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Home My WebLink AboutSHANGRI-LA LT 5hangri -La Lot ; 020-043 -23 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion?;;<HV No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 020 043 23 SHANGRI-LA 5 KELLER MICHAEL R & EKATERINA S 16425 SANDPIPER DR ANCHORAGE, AK 99516 03 29 2023 275 RED JACKET 100C211-8S21 1.00 15 MARTINSON PELLETS ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE AK 99518 O Municipality of Anchorage Development Services Department Building Safety Division ~ ~ On-Site Water and Wastewater Program, 4700 Eimore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: sw050176 PID Number: 020-043-23 Name: Shangdla Builders Wastewater System: [] New [] Upgrade Address: 2631 West 100th Avenue Anchorage, AK 99515 ABSORPTION FIELD Phone: Number of Bedrooms: Six ~ Deep Trench [] Shallow Trench [] Bed [] Mound [] Other: Soil Rating: Total Depth from odginal grade: LEGAL DESCRIPTION .8 GPD/F+ 8 Block: Lot: Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe: 5 Shangri La 2 Ft. 6 Ft. Township: Range: Section: Fill added above original grade: Gravel Length: 2-3 Ft. 94 Ft. Well: [] New [] Upgrade Oravelwidth: Number of lines: Distance between lines: 3 Ft. 2 > 12 Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Private 307 Ft. 30 Ft. 1,128 Ft2 ASTM D3034 PVC Ddller: Date Ddlled: Static Water Level: Installer: Date Installed: Alpine Drilling 7/28/05 41 Ft. Red Dog Excavation 10/7-10/2006 Yield:6 GPM Pump Set at: Ft. Casing Height>2Above Ground:Ft. TANK SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other: T~ To Septic Absorption Lift Holding 'ublic/Private Manufacturen Capacity: Tank Field Station Tank Sewer Line Anchorage Tank 2,000 GaL Material: Number of Compartments: we, > 100' > 100' N/A N/A >25' Steel Two (2) SuffaceWater >100' >100' N/A N/A ~ / LIFT STATION Size: Manufacturer: Lot Line >5' > 10' N/A N/A Gal. "Pump on" level at: "Pump off' level at: in. High water alarm at: Foundation >5' > 10' N/A N/A in. in. ~ Pump Make & Model Electrical inspections performed by: Curtain Drain None Noted Remarks: BENCH MARK Location and Description: Garage Slab. Assumed Elevation: 100.0 Ft. ,, ~ ~B, II~ ~ ~ , Inspections performed by: A. Harala Dates: 1st 10/7/2006 ~w;.._'~_'~,o,. oo?-.</ 2nd 10/10/2006 , (./2. "~:.;:,~ ._.~ Development Services Department Approval ,.: 49~ /~% " .... ~...-, ..... 4.*,~.v~..*.., .... Conditional Approval Date: .......... -, .... -, ..... ;'~r..r..: .... ~.~ % MICHAEL E, ANDERSON ~,~.: CE-4381 .'~-- t 1, ,, '""" ...... '""-' ¢.,..Reviewed04,05) and approved by:~f///,~,/ Permit Number: SW050176 Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Page 2 of 4 PID No. 020-043-23 SHANGRI-LA SUBDIVISION LOT 5 41,996 S.F. S 89'58'36"E 227.80' S1 S2 Sv C4 M1 C6 M2 A 15.4 30.0 35.5 41.1 38.9 56.4 57.7 20' T. & E. ESMT. C7 Alternote Site C6 B 35.8 34.7 35.9 42.1 36.7 54.1 50.1 C5 TH2 TEMPORARY TURNi / AROUND EASEMENT Six ~droom House ~.C. DRIVE WELL SLOPE / 1 O' GAS 89'57'08"E 197.91' ESMT. 3o' SANDPIPER DRIVE PLAN AS-]3UILT SCALE 1' = 40' Municipality of Anchorage 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 Page 3 of 4 PID No. 020-043-29 /~99.0 /04 O4~') ~ ' [12.0oo Oo,on I~ ~ / ISeptic To~k I~ / 94.55~ I J ~94.20 94.1 Finished Grade j92.0 / Existing Ground Geotextile Fabric )0.1 Droinfield Rock 84.0~ 90.0 84' (Trench Length) I NORTHWEST TRENCH 90,5 80.2-- 88.0 /,/ Finished Grade Existing Ground Geotextile Fabric Drainfield Rock 84' (Trench Length) SOUTHEAST TRENCH /"~ 74.0 PROFILE NO SCALE AS-BUILT 86.4 Oct 03 05 12:03p Diamond Builders INC. 245-5733 p.2 ALPINE DRILLING & ENTERPRISES