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HomeMy WebLinkAboutSHANGRI-LA LT 2hangrl* La Lot 2 #020-043-20 Municipality of Anchorage Page 1 of 3 Development Services Department on -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www. cl.anchorege.ak.us (907) 343.7904 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW040051 PID Number. 020-043.20 Wastewater system: New arrwnd Builders 5431 O'Malley Road Anch., AK 99516 ABSORPTION FIELD pl� pk n of ediw W 5' Wide Trench 229.3456 Five 5 Sud R.wp: T" D.Wi Mom OrW* paid.. LEGAL DESCRIPTION 1.2 GPorFP 6 Ft. Lot D.PrM n Fro, t w i Mom aww pais Ckvr a 0" bwwrn P.e. 2 Shan ri La 2 n. 4 FE 7M.Inro: ad.p.: Sac.an Fl.ddtl.Eow onp.W ptla 1.3 Ck. Wglk 66.2 n. Ft. Well: New .�.� 5 N..o.rori.e. 1 M.«..,hw FE Fr. Cbovk n (Pv�. A a. W: pri 1 TOW Depth, 400 Cewd W. 20 ToW abvpo wd 662 Fr " ASTM 3034 PVC 0. 1' AI ne Drilling6812003 IDN" st. ww. L. 17 n Red Dog 516.712004 Yew. w.Psrr: 1 G V W,u GC TANK 4 GPu n. >2 n SEPARATION DISTANCES 0 Septic D Holding O S.T.E.P. ❑ other. To From Septic Tank mmpWn Flea Litt station Holding Tank k6boprivale. sewerr.Mre Anchorage Tank 1,500 we >100, >100, WA WA >25' Steel Two (2) sur.o.w.W >100, >100' WA WA LIFT STATION — NONE ON LOT ,dr u.. >S >10' WA WA G„ FPudMrm >5' >10' NIA WA h erq it, h. None Noted McP.coar. Pwk m Or cu1.h Gain BENCH MARK CW Garage Slab 100.0 n Engineees Stamp rr.Uarsss Inspections performed by. AH Dates: 1p 51612004 : 49t i 2"d 5812004 Department of ealth and Human Services a roval 0 :� ci 41 irPE: E AN ERS M 4WD Reviewed and approved by: ate: 4a,,,,P �:��.• Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 99519-6655 - 343-7904 Onsite Wastewater Disposal System or Well Inspection Report Permit No: SW040051 PID No.: 020-043-20 a In U S H = U PROFILE AS -BUILT Scole: V — 20' !YM Myshan Mayor min ss s+a J�ssa J•a !+1 -sr nT ra area r !.• n s<Jz et-J•L Iva 009010..02 9t!!9■ V Iva r%9■%.0019■ /!Y/ a ✓ p • Q7f, •1 • L•�I1!1/�I 1'.V. VUA IpWW I9111r11V104G. 1110JIIG OJJ ILVUJV Permit Number. #SW 030110 Date of Issue: 5-1-03 Parcel Identification Number. 020-043-20 Date Started: 6-3-03 Date Completed: 6-7-03 Is well located at approved permit location? ® Yes ❑ No Legal Description: Shana�a Lot 2Lot 2 Property Owner Name & Address: Anchorage Development & Construction 9441 Abbott Loop Road Anchorage_ Alaska 995n7 Borehole Data: Soil Type, 711iclmess & Water Strata Stick-up Depth (ft) - From To 0 2 -- Method of Drilling E] air rotary ❑cable tool Casing type: steel Wall Thickness:.250 inches Gravelly cobbly sill 2 11 Diameter. 6 inches Depth: 20 feet bedrock 11 400 Liner Type: Diameter. inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 17 feet Pumping level: 400 feet after 2 hours pumping 4 gpm 1 Recovery Rate: 4 gpm Method of Testing: air lift Well Intake Opening Type: ❑ Open End ® Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonitepanuler Volume: 1 br Depth: Start 0 feet Stopped ? feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: chlorine tablets Comments: Well Driller. Alpine Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property ....�...-.L. .11 J ". ..L -II .....•J. . •.. •..\. 1•.... ."... IJ. 0 11. ..... f.. .. .. :J.'.. /II J... .! ..•.i .. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 SOUTH BRAGAW STREET ANCHORAGE, ALASKA 99519-6650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Diamond Builders DATE PERFORMED: 5/82004 LEGAL DESCRIPTION: Lot 2 Shanori La Subdivision q SI OPF SITE PLAN TEST HOLE # PT/OG/OL 1.Y Poorly Graded Gravel W1Sand Clusters GP Rust/Medium Gray Cobbles to 5" WAS GROUNDWATER ENCOIINTERED9 1% NO IF YES, WHAT DEPTH DEPTH OF WATER None AFTER MONITORING: DATE: 5/14104 Bedrock @ 13.T 49M YILINEL F ANDE 0 S 0 P E SEE SITE PLAN FOR TEST HOLE LOCATION 20/0 GROSS TIME �a 0% READING DATE GROSS TIME NET TIME DEPTH To WATER NET DROP Start 518/04 19:21 1 19:31 10 1" 725" Recharge 19:32 8.5" 2 19:42 10 1.25" 7.25" Recharge 19:43 8- 3 19:53 1 10 .87" 7.13" PERC RATE: 1_4 MIN./INCH PERC. HOLE DIAMETER: 8_ TEST RUN BETWEEN 2.5 FT. AND 3.5 T. COMMENTS: Test Hole Pre Soaked Prior to Test TEST PERFORMED BY: ALAN HARALA I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 12/272004 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SWO40051 Legal Description: ISHANGR" SUBDIVISION .LOT 27 Design Engineer: 0014 Anderson Engineering Owner Name: ANCHORAGE DEVELOPMENT & CONS Owner Address: 9441 ABBOTT LOOP ROAD ANCHORAGE. AK 99507 - Date Issued: Apr 12, 2004 Expiration Date: Apr 12, 2005 Parcel ID: 020-043-20 Site Address: NHN SANDPIPER DRIVE Lot Size: 47686 SO. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: ❑✓ Disposal Field ❑,/ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specked 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 engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 15. The following special provislons.' i'AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM AN ADDITIONAL PERCOLATION TEST. KAT THE SOUTHWEST END OF THE PROPOSED UPGRADE ABSORPTION FIELD. THE INSPECTION REPORT, jZHALL NOT BE APPROVED UNLESS THIS PERCOLATION TEST IS PROVIDED AT THE TIME OF SUBMISSION T, OF THE INSPECTION REPORT. Received Issued Municipality of Anchorage Development Services Department Building Safety Division i On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 020.043.20 Permit Number SW 0 400 S/ Property owner(s) Diamond Builders, Inc. Day phone 522.4826 Mailing address (1) P.O. Box 221233 Anchorage AK 99522 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 2 Shangri-La Subdivision i Legal description (Section, Township & Range) J (03_) SJ S6 "A (21 jO0 t- TV. Lot Size 47,686 SF Acre q.Ft. Number of Bedrooms Five (5) THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ® Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: 05— 1 Waiver Fees: � 1 Date of Payment: 12 104 / Date of Payment: Receipt Number: .'x102 PY) T Receipt Number: (Rev. 12100) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522.6779 FAX April 8, 2004 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 2, Shangri-La Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 2, Shangri-La Subdivision intends to construct a five -bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new well and septic system to serve the new home. The attached Site Plan and backup documentation identify the location and configuration of the well location, proposed septic system and alternate site. The lot to the west is currently vacant and the property to the north is unsubdivided. No conflicts exist between the proposed well and septic system and those currently in place in the subdivision. Existing spot elevations and the current drainage pattern are identified on the Site Plan. The drainage pattern will be maintained after development of this lot is complete. Test holes placed on the lot in the area of the new absorption trench and alternate site indicated poorly graded sand and gravel and some cobbles to 12" in diameter. The accepting soils were tested and found to have percolation rates ranging from .5 to 2 minutes per inch. No groundwater was found during excavation and none was noted during the monitoring period. We are therefore proposing to place a new 1,500 -gallon septic tank along with a 63' long by 5' wide by 4' effective depth absorption trench to collect and treat the sewage generated in the house. The bottom of the trench will be 7' below the surface. A minimum of 3' of cover will be placed atop the trench and 4' atop the new septic tank. The exact location of the test hole placed on this lot is unknown. We will furnish a completed test hole log and percolation test in the exact area of the absorption trench prior to construction of the septic system to verify the criteria used in the design. The ground surface on the lot slopes at grades up to 15% from east to west as shown Lot 2, Shangri-La April 8, 2004 Page Two on the Site Plan. The absorption trench will be constructed parallel with the slope of the ground surface as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 10' from the water service proposed for the lot and on adjacent lots. It will also be constructed a minimum of 100' from any surface water in the area. 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, Michael E. Anderson, P.E. Attachments a/ ..... `, 1* MICHAEL E. ANDERSON I., No. CE -4391 o #•1 d f i {� •ju) ` cw c Z L I L 40 Q � LCL I i 4 0 d O Q J v O J 800)d MaIA .A10.1 • / ���Af/\\� y {gyp• ON i I i 2C 6 / � W `C :10l ate• YS SO Z 26 00 5?