HomeMy WebLinkAboutSHANGRI-LA LT 11han.qri La
Lot I I
#020-043-29
Municipality of Anchorage =-
Development Services Department
Building Sarety Division „
On -Site Water and Wastewater Program, 4700 S. Bragaw SL
P,O. Box 196650 Anchorage, AK 99519.6650 Page of
www d.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT
Permit Number. SWO60261 PID Number. 020-043-29
r+anw
Bob Falk Wastewater System: (D New ❑ Upgrade
16100 Lost Horizon Drive Anch. AK, 99516 ABSORPTION FIELD
Phone 243-1109 Five (5) N"ff-WdBa&oo 0D"PT,.xh0srwoowTmxhE3aed ❑mou,a ❑pq
LEGAL DESCRIPTION $dR*xV- A5 Total Deparfrom on Wooe.
11 Shangri La 069th b MOO Barm, horn «qn+r v— cxavel depm bwmKh p -M
Townehp R-90 Sam= F0 S FL
Fd eaoeo above orprwt praoe. Ckwei Length,
2-4 Ft 306
Fr.
&W.*a� 5 "h'o'of""': D*Uvxobetweenerra
Well: ❑New El Upgrade
Ft. 4 10
CWW6aum (FYa . A S. C) Tour Do" Cased Tow Toaboorpoan "It FL
° 4a1ef1Y
30o Ft. 20 � 1A8D � ASTM Q3034 PVC
ordw Dew swot
Drow water LJevd Instlow 0K*tnsU"d
Alpine Drilling 2/12/04as24 FL Ownerhutalled a117-=006
Yrrt Pr+rp Set al Cmq HPV Pbow Grourri
5 c Fz 2 FL TANK
SEPARATION DISTANCES []Septic []Holding pS.T.E.P. 009uh-
To Septic Absorption Gil Holding u Ocmrivate A°1fw
From Tank Field Station Tank Sewer Line Anchorage Tank 1.500 Ga<
wed >100' >100' N/A N/A >25' Ma+«w Steer ManDerdCarparmwn"
Two (2)
srn,.awar« >100' >100, N/A NIA LIFT STATION
LAX LVA >b• 3' N/A NIAV Gel amaw
FourooWn >50 >10' NIA N/A °A• -wnP orr revol at HO rarn a
In, in nr yh
C~ orae None Noted P""p Molt`° a Mara Eie— Irapecoorn pertonned ter
RamarMa
BENCH MARK
Loutson.,d o..ofWa
Garage Slab
"'on,
100.0 FL
' ' •' ,�x+gint�bYs stamp
, tion
Inspections performed by: A. HaralaDates: 1" 8/17/2006 :•Y•��: • -�'%r `1r%j}ss: �%%%% • ::' �f
2nd 8,2312006
ment Services Department A �' • �+ c�ta�t �. � :•: •:'� : � . r
P P pproval I a:• �� ce
Development
Conditional Approval by: (l) Date:2 c 1 to o�JfLS't 7�.:• W
Reviewed and Approved by: �t Dae.4� k �� T ��t�'1_1
CoNGi. ` Joh'` op S.0 i ( �' cePjI,� ¢a 3e coy+• r k 4,e i -j 'SPR IN 9 200 PEK M % kf
ANcJPnSO4 rl-,eM0 L'i ICd F,- 6 07/ dl� ecs`15 '-x� c -P ruv` Li,
7e�O� si- ?AOI,
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519.6655 - 343-7904 Page 2 of 4
Permit Number. SWO60261 On -Site Wastewater Disposal System or Well Inspection Report PID No. 020-043-29
Sandpiper Drive
SHANGRI-LA SUBDIVISION
LOT 11
AREA = 40657 SQ. FT.
PLAN AS -BUILT
SCALE V = 40'
49th
+aCKUL E
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CII
20".,\ pe/Snow Storage Easement
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191.18•
SHANGRI-LA SUBDIVISION
LOT 11
AREA = 40657 SQ. FT.
PLAN AS -BUILT
SCALE V = 40'
49th
+aCKUL E
Municipality of Anchorage Page 3 of 4
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519.6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW060261 PID No. 020-043-29
92.3
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vXA01
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1.500 Callon
ieptic Tank
Draintield Rock
84' (Trench Length)
95.8
TRENCH ONE N
U 2 F- 2 U
93.5 n o 0
R 81.0
Droinfield Rock
84' (Trench Length)
TRENCH TWO
PROFILE AS -BUILT
NO SCALE
2 81.5
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-0855 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO60261
Page 4 of 4
PID No. 020-043-29
CO M N
U 3 �m
98.9
Drcinfield Rack
84' (Trench Length)
TRENCH FOUR
PROFILE AS -BUILT -
NO SCALE
m
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2
3
4
5
6
7
8
9
17
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM
4700 BRAGAW ANCHORAGE, AK 99519
SOILS LOG P
PROJECT #: - ERCOLATION TEST
PERFORMED FOR: Bob Falk DATE PERFORMED: 10/1/2005
LEGAL DESCRIPTION: Lot 11. Shanari La Subdivision
?• 49th .
Ibua C ANXT4N
91
SEE SITE PLAN
SEE SITE PLAN
READING DATE
Organic TEST HOLE # 1
Layer- OL
SLOPE
DEPTH OF
WATER
NET
DROP
777
•. ' i
Perc Rate .5 Min./Inch
9.38"
•
Between 1' and 2'
30
8.25"
1.13"
3
12:05
30
7.19"
Denser with Depth
4
N
30
6.19"
1.00"
• '
Silty Sand
with Gravel
SM/GM
' •
WAS GROUNDWATER
'•: ••
ENCOUNTERED?
Yes
S
e:
L
�!' • *
IF YES, WHAT DEPTH?
6
0
DEPTH OF WATER
5.5'
P
L-4
AFTER MONITORING:
E
''
DATE:
10/15/05
BOH - 12'
?• 49th .
Ibua C ANXT4N
91
SEE SITE PLAN
SEE SITE PLAN
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
1 10/1
11:05
9.38"
2
11:35
30
8.25"
1.13"
3
12:05
30
7.19"
1.06-
4
12:35
30
6.19"
1.00"
PERC RATE: 30 MIN./INCH PERC. HOLE DIAMETER:_'
TEST RUN BETWEEN 30 FT. AND 4.0 T.
COMMENTS: Test Hole Pre Soaked Prior to Percolation Test,
TEST PERFORMED BY: ALAN HARALA
I, MICHAEL F ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 7/25/06
03/09/2004 15:23 9072737350 KEUIN TAYLOR PAGE 02/02
Municipality of Anchorage
Department of Health and Human Services AWwM
826'-1 ' Scree:
P.O. Box 196650 Anchorage, Alavka 90519-6650 ME..
