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HomeMy WebLinkAboutSHANGRI-LA ESTATES EAST BLK 2 LT 1Onsite File ,,.sta es ab- Municipality of Anchorage j On -Site Water and Wastewater Program • (907) 343-7904 A ON-SITE WASTEWATER INSPECTION REPORT OSP191226 020-043-56 NOV 2 0.z019 Permit Number.. PID Number.. Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: 0 New ❑ Upgrade Name: Crowne Pointe Homes ABSORPTION FIELD Address ❑ Deep Trench 0 Shallow Trench ❑ Bed ❑ Mound 3230 C St, Anchorage, AK 99503 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade (907) 748-5579 4 5.0 GPD/SF 7.95 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3.95 Ft. 4.0 Ft. Shangri-La Estates2 1 Fill added above original grade Gravel length Township Range Section 0.6 Ft. 15 Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 5.0 Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 150 Ft2 1 Ft. Well >50' >50' N/A N/A >25' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding X Other Manufacturer Capacity Surface Water >50' >50' N/A N/A Anchorage Tank/Orenco 1,500 Gal. Material Number of compartments Lot Line >5' >10' N/A N/A NA FAP 2 Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Tank and trench inspected on same day. Pump on level at Pump off level at High water alarm at in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank to Installer drainfield D3034 Northern Excavation Drainfield D3034 CO/MT Inspector L. Tidwell BENCH MARK (Assumed elevation) 100 ft Inspdecct Sn 151 9/23/19 2nd 9/23/19 Location and description 3rd 4th Bottom of siding North side of house near FCO. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF Conditional Approval: Date 1WP�E" "'°".�°�� �'7,• r 69th0. MICHAEL E. ANDERSON cL �c No. CE -4381 ,' �& Approved � 7 l � �` •,°° 11/ .... Date ®�'OROFLSSO Inspection Report-9-1-12.doc @ I 0 (:. �. iV v�1rwN 1 PROFILE AS-BUILT (NO SCALE) 94.15 89.75 98.05 88.65 FINISH GRADE 15' DRAINFIELD ROCKMTFCOMH MH2COTH#1NO GROUNDWATER 11/19/2019 80.1 84.1 COCO68.05 80.1 84.1 88.05 ORIGINAL GRADE PERMIT # OSP191226 PID # 020-043-56 SHANGRI-LA ESTATES EAST B21 L1 AX-20 POD AND MANHOLES 11/19/19 1500 GAL. ADVANTEX F.A.P. TANK G 5 / 29 /' 2 0 19 22 : 48 9c1 7 —.3 4 5- %3''J2 ALPTHE DRILLINGPAGE 011 I /01 Alpine Drilling & Enterprises &IMMIEW Permit Nimber: tC%,,W19-1,22.Q2 Dtate of fsgue,*-9DIALI-9 Parcel .Identification Number- -0200435iQ00- Yes Da : Date onip!eted-- Date Started- 9- 49 C— n? Is well located at approved permit locallox -NO-6 Legal Description. ShaOglllka East ao(* 2 Lot property Ow. aer Name &- Addres5l. CrOVO PC*)t'-" 1?7C PO Box 112313 Anchol.,ge, Masklo 99511 Borehole Data: Depth (ft)INIethod of Driffing x air rotary cable, tool F oil Type, -Ibiekum: & Viater Strata i-om To c F'asLng type. nregel 2 Wal I ThidC-Iess; .2,50 imhes stick-up Diameter: 6 imlws Depth- 34 feet gravelly sill 18 Liner T- sI14, gravel 18 26 Diameter: -- inches Depth: ---- feet bedrock 26 226 (,lasing stickup above proaad; 2 feet 'Static water level �,ound lavell): 3_( feet ptimping level: 229 feet after 413olms P1jmPi1QA:!A 9PM Reca%,ery Rate- 2. 5 gprn MeViod of Testing: c-drAl� Well Intake Opening Type:._ pe: C1 Open, End x Opal Henle Se r f, e ri e d Stopped s d PelforaonStart Aleet Stopped feet'T-,", —'P'V1510 i )Ut bis WATER QUALITY TESTING Coflfbrm Ob Col/100ml- Nitrates 0.2- mg/L ksomc U9& L [Fe"Du 51, �i TU, 11' . - purnp. Intake- Depth feet ttimp size ___ hp 13,ad Ilmne Well Disinfected Upon Coraptetion'T x Yes El No Method of Disinfectiou- chlodne fablety Comaxelits., Cruite grinales installed -while instalting casing to 34 feet. A 4 iiaeb liner was installed froul 10 feet hg to So feet bg. aentoftite hips were installed outside the 4 Jiuch linter fron, 10 feet to 59) feet. Well Dtiller.