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Home My WebLink AboutSHANGRI-LA LT 7Shangri-La Lot 7 020-043-25 EXPIRED PERMIT Mayor Mark Begich Altuiieipality of Anehorage ,a P.O. Mm 176,90 • Anchorage, Alaska 7519-6(V0 • Telephone 017) 343-K301 • Ru (!K)7) 343.821X1 471X1 Ilntgim Sum • Anrhomgc, Alaska 74507 "'Iv.numLorg Iluildinct Safety Division June 13, 2005 Crown Pointe, Inc 16372 Sandpiper Drive Anchorage, AK 99516 Subject: On -Site Water and/or Wastewater Permit. Permit Number: SW040276 Legal Description: Shangri-La Lot 7 Dear Crown Point, Inc: An On -Site Water/Wastewater Permit, number SW040276, issued by this office for a single-family system, will expire on July 21, 2005. The permit is valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well permit. If you have any questions, please call this office at 343-7904. Sincerely, Daniel J. Roth Program Manager On -Site Water and Wastewater Program Enc: Copy of permit Community, Security, Prosperity MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 Permit Number: SW040276 Legal Description: 5iiangr-L`a Lot 7 Design Engineer: 0000 None Required ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Jul 21, 2004 Expiration Date: Jul 21, 2005 Parcel ID: 020-043-25 Site Address: Not listed yet Owner Name: CROWN POINTE, INC. Lot Size: 48309 SO. FT. Owner Address: 16372 SANDPIPER DRIVE Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE. AK 99516 - This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. WHEN THE WELL HAS BEEN COMPLETED AND SATISFACTORY WATER PRODUCTION HAS BEEN DETERMINED, THE WELL DRILLER SHALL PLACE AN APPROVED SANITARY SEAL ON THE WELL HEAD AND NO PITLESS ADAPTER OR PUMP SHALL BE INSTALLED UNTIL AND APPROVED WASTEWATER DISPOSAL SYSTEM HAS BEEN CONSTRUCTED Received By. LAISDate: Issued By. Date: 2/ Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Y SA CTT Parcel I.D. 02-0-041-3a25,000-04 Permit Number SW Property owner(s) i.�Y-0? df), %-0/ /I tE� SNL' Day phone _6 45 62 77 cMailing address kt2rtfng address Zip Code C%RZV Legal description (Lot, Block & Sub'd.) L0T 'I 7tiit_—t--�J ht2Y1C► f- I - l_ -CL_ Legal description (Section, Township & Range) Lot Size -14 g, 30q Acre q.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: ��f'� Waiver Fees: Date of Payment: //i�� Date of Payment: r Receipt Number: 5`J D59 Receipt Number. (Rev. 12/00) , SHANGRI-LA SUBDIVISION LOT 7 48,309 S.F. _ SANDPIPER DRIVE (_ 100' 0-� M S 89'57'08"E 205.94' 1� 17 RELATIVE 120 N 87'26'41'E 206.1 SITE SCALE 1" = 40' 14 OF •�� Illa4 a a•• ................... as rw r 47 49 h y1 M N1�CNaEL E. ANOERSDN . C NO. CE -4381 �t�r 5/8" REBAR I 20' SLOPE \ SNOW STORAGE ESMT. I --I------------------------- — --- I I SAS plemou I I �i I �' 7H u 5' Wme cc) 5y',Lono .. . Devin Absorption Tnncn p s ption I M c SIM Tanikn Q a I pj N 04 N W I I N N N N I Fns Bedroom N O Nome b 0 z I I EL aF 121• z I I 120 x Proposed -d I ® Wall Lj,-:I W I o_l ^O=I ---------- --1----- -----10' T. & E. ESMT. 120 N 87'26'41'E 206.1 SITE SCALE 1" = 40' 14 OF •�� Illa4 a a•• ................... as rw r 47 49 h y1 M N1�CNaEL E. ANOERSDN . C NO. CE -4381 �t�r Municipality of Anchorage Page 1 or 3 Development Services Department OnSU Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519M50 www.ci.anchorage.ak.us (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO40091 PID Number. 