RidrNymnm hA Jh&w.cianeh9We.tk.aa
MOW
PetmitNutnber. #SW 040015 Dab eflraoe: -210-04 . Parcel IdeatiffKation Number: 020-04X2
Date Sra tedr-12 f:Q4 Daft Comp"d: 2-12-04 is well located at approved permit Joca6on7 ® Yes UNo
Legal Description: ShannriLo Lot 11
Property Owner Name & Address: Anchorage Development b Constntcfion
NHN Lost Horizon Drive
Dorshob Data:
Soil Type, Thick wu A WawT Snore
stick-up
orgenlcT tt vi?t
grsvelty aUt
bedrock
Depth (ft)
Method of DriWag ® air rotary ❑ cable tool
tram To
casingtype.MC-0
..w•
n.4hG+__Z3... ... .__.
.0
... , ...
2 3
_0ADchC9
Diameter: ¢ inches Depth: 20 feet
3 11
Liner Type: ave well casino
11 300
Diameter 4 bwl r•a Depth: 13 to 300 feet
Casing stiekep *bare ground: 2 feet
Static rater level (from ground level): �4 feet
Pumping levtl:,lafeet after
2 hours pumping 5 am '
Retovety Rate: b gp:a
Method of Testing: ate! f/jt
wen Intake Opooing Type;
❑ Open End 0Open Hole
❑ Screened Start feet Stopped feet
® Pwfotateous Start So feet Stoppod 300 feet
Grout Type: benrontre ua-n Volume: j
Depth: Start 0 feetraw Stepped 20 t> of
Pttmp:,�,ntake Depth deet -
size bp Brand Name
WCUDitWeebed Upon Completion? ® Yes ❑ No
Method of Dislnfeetioa: chbdne tablets
Coustuenta: A shale packer tzar lnrtaUed civ !0 jeer bg
on rhe pve and bmtonire medlwn cUpt were added to rhe
mmira between rbc pvc anrf errerior of ft boring bock it
lSfcel brio rhe boring it c.fectrvely seotrd f vm the
arrface to 40feer bg, 29feer below bedrock seafm which
shotdd meer fawr MOA regviremenir
Well Driller:
Alpine Driling d Entcrprfses
PO Box 110496
ntteetien: 'Ile well driller cUl provide a well Jos to the property owaet within 30 days of completion and the property
_ SEP -30-2015 12_20A FROM: _ 70:3437997 P:2/4
OaysloPnMnt baiv:ua Daputat-ft"
BuOdbv Safety CM"
on -an. Water A Wastewater Pror m •.• '•,
4700 &w= Street
*Muk P.O. Box 1966W •
AnehaMs. AK 99619-6680 • •, •
amrasttllsshaatL
PumVinCillon Log
J�343 7Y9 7 Date of In":
Wel DrUlht= Permit Netnbar. _...-;..�...._
Parcel Ident[ttestin NumWA-A • ate-
1EA4pl DUU%disa aloe&, W Property Owner Name & Addrera:
S A6IA G ru LQ K I I I RA"l- F"- I [,�-
Pump Intake Depth Below Top of Wall Coatrp Qq0 fret
PompMaarhetaetr'yName 6l U l,�l Ji2`
PUMP Mndai: 16 J <C 0 E15—r)9'0
Pump Base I %A bo
PitlatoAdaptarlorwDeptlu 9 f«t
PlttmAdepterManahmarsesName: NieQo,5 — C—('
PltlaaAdaptalasWer. & row PLA
WaD Dtrhnfceted Upon Camaldion? 14 -Yes 0 No
Method of Diainfeedon: t i iti
Comments:
PumptastaaerNeme: Rriatt f.(7l/le-
Conrpastro Aaroce'. SMA Y-oell'SPjd e -f
Manta= Addrom _[, 0, DDX I L0 II F,
Attatt I W The PWq ImWkr ahtll piwide a pump leda W*n lop to DO within 30 days of puaq lnan iatloo.
c
Ala#or Mark Begich
Municipality of Anchorage a
1'(). Ik"c 196N-50 • .Lach0rage, Alaska 9(4519-Gf i() • Telephone (9)7) 313 O)l • rax (907) 3M.&NX)
47(() Bta 1.e gnStreet • t,
AIMhom N. Alaska 9!4507
MIMMunl.org
I3nilding Safety Di-3sion
February 9, 2007
Michael E. Anderson
Anderson Engineering
P.O. Box 240773
Anchorage, AK 99524
Subject: Waiver Request for Shangri La Lot 11
Waiver Request WR#: 070006
Parcel ID # 020-043-29
PERMIT # SW060261
Dear Michael E. Anderson:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to the property line has been approved. The approved separation
distance is a 3 foot horizontal separation from absorption field to north property line.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,.
WGdall
er
On -Site Water & Wastewater Program
Contr►tu7lity, Security, Prosperity
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchoragc.ak.us
(907)343-7904
Waiver Review Worksheet
WR#:070006 PID#:020-043-29
Date Received: February 9, 2007
Legal Description: Shangri La Lot l I
Engineer.
Michael E. Anderson
Anderson Engineering
P.O. Box 240773
Anchorage, AK 99524
Applicant: Bob Falk
HA/Permit# PERMIT # SW060261
Waiver Requested: A 3 foot horizontal separation from absorption field to north property line.
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver Is Granted: X Waiver is not Granted.
List Conditions or Reasons for above:
Date: 219/07 By: Joe Goodall
Name of Reviewer
Rec#: Amount: $M Date Paid: 2/912007
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
MEMORANDUM
DATE: February 7, 2007
TO: Joe Goodall
FROM: Mike Anderson, P.E.
SUBJECT: Lot 11, Shangri La Subdivision
Septic System As Built
No topsoil or seed has been placed on the absorption trench area. The homeowner
intends to complete the work in the spring when weather conditions allow.
Test Hole No. 2 has been added to the profile for the absorption trench as built.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 Wn-77aa WAY►
MEMORANDUM
DATE: February 2, 2007
TO: Joe Goodall
FROM: Mike Anderson, P.E. _r4 S6L
SUBJECT: Lot 11, Shangri La Subdivision
Septic System As Built
The test holes shown on the septic system design and permit application submitted in
July of 2006 were located based on field taped measurements over property that was
yet to be cleared. The test holes shown on the final as built are shown at their location
in relation to the absorption trench construction. Several percolation tests were
completed on this project to verify the soil absorption rates. Test holes shown on the
plans verify the groundwater elevations. The KND test hole was placed during the
subdivision phase and was not accurately located on the subdivision map. The actual
location was determined in the field during the construction of the septic system.
The application rate used was .45 GPD/SF as stated in our memo to you dated August
15, 2006. The memo further states the absorption system is a series of 5' wide shallow
trenches. A permit renewal fee was paid when the redesign was submitted. The permit
was then issued for the 5' wide absorption trench system with the .45 GPD/SF
application rate. A copy of the memo is enclosed for your use.
The surveyor certified as built survey was submitted to the Zoning Department. Since
the client is not seeking a COSA the as built survey is not required to be submitted to
the On Site Department.
