Loading...
HomeMy WebLinkAboutSHANGRI-LA ESTATES EAST BLK 4 LT 7Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s E T Y Certificate of On -Site Systems Approval Parcel I.D. 020-043-77 Expiration Date: l V Dy oZ ( , �0'� 1. GENERAL INFORMATION: Complete legal description SHANGRI-LA ESTATES EAST: BLOCK 4, LOT 7 Location (site address) 16369 Mt. Breeze Dr.: *Anchorage Current Property owner(s) Douglas & Jana Smith Day phone 830-7871 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 _ 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well © Individual 171 Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 50 Waiver Fee $ Date of Payment g .Z 0 z l Date of Payment Receipt Number_ 0 5 R 3E; G Receipt Number COSA # O.S C 2-111-175 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: It -_7/ 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. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, OF A. .......... J ey A. Garness.: `v Qo �or es slon° #AECC884 y��QP���Y ON-SITE with the followirsiPuWAMR AND M WASTEWATER ? J� PROGRAM c By: Original Certificate Date: 26 020-2 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 COSA Checklist Legal Description: SHANGRI-LA ESTATES EAST; BLOCK 4.LOT 7 Ifmore than 1septic system onlot: CUSAChecklist #of A. WELL DATA 0 Well log is filed with Onsite (or attached) 5111/14 Total Tota|dapUh 348 ft Cased to 20.5 ft ��Sanitary seal ksfunctioning correctly AlWires are properly protected Casing height (above ground) 18+ in. Date offlow test fo5/14/21rCOSA Static water level atbeginning oftest 137 ft. Comments B. TANK DATA ars Age of tank(s) 7te Tank type/material IPEPMISTA" Measured operating fluid level inseptic tank N/A FWStandpipes/foundation cleanout per record drawing Date ofpumping ADVANTEX D. ABSORPTION FIELD DATA _____ Which system tested (date installed) ynsn^ FWALL standpipes present per record drawing Total measured depth from grade 80 ft (max) Measured depth hzpipe invert from grade 433 ft (min) FlN/A—pnensurizedfie}d ----- On Monitor tubes 0o to bottom of effective. If not, state depth into effective .__ Code -required soil cover over field System presoaked (Required ifvacant for greater than 30days prior to date oftest) Gallons introduced N/A ~e||ono Comments/Dohnienciee:*MONITORING TUBE EXTENDS u.ax'asLuw/wvem COSxChecklist yellow sheet Parcel ID: 020'043-77 Structure served by this system Well production attime oftest 0.5+ ~pm Water storage tank volume N/A geUono 7disinfected for coliform test? FJ Yes F01 No co|ifonnbacteria ieNegative Nitrate mg/L E] Nitrate less than MRL (ND) Ansenicug/L &rAnsenicless than MRL (NO) Collected by GEG.LTD. Date nfSample ""°u/ t~///t �^-` 06 C. LIFT STATION _y Required maintenance completed Age oflift station ___years Lift station material Comments: ADVANTE)( 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' ✓❑ 50'+ Community Sewer Manhole/Cleanout > 100' Yes if No ft ❑ Yes if No ft Q Yes Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'✓❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No 50'+ ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No ft Q Yes if No ft if No 50'+ ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No 50'+ ft Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑ Yes if No 50'+ ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' M 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' ❑ Yes if No 50'+ ft Water Service Line > 10'✓❑ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No 50'+ ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION _o© OF ���'��� 1 certify that I have determined through field inspections and review 