% -91 Z 5, Zo,O N ��liS'"• •• � •�� �....a: •sem `o 0 2r r 4 � Y.� }� et �"•'� •'y,.r ya.tiJ. , � f(7�1 rl r ry �4 ry +-d t it -... - �L� • Ow ^�� ' � � 1 � t• T ,�• ' � 6� ! .!.-i . • I IFIL. g �••�o il�S�'•1yi. �? 6 n. '{lt;iI p .._ � 4' �• to 1.1 d 1�' ~ s ,K��' N\ f'•f,} a ! I Ci+t t� : i T ..I L.L� S�•!o• > J 2 LI U7 6 y r' -t; i �SSi'.,•, s.� F�� Ova VIO 1� ta Cw Y a" "fir is o• I 1 oo P ^' I ►7 �� �' �`� I 10 1 m 1 .. W �_ L. w ®F I C a p m I I I1 Atcd c. NU4 (apo +p1 . C v V) in` -I 1"1 ; Q N �v FI< W44 00 X91 t Q n• N 2 I M �. �Iv, N N N U_.._... I I >, a H 41 to >a; in �ov9las �o/s,52 I I 0IrUP UA) 6. 00.58/ 29 20 O /1/ a �h. L ZO'I 01, �/ LOT 2, SHANGRI-LA SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Five Bedroom House 5' Wide Trench System Perc. Rate: <5 Min./inch 1,500 Gallon Septic Tank Application Rate: 1.2 GPD/SF 4' Drainfield Rock 5 Bedrooms X 150 GPD/1.2 GPD/SF (L lication Rate) = 625 SF Absorption Area 625 SF/5 SF *.5 (Red. Factor) = 62.5 LF Trench Length THEREFORE: Construct a 63' Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be 7' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Natural Backfill 2'6- GeoteAle Fabric 6• 40 Perforated PVC (Holes Down) 4'00 I I ">—� Drainfield Rock 5' Ii TYPICAL 5' WIDE TRENCH SECTIONCF .,...•�..� (NO SCALE) ••p� ••• NOTE: Grade Area Over Trench to Drain Away. a 491h Minimum 6' Separation From Bedrock. •..... TM Minimum 4' Separation From Groundwater. L Minimum 100' Separation From Welts in the Area. �; rwwE'i�ocwon Minimum 100' Separation From Surface Water or Streams. ��� No. cE+ae, L - -• .. OF At KND •• j% ENGINEERING * i491si i��I 20441 PTARMIGAN BLVD r• ..•..«..... ».. 2.-.s EAGLE RIVER AK 99577-8736if i r '.»aann•.A M '.�"Z... .. i��.ZI �I N CE 711 SOILS PERCOLATION TEST •:'�% E C�OF�oROF-•g10FP+ CP—brown med dense sandy Performed for Ear] Ford Date Performed 08/04/00 Project Lot 2 Shanola TEST HOLE p 00.1 SEE ATTACHED SITE PLAN ORC— rootmat I FOR HOLE LOCATION Was Cround water encountered? NO What depth? NA Depth to water aftermonnonng? NA Date? 08/14/00 I, Kenneth M. Duffus, certify that dus test was performed m accordance with all State and Mumapal gutdehnes in effect on thu date Readmg Date Cross Net Depth to Net Tune Tune Water Drop CP—brown med dense sandy gravel w/cobbles & boulders 1 8/30/00 100 - 9' - 2 110 10mm 61/16" 215/16' 3 • 111 - 9" - 4 121 10 mm 67/16" 29/16" 5 122 - 9" - 6 132 10 mm 611/16" 25/16' 7 133 - 9' - 8 143 10 nun 613/16" 23/16" Density maeasmg w/depth larger angular cobbles/boulders 9 144 - 613/16" - 10 154 10 mm 410/16" 23/16" B.O.H. boulders 11 • 155 - 9' - 12 205 10 mm 613/16' 23/16" • Water Added Percolatron Rate 4 57 (mm/m) Perc Hole Diameter= HOLE PRESOAKED PRIOR TO TEST Test Run Between 3 feet and 4 feet I, Kenneth M. Duffus, certify that dus test was performed m accordance with all State and Mumapal gutdehnes in effect on thu date I SEE ATTACKED SITE PLAN I ORG - rootmat FOR HOLE LOCATION SWGM -loose tan brown Was Cro=dwater encountered7 NO Whatdepth) NA Depth to water aftermorutonngT NA Date? 08/14/00 .0t Readmg K D ENGINEERING i Net {49141 i� 20441 PTARMIGAN BLVD «` EAGLE RIVER, AK 99577-8736 ••»»• K~h M a-%01�+r•+n�i D Cf 7116 SOILS PERCOLATION TEST ,�I9Eo~''••»••• GP/GW - w/nand & cobbles to Performed for Earl Ford Date Performed 08/05/00 Project Lot 1 Shangrila TEST HOLE t KND MI I SEE ATTACKED SITE PLAN I ORG - rootmat FOR HOLE LOCATION SWGM -loose tan brown Was Cro=dwater encountered7 NO Whatdepth) NA Depth to water aftermorutonngT NA Date? 08/14/00 .0t 1, Kenneth M Duffus, certify that this test was performed m accordance with all State and Muntapal gwdelmes in effect on this date Readmg Date Gross Net Depth to Net Time Time Water Drop GP/GW - w/nand & cobbles to 2'loose,med denscw/depth 1 8/10/00 100 - 9" - 2 110 10 mm 42/16" 414/16' 3 • 111 - 9" - 4 121 ID mm 43/16` 413/16' 5 • 122 - 9" - 6 132 10 nun 46/160 410/16' 7 0133 - 9" 8.0 H no bedrock encountered 8 143 10 mm 49/26" 4 7/16" • 9 • 144 9" - 10 154 10 nun 49/16" 47/16" 11 0155 - 9" - 12 205 10 nun 49/16" 47/16' • Water Added Percolation Rate S 25 (mm/m) Perc Hole Diameter_¢= HOLE PRESOAKED PRIOR TO TEST Test Run Between _ I feet and 4 feet 1, Kenneth M Duffus, certify that this test was performed m accordance with all State and Muntapal gwdelmes in effect on this date I Depth ^E'OF ! = yip•(•.