- 41 nter jpine Drifting & L, prises PO Box 110496 Anchorage AK 99.111 0 9 1, 0 3 " "101 013: 59 907-; 5-N2�2 LPINE DRILLIHG PAGE 611/01 MUNI(.'�'&IPALITY oF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site "'titer & Wastewater Section Fax, 907-343-7997 Pump Installation Log Well Downg Perwit Number: 191226 Date of Issue: 9 -9 __ 119 Parcel IdentifleatioE, Number; 02004456M) Legal Description Blocki c110t 11 rop�rty Owner Name & Address: row . r Renta SHANGRI-LA EA5T 2 P.O. Box 1123I3 Anchorage, AK 9951122313 PtUnp InStaftatiori Date; 12— 21 _2010 Pump intake Depth Beluw Top of Well Casing: 212 feet Pump "VIAnufacturey"s Meyers - Pump Model. IMYS2NFL1028 P4 Pump Size: 1 hq J101 ass Adapter Burial Depth: N/A ___ feet Fitness AUpterMainufactueer's Name: Pilless Adapter Xnstaller:N/A Well Disinfected Upon Compleboo? U Yes D No Method of Dishifection: Chlorine tablet', Comments-. PLEASE SASE FOR COSA. Pump ins Wier Name; ,,,,P,,,,..,Aaro%jv Pump & Well Service, LLC Malting Addrie-M, P.0. Box 110496 ,,ty. Anchorage State- AK\ 99511 AttentlGu: The parnp wValler shall pmvidc a pump installatiou log to On-site witbin. 30, days of pump instaftttion. P- m ot LOST HORIZON DRIVE (A 0 N 00004'50"E N 00'00'40"E 165.03' - - - 10' DRAINAGE ESM - T, - - - - - -- - -- - - - - - - - - - - 7 03iV r- i R' d ro M -1-1 co 4 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water & Wastewater System Permit Permit Number: OSP191226 Work Type: WellSeptic Initial Tax Code Number: 02004356000 Effective Date: Expiration Date: Site Legal Address: SHANGRI-LA ESTATES EAST BLK 2 LT 1 G:3239 Site Mailing Address: 16501 SANDPIPER DR, Anchorage Owner: CROWN POINTE INC Design Engineer: FORGE ENGINEERING This permit is for the construction of: Q Disposal Field © Septic Tank ❑ Holding Tank ❑ Privy a De p7rtin cnt 6/14/2019 6/13/2020 Lot Size in Sq Ft: 40013 Total Bedrooms: 4 Q Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Date: Issued By: E PPL J IV MUNICIPALITY OF ANCHORAGE S� Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-043-56 Property owner(s) Crown Pointe, Inc. Mailing address P.O. Box112313 Anchorage, AK 99511 Site address NHN Sandpiper Drive Anchorage, AK 99516 Day phone 229-1886 Legal description (Sub'd., Block & Lot) Shangri-La Estates East, Block 2, Lot 1 Legal description (Township, Range & Section) Lot Size 40,013 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑X Single Family (SF) ❑X ADU) Septic Tank ❑X Upgrade El(w/wo Duplex (D) EJ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage A ❑ S� 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. -ft� aat'� (Signature of property owner or authorized agent) Permit/Rush Fees: I J u Waiver Fees: Date of Payment: Date of Payment: Receipt Number: 0Receipt Number: Permit No. O SP 19 1-21Q6 Waiver No. Permit App_.:-: PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) June 12, 2019 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Shangri-La Estates East, Block 2, Lot 1 – NHN Sandpiper Drive Septic System Design Dear On-Site Services Engineer: The owner of the above lot intends to build a 4-bedroom home on the property. We are submitting this permit application for the construction of a new well and septic system. The attached site plan identifies the location of the home and the proposed well and septic location and alternate site. No conflicts exist between this proposed system and any other well or septic system on this lot or adjacent lots. The ground surface on the lot in the area of the absorption trenches slope slightly to the north. Slopes greater than 25% may be found less than 35’ from the trenches. The trenches have been designed in conformance with the steep slope provisions of the ordinance and no waiver is required. Drainage arrows are shown on the site plan indicating the grade and direction of flow. Storm water drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 50’ from all wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached test hole log and plan and profile sheets for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE 6/12/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191226, Rebecca Carroll, 06/14/19 ALTERNATE SITE 10050 0 FEET 1"=50' 15' LONG x 5' WIDE x 4' EFFECTIVE DEPTH ABSORPTION TRENCH 4-BDRM HOME 1500-GAL FAP ADVANTEX TANK W/ AX20 POD NOTE: CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TH#10 SHANGRI-LA ESTATES EAST, BLOCK 2, LOT 1 6/10/19 CO CO MT 2CO FCO PROPOSED WELL 50' WELL RADIUS SA N D P I PER DR I VELOST HORIZON DRIVE10' DRAINAGE EASEMENT10' T. & E. EASEMEN T 5%5%SLOPES >25% MAY BE WITHIN 35' OF THE ABSORPTION TRENCHES. THE TRENCHES HAVE BEEN DESIGNED TO COMPLY WITH THE DEEP SLOPE PROVISION OF THE ORDINANCE. NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS.25-30%25-30%NOTE: A PERCOLATION TEST MUST BE PERFORMED IN THE GM LAYER OF THE SUBSURFACE MATERIAL PRIOR TO CONSTRUCTION. REDESIGN MAY BE REQUIRED BASED ON THE TEST RESULTS. PROPOSED PERCOLATION TEST Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191226, Rebecca Carroll, 06/14/19 SHANGRI-LA ESTATES EAST, BLOCK 2, LOT 1 DESIGN FACTORS: SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 1-5 MIN/IN APPLICATION RATE: 5 GPD/SF 5' WIDE ABSORPTION TRENCH SYSTEM 1,500 GALLON F.A.P. ADVANTEX TREATMENT SYSTEM w/AX-20 FILTER POD TYPICAL TRENCH SECTION (NO SCALE) 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 6" 6" 3' 4' NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY BOTTOM OF TRENCH: 7.5' BELOW GRADE FLOW LINE ELEVATION: 3.5' BELOW GRADE TOP OF TRENCH: .5' ABOVE GRADE 600 GPD / 5 GPD/SF /5' WIDE *.5 RED. FACTOR = 12LF TRENCH REQUIRED (15 LF SPECIFIED) 6/12/19 A PERCOLATION TEST IS REQUIRED AT THE 1' to 5' LEVEL TO VERIFY THE CONSISTENCY OF THE SUBSURFACE SOILS. REDESIGN MAY BE REQUIRED. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191226, Rebecca Carroll, 06/14/19 N -SITE WATER AND WASTEWATER PM~� M V Y y 00 SOUTH BRAGAw ANCHORAr , AK ' SOILS LOG - PERCOLATiON TEST PROJECT #: PERFORMED FOR: LanTuh.lnc. DATE PERFORMED: VQ4/2opj L 1� -ZLEGAL DESCRIPTION: LO 1 lock 1 Shmari-Lo East Su d'v sion TEST HOLE # 10 SLOPE SITE PLAN ' 4/ ornark I • ' '� Ln er -• 11L 14:42 •• mr 10:52 PROFEssl g Silty (wave[ Recharge- 10:53 with Sand // 4} a a - 2 11:03 e Dr 8' Recharge Gm 1 6 4e -:ky 10 _ Or y $" 7 ♦� a 'a aY f. ®: well Graded Gravel wAs GROUNPwATER ENCOUNTERED? No V Giw IF YES, WHAT DEPTH? --- --- - • DEPTH OF WATER • None _a AFTER MONITORING. DATE: 7/11/2004 S 0 P E 4/ d� a A � • ' '� '49M r..Nr rr.ri....n 14:42 •• mr 10:52 PROFEssl SOH — i7' 'r Recharge- 10:53 S 0 P E READING DATE 4/ s DEPTH OF WATER i Start 7/4 READING DATE GROSS TIME NET TIME DEPTH OF WATER NET DROP Start 7/4 14:42 E" 1 10:52 10 Dr 'r Recharge- 10:53 8" 2 11:03 10 Dr 8' Recharge 11:04 3 11:14 10 _ Or y $" PERC RITE: 1.2 MIN./INCH PERC, -HOLE DIAME=TER: -_.,,V" TEST RUN -BETWEEN S,Q FT. AND 5.5 FT• COkENTS- Fest Hale Pre Soaked Prior to Percolation Test. TEST PERFGf�0ED -By- Eg SAMERSON 4.;MICHAEL Z. ANKRS4N, CERTIFY THAT .THIS TEST WAS PERF D 0 ACCOFiDANCE:' WITH ALL STATE AND MUNI CIPAL'GUt€lELIMB, 014 THIS DATE:. /1r,/2004 MUNICIPALITY OF ANCHORAGE a Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 020-043-56 Certificate of On -Site Systems Approval Expiration Date: 12 2 zo z3 Legal description SHANGRI-LAESTATES EAST BILK 2 LT 1 Site address 16501 SANDPIPER DR Anchorage AK Current property owner(s) HODGE X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 9/12/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 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 Application 1. GENERAL INFORMATION Parcel I.D. 020-043-56 Complete legal description Shangri-La