00 � of Municipal records that the above systems are in conformance with Com. H y MOA COSA guidelines in effect on this date. ..... ...... ... �'. �O ,Jeff rGarne S. CE —7 COSA Checklist yellow sheetr o f e s s1or�© #AECC884 05/26/2021 16:03 8686770 APLUS PAGE 08 399439 E 0 offinom I among No n■®■ a on a 5 0 Im a loll I a on 0 1 a 9 on _ 9 'IN Rosso Rosso 0 Olson 5 iisiiii Z' FA--aveknTwi -6 Field Maintenance Rellort AnchorageTank Annual InspE ation 907-272-3543 Property Ownw/rrockinq # opdraftr Doug & Jana Smith Larry Betts Site Addrxisr - 16369 Mountain Br,.eze Drive, Anchorage AK 99516 CofftVt Phonr? (907) 555-5565 AX 5" ID it Coextty Pod # Frru Plut. 0 Dats of Loot InsoectIon RTu Ppto* AX -135044 OSP141124 1 419310 RTU129058 06111/2020 Retrieve O&M Into Daily flow— Redrc ratio — Timer settings. 3 - Perform Field Sampng/Observations WU (IS ± NTUS) P DO (2`g) 3k, ,rj 2nd Compartment Odor Of Sample Typical ZMuEr r ❑ Earthy 0 Moldy Non -typical 4 SWIi Cabbago El Decay 0111Y RIM In PVU L Yes Z, No Foam In tank Yes No Check Control Para FlIocirc Ampe Discharge Amps Audible and visual A mg ZOK OW tons (telemetry a ly) Dyes r M 7 Inspect/Clean Pumi System inspect Rkw/Ud ......... ........... Splice Sox ........ ........... Float Cords ....... ........... Floats ............ ........... Pump ............ ........... alotubex Filter..... ........... Viotube Pump Vault ..... Recirculating Split" Calve..... . Comments Signature Clean Measure Sludge/Scum A1111daA I at Compartment Current�' 4( Pmvloua Current Previous 2nd Compartment Current Previous Current Prevlous inspect/Clean AdvanTex Filter Odor., Nonnal D Pungent skimfft: 14crinal ❑ I!xcesalve Bridging/Ponding: Nono-IMInor ❑ FxCessive Irmpact/Clean Discharge Pump System Inspect Rlserfl-ld 0 splice Box M Float Cords n Inspect Clean Laterals/Orifices Pod Bottom 71. Intake Vent inspect Clean Floats ❑7— Pump ❑ E-1 Inspect/Service Other System Components inspect Clean Inspect Clean Disinfection Equipment DI aparsal LateralsirOfifioes Er observations; ---D (" -- Additional Services Rendered ❑ Cteaned textile ghosts? ❑ Replaced UV Items? ReplaceClNsad other items? Parts Used: W w warranty, 8 = Billable (41 appropriate selection) w a Itm dumber Description rinjasafety Inspection RSV reinstalled Manifold reconnectedi flush valves closed Surn m t ry/Recommendations D System perfon-ning; no further action needed E3 Gait for service Date Fax completed form to 1-866-384-7404 Lids bolted on Conboi panel reactivated E-1 Tank needs pumping 0 Other? MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND %EPAIR AGREEMENT, herein the "AGREEMENT" made and . r/r entered into as of this r Day of of 20 by and between J:�5GI' e,:t herein the "OWNER.," and the Municipality of 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 described as located at (legal 2. an Ad 7anced Wastewater Treatment System (AWWTS), iption) &- /' y � A ell � 1- 4 Owner is required to read, understand and initial each section) 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 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. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 �r Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider, ----- - Owner acknowledges that the fine for failing fo inainfairi and iepair ah AWWTS maybe" 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-A--W-WTS-vendor/installer_and_approved_by-the-Municipality. are..the_governing_—_.._.._._.