No redesign fee is necessary. The redesign was submitted at the time of the renewal
of the septic system permit. The revised permit included the new design.
The as -built profile includes all necessary elevations. The lot slopes at a 10% grade
from the southeast to the northwest. The water table is assumed to slope at the same
grade and was found to be 6' below the surface at most locations.
A letter of non objection from the Right of Way Department allowing the absorption
trench and well to encroach into the slope/snow storage easement is enclosed.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
January 3, 2007
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Lot 11, Shangri La Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
Soils found on Lot 11, Shangri La varied significantly from those represented during the
subdivision development. Shallow groundwater and tighter soils required an absorption
system composed of 4 -84' long trenches with a maximum depth of .5'. The majorityof
the surface area of the lot was required for the system. The northernmost trench
encroaches into the Slope/Snow Storage Easement and within 3' of the lot line. The
surface slope in the area is less than 15% and the property line is 13' from the
centerline of the ditch along the road. Snow will be stored along the road shoulder and
in the ditch. No snow will be stored atop the absorption trench. The road is
constructed and no back slope onto the property will be required. The trench will not be
affected by roadway slopes. We therefore recommend a waiver be issued allowing the
trench to be 3' from the north property line.
Sincerely,
711, Q
Michael E. Anderson, P.E.
NC11AE1. E. A%,ER50N
Edge of Paved Road
_
Sandpiper Drive
2' Edge of Paved Road
3' Centerline of Ditch
I
n
20' Slope/Snow Storage Easement
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10' Td- en
Easement
Well
S7"
191.18'
LOT 11
SHANGRI—LA SUBDIVISION
PLAN AS -BUILT -
SCALE I' a 40'
Municipality Of Anchorage
W). IArc 1966i(1 r.
� � •,+ � lnehnmge, .tlaskn J!6519-6('nMl047(M)ISrilnnvSl reel
baim (4X)7) 343-RA11 r Fuc: (4X17) 3-t3•8_'()0 hup://uv�cnnmLu
Mayor 31ark Begich Developn►cnt Services Dcpttrtmcnt
January 30, 2007
Robert and Karol Falk
8355 Eleusis Drive
Anchorage, AK 99502
Dear Mr. and Ms. Falk-
RE:
alk
RE: Septic System Absorption Trench and Well In Slope/Snow Storage Easement
Shangri-La Subdivision, Lot 11, Grid MV3239
men[
4 -
115 -6 -ILA
Department
The Right of Way Division has reviewed a request for a letter of non -objection to an existing septic
system absorption trench, which encroaches 13' into the 20' slope and snow storage easement at the
northern side of the property, and a well that encroaches 3-1/2' into the same easement on the eastern side
of the property. On the as -built plan dated 1-23-07, submitted with the request, the petitioner has shown
the septic system absorption trench and well.
This letter of nonobjection is issued with stipulations, and by using it the petitioner is agreeing to the
following:
1. Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or
injury to any person as a result of the encroachments.
2. All applicable codes and regulations will be observed and maintained within the easement.
3. This letter of nonobjection will in no way preclude MOA from full use and enjoyment of its
rights within any portion of the easement.
4. Additional and extraordinary costs incurred during any future required construction, repair or
reconstruction of MOA improvements to accommodate any or all of the encroachments shall be
paid by the property owner.
5. Obtain letters of nonobjection from the following utilities:
❑
Anchorage Water & Wastewater Utility
❑
Alaska Communications Systems
❑
Chugach Electric Association, Inc.
❑
Matanuska Telephone Association
❑
Matanuska Electric Association, Inc.
❑
Enstar Natural Gas Company
❑
Municipal Light & Power
❑
GCI Cable of Alaska
❑
Eyecom (Girdwood Cable TV)
®
No letters required
All letters of nonobjection should be retained in your permanent files. If you have any questions, please
call me at 343-8033.
Sincerely,
�-'4 —/-)� 4--�
Jack L. Frost, Jr.
Right of Way Supervisor
Concur
Property Owner(s)
Community, Security, Prosperity
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MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Renewal
Permit Number: SW060261
Legal Description: SHANGRI - LA sUBDIVISION LOT 11
Design Engineer: 0014 ANDERSON ENGINEERING
Owner Name: BOB FALK
Owner Address: 16100 LOST HORIZON DRIVE
ANCHORAGE, AK 99516 -
Date Issued:
Expiration Date:
Parcel ID: 020-043-29
Site Address:
Lot Size:
Total Bedrooms:
This permit is for the construction of:
0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy
15, 2006
15, 2007
NHN LOST HORIZON DRIVE
40657 SQ. FT.
5 Permit Bedrooms: 5
❑ 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.
5. The following special provisions.
-THE UPPER SIX INCHES OF THE MOUND SYSTEM MUST CONSIST OF TOP SOIL AND THE MOUND MUST
BE VEGETATED SUFFICIENTLY TO PREVENT EROSION.
Received By. —" �}✓ 1 Date: Jr, "It "le�'
Issued By. Date: 10 i o
Munici ity o Ancl age
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Property owner(s)- Dtno Fa ly— Day phone
Mailing address tc on/r) ) s� } `!'71Z{� 1 ,�� Zip Code C.
Site address Zip Code
Legal description (Sub'd, Block & Lot)
Legal description (Township, Section & Kange)
Lot Size 'i`0&Jr,? Sq. Ft. Number of Bedrooms -Ir
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
Sb
Septic Tank
41
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION IS AN:
Initial
Upgrade
Renewal
certify that the above information is correct. I further certify that this application is being
Single Family Dwelling and is in accordance with applicable Municipal Codes.
property owner or
Permit/Rush Fees: `VO
Date of Payment: 71,25-1,00
Waiver Fees:
Date of Payment:
Receipt Number: if 30 �7 Receipt Number:
(Rev. 11105)
91r
for a
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
MEMORANDUM
DATE: August 15, 2006
TO: Joe Goodall
FROM: Mike Anderson, P.E.
SUBJECT: Lot 11, Shangri La Subdivision
Septic System Construction Permit
SWO50010
We have revised the septic system design for the subject lot to utilize the slo,
percolation rate (40 Minutes per Inch). The application rate used in the design is
gallons per day per square foot. A total of 425 L.F. of 5' wide trench will be required
new site plan and sectional view of the trench is attached for your review.
Please modify the septic system permit accordingly.
.45
A
4t
2002-118
SHANGRI-LA SUBDIVISION
LOT 11
40,657 S.F.
SANDPIPER DRIVE
0
r�
N 89'57'08' W 205.94'
20' SLOPE \ SNOW STORAGE ESMT.