Estates East Block 2 Lot 1 Location (site address) 16501 Sandpiper Dr. Anchorage, AK Current property owner(s) Cameron George & Heidi M Hodge Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: © Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: V Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete 0 Fiberglass Age 4 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ® AWWTS ❑ Bed ❑ Deep Trench © Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: AN Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 1?9 0 Waiver Fee $ Date of Payment 9 3 / -z-0 Z 3 COSA# OSC2 3 f 3 �_L0 Date of Payment Waiver # COSA Application—June 2022 Legal Description: COSA Checklist Shan2ri-La Estates East Block 2 Lot l Parcel ID: 020-043-56 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 9/9/t9 Total depth 226 ft Cased to 34 ft ✓❑ Sanitary seal is functioning correctly ❑- Wires are properly protected Casing height (above ground) 19 in. Date of flow test for COSA 8/31/23 Static water level at beginning of test 35 ft. Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping NA* ❑✓ Required maintenance completed, if AWWTS Comments: *Advantex D. ABSORPTION FIELD DATA Which system tested (date installed) 9/23/19 ❑ ALL standpipes present per record drawing Total measured depth from grade 13.8 ft (max) Measured depth to pipe invert from grade 10.8 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3 ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies *Per field observation. COSA Checklist June 2022 Well production at time of test 2.5 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ✓❑ No ✓❑ Coliform bacteria is Negative Nitrate 0.250 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 2] Arsenic less than MRL (ND) Collected by Areterra Consultina Date 817,9/23 STATION ❑ Require - b Age of lift station Lift station material Comments nce completed Adequacy test date 8/31/23 Results 0 Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 0 in Elapsed time _ 0 min Final fluid depth 0 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 12* in Effective depth remaining 36 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ❑-/ Yes if No Community Sewer Manhole/Cleanout > 100' ✓❑ Yes if No ft © Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' ✓❑ Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' ✓❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft 0 Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' © Yes if No ft ❑✓ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑-/ Yes if No ft Surface Water > 100'J❑ Yes if No ft Tank to Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ✓❑ Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' P1 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The now and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist June 2022 MUNICIPALITY OF Development Services Department `^ On -Site Water & Wastewater Section Parcel I.D. 020-043-56 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: V CST CJ� Complete legal description Shangri-La Estates East, Block 2, Lott Location (site address) 16501 Sandpiper Drive Anchorage, AK Current property owner(s) Crowne Point, Inc Day phone _ Mailing address Real estate agent P.O. Box 112313 Anchorage, AK 99511 2. TYPE OF DWELLING: ❑E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Fm� Private Septic ❑E Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 25 Waiver Fee $ Date of Payment 6/�6�20 Date of Payment Receipt Number OZ6�(�{D Receipt Number COSA # 05(. 2.0/Z% Waiver # Distance: 5. STATEMENT OFINSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Civil Engineering Phone 522-7773 Address 1399 W. 34th Ave., Ste. 100 Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 6/24/2020 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for th •^ u....nn.............................. � bedrooms MICHAEL E. ANDERSON 4 bedrooms s° NO. CE -4381 ®��TFp ° •.