____ ___ ... guidelines for the construction, maintenance and repair of the Owner's AWWTS. C , 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 shalt 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 QWNER- By: (signature) Date: — ' �'--og ` /v -z o t` (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this c�j) qday of — �- 20,�J_ , by V1 NOTARY PUBLIC FOR ASICA My Commission expires: .f —a,/ -/_O7 c�7_45 (rev. 05/18/2018) Page 3 of 3 ,.PUB 111111111111\�� MUNICIPALITY: -R�"&—(signature) By: Date: RQ. 9 ar CCa. r0 (print name) Title: (rev. 05/18/2018) Page 3 of 3 hangri -La Estates East Block 4 Lot 7 #020-043-77 Inspection RepIcr_9-1-12.doc Municipality of Anchorage On-Site Water and Wastewater Program ° (907) 343-7904 Page ( of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSIO Ii.l t (Zq PID Number: 0219 •—OqS —7 Dwelling: 11single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: XNew ❑ Upgrade Name: ABSORPTION FIELD ❑ Deep Trench 56 Shallow Trench ❑ Bed ❑ Mound Address Ilam lnuk, t T-r, ?-r, & Other Phone Number Soil Rating // Total depth from original grade �of/Bedrooms &l 4t GPD/SF 5; 0 Ft. LEGAL DESCRIPTION 4 Depth to pipe invert from original grade K, S Ft. Gravel depth beneath pipe (9, '5—Ft. Subdivision Block of — tt y� M A I-T Fill added above original grad gg — J. Ft. Gravel length _? Ft. Township Range Section Gravel width p Ft. Beds: Number of Lines Distance between lines �' Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1315- Ftp t Ft. WellrGO r� l Uri ) t1 TANK El Septic S.T.E.P. El Holding ❑ Other Manufac rer 1. Capacity - hA l� ( s0 Gal. Surface Water J (/ t i UY wt Material f ���el �(1AC Number of compartments z� Lot Line r'f7 r4- /�rl(' NA Foundationt 11D4-10 LIFT STATION Manufacturer -,� C� (V�,� Capacity IS p� Gal. Curtain Drain A Remarks � Pump on level at Pump off level at/ High water alarm at in. Pump make bnd model Electrical Inspections performed by P5 2-0 M0J, Installer PIPEMATERIAL Housetotank Tankto � drainfield b �"�� IC1 s� /Fl66Uh Drainfield •3U$ -* GO/MT Inspector Mi,f pwl c�rr4 e r BENCH MARK (Assumed elevation) /it p ft Inspection s, 1 Location and description dates: or/ltchf 2nO 'P Irs ^ �1 3m 4in %W4 S'�j �%�!✓i� COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date JBa 00 49 H ............<'r d] It . . %. MICHAEL N. ANDERSON r° CCc 9 �+�1�'Fo� Approve Date* I "•2�•.°,�����_> 1� PROFESSIv# Inspection RepIcr_9-1-12.doc Permit No. OSP141124 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SHANGRI—LA ESTATES EAST BLK 4, LOT 7 PID No.: 020-043-77 BENCH ` / 1 � I / \ I � I / i i i i 1 ADVANTEX =50' ILL 'G i {z a 49TH } p ••. ....••.•..•..... ....... 0� :.MICHAEL N. ANDERSON: No. CE 946- �O��Essla �O� MARK A B c01 10 14 TC01 31 29 C04 55 44 MT 55 44 BENCH ` / 1 � I / \ I � I / i i i i 1 ADVANTEX =50' ILL 'G i {z a 49TH } p ••. ....••.•..•..... ....... 0� :.MICHAEL N. ANDERSON: No. CE 946- �O��Essla �O� 06/27/2015 06:45 907-345-0202 ALPINE DRILLING PAGE 01/01 4 � Alpine Drilling & Enterprises Well Log Permit Number. NSWII= Date of Issue: 5-21-1 Parcel Ideuti6catfioa Number: Q�377 0� Date Started: 5-27-1 ¢ Date Completed: 5-28-14 Is well located at approved permit location? x Yes No Legal Description: Shangni-La Estates East Block 4 Lot 7 r���� Property Owner Name & Address: Anchorage Development & Construction Ir 9441 Abbott Loop Road Borehole Data: Soil Type, Thickness & Water Strata Stick-up Gravelly silt ii / M Depth (ft) From To PA 346 WATER QUALITY TESTING OulftrrnlJe--g----Co11100ML Titratesd_ M91L Arsenic U —UWL F II1 M!r7<fiiii t Method of Drilling xair rotary ❑cabletool Casing type- ski Wall Thlokness: ,250 inches Diameter: 6 inches Depth: 2U feet Liner Type: w Diameter: dj inches Depth:10 to 50 feet Casing stickup above around: 2 feet Static water level (from ground