---------------------------�
temata Site — Advantax
reatment System
j � I
a` I
` N I
4-84' Long x 5' Wide
2 x .5' Etle give Depth
1 \.Ker Absorption Trenches
w sv I
N I
a I
sputter
Sem ballon I
Dtic Tank
s I
F.ve Bedr
souse
MICHAEL L ANDERSON
Pavedt
Drive I
I
I
I
I
I
S 78'51?7f
191.18'
SITE PLAN
SCALE 1' = 40'
LOT 11, SHANGRI LA SUBDIVISION
DESIGN FACTORS:
Five Bedroom House
Pen:. Rate: 40 Min./inch
Application Rate: .45 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,500 Gallon Septic Tank
6" Drainfield Rock
5 Bedrooms X 150 GPDL45 GPD/SF (Application Rate) = 1,666.7 SF Absorption Area
1666.7 SF/5 LF (Width)= 333.3 LF Trench Length
THEREFORE: Construct 4 - 84' Long x 5' Wide x 6" Effective Depth Absorption Trenches.
Flow Line Elevation in Trenches to be at the Original Ground Surface. Total Depth to be
.5' Below Existing Ground. Place 2" of Insulation and 2' of Cover Over Absorption
Trenches. Provide 3 Flow Splitter Valves to Assure Even Flow to Trenches. PlaceTopsoil
and Revegetate All Disturbed Areas.
Natural
Backfill
O
Place 6" Topsoil &
Revegetate Disturbed Area
2" Insulation &
Geotextile Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE) �•�.,
NOTE: Grade Area Over Trench to Drain Away. Z
Minimum 6' Separation From Bedrock.'....... 4'
Minimum 4' Separation From Groundwater. ;�►�,,1,
Minimum 100' Separation From Wells in the Area. �; NKNAE,
Minimum 100' Separation From Surface Water or Streams: *#-<.% No.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
MEMORANDUM
DATE: July 26, 2006
TO: Joe Goodall
FROM: Mike Anderson, P.E.
SUBJECT: Lot 11, Shangri La Subdivision
Septic System Construction Permit Renewal
SW050010
The permit for the construction of the septic system on Lot 11, Shangri La Subdivision
has expired. We are hereby applying to renew the permit based on the attached
design. A memo was forwarded to you on August 5, 2005 indicating soils encounterd
on the property varied from those shown in the test hole completed at the time the
subdivision was platted. The design for the system was modified to include 4
absorption trenches with a total length of 250'. Three splitter valves are required to
insure even flow to all the trenches.
A modified design is included for your review with all required back up information. The
fee has been paid to renew the permit. Please let me know if you have further
questions.
ANDERSON ENGINEERING
P.O. B0X 240773
ANCHORAGE, AK 89524
occ•i i f.3 Of f -f fO f It -AA)
MEMO
DATE: 10/5/2005
TO: Joe Goodall
WITH: MoA/On-Site Water and Wastewater
FROM: Mike Anderson
SUBJECT: Lot 11, Shangri La Subdivision
Septic System Construction Permit No. SWO50010
Soils encountered in the test holes on Lot 11, Shangri La Subdivision are different than
noted on the test hole logs for the subdivision. We are therefore designing the system
for 20% accepting soils with a percolation rate of 1 to 5 minutes per inch and 80%
between 30 and 60 minutes per inch. The average application rate will be .6 gallons
per day per square foot. For a 5 bedroom home a total of 1250 square feet will be
required or a total of 250' of 5' wide trench. We intend to construct 4 trenches utilizing
3 splitter valves with no effective depth. The total depth of each trench will be .5' to
provide 4' separation from groundwater. i
Please let me know if you have further questions.
is
N
of
n
N
w
N
Ir)
O
O
2002-118
SHANGRI-LA SUBDIVISION'
LOT 11
40,657 S.F.
SANDPIPER DRIVE
0
N 89'57'08' W 205.94'
20' SLOPE \ SNOW STORAGE ESMT.
------------
Altamote Sile — /advantex
---------------1
Treatment System
I
\,%
I
x'
Z
Atter
4-63' Long x 5' Wide I
Flow SF
Vow
x'.5' Effective Dept I
/absorption Trenches
I
ie
3 �Oya Splitter
1,300
Sept;c�kn I
B' I
P
f
d Drive 1
I
I
I
_ I
10' T _ I
I
S 78'51 2 , E ES�1T
E 191.18'
SITE PLAN
SCALE V = 40'
LOT 11, SHANGRI LA SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom House 5' Wide Trench System
Perc. Rate: 1-30 Min./inch 1,500 Gallon Septic Tank
Application Rate: .6 GPD/SF 6" Drainfield Rock
5 Bedrooms X 150 GPD/.6 GPD/SF (Application Rate) = 1,250 SF Absorption Area
1,250 SF/5 LF (Width)= 250 LF Trench Length
THEREFORE: Construct 4 -63' Long x 5' Wide x 6" Effective Depth Absorption Trenches.
Flow Line Elevation in Trenches to be at the Original Ground Surface. Total Depth to be
.5' Below Existing Ground. Place 2" of Insulation and 2' of Cover Over Absorption
Trenches. Provide 3 Flow Splitter Valves to Assure Even Flow to Trenches. PlaceTopsoil
and Revegetate All Disturbed Areas. i
Place 6" Topsoil &
Revegetate Disturbed Area
/ Natural
Backfill 2" insulation &
Geotextile Fabric
6" o
4" Perforated
6„ PVC (Holes Down)
5, Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE) 04
it
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater. 0A
Minimum 100' Separation From Wells in the Area. �
...;
Minimum 100' Separation From Surface Water or Streams: 0#
49th
MICI EIE.ANDER50N
, No. CE4381 ;
2
4
5
6
7
8
9
K
11
17
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISI
ON-SITE WATER AND WASTEWATER PROGRAM
4700 BRAGAW ANCHORAGE, AK 99519
SOILS LOG - PERCOLATION TEST
PROJECT #:
PERFORMED FOR: Bob Falk DATE
LEGAL DESCRIPTION: Lot 11, Shandri La Subdivision I
Organic
TEST HOLE # 2 SLOPE
—777 Layer- OL
a' Perc Rate .5 Min./Inch
,• Between 1' and 2'
Denser with Depth
a:
• '" Silty Sand
with Gravel
SM/GM
•� WAS GROUNDWATER
'• ENCOUNTERED? Yes S
L
• IF YES, WHAT DEPTH? 6 0
.� 4 •�. DEPTH OF WATER 5.5' P
AFTER MONITORING: E
:'�•' DATE: 10/15/05
BOH -12'
'I 49th W1 �E*
IOIAO. L ANDO !
10/1/2005
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
1 10/1
9:15
8.25"
2
9:4S
30
7.38"
.87"
3
9:46
8.13"
4
10:16
30
7.38"
.75"
5
10:17
8.2S"
6
10:47
30
I
PERC RATE: 40 MIN./INCH PERC. HOLE DIAMETER:
TEST RUN BETWEEN_3.0 FT. AND 4.0 T.
