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HomeMy WebLinkAboutSHANGRI-LA LT 19Shcxngri -La Lot 19 #020 - 043 - 37 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 020-043-37 1. GENERAL INFORMATION: Complete legal description SHANGRI-LA: LOT 19 Expiration Date: J —' � Z��Z Location (site address) 6796 Shangri-La *Anchorage 99516 Current Property owner(s) Lisbeth Berge Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 242-6125 Day phone-. 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55 O Waiver Fee $ Date of Payment 1 a 15 b 21 Date of Payment Receipt Number 0')N'39 G Receipt Number COSA# 056.21 t 715 Waiver# dl 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 12- /1412-/ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6.D�IGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the followi #AECC884 \?NLITY n/ r o wqT 'SITE lg�tipo(4& ' q Np r P, v rr Original Certificate Date: i z—[G - 7-1 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 Nitrate Advisory_ Septic System Advisory Arsenic Advisory Well Flow Advisory Other C0SA'%'-.;heck1ist Legal Description: SHANGRI-LA; LOT 19 if more than 1 septic system on lot: COSA Checklist # of A. WELL DATA (IIm Well log is filed with Onsite (or attached) Date drilled 8/21108 Total depth 301 ft Cased to 47 fit Sanitary seal is functioning correctly �M Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 12/7/21 Static water level at beginning of test 26.1 ft Comments B, TANK DATA Age of tank(s) 13 years Tank type/material SEPT"" _ fvieasured operating fluid level in septic tank - i�l Sandpipes/foundation cleanout per record drawing Date of pumping SEE ATTACHED MAINTANENCE D. ADSORPTION FIELD DATA Which system tested (date installed) 8/20/08 W ALL standpipes present per record drawing T otai measured depth from grade 6.25 ft (max) .Measured depth to pipe invert from grade 3.83 ft (min) ❑ N/A — pressurized field U Monitor tubes go to bottom of effective. If not, state depth into effective U Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 020-043-37 Structure served by this system Well production at time of test 1.6 gpm Water storage tank volume 300x3 gallons Well disinfected for coliform test? ❑ Yes F1 1-1 No [1foliform bacteria is Negative Nitrate ' ' `j mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Yrsenic less than MRL (ND) Collected by GEG Date of Sample 1213/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station 13 years Lift station material STEEL Comments,- Adequacy omments: Adequacy test date 12/7121 Results [Z]Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 792 gal New depth 4 in Elapsed time 40 min Final fluid depth 0 in Absorption rate 750+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date N/A Q�1 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes **501+ Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' p _ ❑Yes if No **50+ ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Water Main > 10' Q Animal Containment > 50' ✓ Yes if No ft ✓❑ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' El Yes if No it Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100' ❑ Yes if No —501+ ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Absorption Field > 5' ❑✓ Yes if No fit Private Wells > 100' ❑ Yes if No **50'+ ft Water Main > 10' Q Yes if. No ft Community Wells > 200' ❑ 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' ❑✓ 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' Q Yes if No ft Private Wells > 100' **50+ _ ❑Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Z Yes if No ft Surface Water > 100' ❑ Yes if No **501+ ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL **AWWTS -SINGLE 2000 -GALLON ADVANTEX TANK WAS INSTALLED & APPROVED BY MOA IN 2009. G. ENGINEER'S CERTIFICATION ��`JOF I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with pl , i H y i MOA COSA guidelines in effect on this date. G • � j • . . .... ....:.. . �% J ff;,-yless: l� CF— 79 - 3 si. c°i G �f CCSA Checklist yellow sheet v V�/ p,o f e s stor°\ o #AECC884 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 211715 Subdivision: Shangri-la Lot 19 A water sample revealed a nitrate concentration of 6.84 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER. TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day of Q-A- of 20 21 , by and between Al j7 j a SEVCAI AIA 7149 herein the "OWNER," and the Municipality of Rpm Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advo, te- J,'S rern located at (legal description) mAaepo 1-4 L-73 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) - r Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory r 1. przn, condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. wner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 *�, - Owner acknowledges that the Municipality may request records of maintenance and 4 repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. �. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: ignature) Date: l F— 9 THAJI;�-CV", (print name) STATE OF- E*Sf ik M SSS Ot,L(1 ) ) ss. 5� UOVis Co%.AA tq ) h The foregoing instrument was acknowledged before me this`� day of 2(t 20_QL, by NOTARY PUBLIC FOR 1'SSQ� My Commission expires: j3�1 S KRISTIN PONZAR Notary Public - Notary Seal STATE OF MISSOURI St Louis County My Commission Expires: May 19, 2025 Commission ##21273287 MUNICIPALITY: BY \� (signature) Dater (print name) Title: (rev. 05/18/2018) Page 3 of 3 05/31/2021 14:12 8686770 APLUS PAGE 03 401 313 mew n IN sal on » men Room on I on am RT i 5 INMO a M. R R 111 R BE 0 mm I IBM MEMO OEM man so a NONE oil IN E IN Y ®111 *hMwffLai.10 Field MaintenanceAnchorageTank Annual InspE.ction 907-272-3543 Pmparty OwnadTtacWng i operator Jahn & Lisboth Mui Dletto Larry Betts SnoAddreia Come Phwe 6796 Shangri-La C t1e, Anchorage AK 99516 (907) 3487464 AX 649 10 R Cwmty 10 A Pod q RTU ANL I Data d L=1n=pctVon AX -119343 SWO80063 406679 406672 RTU115202 03/24/2021 Retrieve O&M info Daily flow Recirc ratio Tatter setttings; -S I )A Perform Field Sampl'ng/Observations MfU (15 xNTUs} p (6-9} DO (2-6) 1 51\ Odor of Sample Typical WMust [I Earthy ❑Moldy Non-typk:al asultN a ❑Cabbego ❑Davy ofy film in pVU [ lyes to o Foam in tank [ I yes Check Control Pano Rociro Amps DischsMe Amps Aurgble anti visual ala ns OK Dias tone (t¢kemotry of y) Yes ❑ No inspect/Ciean Pump system Inspect Clean Rl"rAJd .......... .......... Sptice Box ......... ......... Float Cords ........ .......... Floats ............. .......... Pump............. .......... Biotube° Fitter ...... .......... 131olube Pump Vault . .......... Rocircitatino Sputter' We...... comments U r Measure Sludge/Scum Sludge Scam 1stCompartmant Current Q V Previotts Cummt Previous 2nd Compwtmont Current Previous Current Previous Inspect/Clean AdvanTex Filter Insp Ci n Odor: Normal ❑ Pungent t.ateratslOdflcas Biomat: Normal 0 Excesai a Pod Bottom Bridging/Ponding None/Minor ❑ excessive intake vent inspect(Clean Discharge Pump System ins to CI n Rlser/Ll Floats " spl' Box // Pump /jJrr � r oat co �J li Inspect/Service Other Systarn Components In, t d�e,ra,n ins C Disinfection Equipmom N..1 Dispersal f'es Observations AddHional Services Rendered ❑ Cleaned textile shoats? ❑ Replaced W items? ❑ Ropiaced/Used other Rams? Parts Used; W o Waanaanty, S = Biftbla (l appropriata selection) W a Item Number Description Final/Safety Inspection ® RSV reinstalled (j LM halted on dmwffold reconnected; flush valves closed Control Pattal reactivated Sumpary/Recommendations V System perf—Ing; no further action needod i� Cast for service ❑ TVk meds pumping C other? signmtvre____.-- ^ 4 nate, Sf' 1-1 %--2„ 01 Fax completed foam to 1-866�384-7404