level): Meet Pumping level:,?, ¢feet atter 4 hours pumping 2 gpm Itecovery Irate- 2 gpm Method of Testing: air lift Well Intake Opening Tyle: ❑ Open End x Open Hole ❑ Screened Start _ feet Stopped _ feet Q Perforations Start _ fed Stopped ^ feet Grout Type: bentonite gramdes Pump: Intake Depth _ fed Pump size _ hp Brand Name IWall Disinfected Upon Completion? x Yes ❑ No Method of Disinfection: chlorine iahlets Comments: 4.5 inch pvc with shale, packer at 50 feet with bentonite pellets above packer to casing. WellDriller: Alpine Drilling & Enterprises PO Box 110496 Anchorage AK 99511 Development Services Department Building Safety Division On -Site Water & Wastewater Program rp" 4700 Elmore Road P.O. Box 196650 Mark eegieh Anchorage, AK 99507 s a F r= r Mayor www.muni.org/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW 141124 Date of Issue: 3.21-14 Parcel Identification Number: 02004377000 Legal Description Property Owner Name & Address: Shangri-La Estates East Block 4 Lot 7 .Anc`orage Development & Construction I Doug Smith 9441 Abbott Loop Road Anchorage, Alaska 99507 Pump Installation Date: 9/23/14 Pump Intake Depth Below Top of Well Casing: 333 feet Pump Manufacturer's Name: Grundfos Pump Model: 10 SQE 15330 Pump Size 1.5 hp Pitless Adapter Burial Depth: NIA feet Pitless Adapter Manufacturer's Name: NIA Pitless Adapter Installer: NIA Well Disinfected Upon Completion? 0 Yes ❑ No Ivlethod ofDisinfeetion: Comments: Pump Installer Name: Aarow Pump & Weil Service, LLC P.O. Boz 110496 Anchorage, AK 99511-0496 Please save for your engineer. This is needed for your COSA. Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. On -Site Water & Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141124 Tax Code Number: 02004377000 Work Type: WellSeptic Initial Permit Effective Dates: May 21, 2014 to May 21, 2015 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SHANGRI-LA ESTATES EAST Site Legal Address: SHANGRI-LA ESTATES EAST BLK 4 LT 7 G:3239 Owner/Address: ANCHORAGE DEVELOPMENT & CONSTRUCTION LLC 9441 ABBOTT LOOP ROAD ANCHORAGE AK 995074221 Site Mailing Address: Lot Size in Sq Ft: 40128 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received B Issued By: La y' Date: Date: MUNICIPALITY OF ANCHORA L5, 6 114 1 T TA i Community Development Department Phone? -4 -7x04 Development Services Division Fax: 7- 4 -� On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-043-77 Property owner(s) Michelsohn & Daughter Construction, Inc Day phone Mailing address 9441 Abbott Loop Road, Anchorage, AK 99507 Site address Mountain Breeze Drive Legal description (Sub'd., Block & Lot) Shangri-La Estates East, Block 4, Lot 7 Legal description (Township, Range & Section) Lot Size 40,128 Sq. Ft. APPLICATION IS FOR: (® all that apply) Number of Bedrooms 4 APPLICATION IS AN: TYPE OF DWELLING: Absorption Field Q Initial 0 Single Family (SF) X❑ (v Septic Tank Q Upgrade ElDuplex ex ADU) (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well -1 Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or authorized agent) PermiVRush Fees:- 6W Z<<J Waiver Fees: Date of Payment: it to Date of Payment: Receipt Number: mq ts G Receipt Number: Permit No. 05M Illy Waiver No. _ Permit App_.:. