HomeMy WebLinkAboutSHANGRI-LA ESTATES EAST BLK 1 LT 14Onsite File
Shangri-La
Estates East
Block 1
Lot 14
#020-043-55
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191431 PID Number: 020-043-55
Dwelling: ■❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: *1 New ❑ Upgrade
Name
Harvey Richard Shane
ABSORPTION FIELD
El Deep Trench 9Wide Trench El Bed El Mound
Site Address
16380 Mountain Breeze Dr
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
(907)229-1886
Four(4)
3 GPD/SF
7.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.0 Ft.
Gravel depth beneath pipe
4.0 Ft.
Subdivision Block Lot
Shangri-La Estates East 1 14
Fill added above original grade
3.6 Ft.
Gravel length
20 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
1
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
1
Dist. between trenches
From
Tank
Field
Tank
Line
200 Ft2
N/A Ft.
Well
>50'
>50'
N/A
N/A
>25'
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑� Other
Manufacturer
Orenco/Advantex
Capacity
1,500 Gal.
Surface Water
>50'
>50'
N/A
N/A
Material
Fiberglass(FAP)
Number of compartments
Two
Lot Line
>5'
>5'
N/A
N/A
NA
Foundation
>� 0'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Remarks
n/a
Gal.
Alarm location
Electrical installed by
Installer
TanktO
PIPE MATERIAL House to tank D3034 D3034
drainfield
Northern Excavation
_ Drainfield D3034 CO/MTD3034
Inspector Luke Tidwell
BENCH MARK (Assumed elevation) 100 ft
Inspection 15,9/14/20
Location and description
dates: 2 n
t
Garage Slab
3b 4
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
.` Aq 1
Conditional Approval: Date
•
o
v co49 TF1
...
Septic System
% Benjam�r}35chiller /
Approved Date �� �'2
12592
�� 1 ��J1�c9.. C0/12/21
�il� pR0FESS10Na4`
Note: this approval does not include well permit requirements.
(rcev ubtuuiu)
SHANGRI-LA ESTATES EAST, BLOCK 1, LOT 14
PERMIT # OSP191341 PID # 020-043-55
\ TH#2
', \ \ d \ \
LOT 13
MH7 MH2
1 A 1500 -GAL
co r ADVANTEX TANK
B �1 W/ AX20 POD
Cot
_ `4rBDRM HOME
- r �T i LOT i14 v
r
E STIN(GIVVELL w/ i' }
RADIUS cot s 1 V11
RADIUS
� 1 I
20' LONG x 5' WIDE x 4'
2f}/ GREEMENT TO
EFFECT
V DEPTH
1 PF2�S4E ABSORPTION TRENCH
tVIDE�ACCESS ALTERNATE
—�7'----s/D.TH-26Q
f
l
r -------------- --------------------------i \
10' T&E EASEMENT
� l
q B C1\
FCO 1 8.35, 13.5
MI -11
14.41 15.8
MH2
24.0 14.8
CO1
25.4 53.4 'r
MT
'32.5 42.2'
CO2
38.6 38.6
LEG
OF Ak
CO ECLDEANOUT
LAN AS -BUILT 2CO - DOUBLE CLEANOUT
TH �r FCO -FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
... 0 50 100 MH - MANHOLE
Benja Schiller ®ism m k1m FEET MT -MONITORING TUBE
''�`F��Jp • � 12592 1021021.•'V���� 1 "=50' SV - SEPTIC VENT
`t�►��PRO FESSIONP��eAW TH -TEST HOLE
PROFILE AS-BUILT
(NO SCALE)
90.4
98.8FCOMH1MH2PERMIT # OSP191341 PID # 020-043-55
SHANGRI-LA ESTATES EAST, BLOCK 1, LOT 14
AX-20 POD AND
MANHOLES
95.6
Sep 24, 2021
99.0 FINISH GRADE
20'
DRAINFIELD ROCK
TH#1NO GROUNDWATER 9/8/19
88.4
92.4 CO1CO285.4
92.4
95.4 ORIGINAL GRADE MT19/24/21
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
September 24, 2021
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Shangri-La Estates East, Block 1, Lot 14 – NHN Sandpiper Drive
Steep slopes justification
Dear On-Site Services Engineer:
During construction, on this property, the trench was installed in a different location than
permitted, placing it on slopes greater than 25% but less than 46%.
The vertical separation distances were measured from the up-gradient side of the field, the trench
does not exceed 60” wide, and the pipe invert is 3’ below the original grade. Any disturbed
vegetation within 50’ downhill has been restored with erosion control vegetation.
The proposed design meets all MOA steep slope requirements as stated in AMC 15.65.210.B.4.