COMMENTS: I est Hole Pre Soaked Prior to Percolation Test. I
I
TEST PERFORMED BY: ALAN HARALA I, MICHAEL . ANDERSON. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 7/25/06
KNDENc>Ni:E mlc;
26111 PTARMIGAN $LVD-
SOILS PERCOLATION TEST
El
x..xsh aL c
I C.71ic
lafom*dfor. E3-iFor L]ae4edMT`• n6/0�I0n
JrojeR� ( i�r,n iotrOSha TESTIIC�LEC oo
KoiJ LOT It I
SEE ATTAmM SiIE PLAN
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0.013.
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I
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ills
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e3feG o:t tti+ dm.
Municipality of Anchorage
=h;'
49Mi
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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
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SWO50010
Legal Description: SHANGRI - LA SUBDIVISION LOT 11
Design Engineer: 0014 Anderson Engineering
Owner Name: BOB FALK
Owner Address: 16100 LOST HORIZON DRIVE
ANCHORAGE, AK 99516 -
Date Issued: Jan 14, 2005
Expiration Date: Jan 14, 2006
Parcel ID: 020-043-29
Site Address: NHN LOST HORIZON DRIVE
Lot Size: 40657 SO. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit Is for the construction of:
❑Q Disposal Field E 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.
5. The following special provisions.
ADDITIONAL PERCOLATION TEST SHALL BE PERFORMED SO THAT A THIRTY FOOT RADIUS CIRCLE
COVERS THE ORIGINAL AND UPGRADE ABSORBTION FIELDS. THE SOILS TEST MUST BE COMPLETED
PRIOR TO CONSTRUCTION OF THE PROPOSED WASTEWATER SYSTEM. THE ONSITE DEPARTMENT
NEEDS TO BE CONTACTED, IF THE TEST HOLE DETERMINE A CHANGE IN THE DESIGN. TEST HOLE
NEEDS TO BE SUBMITTED WITH THE AS -BUILT.
Received By.
Date: s o .o
Issued By. ! If I' Date: u!ij o <
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.aRus
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. U,20 —pq 3 - p9 Permit Number SW
Property owners) Bob Falk Day phone 243.1109
Mailing address (1
Mailing address
Legal description (Lot, Block & Sub'd.) Lot 11 Shanori La Subdivision
Legal description (Section, Township & Range)
Lot Size 40.657 SF Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Code
Number of Bedrooms Five (5)
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I 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.
s4 -144.L CIS
(Signature of property owner or authorized agent)
Permit Fees: A41PO. 4b Waiver Fees:
Date of Payment: /i r% 05' Date of Payment:
Receipt Number. �a�C/a— Receipt Number:
(Rev. 12M)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
January 9, 2005
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 11, Shangri La Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer.
The owner of Lot 11, 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
septic system to serve the new home. The well is currently in place on the lot. The
attached Site Plan and backup documentation identify the location and configuration of
the existing well and proposed septic system. No conflicts exist between the well and
septic system on this lot and on adjacent properties. Drainage arrows are shown
indicating the current patterns. The drainage patterns will be maintained after
construction.
A test holes was placed on the lot in the area of the new absorption trenches during the
subdivision phase of the project. The results indicated dense brown sandy gravel with a
classification of SP/SM. This is consistent with other materials encountered on other
lots in the subdivision. The material was determined to have a percolation rate of just
over minutes per inch. We will verify the type of soil and percolation rate during
construction of the trenches. Groundwater was found in the monitor tube on May 15,
2002 at 4.7' below the surface. We have therefore designed the system for a 1,500
gallon septic tank along with 2 - 63' long by 5' wide by .5' effective depth absorption
trenches. The total depth of the trenches will be .5' below the existing ground surface.
A minimum of 4' of backfill will be placed over the septic tank and 3' over the absorption
trenches or 2" of insulation and 2' of fill. A flow splitter valve will be placed to assure
even flow to each trench.
The ground surface on the lot slopes at 15% to 20% grades as shown on the Site Plan.
Spot elevations are also shown on the plan. The trench will be constructed parallel with
Lot 11, Shangri La Subdivision
January 9, 2005
Page Two
the slope as much as possible in conformance with Municipal requirements. The new
septic system will be constructed a minimum of 100' from the existing well on the lot and
the existing wells on the 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:
1. 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,
/ rw/
-et.t.(i
Michael E. Anderson, P.E.
Attachments i
', 49th /r \-*
WCNAEL E. ANDERSON
LOT 11, SHANGRI
DESIGN FACTORS
Five Bedroom Home
Perc. Rate: 1.2 Min./Inch
Application Rate: 1.2 GPD/SF
LA SUBDIVISION
SYSTEM REQUIREMENTS
5' Wide TrenchSystem
1,500
Gallon Septic Tank
6 Drainfield Rock
Five Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) - 625 SF Absorption Area
625 SF/5SF w 125 LF Trench Length
THEREFORE Constrict 2— 63' Lang X 5' Wide X No Effective Depth
Absorption Trenches.
Flow Una Elevation in Trenches to
be at Original Ground Surface. Total
Depth to be
6' Below Existing Ground. Provide
4' of Cover Over Septic Tank and
3'
Cover Over
Absorption Trenches. Place a Flow
Splitter Valve to Insure Even Flow
to
Each Trench.
Provide 2' of Insulation and 2' of
Cover Over Tranches. Grade Area
to
Drain Away.
Original Ground
6'
6'
Natural Backfill
Drainfieid Rock
TYPICAL 5' WIDE TRENCH SECTION
NO SCALE
NOTE: Grade Area Around Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water.
do
Sandpiper Drive
1093.00 ELEv
FOU _ ND PROP CORNER FOUND PROP CORNER
1097.00 EUEV
FOUND PROP CORNER
20' Slope/Snow Storoge Eoeement
�f en.nat. Se*
Z S' Nad* • ST lmq
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0
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10EoPROP
ement
OXD
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1D1 r.•
1121.00 EUV
FOUND PROP CORNER
SHANGRI—LA SUBDIVISION
LOT 11
AREA = 40657 SQ. FT.
SITE P LAN
SCALE 1' - 40'
No Conflicts with Existing
Wells or Septic Systems.
enup UOZUGH ism?
K-14 D.ENwaumiG
20441 FTAR WG.9N BLVD
SOILS FERCOLATION TEST
Pcfoen*d for. /
�a 1Fort Pateoadormed- 0s/OS/00
I Vnr[1 Lot 1056an¢ri)a1 TEST HOLE# W, -
�^'ta7
NOW 14Th
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pitta - motmst FOR HOLE LOCATION
1Vw Ground w&brr;.CQ.nta.& +`10 Whit dq>th! Ki I
travel dtnse brvLnsendg 1?epth to water aft" monitvrirt8' Nx D.tct 08/la/u0
Colkley < Y du.
B.O.E.
Res.tuts
1 Date
i
ss
Time
Net
rime
Water
1
8/10/00
lltt0
-2
1105
!;min
T14/16"4
4
11:11
Sade
213/16"
43/16'
5
I
11:12
�
6
11:17
Saun
1315 16'
31/lti"
S
•
11.19
1123
5min
S'
51/16'
315;16'
9
1124
a
10
112'
Sorin
31/16'
315126'
11
1150
S.