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(@oanengak.com March 19, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Shangri-La East, Block 4, Lot 7 Well and Septic System Permit Request Ladies and Gentlemen: I am writing to request a permit to install a new well and septic system be issued for this property. The proposed systems will serve a proposed four (4) bedroom house. Currently the lot is undeveloped. The proposed system will utilize a 1500g S.T.E.P. tank with AX20 POD and drain field. The surrounding developed lots are served by private wells. There are no wells on surrounding lots within 100 feet of this system and there are no septic systems installed on the surrounding lots. Soils. One test hole was performed by Pannone Engineering Services in March of 2014, and groundwater was monitored for seven days. The test hole monitor tube was dry after the seven day monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 6 gallons/day/square feet should be used for a CAT III wastewater system. 1. Soil Absorption System Design. a. See Sheet 2 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography slopes from the southwest to northeast at approximately 20%-25% in the area of the proposed drain field. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation to the road cut -slope adjacent to the downhill side of the lot. 4. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 -3v WELL (E) I z' "k 00,V WELL (E) 1y LOT VACANT NO WELLS OR SEPTICS PRIMARY/ RESERVE DRAIN FIELD (P) 25LF x 5'W x 0.5'ED x 5.0'TD WITH 2' SAND pp ROAD CUT SLOPE kk TH-1 k 413R X/ HOUSE 45.4 (P) 50.41 k, 29.0 108. 0, 15008 S.T.E.P. TANK (P) /V/, 41,1V WITH AX20 POD WELL (P) k V CD C3 LOT VACANT \ \ X43' NO WELLS OR SEPTICS LOT VACANT NO WELLS kk OR SEPTICS IV-- W--� LOT VACANT k NO WELLS OR SEPTICS k------------------- NOTES: Date PAMOM ENG SVC, LLC 5/20/2014 FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 Scale PHONE (907) 272-8218 FAX (907) 272-8211 SD P.I.I. NO SHANGRI-LA ESTATES EAST, BLOCK 4, LOT 720-043-77 MICHELSOHN AND DAUGHTER CONSTRUCTION, INC. Steven nnope PERMIT NO. CE 8149 OSP141124 MOUNTAIN BREEZE DRIVE ANCHORAGE, AK 99516 Sheet PLAN PROFES9(0�- I OF 4 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS. 2. SCOPE OF WORK: INSTALL NEW 1500g S.T.E.P. TANK WITH AX20 POD. INSTALL NEW SOIL ABSORPTION SYSTEM. INSTALL NEW WELL. 3. GROUNDWATER WAS NOT OBSERVED TO A DEPTH OF 11.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 11.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4" 0 PERF PIPE FILTER FABRIC DRAIN ROCK 2.0 f 5.0-- 1 z COPPER DIP DUCTILE IRON PIPE o> <o Dn s 0 n o N s m s T# TANK CLEAN OUT NO. C# CLEAN OUT NO. In In R.I. M 1500 g S.T.E.P. TANK (P) W/ AX20 POD DESIGN PARAMETERS UPGRADE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1500g S.T.E.P. W/ AX20 POD PERC RATE = <1 MPI SOIL RATING: 6 GPD/SF AREA ROD: 100 SF SYS. TYPE: WIDE TRENCH 0.5' E.D. MIN LENGTH: 20 LF USE: 25 LF X 5' WIDE, 0.5' E.D., 5.0' TD TOTAL AREA: 125 SF TH-1 OR/ 5.0 GL —2.5 :uu+ansux 6 GP 6 0 5.0 —i —11.0 SECTION i FABRIC N ROCK 6" ABOVE PIPE INV 0 DRAIN PIPE TRENCH SEE DESIGN PROFILE LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC a� oo tjL 0 2. ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE N01ES PMNONE ENG SVC, LLC of A/-. 5xte 20 2014 FOR CONSTRUCTION �'�... .... P.O. BOX 100217 ANCHORAGE, AK 99510 r�P.•' •,�- � Scale PHONE (907) 272-8218 FAX (907) 272-8211 * , *�j� NTS .. ... ... ....... P.I.D. NO SHANGRI-LA ESTATES EAST, BLOCK 4, LOT .. / - 43-77 MICHELSOHN AND DAUGHTER CONSTRUCTION, INC. % S'teve'n' �a none PERMIT N0. ' PF:. CE 8149 j OSP 141124 DESIGN DETAILS MANCHORAGE, AUNTAIN EAKE99516E ++��I�EDSS�pr Sheet �O 2 OF 4 TEST HOLE 1 OR/ ORGANICS/ OL ORGANICSILTS 2- 3a5a73- 4- 5- 6- 7 POORLY 8 GP GRADED GRAVEL WITH 9 SOME FINES 10 11 BOH 12 13 14 15 16 17 18 DATE PERFORMED: 3/1/14 SOILS LOG - PERCOLATION TEST SLOPE M 0 4BR X05 \ TH—\ HOUSE (P� WAS GROUND WATER ENCOUNTERED? N IF YES AT WHAT DEPTH? —: DEPTH TO WATER AFTER MONITORING? DRY DATE: 