Sincerely,
Benjamin Schiller, PE
9/24/21
October 7, 2021
MOA Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Shangri-La Estates East, Block 1, Lot 14 — NHN Sandpiper Drive
Test hole justification
Dear On -Site Services Engineer:
During construction, on this property, the trench was installed outside the 30' radius of a test hole.
However, after comparing the test holes performed by Forge Engineering in 2020 to the
subdivision test hole dug on the south side of the property in 2006, we are confident that the soil
in the location of the existing trench is either identical to or better than the soils encountered in the
test holes used for this design.
The subdivision test hole log shows a percolation rate of 1.6 MPI and no groundwater in the month
of May down to 16'. Please see the aforementioned test hole log attached for reference.
Sincerely,
Benjamin Schiller, PE
Awl -
we
r C2
TH49
...
yy Benjarrin>Schiller
.CE 12592
10/7/21.•
����pR4fESS14N� ,
W.O.# 05716
DHI CONSULTING ENGINEERS
800 E. DIMOND BLVD. SUITE 3-545
ANCHORAGE, ALASKA 99515
SOILS LOG—PERCOLATION TEST
TEST HOLE LOG # L14B1
Pati OFAnot
4,
0.
g TH :� f
.. .06 •.O . • •• 000
of 0
'�DENNIS DEE G :; �¢i 0
.9 s
PERFORMED FOR: ANCHORAGE DEVELOP. Sc CONST. DATE PERFORMED: 2/14/06 +��'��'•, CE 5807 e•: �AV
LOT 14, BLOCK 1 SHANGRA—LA EAST SUED. ++~�aP ���•��r°I 4 ~
LEGAL DESCRIPTION: rofesSlO
e
O R � VAW'W'W*ti
Date:
17
WAS GROUND WATER
ENCOUNTERED ? NO
IF YES, AT WHAT
DEPTH ? —
DEPTH OF WATER
AFTER MONITORING ?
NONE
SITE PLAN
DATE:I SEM MENEM 0
No MEMMEMM
ml
mmoMMEMEMM
7NE,
READING
MN
FROZEN ORGANIC MAT
n Q•. e
1
NET DROP
2
1
REDDISH BROWN
4:19.00-
x26.32
a • :.
SANDY GRAVEL, CLEAN
3
.4
GW
2/14/06
4
.'.1.
6"
6'
1.67
3
2/14/06
4:40:00-
10.52 MIN.
5
6'
1.81
6
2/14/06
40200- 40
10:40 MIN.
fi'
6`
7
:,•:
2/14/06
8
µ :.'.
BROWN SANDY GRAVEL,
6`
1.78
w/ TRACE SILT.
2/14/06
:.
ROCK 4"-8"
9
6`
BOULDERS 18"
7
2/14/06
MORE GRAVEL
10
'
W/ DEPTH
1.66
'
GM
12
13
14
15
1:
•
B.O.H.
16
17
WAS GROUND WATER
ENCOUNTERED ? NO
IF YES, AT WHAT
DEPTH ? —
DEPTH OF WATER
AFTER MONITORING ?
NONE
SITE PLAN
DATE:I SEM MENEM 0
No MEMMEMM
ml
mmoMMEMEMM
7NE,
READING
DATE
CROSS 1WE
NET 114E
DEPTH OF
1Y
NET DROP
PERC,RATE
1
214/06
/
4:19.00-
x26.32
7:32 M IN.
6'
6'
1.26
2
2/14/06
4:29: DO'
4:39:00
10 MIN.
6"
6'
1.67
3
2/14/06
4:40:00-
10.52 MIN.
6'
6'
1.81
4
2/14/06
40200- 40
10:40 MIN.
fi'
6`
1.78
5
2/14/06
5:04:00-
5:14:41
10:41 MIN.
6'
6`
1.78
6
2/14/06
5:16:00-
5:25:50 1
9:50 MIN.
6`
6`
1.64
7
2/14/06
5:27:00-
9:56 MIN
6'
6'
1.66
PERCOLATION RATE: 1.66 (MINUTES/INCH.) PERCHOLE DIAMETER: 6"
TEST RUN BETWEEN: 4.0 FT. AND 4.5
COMMENTS: THIS TEST HOLE INFORMATION IS PROVIDED TO COMPLY WITH THE SUBDIVISION APPROVAL PROCESS AS
OUTLINED IN AMC 15.6.180.8.1. ANY USE OF THIS DATA FOR ANY OTHER PURPOSE, INCLUDING THE
DESIGN OF AN INDIVIDUAL SEPTIC SYSTEM IS STRICTLY PROHIBITED, WITHOUT THE WRITTEN CONSENT
OF THE ENGINEER OF RECORD.