•...... f�T KND ENGINEERING i 4911 20441 PTARMIGAN BLV_ PD " 1 EAGLE RIVER, AK 99577.8736 �� ��. K n ♦ fr •. �i SOILS PERCOLATION TEST 1%I.;;" Was Groundwater encountered? NO Whatdeptr7 Performed for Earl Ford DatePerfortned 08/05/00 Progect Lot 3 Shangrila TESTHOLE 1 00-3 I Depth 1, Kenneth M Duffus, on* that this test was performed In accordance with all State and Muructpal gtttdeltnes m effect on this date SEE ATTACHED SITE PLAN ORG- rootmat I FOR HOLE LOCATION I SP - gravelly sand Was Groundwater encountered? NO Whatdeptr7 NA SP/SM-dense brown sandy I I gravel Depth to water aft" morutonng? NA Date? 08/14/00 Intermittent sand lenses Reading Date Gross Net Depth to Net 8"-10'thick Tune Tune Water Drop 1 8/10/00 1100 - 9" - 2 1105 5mm 314/16" 52/16" 3 • 1106 - 9" . 4 1111 5mm 313/16" 53/16" 5 • 1112 - V - 6 1117 5mm 315/16' 51/16" 7 • 1118 - 9" - 8 1123 5mm 41/16" 415/16" 9 • 1124 - 9" - BO.H 10 1129 5min 41/16' 415/16' 11 1130 - 9' - 12 1135 5mm 41/16" 415/16" • Water Added percolattonRate 101 (mm/m)Perc Holeihameter-9= HOLEPRESOAKED PRIOR TO TEST Test Run Between 4 feet and 5 feet 1, Kenneth M Duffus, on* that this test was performed In accordance with all State and Muructpal gtttdeltnes m effect on this date TEST HOLE ty 1 FLATTOP TECHNICAL SERVICES ,,.' Arcy ;,'.:.: `G, 14530 ECHO ST. N ANCHORAGE. ALASKA 99516 �y C1490'/V SOILS LOG —PERCOLATION TEST °'T�: "' '- LEGAL DESCRIPTION; __I.0 tj.ngrl_U SID DATE PERFORMED: __darch.5.YD07 PERFORMED FOR: _-DeaM1FDrd PL SM Reddish sandy loam GM Coarse gray silty gravel GP Coarse dean Clack sandy gravel Many codes and boulders Sidevratla retativety stable SP/GP Coarse gravelly Lard Many bobbles and boulders Lenses o(cleaner sand B.H. SLOPE Depth 10 Orourd"ter I Dale .. 0./ Pereometer Reading Net Drop moms) Date Reading CIock Net Time Time (minutes) Pereometer Reading Net Drop moms) auorlpmoak allan reaosk a1- s7 t7 214Q50 2{41,50 2:44 2'45 2'�6 I' 61/2 9 BI/8 L18 PERCOLATION RATE 44(ml aaesMch) PERC HOLE DIAMETER _§__ TEST RUN BETWEEN_" FTAND 5,0_FT COMMENTS: SMateAa udlr�sleaysand.k^_ses!touMD!4!deAualeSJtration,�owoiCgeeQ.(orknpohed}andbtter. _ PERFORMED BY FLATTOP TECHNICAL SERVICES. I dr ••�`�t CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS OATS. DATE: M4"��j ZUa ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 2, SHANGRI-LA SUBDIVISION GENERAL: The scope of this project includes the procurement and placement of a new 1,500 -gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 63' long X 5' wide X 4' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 3' below the existing ground surface. Total depth of the trench will be 7' below the existing ground surface. The new septic tank and absorption trench must be placed a minimum of 100' from the well on this and adjacent lots. In addition, a separation distance of 100' must be maintained between the septic tank and absorption trench and any surface water. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,500 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Lot 2, Shangri-La April 8, 2004 Page 2 of 3 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. Lot 2, Shangri-La April 8, 2004 Page 3 of 3 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. March 31, 2004 Municipality of Anchorage Mark Begich, Mayor Btdlding Safety Di -s ision P.O. Box 19G650 • 4700 Bragaw Street Anchorage, Alaska 09519-6650 • (907) 343-8301 • Pax (907) 343-80-00 Anchorage Development & Construction 9441 Abbott Loop Road Anchorage, AK 99507 http://U�W.Munl.org Subject: On -Site Water and/or Wastewater Permit. Permit Number: SW030110 Legal DescriptiontSbangri-LA Lot 2 i ZD Dear Anchorage Development & Construction: An On -Site Water/Wastewater Permit, number SW030110, issued by this office for a single-family system, will expire on April 30, 2004. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this orrice. A new permit for a second year may be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well permit. If you have any questions, please call this office at 343-7904. Sincere , r, Jame Cross, P.E. Ma ager On -Site Water and Wastewater Program Enc: Copy of permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WATER SUPPLY PERMIT Initial Permit Number: SW030110 Legal Description: iSHANGRI-LA SUBDIVISION LOT 2 Design Engineer. 