-
12
1135
5min
3 1/16'
315-416'
- I
Water
Added
Yrratlatim ateyQL < /�) PescHolc Dlameter,4 _
BOLE PRESaA=
rRIOPTOTEST TestRm"Batween 3 foetmid _4 feet
I, YA-meth M. Duffu I. =UY that this ter, %%w perforated to accordance with all State and Munidpal guidelines in
, fect cm this dare.
A„d.sae pe,d.emW.l en1 Cenew.eun
Owe pw%., 17 MAY 02
rMTWn'b Cx. T11k ■V SEC 2 CWE 1/A)
(e9d De.eNPUe�: u
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CQHNENTS'
Sl1 SOILS REPORT
Sap7Z"Zji 2000
(Lara aNCINJFS NG)
Lor to
WAS CRMM WATER
NO
ENCOP Tm?
OF
W TES, AT WHAT
.At
p St
Municipality of Anchorage
*' 49m*�
Development Services pep rLTtent
..................................
ptJei.p Safety WPM
On Site WOW rid we/tv"ty Program
j.......«....»...««».«».«.«
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♦ I��•.,...,,.• `tom
SOBS Log - Percolation Test
A„d.sae pe,d.emW.l en1 Cenew.eun
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(e9d De.eNPUe�: u
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(Lara aNCINJFS NG)
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WAS CRMM WATER
NO
ENCOP Tm?
W TES, AT WHAT
M A
WIN?
!.7 S S 2
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« Y-02 AND 20 -NAV -02
MEN
rOtCQAnON RATE (mhwb.nnd.) PCM I -Mr ERAW"
TEST RUN BCTWTtm rt ANO rT
!�' NMO IIcG0/e1CLL 1 CERT6Y TWAT TNS TEST
PEerOR11CD 14,AMC 02
WAS p0WORutO w ACCORDANCE "54TH Al STATE: AMD I."C"AL GUIDCUMCS m r77CCT am TNS OAT[. OATC ,A
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Permit Number: SW040015
Legal Description: "SHANGRI = LA sUBDIVISION LOT I V
Design Engineer: 0000 None Required
Owner Name: ANCHORADEVELOPMENT & CONS
Owner AddressL ORIZON DRIVE
ANCHORAGE. AK 99516 -
Date Issued: Feb 10, 2004
Expiration Date: Feb 09, 2005
Parcel ID: 020-043-29
Site Address: NHN LOST HORIZON DRIVE
Lot Size: 40657 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank p Privy Q 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: &',, `� csp7w.
Issued
Date:
By: L= a 10V_ Date: 2 G d y
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
�j P.O. Box 196650 Anchorage, AK 99519-6650
i1 www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 02-0—OZ13-Z9-000+Qtl Permit Number SWOP00/S
Propertyowner(s)�1�Y�CJA �' �CoY�T L
IL
Mailing address (1) "I Lf U ( boA— UP R--4
SITE/1 /1 !0 NNN L017- NojVj
-Mailing address (2) (�% a (J+
Legal description (Lot, Block & Sub'd.) LO'r
Day phone X34 ;q 4%
row vR.9gsz /
Zip Code
V - 1"t
Legal description (Section, Township & Range)
Lot Size 40 i05rl Acre q.FL Number of Bedrooms 4
THIS APPLICATION IS FOR:
X
Sewer Only
❑
Well Only
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
I 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:
Date of Payment:
Receipt Number:
(Rev. 12100)
I 1 \ Waiver Fees:
—1 o 1q Date of Payment:
�I ReceiptNumber.
MUNICIPALITY OF ANCHORAGE
Development Services Department
- �' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-043-29 - - -
1. GENERAL INFORMATION
Complete legal description SHANGRI-LA LT 11
Expiration Date: �F- f Z/ -
Location (site address) 16100 LOST HORIZON DR, ANCH AK
Current property owner(s)
Mailing address
Real estate agent
NICHOLAS MCGRATH Day phone
8750 TOWER ESTATES CIRCLE, ANCH AK
2. TYPE OF DWELLING:
I] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
Day phone
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well [] Private Septic El
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ -5-50
Date of Payment i 17 021
Receipt Number 0 1 9 Ll
cosA # Q�2117'26
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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661_NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 5-13-21
6. DSD SIGNATURE
_�_c System #1 Approved for 5
System #2 Approved for
Disapproved
Conditional approval for
000,
bedrooms...... ;.......,.,...:�
.mss PNtt:"Aa N
bedrooms"�"6•• t�-9 b.
.•. df'
bedrooms, with the following sti ulati ir,ax"" ~
1�
J
JJ
Jai 1
«tcct�tcrrrr�,
By. �"`^' - _ Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: SHANGRI-LA LT 11
If more than 9 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 2112/04
Total depth 300 ft
Cased to 20 ft
❑ Sanitary seal is functioning correctly
OR Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 4/28/21
Parcel ID: 020-043-29
Structure served by this system
Well production at time of test 5+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 0.606 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L JR Arsenic less than MRL (ND)
Collected by NINA
Date of Sample 4128121
Static water level at beginning of test 22 ft.
Comments water retested, 5/7/21, well chlorinated by Hefty Drilling
B. TANK DATA
Age of tank(s) 15 years
Tank type/material S.;,:i
Measured operating fluid level in septic tank 48
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 4/28/21
D. ABSORPTION FIELD DATA 4 shallow trenches tested
Which system tested (date installed) 8117/06
❑ ALL standpipes present per record drawing
Total measured depth from grade 3.5 ft (max)
Measured depth to pipe invert from grade 3.0 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. if not, state
depth into effective
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 4/28/21
Results 2✓ Pass For 5 bedrooms
Fluid depth prior to test 0 in
Water added 800+ gal
New depth *2 in
Elapsed time 1440 min
❑ Code -required soil cover over field Final fluid depth 0 in
❑ System presoaked Absorption rate 750+ god
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced 0 gallons If yes, enter date
Comments/Deficiencies: ` 4-5 wide shallow trenches, only had water in the north tench after 800 gallons added
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
M
Yes
Septic Tank/Lift Station on Lot > 100'
ft
Surface Water > 100'
Community Sewer Manhole/Cleanout > 100'
Property Line > 5'
Yes
if No
ft
M Yes
if No
ft
Neighboring Tank > 100' ✓� Yes
if No
ft
Private Sewer/Septic Line > 25'[Z] Yes
if No
ft
Absorption Field on Lot > 100' [✓ Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No
ft
Neighboring Absorption Fields > 100'
M✓ Yes if No ft
_
Animal _Containment ->-50' M✓ -Yes
if No
- ft - -
[j✓ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 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'
M
Yes
if No
ft
Surface Water > 100'
0 Yes if No ft
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q
Yes
if No
ft
Private Wells > 100'
[f✓ Yes if No ft
Water Main > 10'
❑✓
Yes
if No
ft
Community Wells > 200'
M✓ Yes if No ft
Water Service Line > 10'
[✓
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Q
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'[]✓
Yes
if No
ft
Private Wells > 100' E✓ 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
l certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
z
')-r • 49TH
MIFtP J A�UiR�C is .