ALL SOILS WERE PRE—SOAKED PRIOR TO STARTING THE PERCOLATION TEST.
PERFORMED BY: DHI CONSULTING ENGINEERS. I DEE HIGH CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2/07/06 716CSSWD
08/30/202a 90:30 S07-:345--9202 r"LPIHE DRILLING PAGE E,1/02
AMell Log
Penult I ufflbe-r: rS 191 �3 E -pate of� sue: 2--l—t-20
l as gel en�iiic 4lo ;�Ia olber.: 02004 355010
Is vtell. i
Date started:
12-_�`'t3 gages}glab�ete�3.� i_15-e�0 ��c�aie�1 at't)pFoae6ealnit lar.atioii?
LE`gSi� ��'SGb6�]$€t6el: S�';�r��{ri-L�t �Q�t ��Idck
Ri,��3epfa� �Yt�
�! avrPointe
C[
Propel,ty ow>aea i9a.e & Address-
Borehole
i kess;Borehole
))Eta:
Soil Type., Ttiic --liess & "Nater "!Ixata From To
stick auv0
gr••crrel.`v .sift
beck-ock 5 267
W ff Y TESTING
CdltDrM 1 Coviooml-
ugn-
ivietbod of Driffirng x air zonary 0 ca�,le tr)(A
Casing 4, p .; ,cl@fir
W3.111hick-ness:.IL"tl inches
Diarztet.r: r? iliclles L the 44 f lot
L)lsoaeter: �_ inebes lrDeptlt: — f Nt
'as�aaf8 stisl��xlr �Rac��r� ;xalHlad�2 Iee- ett —_
Static,':atcH• level ;from gm,111d level;, ?I fef:t
Pumplug le'Tel, .2 0 feet of
2 hours putng ng 5 9Pr"
Recj)very Rate: 5 gp.m
Amet.hod of Testing. pfILLIA,
WA bltak.e opeaging Type -
open End x Open Hale
jJ
Screened start _ Ieet Stopped feet
�] }'eg`araL'icns Start _ lest stopped
Groep T`y , nerrlc,rt to r�r tiles Volume..l his
P aa.p; futak:e Depth , feet.
Pl!1i3H3 SIVE Illi Braild Name - --- ��
jh',L;l9 lDigftif€ cted Upon COMPIetaOal? %'VC[I ;Nki
M.&,hud ofDisinteetiara: c1i1<»int? t �bl�
�"�,,la�xaaealtc�;
7(z 7(Z l j` well ) Dvillen: Alpine .DrPling d EtarerP?'!Ses
Ptd Box 110496
it AiE! °�ar�che illi 99 15 11
L1'_,'/ 1 i U1: U r ':3W ALPIHE DRILLR-6 PAGE 02%02
MIV.-NIIPIPALITY OF 'Am NCHORAGE
ffevelopment Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Peradt Number: 191431 Date of Issue: 9
Parcel Identiflimflon Number" 020 -04' 3 _svwo
Legal Description Block Lot
Property ONImer Name Z_,Zd_drew.
Crown P,oin'e/ Richard Harvey
A
Shangri-La East 1 14 P.O. Box *112313
K 99511
Pump Installation Date; -2020
Pump btake Depth Below Top of Well Casing: 260 feet
Pump Manufactnrvr% Name -Goulds
Punip Model, 7HS10
Pump Size- 1
PitlessAdapter Burial Depth: N/A feet
Pidess Adapter Manufacturer's Name; N/A
Fitless Adapter lnstalier;N/A
Well Dhslufected Upon Completion? � Yes 0 Nu
Method ot"Disilifectiorl: chforine tablets
comments"
PLEASE SAVE FOR COSA.
Pump Installer N"ame,
Aarow Pump & Weil Service, LLC
Mailing Address. P.O. Box 110496
City. Anchorage AK 99511
J 1 _2020
Attention: The pump installer.3halt provide a pump imitallation log - oj}_
Site within 30 days, (if piunp mstallatiot.