Permit Number:. #SW050176 Date of Issue: 6-16-05 Date Started: 7-28-05 Dat~ Completed: 7-2~-05 Legal Description: Property Owner Name & Address: D/amend BuilOe~, Inc. PO Box 221233 Borehole Barn: Depth fit) ~ ~ ~c~ss ~ Wa~ S~ From To ~'~-up 0 2 g~v~ly s~ 2 bedmck 21 307 Parcel Identification Number: 020-043-23 Is well located at approved pennil location? [] Yes ~] No Method of Drilling [] air rotary [] cable too] Casing type: steel Wall Thickness: .2___~_~ inches Diameter:. _6 inches Depth: 3_~0 feet Liner Type: ~ Diameter: -----_ inches Depth: Casing stickup above ground: _2 feet Static water level (from ground/eveI): 4__~./feet Pumping level:_307 feet after _2 hours pumping _6 gpm Recovery Rate: _6 ~m Method of Testing: .~rii~ Well Intake Opening Type: [] Open End [] Open Hole [] Screened Staxt_ feet [] Perforations Stan~ feet Stopped .... feet Stoppecl.~__ feet Grout Typ e: B._entonite granuley Volume: ~ Depth: Start 0 feet Supped .9 feet Pump: Intake Depth ~ feet Pump size Brand Name__.____ Well Disinfected Upon Completion? [] Yes L--] No Method of Disinfection: chlo~fne tablet~ Comments: Well Driller: Alpine Drilling & Enterprises PO Bo 110496 Anchorage AK 99511 Attention: Thc well driUer shall provide a well log to the property owner wit3Jn 30 days of cornpletion and the property Mark Begich Mayor Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.rnuni.org/onsffe (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW050176 Date of Issue: Parcel Identification Number: 020-043-23 Replacement Only: YES NO Legal Description Lot 5 Shangri-La Property Owner Name & Address: lJohn Oney Pump Installation Date: 11/15/2007 Pump Intake Depth Below Top of Well Casing: 292 feet Pump Manufacturer's Name: Grundfos Pump Model: 15SQE15-290 Pump Size 1 1/2 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: C-6 Midwest Pitless Adapter Installer: N/A Well Disinfected Upon Completion? [] Yes [] No Method of Disinfection: Recirc Comments: Pump Installer Name: Aarow Pump & Well Service LLC PO Box 110496 Anchorage AK 99511 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 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 I WATER SUPPLy PERMIT Initial Permit Number: SW050176 Legal Description: SHANGRI-LA SUBDIVISION LOT 5 Design Engineer: 0014 Anderson Engineering Owner Name: DIAMOND BUILDERS, INC Owner Address: P.O. BOX 221233 ANCHORAGE, AK 99522- Date Issued: Jun 16, 2005 Expiration Date: Jun 16, 2006 Parcel ID: 020-043-23 Site Address: NHN SANDPIPER DRIVE Lot Size: 41996 SQ. FT. Total Bedrooms: 6 Permit Bedrooms: 6 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be Jn 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. Issued By:~ Date: ~,?/~,/~/-- 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.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-043-23 Permit Number SW Property owner(s) Diamond Builders, Inc. Mailing address (1) P.O. Box 221233 Anchoraqe, AK 99522 Mailing address (2) ~J ~J Sandpiper Drive J~//t, Legal description (Lot, Block & Sub'd.) Lot 5, Shan.qrt La Subdivision Legal description (Section, Township & Range) Lot Size 41,996 SF Acres/Sq. Ft. Day phone 522.4826 Zip Code Number of Bedrooms Six {6) THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [] Well Only [] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] 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. 