3/13/2014 SLOPE TH X READING DATE CLOCK WATERTIME NET TIME LEVEL NET DROP READING 1 3/1/14 4:30 -- 2.55 — 2 4:32:05 2:05 MIN 8.55 (DRY) 6.00 3 4 5 6 PEROLATION RATE 0.3 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 4 FT AND 5 FT COMMENTS: Test hole excavated by RICHIE GENERAL CONTRACTING LLC. Perc hole was presoaked PERFORMED BY: Steven R. Pannone P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDL77II�NEES IIN EFFECTON THE DATE OF THIS TEST. NOTES: PtllVl�lO1�IL' ENG SVC, LLC '�`�OFA , kk Date FOR CONSTRUCTION •... �,qs 5/20/2014 P.O. BOX 100217 ANCHORAGE, AK 99510 tP, •,� Scale PHONE (907) 272-8218 FAX (907) 272-8211 TV • *+�� NTS %P.I.D. NO SHANGRI—LA ESTATES EAST, BLOCK 4, LOT /,,,,, -043-77 MICHELSOHN AND DAUGHTER CONSTRUCTION, INC. PanW6" / PERMIT NO. ' �},•.. CE 8149 ,� % OSP141124 MOUNTAIN BREEZE DRIVE M�+11\�tOFESS OC`��^r Sha eOF 4 SOILS LOG ANCHORAGE, AK 99516 \\ 4" JIM 4" PU SLIDE SECTION OF 6" PIPE OVER THIS CONNECTION TO PROVIDE SHEER PROTECTION— EXTEND TO BRIDGE EXCAVATION NOTES: FOR CONSTRUCTION SITE SECTION ADVANTEX DESIGN 2EA ADVANTEX 24.. PASSIVE AX20 PODS INSULATED AIR �.o \ s RISFR. VENT 10 GAUGE 1500 GALLON ANCHORAGE TANK PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SHANGRI-LA ESTATES EAST, BLOCK 4, LOT 7 MICHELSOHN AND DAUGHTER CONSTRUCTION, INC. MOUNTAIN BREEZE DRIVE ANCHORAGE, AK 99516 CE 8149 *I/ NTS ••••• I P.I.D. NO - -n iorie� PERMIT NO. •/ OSP141124 Sheet ` 4OF4 ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY /OF ANCHORAGE AND L ! THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this Day of of 20/9,by and between � herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System described as located at le al descri tion . 2. Definitions. Alteration. Any change to the design or function of an AW WTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AW WTS that were included in the original design which would allow the AW WTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AW WTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations. Installation and Removal of Additional Eauioment. Prior to performing any alterations to an AW WTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AW WTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AW WTS service and maintenance provider approved by the municipality and the manufacturer of the AW WTS for the entire term of the AW WTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AW WTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AW WTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AW WTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AW WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AW WTS. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: b. Municipality: Director Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: By: (signature) Date: , ,____ L (print name) 101, STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me thisQ day of , 201 , by `)mlm 56414 . owukL"t4— NOTARY PUBLIC FOR ALASKA My Commission expires: 04-04-"16 MUNICIPALITY: By: (signature) Date: name) Title: p11 5li • Municipality of Anchorage r11 5 aNa On -Site Water and Wastewater Program R (907)343-7904 s'1Ery CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-043-77 Expiration Date: 1. GENERAL INFORMATION Complete legal description SHANGRI-LA ESTATES EAST S/D BLOCK 4 LOT 7 Location (site address) 16369 MOUNTAIN BREEZE DR ANCHORAGE AK 99516 Current Property owner(s) DOUG SMITH Day phone Mailing address 16369 MOUNTAIN BREEZE DR, ANCHORAGE AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING ry —e ® Single Family (w/wo ADU) 1, ❑ Duplex a OCT ❑ Multiple Dwellings (Single Family and/or Duplex)6 / N z� 3. NUMBER OF BEDROOMS: 4 b 'G5 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: Received by: "'qy I� ;7 C. Vl t t y !