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9/14/20
EPU}NS
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWERIWELL PERMIT APPLICATION
Parcel I.D. 020-043-55
Property owner(s) Crown Pointe, Inc. Day phone 229-1886
Mailing address P.O. Box112313 Anchorage, AK 99511
Site address NHN Sandpiper Drive Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Shangri-La Estates East, Block 1, Lot 14
Legal description (Township, Range & Section)
Lot Size 40,443 Sq. Ft. Number of Bedrooms Four (4)
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑x
Initial ❑X
Single Family (SF) ❑X
(w/wo ADU)
Septic Tank
1ZUpgrade
ElDuplex
ElHolding
(D)
Tank
ElRenewal
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑x
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.
wl"a'k E'0tx"q--'
(Signature of property owner or authorized agent)
Permit/Rush Fees: `4 $zC)
Date of Payment: C1I zSll9
Receipt Number: 6 V Coto D
Permit No. los pj4 l y3 i
Permit App_-'-: - :
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
October 2, 2019
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Shangri-La Estates East, Block 1, Lot 14 – 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, but the total drop between
the distribution line in the trench and the base of the slope is less than 10’. Surface contours 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
10/2/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191431, Rebecca Carroll, 09/11/20
127012651275ALTERNATE SITE
10050 0
FEET
1"=50'
20' LONG x 5' WIDE x 4'
EFFECTIVE DEPTH
ABSORPTION TRENCH
4-BDRM HOME
1500-GAL
ADVANTEX TANK
W/ AX20 POD
NOTE:
SLOPES >25% ARE WITHIN 50', BUT THE TOTAL DROP IS 10' OR LESS
BELOW THE INVERT ELEVATION OF THE DISTRIBUTION LINE. 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.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
MT
TH#2
SHANGRI-LA ESTATES EAST, BLOCK 1, LOT 14
MOUNTAIN
BREEZE DRIVE
10/2/19
10' T&E EASEMENT
20' AGREEMENT TO
PROVIDE ACCESS
50' RADIUS TEMPORARY
TURNAROUND
TH#1
PROPOSED WELL w/50'
RADIUS. MAINTAIN 25' FROM
ALL FOOTING DRAINS.
CO
CO
FCO
MH
MH 2CO
PROPOSED TH TO VERIFY
SUBSURFACE SOIL CONDITIONS
FOR ALTERNATE SITE.
NOTE:
PLACE TEST HOLE AND PERFORM PERCOLATION TEST AT LOCATION SHOWN
TO VERIFY SUBSURFACE SOIL CONDITIONS FOR ALTERNATE SITE.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191431, Rebecca Carroll, 09/11/20
SHANGRI LA ESTATES EAST, BLOCK 1, LOT 14
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 16-30 MIN/IN
APPLICATION RATE: 3 GPD/SF
TYPICAL TRENCH SECTION
(NO SCALE)
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' BELOW GRADE
FLOW LINE ELEVATION: 3' BELOW GRADE
TOP OF TRENCH: 0.5' ABOVE GRADE
600 GPD / 3 GPD/SF /5' WIDE * .5 (RED. FACTOR) = 20 LF TRENCH REQUIRED (20 LF SPECIFIED)
9/25/19
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
5'
6"
6"
2.5'
4'
GEOTEXTILE FABRIC
5' WIDE ABSORPTION TRENCH SYSTEM
1,500 GALLON F.A.P. ADVANTEX TREATMENT
SYSTEM w/AX-20 FILTER POD
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191431, Rebecca Carroll, 09/11/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TH1 - EAST
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
Shangri-La Estates East, Block 1, Lot 14
9/6/19
L. Tidwell
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? -
10.9 6
4 5
020-043-55
Crown Pointe Homes
8:50 - 9:20
9/11/19
1
2
3
112 - 115 11
16
9:23 - 9:53
9:54 - 10:24
OB
Professional Engineers Stamp:
9/25/19
30
No
None
9/18/19
GM
3 11
16
112 - 114 12
1630 2 12
16
112 - 114 12
1630 2 12
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191431, Rebecca Carroll, 09/11/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TH2
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
Shangri-La Estates East, Block 1, Lot 14
9/6/19
L. Tidwell
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? -
17.8 6
4 5
020-043-55
Crown Pointe Homes
8:47 - 9:17
9/11/19
1
2
3
4
9:20 - 9:50
9:54 - 10:24
OB
Professional Engineers Stamp:
9/25/19
30
No
None
9/18/19
GM
30
30
10:27 - 10:57 137 - 138 11
1630 1 11
16
137 - 138 11
16 1 11
16
137 - 139 0
16 2
137 - 139 8
16 2 8
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191431, Rebecca Carroll, 09/11/20
ril?) 0, E��) N
hIAUNMP UTY OF FACHORAGE
4
-
Development Services Department Phone. 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-043-55
1. GENERAL INFORMATION
Expiration Date: I — ( � - 2 0 2-Z-
Complete legal description Shangri-La Estates East, Block 1 Lot 14
Location (Site address) 16380 Mountain Breeze Dr
Current property owner(s) Jason & May Scott Day phone 229-1886
Mailing address 2731 Cutwater Circle Anchorage, AK 99516
Real estate agent Day phone
2. TYPE OF DWELLING:
0 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:
Private Well®❑
Private Septic
❑■
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 7 Z 4'-� 9 S Waiver Fee $
Date of Payment 1(9 1 (z / / 2 ( Date of Payment
Receipt Number C)I60Y-P Receipt Number
COSA#_ 05C2) 160S Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 10/7/21
of "kl�l
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6. DSD IGNATURE
... .. ... ... ,..