12/00) Waiver Fees: Date of Payment: Receipt Number: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMO DATE: 6113/2005 TO: Joe Goodall WITH: MoA/On-Site Water and Wastewater FROM: Mike Anderson SUBJECT: Lot 5, Shangri La Subdivision Well and Septic System Construction Permit Water monitoring was completed on the test holes at Lot 5, Shangd La Subdivision on June 3, 2005. At that time no groundwater was found in Test Hole No. 2. Groundwater was found at 14' below the surface in Test Hole No. 1. The absorption trench for this lot was designed for a total depth of 8'. The bottom of the trench is therefore 6' above the observed groundwater table. We have included the test hole logs with the water monitoring noted. Please let me know if you have additional questions. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) May 28, 2005 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 5, Shangri La Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer:. The owner of Lot 5, Shangri La Subdivision intends to construct a new six-bedroom home on the lot, We are therefore requesting a permit be issued for the construction of a new well and septic system to accommodate the home. The attached Site Plan and backup documentation identify the location and configuration of the proposed well and septic system along with the alternate site. Also identified on the plans are the locations of the existing wells on adjacent lots in the subdivision. No conflicts exist between the proposed well and septic system and those on adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction, Test holes placed in the area of the absorption trench and alternate site indicated silty gravel with minor amounts of sand. The percolation rate of this material was determined to be 6.5 to 9 minutes per inch. No groundwater was found during the placement of the test holes and none was noted on May 15, 2005 during the monitoring period. We are proposing to place a new 2,000-gallon septic tank and 2 - 47' long by 3' wide by 6' effective depth absorption trenches to treat and dispose the effluent generated in the house. The elevation of the distribution line in the absorption trenches will be 2' below the surface and the total depth will be 8'. A flow splitter valve will be placed to insure even flow to each trench. A minimum of 3' of fill will be placed over the absorption trenches and 4' over the septic tank. The ground .surface on the lot slopes at varying grades from southeast to northwest. The new trench will be constructed parallel with 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 wells and any surface water in the area. Lot 5, Shangri La Subdivision May'28, 2005 Page Two 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. 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. 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. 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 I N 00'02'52"E © N 00'00'55'E 155.18' C~ C) LOST HOEIZON DELVE ooo LOT 5, SHANGRI LA SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Six Bedroom Home Deep Trench System Perc. Rate: 9 to 12 Min./Inch 1,250 Gallon Septic Tank Application Rate: .8 GPD/SF (Average) 6' Drainfield Rock 6 Bedrooms X 150 GPD/.8 GPD/SF (Applic.~tion Rate) = 1,125 SF Absorption Area 1,125 BF/12 SF/LF = 93.75 LF Trench Length THEREFORE: Construct 2 - 47' Long x 3' Wide x 6' Effective Depth Aborption Trenches at the Location Shown. Flow Line Elevation in Trench to be 2' Below Odginal Ground Surface. Total Depth to be 8' Below Existing Ground. Provide 3' of Cover Over Trench and 4' Over Tank or Provide 2" of Insulation and 2' of Cover. Maintain 100' Separation Between Existing Wells in the Area and the Absorption Trench and Septic Tank. Natural 1'6" Backfill # 6'0" Geotextile 4" Perforated PVC (Holes Down) -- Drainfield Rock TYPICAL DEEP TRENCH SECTION NOTE: (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Pdvate Wells in the Area, Minimum 100' Separation From Surface Water or Streams. Minimum 10' Separation From Water Service Line. Legal Desoription: 6- 7- 8- 9- 10- 11- 12- 13- 14--- 15- 15- 17- ' 18- 19- 20- COMMENTS . Municipality of Anchorage Development Services Department Building Safely Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 19S$50 Anchorage, AK 99519-6S$0 (907) 343-7904 Soils Log - Percolation Test D~amond Bu~Zders ; Lot 5, Shangr!