due to (but not limited
to) the following reasons:
• Performance of the septic system
• Deferred maintenance
• Abuse of the septic system
• Workmanship associated with the installation of the system
• Engineering design or inspection work associated with the septic system
• Damages to the system
• Failure of any of the septic components
• Failure to keep a working phone line connected to the system
• Lapsing of a remote monitoring contract (such as RMSYS)
ARM is not associated in any way with the engineering of the septic system, or the corporation
"Quanics".ARM does not offer or imply any warranty of the Quanics system components. Simply put,
ARM is helping to monitor and maintain the existing septic system, solely at the direction of the
owners. The owner(s) are fully (and solely) responsible for the septic system and its operation, the
management of the system, its performance, and directing what is and what is not to be done by ARM
regarding the system.
Limited warranty:
ARM does not offer nor imply any warranty of the workmanship of the existing septic system.Any issues
with the system, components, and workmanship are not covered under a warranty by ARM. ARM does
not offer or imply any warranty of the Quanics system or its components.ARM offers a limited 1-year
warranty for workmanship associated with repairs made to the Quanics Aerocell system.
By signing below, the�ov�er or authorized representative of this system agrees to all of the terms of
this contract, nd�zes M �. provide annual services for this system.
Signature: /C y' . Date: W-z-VA) /W -
G /� `7
Property address/site description: I POOcr/iL _ P.c-1 7 - '\- Cre k � 4.)C- ct1--S-Id
D
GCS -►'e-J 332.132- 4.071-3- 7KnV Q`t 3-EC-/'
24738 Chugiak Drive*Chugiak,AK 99567
Ph: (907) 317-9433 office/fax: (907) 688-9433 Email:ARMServicesAK@outlook.com