0000 None Required Owner Name: ANCHORAGE DEVELOPMENT & CONS Owner Address: 9441 ABBOTT LOOP ROAD ANCHORAGE. A 99507- Date Issued: May 01, 2003 Expiration Date: Apr 30, 2004 ParcelID: 020-043-20 Site Address: NHN SANDPIPER DRIVE Lot Size: 47686 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of. ❑ Disposal Field ❑ Septic Tank. ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: / Municipality of Anchorage Development Services Department ®r�*� Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. y Z — teel 51- —Z'::�37 Permit Number SW 030/ /D Property owner(s) n n� .�c►/ ��nh S % Day phone 3 `/ zlq-% A Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) k. YJ Legal description (Section, Township & Range) / Lot Size ` '% &E_(27 Acres/Sq.Ft. Zip Code , ISZ)7 Number of Bedrooms 41 THIS APPLICATION IS FOR: , ,( Sewer Only ❑ Well Only ^ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPE�TY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: ADD • Waiver Fees: Date of Payment: Y/30 I j -T Date of Payment: Receipt Number: 39(rS Receipt Number: (Rev. 12100) I I li 0 0 r qln OW • • £ QO PP • _� Municipality of Anchorage `° On-Site Water and Wastewater Program 6` _ ,inti/ (907) 343-7904 u' r' .<, ti y, 4y Certificate of On-Site Systems Approval SEP 11 2017 71 Parcel I.D. 020-043-20 Expiration Date: -1 " 1 ' I a 6 9 1. GENERAL INFORMATION: Complete legal description SHANGRI-LA; LOT 2 Location (site address) 16375 Sandpiper Drive*Anchorage 99516 Current Property owner(s) Kelle Stinson Day phone 903-8115 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by �— Date: I COSA to be relea d to the engineer,unless otherwise requested by the engineer. COSA Fee $ 624 Waiver Fee $ Date of Payment 4:7/1 Date of Payment Receipt Number en eril Receipt Number COSA# 0X 111Waiver# 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 t at the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the ri •>:per. 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: Siciii Qo000pO in conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A / 04 in accordance with the guidelines and regulations established by the Municipality of Anchorage and „,,,,./.\c„....•.••' ./. Il5ls l industry practices. The reported results describe the condition of the system/s on the date/s of the oO P.• 1 s O evaluation. Separation distances were measured to readily identifiable features. Hidden defects or P encroachments may exist that were not identified during the evaluation. The operational life of all wells �e 4 9. !`� �*�O and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Q it / groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and 2... r 1' c'�� are outside the control of GEG. Satisfactory test results do not guarantee future performance of the •.. e`fff A.`'SQ ne s. Q� system's; therefore, GEG makes no warranty (express or implied) regarding the future performance of 00 / • the well or septic system. GEG makes no representation whether an alternative well or septic system Q 9 E 79 •. ' \c'2'4: O can be installed on the property in the event either of the current systems fail to perform adequately in d4 re �.17 cc,� the future. The content of this report is for the sole benefit of the person/party that retained GEG to %0 Pro fesso06'” perform the evaluation. Reliance upon the information provided in this report by any other person or DOo000�."' party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE YSystem #1 Approved for . bedrooms System #2 Approved for bedrooms `�,\ �� (t(ititr: Disapproved ,,,:.\-,\-\\( OF ANC61 '', .— V Conditional approval for bedrooms, with the follower �tipu(t aTE : ,,,cWATER AND: WASTEWATER =-iz- PROGRAM t- tsER By: • \ ..Y.__ �~ Original Certificate Date: "( (7 — The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4 T.01 at. Q e1,y +� 7. ATTACHMENTS: a. 9 COSA Checklist i6 Nitrate Advisor ;i". b`�:, 0Y t"Y Septic System Advisory Arsenic Advise;, , Q .