-La Township. Range. Se~io~: ..... ' .I I : WAS GROUND WATER ENCOUNTERED? 1~ Y~-'S, AT WHAT DEPTH? Depth to Water. A~er Monitoring? Date: Reading · Date . Gr~ss Time Net Time I Deplh tbWater Net Drop I~:z,1 "~o. I~.~ ~,~ PERCOLATION RATE ~,. ~ (mlnu~eU',m:h) PERC HOLE DtAMETER ' 7 PERFORMED IN AC'CORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Performed For:. Legal Des=ription: ,4. 7- 8- 9- 10- 11. 12- 13- 14- 15- 15- 17- '18- 19- 20- ~. ~fJ~. Municipality of Anchorage Development Services Department Suilding Safety Division On-Site Waler and Wastewaler Program 4700 South Bragaw St. P.O. Box 195650 Anchorage, AK 99519-6550 wv/w ct anchomoe.a~.u$ (907) 343-7904 Soils Log - Percolation Test D/amond Builders* Lot 5, Shangri-La Dept'n to Water After Monitoring? 14 ' o,t,: 6/3/05 · Reading · Date · Gr~ss Time NetTime Depth IbWater Net Dro;) ',... .... PERCOLATION RATE ~ (m;m,t*u'~) PERC HOLE DIAMETER ./ I PERFORM-'D IN ADDORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Performed For, Legal Des=ription: 1- 3- ;t-~ 7- 8- 9- 10- 11- 12- 13- 14.-- 15- 16- 17- 18- 19- 20- COMMENTS .. Municipality of Anchorage Development Services Department , Building Safely Division On. Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 195550 Anchorage, AK 99519-6550 (907) 343-7904 Soils Log - Percolation Test Lot 5, ShangH-La Slo~e WAS GROUND WATER ENCOUNTERED? IF Y":S AT WHAT DEPTH? Depth to Water. After Monitoring? Date: Reading ' Date · Gr~ss Time Net Time I Depth tb Water Net Drop .I PERCOLATION PATE f,~, ~' (minu~e~'mcs~) PERC HOLE DLAMETER · '7 .TESTR'UNt~ETWEEN ~,~ FT' ~'AN~] ~.~ 'FT PERFORMED E~Y: .,~'~ I CERTIFY THAT THIS TEST WAS PERFOPJ~ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: Performed FOF. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewaler Program 4700 South Bragaw St. P.O, Box 19'~$50 Anchorage, AK 99519-6650 vwwe ~lr an~hgra~e.ak.us (907) 343-7904 Soils Log - Percolation Test Le.~al Des Jiption: 8- g- l0- 11- 12- 13- 14- 15- 17- '18- 20- Lot 5, Shangri-La i WAS GROUND WATER ENCOUNTERED? IF Y~$, AT WHAT DEPTH? Township, Range. Se~i:)'n: ..... . ..... .... -,; I E I · ReaSing · Date · Gr~ss TimeNet TimeDepth IbWater Net Drop ~1,~1~ i-~,.~ ... ~.,..z. _.. I~:D~ ~ I~.~' PERCOLATION RATE ~ ~ (.lautestm~h) PERC HOLE DIAMETER TES~.'UN~E~WEE..-"dl-.'.'~'-~rr' ~.^.~~'o PERFORMED ~Y: ~ [ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: EPLANS 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. 020-043-23 Expiration Date: I -17— 1 ` 1. GENERAL INFORMATION Complete legal description Shangri-La Lot 5 Location (site address) 16425 Sandpiper Drive Current property owner(s) Katherine Haghighi Living Trust Day phone Mailing address 16425 Sandpiper Dr., Anchorage, AK 99516 Real estate agent Chris Swires Day phone 907-830-0073 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex El Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community . ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: � �=-4'tAdj Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 52t, Waiver Fee $ Date of Payment 1QfQ !Ig Date of Payment Receipt Number q(a-7-2Receipt Number COSA# 661216-41/ Waiver# • 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Forge Engineering Phone 907-522-7773 Address PO Box 240773, Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 10/9/18 • *'•:7 #1 *: `9TM *ys. DSD SIGNATURE System #1 Approved for bedrooms •' •" '• Benja chiller / System#2 Approved for bedrooms � • ��'• CE 92592 ��.