° 6/24/20 •,.••••���'® ®,0ROFESS\U' ® ® ®�® bedrooms, with the following stipulations: By: �c �un� Original Certificate Date: 1 2,0 Z,0 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other Legal Description: Shangri-La Estates East, Block 2, Lot 1 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9/9/19 Total depth 226 ft Cased to 34 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '18 in. Date of flow test for COSA 9/9/19 Static water level at beginning of test 31 ft. Comments B. TANK DATA Age of tank(s) `1 years Tank type/material FAP/Fiberglass Measured operating fluid level in septic tank N/A ❑ Standpipes/foundation cleanout per record drawing Date of pumping New Construction 9/23/19 D. ABSORPTION FIELD DATA 5' Wide Trench Which system tested (date installed) 9/23/19 IN ALL standpipes present per record drawing Total measured depth from grade 8.55 ft (max) Measured depth to pipe invert from grade 4.55 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective OR Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced NA gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 020-043-56 Structure served by this system Well production at time of test 2.5 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate •200 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L JS Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 6/10/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: NA Adequacy test date New Construction Results E] Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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 Yes Community Sewer Manhole/Cleanout > 100' Yes if No ft (�✓ Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' F71 Yes if No Absorption Field on Lot > 100' ❑ Yes if No >50 ft Holding Tank > 100' Z Yes if No Neighboring Absorption Fields > 100' Yes if No Water Main > 10' Animal Containment > 50' Fv� Yes if No El Yes if No ft Yes if No. Water Service Line > 10' Q Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' R/l Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ®✓ Yes if No. Property Line > 5' F,/� Yes if No ft Wells on Adjacent Lots: ✓/ Absorption Field > 5' 7 Yes if No ft Private Wells > 100' Yes if No Water Main > 10' ft Yes if No ft Community Wells > 200' Yes if No. Water Service Line > 10' Q 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' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' 7 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓/ Yes if No ft Private Wells > 100' R✓ Yes if No Water Service Line > 10' 7 Yes if No ft Community Wells > 200' R Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet ft ft ft ft ft ft ft ft ft ft 452 906 ■■■ ■ on ■ long ■ ■■■ ■ ■ ■ ■ ■ ■ ■■■ ■ ■ ■■ ■ ■ ■■■ ■ ■ ■ soon on long �dvanTexl" Field Maintenance Report Annual Inspection AnchorageTank 907-272-3543 Property Owner Tracking # Operator Cameron Hodge + Home Services Tech Site Address Contact Phone 16501 Sandpiper Drive, Anchorage AK 99516 Odor: vormal (303) 949-9281 AX Site ID # County ID # Pod # RTU #/UL # Date of Last Inspection AX -148284 OSP191226 432697 RTU141017 Inspect/Clean Discharge Pump System 06/16/2022 Retrieve O&M Info Daily flow._._. Recirc ratio Timer settings: Perform Field Sampling/Observations NTU (15 ± NTUs) pH (6-9) DO (2-6) Odor of Sample Typical L\�_Nlusty Lj Earthy ❑ Moldy Non -typical ❑ Sulfide ❑ Cabbage ❑ Decay Oily film in PVU ❑ Yes NN Foam in tank Yes N(No Check Control Panel Recirc Amps Discharge Amps !0"5 Audible and visual alarms OK Dial tone (telemetry only) 'es :i . No Inspect/Clean Pump System Inspect Clean Riser/Lid ..................... Splice Box .................... Float Cords ...... . . ........... Floats ........................ Pump........................ Biotube® Filter ........ . . ....... Biotube Pump Vault ............ Recirculating Splitter Valve....... Signature Measure Sludge/Scum Sludge Scum 1 st Compartment Current Previous Current Previous Inspect Clean Odor: vormal Pungent 2nd Compartment Current, Previous Current Previous V Excessive Intake Vent Inspect/Clean AdvanTex Filter Inspect Clean Odor: vormal Pungent laterals/Orifices ` Biomat: �ormal Excessive Pod Bottom Bridging/Ponding: 'None/Minor Excessive Intake Vent Inspect/Clean Discharge Pump System Inspect Inspect Clean Riser/Lid ❑ Floats ❑ ❑ Splice Box ❑ Pump ❑ ❑ Float cords ❑ Inspect/Service Other System Components Inspect Clean Inspect Clean Disinfection Equipment Dispersal Laterals/Orifices Observations Additional Services Rendered Cleaned textile sheets? _ Replaced UV items? Replac.ovused othor items? Parts Used: W = Warranty, B = Bill a (✓ appropriate selection) W B Item Number Description Final/Safety Inspection RSV reinstalled ids bolted on Manifold reconnected: flush valve9 closed Control panel reactivated Summary/Recommendations System performing; no further action needed ❑ Tank needs pumping L Call for service ❑ Other? Fax completed form to 1-866-384-7404 MUN ICIPALITY OF A N CHORAGE ADVAN CED WASTEWATER TREATMEN T SYSTEM MAIN TEN A N CE A N D REPAIR AGREEMEN T THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and of 20 _n_, by and between entered into as of this 3 O Day of A-....J~ f- _J,,__A._m_£S_0_ . ......;±:b'-'-----'-'ft~.:ru_1 __ · ___ , 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 operate an Advanced Wastewater Treatment System (AWWtS), described as Advantex FAP with AX20 pod located at (legal description) Shangri La East Blk 2 Lot 1 -16501 Sandpiper Drive, Anchorage 2. Maintenance, Repairs and Alterations .. (Owner is required to read, understand and initial each section) l.{ott-Throughout the term ofthis Agreement, ,the Owner shall enter into a service agreement with an A WWTS 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. M_ 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). Jotf-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 alt~rations to the system. Owner acknowledges that regular maintenance of an A WWTS 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 .JQfr_ Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. jo \+-Owner acknowledges that the fine for failing to maintain and repair an A WWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the A WWTS. The Municipality will give at least 24-hour notice. Jt>H-Owner agrees that any sale or transfer of ti~le of the property will not occur without a new Certificate of On-Site Systems Approval. J!.!f: Owner agrees that the A WWTS installation and maintenance requirements as provided by the A WWTS vendor/installer and approved by the Municipality are the governing- guidelines for the construction, maintenance and repair of the Owner's A WWTS. &li:_ Owner agrees to maintain remote monitoring of the A WWTS as required by the A WWTS 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 A WWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreeme_nt 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 authori_zed 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 . Sever~bility. 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 of3 OWNER: By: (signature) Date: —00-12 4"2 3 es 0. (print name) STATE OF AEASM�- c'oN ) V ) ss. The foregoing instrument was acknowledged before me this day of , 2P33, by _,r.,,,cs o. �'ivfit NOTARYPUBLI FOR vf' iiS My Commission expires: JANIERO HUNTER _ o4"'ems Public, state of Texas Notary Comm. Expires 07-07-2026 ++nma Notary ID 129876062 MUNICIPALITY: By: (signature) Date: J 12 g -3 C/O &:p S name) (rev. X05/ 18/2018) Title: r, / t/ / L C - 4 Page 3 of 3