-%.f.'' Well Flow Advisory Other ° `, R" COSA blue sheet 10-10-12.doc 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: SHANGRI—LA; LOT 2 Parcel ID: 020-043-20 A. WELL DATA *CASED TO BEDROCK 7l` �E ISS w11�/.1 1�✓`S ' $l'7 /c R— - rS u•J1rwouJN Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 6/7/03 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 400 ft. Cased to *20 ft. Casing height (above ground) 18"+ in. FROM WELL LOG AT INSPECTION Date of test 6/7/03 8/25/17 Static water level 17 ft *( ERRATIC READINGS ft Well production 4 g.p.m 1.4+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate.) mg./L. Collected by: GEO. Ltd. Arsenic- Ai'ig./L Date of sample: 8/25/17 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 5/6-7/2004 Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping 61 11 / 1 q- Pumper ! ` T C. ABSORPTION FIELD DATA I.BELOW EXISTING GRADE) Date installed 5/6-7/2004 Soil ratingp.d./ or ft'/bdrm) 1.2 System type SHALLOW TRENCH Length 66.2 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth *8,25+ ft. Eff. absorption area 662 W Monitoring tube YES Depression over field NO Date of adequacy test **8/25/17 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 0 in. Water added 1368 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 750+ g.p_d_ Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at • wa er alarm level at in. - _• Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1004 On adjacent lots 100'+ Absorption field on lot 100'+ On 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'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 6+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS +iv_ OF ,4 .1,•t G. ENGINEER'S CERTIFICATION 4.4,\P..•• 1,.• i 1� �.1 • 49 � i— I certify that t have determined through field inspections and I. , .., review of Municipal records that the above systems are in j. i conformance with MOA COSA guidelines in effect on this • ;'- date. date. . (-.N...• 1-f IrGarness JEFFREY A.GARNESS ♦�C'�J+.t E— 9 3 •�� Engineer's Printed Name �., 1 ��,. '�aCD • • Date ciJ"f LICENSEr • ,I���„S`+ �4� KAECC884 (Rev. 10/12/12) • Cie 6jK -vAis". D by rpcp— - J . _ _--_.N-8S--5 .'10E1441_--2.-5Z.-7sr Zo' r i E Es,+'r 1 i ut i •i - /t � � A.C.. . • 1G 1 / 1 i G f4•. t r c I �t s -3- • • ',1lh �' c-',54. ads • i / N` SGRLE ! z ' . ( ff / n1 C _.. I�\rte ��(`Y_yl/ 1,,.-" ` Ncrr SPiratT ccnr/��/ is �� `� r! AL• �SFpccrIMwTE Gw! T. SNah' t SGL . I•1 ` �W CLL. •' . • 1 .. /0 6.c: EsAt r / A' £1 - 7o€, ,.' 257.74 fI re I • AS-BUILT I NO CORNERS SET THIS DATE SA N D PrP<+k VA WVE �-, ')--.%j } I hereby certify that 1 have psAorm.d a Mortgagee's Inspection (� ----- - --- ..- ----- - --- --1,./..7.71....";-: - ?-1 l °t`.4, a Ithe totwwvhg described Per 1-;7- T O2' � . ' — ` SNANbcI-L4 E5T 1 - � t 1 1 Anchorage Recording Precinct. Alaska. and that the ^. - fI..h.c..r:trL l • .a,.: improvements situated thereon are within the property tines and ' a• = do not overlap or encroach on the property lying adjacent 14,1.4:L,; : / •• i thereto,that no improvements on property lying adjacent thereto ' ., - . .<� 1 encroach on the premises in question and that there are no "-~-••-•x roadways,transmission Ines or other visible easements on said •�. :-x`}'se i property except as indicated hereon. .. •. • Dated ah Anchorage.Alaska this /3/ EASEMENTS OF RECORD,OTHER A!� ti day o1 PE LiM BER Zp O 4 THOSE SHOWN ON THE RECORDED +-t o 4"1' FRED WALAflW c ASSOCIATESh Engineers and Surveyors PLAT ARE NOT SHOWN HEREON. '/_'. JO, (9t)712s8 1666 eyors Parcel I.D. 020-043-20 SEP tt 1 2015 Municipality of Anchora; On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 5 Expiration Date: r (" 1. GENERAL INFORMATION Complete legal description Shangri La 2— Location Location (site address) 16375 Sandpiper Dr. "Anchorage Current Property owner(s) Estrada Bernard and Cora Spaulding Day phone 907-350-5301 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well © Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer lid WaiverNariance request for: N/A Distance: N/A Received by. Date: �igol COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52--�, Date of Payment q,/I Receipt Number COSA # 05C"16 H19 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. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 Engineer's Printed Name Jeffrey A. Garness In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the data/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person,pany who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. in short, GEG disavows any legal duty to anyone other than the person party who paid for this report. 6. DSD SIGNATURE _V_1_�System #1 Approved for 5, bedrooms 0 System #2 Approved for bedrooms Disapproved Date Conditional approval for bedrooms, with the following stipulations: �\QPL\TyOFf ON-SITE cy�Pv� WATER AND m= WASTEWATER z PROGRAM - o Original Certificate Date: '_ — 4 — /•5 The M(in�dipaliiic a Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the rep resentar ns 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 Septic System Advisory Well Flow Advisory COSA blue sheet 9-1-12.doe Nitrate Advisory y Arsenic Advisory Other 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: SHANGRI-LA; LOT 2 Parcel ID: 020-043-20 CASED TO BEDROCK A. WELL DATA - Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (YIN) YES Date completed 6/7/03 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth 400 ft. Cased to 20 ft. Casing height (above ground) 18"+ in. FROM WELL LOG AT INSPECTION Date of test 6/7/D3 8/17/15 Static water level 17 ft. ERRATIC READINGS ft. Well production 4 g.p.m. 2.86 — 9 -p.m -WATER SAMPLE RESULTS: Coliform 0 oolonies/100 ml. Nitrate 5.31 mg./L. Collected by: GEG. Ltd. Arsenic: 5.00 ug./L. Date of sample: 8/14/15 B. SEPTIC/HOLDING TANK DATA Tank TypelMateriall SEPTIC/STEEL Date installed 5/6-7/2004 Tank size 1500 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (1f/N)NE High water alarm (Y/N) N/A Date of pumping 8/17/15 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA OBELOW EXISTING GRADE Date installed 5/6-7/2004 Soil rating (g.p.dMo /bdr 1_2 System type SHALLOW TRENCH Length 66.2 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth _±L4_11 Eff. absorption area 662 fe Monitoring tube YES Depression over field NO Date of adequacy test **8/17/15 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test E in. Water added 751 gal. New depth 4 in. Elapsed Time: 95 min. Final fluid depth 0 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date - **PRESOAKED WITH 2500 GALLON WATER HAUL ON 8/17/15 JUST PRIOR TO PERFORMING THE ADEQUACY TEST D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off" level ' High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 'vi H Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingtvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 8)"45-- (Rev. J"% (Rev. 11/05) Municipality of Anchorage Community Development Department - Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 151479 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 2 of Shangri-La subdivision. This inspection revealed a nitrate concentration of 5.31 milligrams per liter (mg/L) was reported for the property's well water sample. 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. 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. ms° I I I 0 ISI :Izl0 �I 31;1 s � I�I w a aa I Z O � I I tl RJR - r H I I i 9 �G�ogig: �dSS5 2 l z&'gg: 1 I ! I I I ^h I I F E 8%k 5'F'i �E t, 8N 4 Z I :t K1 x^ la.i s 6g all aa (O K RJR - Zig H i 9 �G�ogig: �dSS5 2 z&'gg: E 8%k 5'F'i �E t, 8N 4 Z �. �op 0W�: �R Yja W ti a n bsi m 5m'Z umil� n'$S�km 8 � Municipality of Anchorage Development Services Department Building Safety Division OnSile Water and Wastewater Program *A% 4700 South Bragaw St.. P.O. Box 190850 Anchorage, AK 99519850 . www.d.anclwrage.ek us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0204930 HAA # C) Ll UD15 Expiration Date: U /41a 5 1. GENERAL INFORMATION Complete) gal description �I.ot Z Shanorl La Subdfv)akm Location 4 (site add ressordirections) 16375 SandoloerDrIve Current Property owner(s) Diamond Builders Day phone 229.3456' Mailing address 5411 O'Malley Road Anehonw. AK 99516 fvFy}• Lending agency Day phone Mailing address Real Estate Agent Day pie Mailing Address Unless otherwise requested, HAA wig be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Five (5) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon, the representations given in paragraph 5 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. •7111•'J <: .� �" �.'