� f '/l�'••. 10/9/18.•,..4.,— Disapproved � Disapproved ��1;�\ROFESSt'4. \\71 Conditional approval for bedrooms, with the following stipulations: ,..(2‘?-\- U� �y�t ON SITE o', WATER AND WASTEWATER o c<\ PROGRAM o? 'F'VTSER \C By: ..._ • -, � r1 Original Certificate Date: I 017-1 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet 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 5 Parcel ID:020-043-23 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 7/28/05 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 307 ft Cased to 30 ft. Casing height(above ground) >24 in. FROM WELL LOG AT INSPECTION Date of test 7/28/05 10/4/18 Static water level 41 ft. 43 ft. Well production 6 g.p.m. 1 '1 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 10/3/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/10/06 Tank size 2000 gal Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) NA Date of pumping 10/02/18 Pumper Isaacs Pumping Service C. ABSORPTION FIELD DATA Date installed 10/7/06 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 gpd/sf System type Deep Trench Length 47 X 2 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 10'9" ft. Eff. absorption area 1 128 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/5/18 Results (Pass/Fail) Pass For 6 bedrooms Fluid depth in absorption field before test 0/0 in. Water added 1 074 gal. New depth 0/8 in. Elapsed Time: 1440 min. Final fluid depth 0/0 in. Absorption rate >= 900 g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed NA Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots 100' Absorption field on lot >100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >1 00' Sewer/septic service line >25' Holding tank 100 Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >101 Property line >5' Absorption field >5' Water main >10' Water service line 10' Surface water >100' Wells on adjacent lots 100' ABSORPTION FIELD ON LOT TO: Property line 1�� Building foundation 1�� Water main 10' Water Service line 1�' Surface water 1 00' Driveway, parking/vehicle storage 10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Two trenches, results are given for East trench/West trench respectively. G. ENGINEER'S CERTIFICATION �,,..-%.-Qa0®®, I certify that I have determined through field inspections and _.-::)..--7c._ ��of '�� review of Municipal records that the above systems are in ®`C0.. �: ' conformance with MOA COSA guidelines in effect on this date. f* 49 TH �� Engineer's Printed Name Benjamin Schiller, PE m"` �6 Date 10/15/18 : #0 . Benjamin Schiller : /01 F�' CE 12592 .•�A17.�� e'... 10/15/18 •. �� kk /.PROFESS\O ... COSA brown sheet 10-10-12.doc Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anctib?~i{]~,- AK'99519~6650 www.m uni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DVVELLING Parcel I.D. 020-043-23 COSA# © Expiration Date: GENERAL INFORMATION Complete legal description Lot 5, Shangd La Subdivision Location (site address) 16425 '~C~,J-'¥'~ ~ ~ jr?~'-'. ~lrt!.