T CE .9469 • :{_• ,
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 02-0-0!43.2q COSA# Qq 00"
Expiration Date: 7- It,5— 0-1
1. GENERAL INFORMATION
Complete legal description Lot 11: Shangd-La subdivision
Location (site address) 16100 Lost Horizon Dr. Anchorage, AK 99516
Current Property owner(s) Michael Faust E Melina Westall Day phone 632-1040
Mailing address same
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well❑
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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. (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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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 S s S E'nee^ng Phone 694-2979
Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567
Engineer's Printed Name Robert A. Shafer
S. DSD SIGNATURE
_Z' Approved for bedrooms.
Disapproved.
Date D O
Conditional approval for bedrooms, with the following
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By: Original Certificate Date: L - O q
611011?V
JR" IIft)
Municipality of Anchorage
(• �` t Development Services Department
\ Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:I Ilel - �►j�A Parcel ID:,(2,2 D-�3-��
A. WELL DATA
Well type l k=1VyYTZ-: If A, B, or C provide PWSID # = Well Log m) _
Date completed 41404 Sanitary seal (&) .A*S Wires properly protected,19J)VFX
r
Total depth � �ft. Cased to eft. Casing height (above ground) %8Lin.
FROM WELL LOG
LOG
Date of test t2 f/
I Static water level c`lft.
Well production 9 p•m-
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate 0•2/8mg/L
Arsenic: * - - ug/L' date of sample: 440
B. SEPTICIHOLDING TANK DATA
TankType/Material Jz i'ilG �L
AT INSPECTION
,q 1710el
o? 0 1 n.
— 3 •�� 9.p -m.
Other bacteria D colonies/100 mL
Collected by: `34-'s 6c.Y'Ix1r.Px1('.
Date installed 01-7/04
Tank size 1, St0 gal.Number of Compartments Cleanouts(SV) a
Foundation cleanout(V.)N) i4� Depression over tank (11& _a High water alarm (Y& A)bk-t go
—
Date of pumping 8 Q Pumper L
C. ABSORPTION FIELD DATA _
Date installed t7-'� Soil rating g.p.d./ft r ftZ/bdrm) •qS System type ��olo
Length33� I ft. Width 5 r ft. Gravel below pipe �• 5 / ft.
Total depth —3,S rft. En. absorption area ibPOW Monitorin lube Depression over field
Date of adequacy test 7 D Result (Pas Fail) f /fig For 5 bedrooms
'1 M
Fluid depth in absorption field before test � in. Water added gal. New depth in.
i�
Elapsed Time: A min. Final fluid depth jQL in. Absorption rate >= �60+ g.p.d .
Any rejuvenation treatment (past 12 mo.) (Yo type)�J o If yes, give date —
D. LIFT STATION MIR
Date installed Size in gallons
"Pump on' level at _in. 'Pump off" lev t�
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot A" /
Absorption field on lot &Z 4
Public sewer main AA
/
Sewer /septic service line 015 4
Animal containment areas /
High water alarm level at
Meets alarm & circuit requirements?
I
On adjacent lots 10D 4f
I
On adjacent lots /00 ! F
Public sewer manhole/cleanout
Holding tank dJ/fi
I
Manure/animal excrete storage areas /tom 4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
r ,
Building foundation S f Property line Absorption field S �+
Water main AJ 18 Water service line /0 �+'
Surface water /Lb
r
Wells on adjacent lots /co "7
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
I I
Property line 3 wE%Cr7CC'CC-Building foundation /0 Water main AJJA
1 / 1
Water Service line 10 'r Surface water /00 -fDriveway, parking/vehicle storage /0 '>`
Curtain drain IOC r Wells on adjacent lots lon
F. COMMENTS
G. EN
I certify that I have determined
review of Municipal records th
conformance with MOA COSA at
Engineer's Printed Name
Date _ �� 10
COSA Fee S '
Date of Payment /0
Receipt Number r�SS2�C
(Rev. 11105)
CAIU cxcuft,
h field inspections and
above systems are in
Waiver Fee $
Date of Payment
Receipt Number
In.
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Parcel I. D.
Municipality of Anchorage
Development Services Department
Building Safety Division .
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
020-043-29
1. GENERAL INFORMATION
Complete legal description Lot 11, shangri La subdivision
Location (site address) 16100 Lost Horizon Drive
Current Property owner(s) Bob Falk
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
COSA # 0800 -78
Expiration Date: :7-1 t'0 - 0�3
16100 Lost Horizon Drive Anchorage, AK 66516
Unless otherwise requested, COSA will be held by DSD for pickup.
2 Nt1M8ER OF BEDROOMS: Five (5)
3. TYPE OF WATER SUPPLY:
Individual Well
R]
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone 2411109
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite Systems 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 COSAs upon request to homeowners. Certificates of Onsite Systems 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. (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.
4. 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 OnSBe 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 Anderson Engineering 522-7773
Phone
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
S. DSD SIGNATURE
Approved for 6� bedrooms.
Disapproved.
Date 4/12008
t
MICHAEL E. ANDERSON
Conditional approval for bedrooms, with the following stipulations:
Attachments:
. COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date:
(R. 110M
Municipality of Anchorage
Development Services Department =
Building Safety Division
OnSfte Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsfte
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 11. Shangri to subdivision Panel ID: 020-043-29
A. WELL DATA
Well type Lvate If A, B, or C provide PWSID #_ Well Log (YM) Y
Date completed 2H2rz004 Sanitary seal (YM) Y Wires property protected (YM) Y
Total depth 300 ft. Cased to 2e ft Casing height (above ground) >24 in.
FROM WELL LOG AT INSPECTION
Date of test 2/1212004
Static water level 24' R R'
Well production 5 g.p.m. 9.p -m.
WATER SAMPLE RESULTS:
Coliforrn a colonies/100 mL Nitrate 177 mg/L Other bacteria 0 colonies/100 mL
Arsenic: N1D mg/I Date of sample: 2!22!08 Collected by: A. Harala
B. SEPTICIHOLDING TANK DATA
TankType/Material Staei Date installed
17t2006
Tank
_
Tank size 1.500 gal. Number of Compartments TW . Cleanouts (YM) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping New ConsL Pumper System In Use Only 4 Months. No Sludge Buildup.
C. ABSORPTION FIELD DATA
Date installed 8117-30M6 Soil rating (g.p.dJe or f?/bdrm) •45 GPwSF System type Shallow Trend,
'Length 336 ft Width 5 ft. Gravel below pipe •5 ft
Total dept s R Eff. absorption area 1.680 It" Monitoring tube'Y Depression over field N
Date of adequacy testNew Const Results(Pass/FBil) 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 mod (YM & type) N If yes, give date
D. UFT STATION
Date installed Size in gallons
Manhole/Access (YIN)
'Pump on' level at _ in. 'Pump ofr level at_
in. High water alar level at in.