�: l�Jl '`Y'�r ' 4. STATEMENT OF INSPECTION BY: ErNGINEER ' 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 Health Authority Approval Guidelines for this application, shows- that the on-site water supply and/or wastewater disposal system Is(ars) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l 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 Anderson BwOnsedna Phone 522.7773 Address P 0. Box 240773 Anchorage. AK 99524 Engineer's Printed Name _Michael E Anderson, PE Date 12127r2004 S. DSD SIGNATURE _JL Approved for bedrooms. Disapproved _ Conditional approval for bedrooms, with the following stipulations: rtlSltt^rIT A (NII-.::.'. Additional Comments _ ' 1;% ; .. „ HAA Chedc6st y ... R e Agreements /� Maintenance Agreementt s Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By 0 Li 1L,c Original Certificate Date:_q llaza `'�— Municipality of Anchorage Development Services Department Budding Safety "01= On-Site Water b Wastewater Program 4700 South Bragaw SL P.O. Box 19M Ancftorsge, AK 995198850 www olAnchorage.sk us Wn 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Deacriptton: Pamel ID, 02e. Chn A. WELL DATA Well type BM K A, B, or C provide PWSID M _ Well Log (Y/M Y. Data Completed WrAW 1 Sanitary seal (Y/M Y Wires properly protected (Y/M Y. Total depth JQQ,.1L Cased 10 fit• Casing helght(above ground) —?X.—In- FROM k,.FROM WELL LOO AT INSPECTION Date of test 6fff?Dai Ststio water level 17 fit h ' Well production 4 9•p 0•P m• m WATER SAMPLE RESULTS: Confer► _ jw1onW100 ml Nitrate S,$4�mg A . Olher bacteria colorlbal100 mi. Date of sample: 12/22-29/04 Collected by: 'w EL EEPTICIMOLDINO TANK DATA Tank Typ"40terlei AING ld Dab Installed tiIB1m Tank site 1.600 gaL Number of Comparb'Wft j Cleanouts (YIN) FoondaiiM_deanout (YM),Y Depression over tank (Yds @ High water alarm (YIN) N D(te of pumping: Pumper NewConstrugft C. ABSORPTION FlgW DATA Datetlata9sd I r.:_ Sa ratng (g•P•dA? or fi°Ibdrm) j2 0MW Syatem hips B Ml 6 Tmuh ler>Dth Width 8 .. _ . _ .. - it emmal below tape .4. A. Total depth L$ It. Eff. absorption area ¢Lfe Monitoring tube X Depression over field Date of adequacy test Results (PesalFall) For _bedrooms Fluid depth In absorption field before test _ in. Water added_ gel. • New depth_ in. Elapsed Tyne: _ min. FkW 11W depth _ In. Absorption rate » g.p.d. Any ngumnattan treatment (past 12 mo.) (YIN & type) N K yea. give date 0. UFT STATION Date, ,*,af4anhololAccess (YIN) Pu _ in 'Pump at . oft' level' u a— I st,irL -,Hopweior alwmlevel at—in. Cyclell, lesw (Lists alarm 3 droA requiromenla? I— SEPARATION DISTANCES SEPARATION DISTANCES FROM O&LON' LOT TO: Absorption field on lot MW On adjacent kft _,07 W Puboo sewer main Public $6101i fftffwWdwna4A Sewer /septic servfoe tide' a29 146" t9r* WA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO- swft foundation W :!: ,) , ;. P60" One or Absolptibn foold W vftw main MV WsW senrice In* ),Ir surfsewwww 100 Weft on adjacent Ift jPjW SEPARATION DISTANCE FROMASSORPTION FIELD ON'LOT TO; Property One ),%r BuNdkV ftmistion ?Jr W&W main Mir [� , 1. wow servioi,orli mr surfecewaw ?JW Curtain dradn Um Noted Weft an adjacent loll .),jW F. COMMENTS G. ENGINEER'S CERTIFICATION' lvof*that /have d#WW*jsd'ftbvo fleldk*ocMwsrd mv*w Of MUnkOW records &at the above systems am io caVammom with MOA HAA 9Qtf8kWs in OffiddlOO W* We M71111111.. 171. 7 7 1 WW.Y M,—, T A. HAA Fee S --.577.�-+ Da* of P%wiw Receipt Number (Pa. 12M W",r I"- $ Rdlcolpt Number Am A ft &-Am SGS ReEk Client Name Project Name/# Client Sample ID Matrix Sample Remarks: 1043213001 Anderson Engineering Lot 2, Shangri-La S/D Lot 2, Shangri-La SID Drinking Water All Datesfrimes are Alaska Standard Time Printed Date/time 12282004 13:26 Collected Dateftime 12/22/2004 15:26 Received Date/time 1222/2004 16:17 Technical Director / Steph . Ede Released Bim' Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limit, Date Date Init Waters Department Nitrate -N 0.979 0.100 mg/L EPA 300.0 A (<=10) 12/22/04 B1A -3 0 o W'm� 4g �In W N � =or m m33 n tl k� 05f m N pm OR V Z W M an d p� O w oin go b o _ ul pn� Nmwd JCP tmn o?m m 3 y GGy C A t` 11' W O, ♦ / 1 {1 l•• ♦~ II�� ♦ % o W'm� 4g �In W N � =or m m33 n tl k� 05f m N pm OR V Z W M an d p� O w oin go b o _ ul pn� Nmwd JCP tmn o?m m 3 y GGy C A t` 11' W O,