~f~./ Current Property owner(s) Shangdla Builders Mailing address 2631 W. 100th Avenue Anchorage, AK 99515 Day phone 223-6333 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Six (6) TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] 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 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 pedod 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 vedfy 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 vedfy that based on the information .... obtait~d' from ti~-MUni~Fp~Nty- bTAn-~Dor-a-g~-fil~e~--ahdT~iSifi-my -iri~)e§tig~itiisii ~i~d--i-n§pe~i0h~,' the'-6n:~'ite-~a~er 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 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE ~ ~ Approved for Disapproved. Conditional approval for Phone 522-7773 bedrooms. Date 12/22/2008 ~....CE-4381 ,.~ bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & 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 CHECKLIST Legal Description: Lot 5, Shangri La Subdivision A. WELL DATA Well type Private IfA, B, or C provide PWSID # Date completed 7/29/05 Sanitary seal (Y/N) Y Total depth 307 ft. Cased to 30 ft. FROM WELL LOG Parcel ID: 020-043-23 Date of'test 7/29/05 Well Log(Y/N) Y Wires propedy protected (Y/N) Y Casing height (above ground) >24 in. AT INSPECTION Static Water level 41 Well production WATER SAMPLE RESULTS: 11/15/07 30 ft.' 3 g,p.m. Coliform o colonies/100 mL Arsenic: N/D mg/I SEPTIC/HOLDING TANK DATA Tank Typ~/Material Steel g.p.m. Tank size 2,000 gal. Foundation cleanout .(Y/N) Y Date of pumping New,Const. C. ABSORPTION' FIELD DATA Date installed 10/7-10/06 Length 94 fl:. Total depth 10, fL .Nitrate N/D mg/L. Date of sample: 12/9/08 Other bacteda 0 colonies/100 mL Collected by: A. Harala Date installed .10/7/2006 Number o.f Compartments Two Depression over tank (Y/N) N Cleanouts (Y/N) Y 'High water alarm (Y/N) Pumper Soil .rating (g.p.d./ft2 or ft=/bdrm) .8 GPD/SFSystem type Deep Trench Width 3 ft. Gravel below pipe 5 ft. Eft. absorption area 1,128. fl~ Monitoring tube' Y 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 gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate. >= g.p.d. Any rejuvenation treatment (past 12 mo.).(Y/N & type). N If yes, give date D; LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump o~ level at Cycles tested in. Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main N/A Sewer/septic service line >28' Animal containment'areas None Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots >100' On adjacent lots >lOO' Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A None Building foundation Water main Wells on adjacent lots SEPARATION DISTANCES .FROM SEPTIC/HOLDING TANK ON LOT TO: >5' Property line' >5' N/A Water service line >10, Absorption field >5' Surface water >1oo' >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Water main >10' Driveway, parking/vehicle storage >25' Property line >5' Building foundation >1o' Water Service line. >1o' Surface water >1oo' Curtain drain None Noted. Wells on adjacent lots >lOO' COMMENTS: in. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect'on this date. En. gineer~s Printed Name Michael E. Anderson, P.E. Date 12/22/2008 COSA Fee $ Date of' Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt' Number 1 "- 40' 20' T. & E. ESMT. SEPTIC SYSTEM PLAT NO. 2002-1 18 SHANGRI-LA SUBD ¥ SION LOT 5 41,996 S.F. S 89'58'36"E 227.80' 5.3.8' / / I I \ \ \ \ \ \ EXISTING BUILDING 53.8' A.C. DRIVE 04 LO SLOPE / SNOW STORAGE ESMT. WELL "30' o~ o° o ~ m © 10' GAS ESMT. S 89'57'08"E 197.91' 50' TEMPORARY TURN-AROUND EASEMENT TO BE AUTOMATICALLY VACATED UPOM EXTENSION OF LOST HORIZON DRIVE. SANDPIPER DRIVE AS-BUILq ,HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC IT IS THE RESPONSIBILITY OF THE OWNER TO JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, 2O00 E. DOWUNG RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR 3239 12/10/2008 ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA F.B. JOB NO. I 08-10 SS5I NOTE: NO CORNERS SET THIS DATE.