�h Date: COSA to be released to the engineer, unless otherwise requested by the COSA Fee r Waiver Fee $ Date of Payment�IL ZI }r ck q161Receipt Number q�DO`� COSA# d5Cd5I (Obi Date of Payment Receipt Number. Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date 10/29/15 6. DSD SIGNATURE J/ System #1 Approved for System #2 Approved for Disapproved. Conditional approval for ( bedrooms. bedrooms. bedrooms, with the BY' /JY�/�'y" / Original Certificate Date: Z/ S7 T uniapality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory. Arsenic Advisory Well Flow Advisory Other COSA blue sheet -10-10-1 2.doc If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: SEMNGRI=LA ESTATES EAST S/D BLOCK 4 LOT 7 Parcel ID: 020-043-77 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Well Log (YIN) Date completed 512812014 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 346 ft. Cased to _L_ft. Casing height (above ground) 24" FROM WELL LOG AT INSPECTION Date of test 5/2812014 Static water, level 36 Well production 2 g.p.m. g.p.m. WATER SAMPLE RESULTS: 3 / ColiformNEG colonies/10o mL Nitrate M& mg/L Arsenic: ND ug/L Date of sample: 1011412015 Collected by: Mike N Anderson 21y B. SEPTIC/HOLDING TANK DATA Tank Type/Material SfiPbi@ h&T r�yf�sS. Date installed 911512015 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping NEN Pumper NEW C. ABSORPTION FIELD DATA —1985 SYSTEM TESTED Date installed.911512015 Soil rating (g.p.d./ft2 or ft2/bdrm) 6.0 System type 5 WIDE TRENCH Length 27 ft. Width 5 ft. Gravel below pipe 0.5 ft. Total: depth 5 ft. Eff. absorption area j_35_+_ft? Monitoring tube Y Depression over field N Date of adequacy test NEW Results (Pass/Fail) NEW For 4 bedrooms Fluid depth in absorption field before test NEW in. Water added NEW gal. New depth NEW in. Elapsed Time: NEW min. Final fluid depth NEW in, Absorption rate >= NEW g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) UNKNOWN If yes, give date D. LIFT STATION FIBERGLASS TANK WITH PRE-SET FLOATS Date installed 911512015 Size in gallons 1500 Manhole/Access (Y/N) "Pump on" level at TIMER in. "Pump off' level at TIMER in. High water alarm level at TIMER in. Datum BOTTOM OF TANK Cycles tested 5 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 100'+ Public sewer main 751+ On adjacent lots 1001+ On adjacent lots 1001+ Public sewer manhole/cleanout 1001+ Sewer /septic service line 50'+. Holding tank 100+ Animal containment areas 1001+ Manure/animal excrete storage areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: t Building foundation 54 Property line 51+ Absorption field 5'+ Water main 1001+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 10'+ Water Service line 10'+ Surface water 100+ Driveway, parking/vehicle storage 104 Curtain drain' 50'+ (None Known) Wells on adjacent tots 1001+ F. COMMENTS E 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 MIKE N. ANDERSON, PE Date 1012912015 COSA canary sheet_2.6-15.doc TH y -•• ••4-i?•s aa�Y7vu••••.. • • '� iY°Yy F ........... f MICHAEL N. ANDERSON .ell PLAT NO. 2011-62 SHANGRI-LA ESTATES -EAST SUBDIVISION LOT 7, BLOCK 4 40,128 S.F. Mout N 1 "=40' GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.L.S. 2000 E. DOWLING RD., SUITE E ANCHORAGE, ALASKA 99507 PHONE 248-5454 GRID SW3239 F.B. 15-05 DATE 10/8/2015 JOB NO. SLE74 I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE bUALL: 1 "=20' ,o,* OF 0 ,,,1� F.........v,,. A. Gastaldi l o —6091 �• .•' ai 4 Pr ".••...M ca9