Datum Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100,
On adjacent lots >100,
Absorption field on lot >100'
On adjacent lots >100,
Public sewer main N/A
Public sewer manhole/cleanout N/A
Sewer/septic service line >25'
Holding tank NIA
Animal containment areas None
Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >5' Property line>5_
Absorption field >5'
Water main N/A Water service line
>10• Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >S Building foundation >1a Water main >10'
Water Service line >10' Surface water >100'
Driveway,parking/vehicle 5'
p g/vehide storage >2
Curtain drain None Noted Wells on adjacent lots
-�1m' / 0 V
F. COMMENTS: Well was Installed in 2004 and only recently placed In service.
•••�� �4
G. ENGINEER'S CERTIFICATION = � Pr,.r• .k
1 certify that I have determined through field inspections and t`; 49th sto
review,�of Municipal records that the above systems are in -�—• *-
conformance with MOA COSA guidelines in effect on this date.
En meer's Printed NMichael EAdP.E.eame E. Anderson. C. ANDft
g PJl% No. No. tt-+381 f
Date 4112008 •1f�fQ"...* �••
41._ �'Krcatf7�P� •
COSA Fee $_
Date of Payment
Receipt Number.
(Rev. 11105)
Waiver Fee $ _
Date of Payment
Receipt Number,
Sun Java System Communications Express - Please View Frame I Page 1 of 1
From 'Poet, Jeff W.' <PoetJW@ci.anchorage.ak.us>
Sent Wednesday, April 9, 2008 7:33 am
To-andengr@gci.ner <andengr@gci.net>
Subject FW: Lot 11, Shangri La
Mike
Yes, I just need a new blue sheet And no, the tank does not need pumped.
Jeff
From: MIKE ANDERSON [mailto:andengr@gci.net]
Sent: Wednesday, April 09, 2008 7:25 AM
To: Poet, Jeff W.
Subject: Lot 11, Shangri La
Jeff:
Attached is a picture of the lawn over the septic system on Lot 11, Shangri La Subdivision. It was
taken by the realtor last fall when they first started advcrti-ing the house for sale. We currently have a
Conditional Ila th AuL,orjty u : dLe lit operty. Can we no.w get a full COSA witli this picture as
evidence of topsoil and seeding?
I was also told the previous owner lived in the residence for 4 months prior to the sale. Do we have to
pump the septic tank? We found no evidence of any solids in the septic tank.
Thanks
Mike
https://mailstore-1 .gci.nedframe.html?&security=false&lang=en&popupLevcl=undefined... 4/15/2008
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
MEMORANDUM
DATE: February 25, 2008
TO: * - "' ' Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lot 11, Shangri LaSubdivision
COSA
The area over the absorption trenches on Lot 11, Shangri La Subdivision has been
topsoiled and seeded. A picture of the area was forwarded to you last week. We
therefore request a new unconditional COSA be issued an the property.
Parcell.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
OnSfte Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
020-04129
1. GENERAL INFORMATION
Complete legal description Lot 11, Shwgri La Subdivision
Location (site address) 16100 Lost Horizon Drive
Current Property owner(s) Bob Falk
Mailing address
Lending agency
Mailing address
COSA # 09 P)19
Expiration Date: ?— 3 - O 2
161 DO Lost Horizon Drive Anchorage, AK 66516
Day phone 2411109
Day phone
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2 MUMRER 0' BEDROOMS: Five (51
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual On -sit R1
Individual Water Storage
❑
Individual Holding Tank ❑
---CommunityrClass--Wdtl
E]-- Oommumty—Orrsrt ❑---�
Public Water System
❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -She Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of OnSfte Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-sfte wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of Onsite Systems 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. (Certificates may 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.
4. 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-Sfte 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 verity that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-sfte 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 Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Phone 522-7773
Engineer's Printed Name Michael E. Anderson, P.E. Date 411ao0e
6. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the
/ L -
Attachments:
.COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
stipulations:
Maintenance Agreements
Supplemental Engineer's Report
Other
e
BY Original Certificate Date:
Municipality of Anchorage
Development Services Department y =
Building Safety Division
Onsite Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsfe
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Loc 11. Shangri to SubdMslon Parcel ID: 020-043-29
A. WELL DATA
Well type Pr vate If A, B, or C provide PWSID # _
Date completed 2/1=004 Sanitary seal (Y/N) Y
Total depth 300 R Cased to 20 R
FROM WELL LOG
Date of test 2/1212004
Static water level 24 R
Well production 5
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: N/D mgA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
9 P -m -
Nitrate •127 mg/L
Date of sample: 2!79!08
Well Log (Y/N) Y
Wires properly protected (YIN) Y
Casing height (above ground) >24 in.
AT INSPECTION
ft
9.p -m.
Other bacteria 0 colonies/100 mL
Collected by: A. Harela
Date installed 8117200.
Tank size 1.500 gal. Number of Compartments Two Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alar (Y/N) N
Date of pumping New Const- Pumper system Has Never Been In use
7----C.—ABSORPTION FIELD --------
Date installed 8/17-30106 Soil rating (g.p.dJe or fe/bdr) •45 GPD/SF System type Shallow Trench
Length 336 fl. Width 5 ft Gravel below pipe •5 R
Neu,
Total depth Z. r fL Eff. absorption area 1.680 ff? Monitoring tube v Depression over field N
Date of adequacy test New Const Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test in. Water added gat. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 8 type) N
If yes, give date
D. LIFT STATION
Date installed Size in gallons
'Pump on' level at _ in. 'Pump off* level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >1004
Absorption field on lot >100,
Public sewer main N/A
Sewer/septic service line >25'
Manhole/Access (YIN) _
High water alar level at
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >10a
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas None Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >S Property line >S Absorption field >s,
Water main N/A Water service line >10' Surface water
Wells on adjacent lots >100 -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
>100'
Property line >3' Building foundation >10' Water main >10'
Water Service line >10' Surface water >1W Driveway, parkingtvehide storage >25'
None Noted , C D !19 1�.
Curtain drain Wells on adjacent lots >�'-
F. COMMENTS: Well was Installed in 2004 and only recently placed In service.
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 411/2o08
COSA Fee $ 57 -so
Date of Payment _ 14-1t �1�6
Receipt Number
(Rev. 11105) _
Waiver Fee $
Date of Payment
Receipt Number
4 i 49th N>f
.� MICHAEL E mulm
in.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
MEMORANDUM
DATE: April 1, 2008
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lot 11, Shangri La Subdivision
COSA
The original COSA for Lot 11, Shangri La Subdivision has expired. The property has
now sold and we are applying for a renewal to the existing COSA. The COSA review
fee of $430.00 has been paid.
The property has remained vacant since construction was complete. New water
samples were recently taken to verify the quality of the water.
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