System #1 Approved for 4 bedrooms . Benjaff�5Schiller
System #2 Approved for bedrooms �'��sjF . • ioi�2z92``i,,f
Disapproved�� ESSIO: �
Conditional approval for bedrooms, with the following stipulations:
cc(c(r
ON-SITE
WATER AND
o;
Jm PROGRAM
lSERN
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`^^ f Original Certificate Date: to `
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description
Shangri-La Estates East 131 L14
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 12/15/20
Total depth 267 ft
Cased to 49 ft
0 Sanitary seal is functioning correctly
R Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA N/A
Static water level at beginning of test 23 ft.
Comments NEW WELL
B. TANK DATA
Age of tank(s) <1 years
Tank type/material Adva ntex/Fi berg lass
Measured operating fluid level in septic tank N/A
FRI Standpipes/foundation cleanout per. record drawing
Date of pumping NEW INSTALL
D. ABSORPTION FIELD DATA Wide Trench
Which system tested (date installed) 9/14/20
Q ALL standpipes present per record drawing
Total measured depth from grade 10.6 ft (max)
Measured depth to pipe invert from grade 6.6 ft (min)
❑ N/A — pressurized field
0 Monitor tubes go to bottom of effective. If not, state
depth into effective
❑® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies: NEW INSTALL
COSA Checklist yellow sheet.
Parcel ID: 020-043-55
of Structure served by this system
Well production at time of test 5 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
®❑ Coliform bacteria is Negative
Nitrate 0.211 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L 9 Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 9/27/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station <1 years
Lift station material Fiberglass
Comments:
Adequacy test date N/A
Results EJ 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+
Community Sewer Manhole/Cleanout > 100'
0 Yes
if No
ft
M 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
50+ ft
Holding Tank > 100' 0✓ Yes
if No ft
Neighboring Absorption Fields > 100'
0✓ Yes if No ft
Water Main > 10'✓0
Animal Containment > 50' 0✓ Yes
if No ft
ED Yes
if No
ft
✓v Yes if No ft
Water Service Line > 10'
M
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' MYes
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'
0✓ Yes if No ft
Property Line > 5'
Yes
Yes
if No
ft
Wells on Adjacent Lots:
Q
Absorption Field > 5'
if No
Yes
if No
ft
Private Wells > 100'
0✓ Yes if No ft
Water Main > 10'✓0
ft
Yes
if No..
ft
Community Wells > 200'
✓v 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'
0✓
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Q
Yes
if No
ft
Private Wells > 100' El Yes if No ft
Water Service Line > 10'
R�
Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that 1 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
of �4,t.``kk�
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.. ........
BenjarytiSchiller
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�J'lF • 10/11/21 , • •�Csi„'�
���� PROFESSWO
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATERTREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this. _ Day. of ()�j IM ' -of 24AI by and between
Js�jnr-�2� ,herein the "OWNER," andthe Municipality of
Anchorage, herein the "MUNICIPALITY";, in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual,covenants contained herein, theparties 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 Waste Water Treatment System
located at (legal description)
Shangri-la Estates East B1 L14 ' -
'2. Maintenance, Repairs and Alterations.
(Owner is required to rbad, understand and -initial each -section) .
Throughout the term of this Agreement, the: Owner shall enter Ynto a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AW T -S shall, be maintained in a satisfactory
condition capable of performing as designed and producing.treawd septic effluent in
accordance with the equipment's .approval for operation in the. Municipality.
It shall be -theses onsibili of.the Owner duan the term of this Agreement P tY $ . _ . gr _ to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes anannual maintenance -fee (typically -$400 to UK).
--I r— 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. 05118/2018) Page 1 of 3
C
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 to maintain and repair an AVJWTS 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 Agreemenfishall 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
3tw•e)
Date:/6 % Z
name) ,
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The forego' 'nstrument was ac owledged before me thishday of .
20'01 ; b Q i� Q
NO Y PUBLIC FOR ALASKA. JP N
Commission expires: `�% f % / Q �j stmt ofAtaidm
My Coy m*sion Exon iuD11,202�3
MLTh]ICIPALI _
�- (signature) Date: (9 r
(print name) Title•
(rev. 05118/2018) Page 3 of 3