020-043-25 N'' Crown Pointe Inc. Wastewater System: New P.O. Box 112313 Anchorage, AK 99511 ABSORPTION FIELD "Five 5 P'" 5' Wide Trench 345 6277 LEGAL DESCRIPTION sa fWp. 1.2 Ta DOM tom iy M 6 GPDIFe FI. 11 a Lal: slOemwt Dpth b pp, nonan nom ogr ip a Gc. O.M hwwalll pph. 7 Shand La 2 Fl. 4 Ft TvAn" R.I10.' sa Ffi * e w.WVW. Gnwl Lolpm: 1.3 Fl. 65 FI. W.l wdln. NunEo W hMw h.l eat Y Well: New 5 Ft. 1 Ft CM"ft* al (PrnM., A, 9. C): 7" Dpe% C wd w: oW Aowpual e.h " W. Private 360 FI. 29 FL 650 FP I ASTM 3034 PVC DothD.I. DnlW . suho WMo Lent 8!5103 84 Sanders & Sanders 619-1012004 Alpine FL rna. wro sat ■. a V Ahoy. Grwld. TANK 2 GPM FI. >2 FI SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lift Station Holding Tank bto?nvaro sewerLine Anchorage Tank 1,500 w« >100, >100, N/A WA >25' Steel Two (2) >100' >100' WA WA LIFT STATION — NONE ON LOT Ld un >5' >10, WA WA GM Fondron >5' >10' WA WA nn inh W m at k None Noted �P � h+�« Wv W-P.n�l» maw c~ D. BENCH MARK �R. Garage Slab 100.0 Ft Engineer's Stamp ��ww�upaa ()FV aa4 \ a, *NA Inspections performed by: AH Dates: 1a 619104 49th y 2"a 6110104 •—A U1 +� CNAEI E. ANDER507 W � Department of Health and Human Services approval 1 00 NO. CE-�3s1,. Reviewed and approved by: Date: O •� ��pP•' Dw. raw> aaaa� �5:: �•�. 7 Municipality of Anchorage Page 2 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SWO40091 PID No. 020-043-25 a ai M N w N N N O b O SANDPIPER DRIVE 0 S 89'57'08"E 205.94' AS -BUILT PLAN SCALE V = 40' SHANGRI-LA SUBDIVISION LOT 7 Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655-343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SWO40091 NUU N N Gallon PID No. 020-043-25 PROFILE AS -BUILT - Scale: T • 10' OM ALPINE DRILLING Municipality of Anchorage Department of Health and Human Services 825 "V Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Rick Mysfiorr+ http:i&w .d.and or*q*.jW- m Mayor FAX NO. : 907 345 0202 Dec. 09 2004 07:08PM P1 Permit Number. *SW 040091 Date of Issue: Date Started: 8.3-04 Date Completed: �5 04 Legal Description: Shand -La LO( 7 Property Owner Name & Address: Crown Point, Inc PO Box 112313 Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To stick-up - 0 2 gravelly sltt 2 24 bedrock 24 367 H2O .75 160 180 H2O 1.25 340 360 Parcel Identification Number: 020-043-25 Is well located at approved permit location? ® Yes ❑ No 9-9.511 Method of Drilling ® air rotary ❑ cable tool Casing type: Meet Wall Thickness: .250 inches Diameter: 6 inches Depth: Z_9 feet Liner Type: Diameter inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): ¢L4 feet Pumping level. -.M7 feet after 12 hours pumping 2 gpm Recovery Rate: Z gpm Method of Testing: aur lift Well Intake Opening Type: ❑ Open End ® Open Hole ❑ Screened Start feet Stopped feet ❑ perforations Start feet Stopped feat Grout Type: bentonite # f Volume: L Depth: Start2 fee: Stopped ?- feet Pump: Intake Depth feet Pump size Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: ¢p ng tablets Comments: Well Driller. Alpine Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property J. 11 J.'. --L.11 ....A J. --111.... J.. M... .l .... ,.L • 1".-. •- .t. tr4•. 'n ..-.- ....-. -1..1 MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SWO40091 Date Issued: Apr 28, 2004 Expiration Date: Apr 28, 2005 Parcel ID: 020-043-25 Legal Description: Shangri-La Lot 7 Design Engineer: I j' E P R S , Site Address: Not listed yet Owner Name: Crowne Point, Inc I Lot Size: 48309 SO. FT. Owner Address: P.O. Box 112313 Total Bedrooms: 5 Permit Bedrooms: 5 Anchorage , A 99511 - This permit is for the construction of: ❑✓ Disposal Field ❑? Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and dosed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: Date: ' Issued By. YV Date: 02910.4 MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Wafer d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 �)q)6q-llz.wl. 1p I IO164- C(t4N ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW040091 Date Issued: Apr 28, 2004 Expiration Date: Apr 28, 2005 Parcel ID: 020-043-25 Legal Description: f$g8n rl-La Lot 7: 1 Design Engineer: 0041 AK Water & Wastewater Consultani Site Address: Not listed yet Owner Name: Crowne Point, Inc Lot Size: 48309 SQ. FT. Owner Address: P.O. Box 112313 Total Bedrooms: 5 Permit Bedrooms: 5 Anchorage , A 99511 - This permit Is for the construction of: ❑✓ Disposal Field E Septic Tank Holding Tank ❑ Privy 0 Private Well E] 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 engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Date: A 6 Issued By..'J`U V Date: t•'16 0 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 020.043.25 Permit Number SW Property owner(s)_Crown Pointe, Inc. Day phone 345.6277 Mailing address (1) P.O. Box 112313 Anchorage, AK 99511 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 7. Shangri-La Subdivision Legal description (Section, Township & Range) Lot Size 48.309 SF Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Five (5) Sewer Only ❑ Well Only ❑ Sewer and Well ® Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and Is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: L3S Waiver Fees: Date of Payment: /- Z G - n Sr Date of Payment: Receipt Number: J Receipt Number: (Rev. 12/00) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 April 23, 2004 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 7, Shangri-La Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 7, Shangri-La Subdivision intends to construct a five -bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new well and septic system to serve the new home. The attached Site Plan and backup documentation identify the location and configuration of the proposed well, septic system and alternate site. Septic systems and wells on adjacent properties are also shown. Existing spot elevations and the current drainage pattern are identified on the Site Plan. The drainage pattern will be maintained after development of this lot is complete. A test hole placed on the lot during the subdivision phase indicated dense sand with gravel in the area. The exact location of the test hole is unknown, but the logs for all of the lots in the subdivision are similar to that on Lot 7. The accepting soils were tested and found to have percolation rates of 1 minute per inch. No groundwater was found during excavation and none was noted during the monitoring period. Our design includes the placement of a new 1,500 -gallon septic tank along with a 63' long by 5' wide by 4' effective depth absorption trenches to collect and treat the sewage generated in the house. The bottom of the trench will be 7' below the surface. The distribution pipe will be 3' below the surface. A minimum of 3' of cover will be placed atop the trenches and a minimum of 4' of cover will be placed atop the new septic tank. The ground surface on the lot slopes at shallow grades from south to north as shown on the Site Plan. The absorption trench will be constructed parallel with the slope of the ground surface as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 1 00'from the well proposed for the Lot 7, Shangri-La April 23, 2004 Page Two lot and on adjacent lots. It will also be constructed a minimum of 100' from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, V 4L ez� Michael E. Anderson, P.E. Attachments j 49th' MICHAEL E. ANDERSON t,_ No. CE -4381 i SHANGRI-LA SUBDIVISION LOT 7 48,309 S.F. SANDPIPER DRIVE 100' 1i�7 r—RELATIVE S 89'57'08'E 205.94' 5/8' REBAR I 20' SLOPE \ SNOW STORAGE ESMT. --i------------------------- I — --- I I Nle�� yl. I 1P t3 3H v0i I • 4 I, ,y. psDlh O Msorptw� 7r.nch GI to I v > 0 st- 00 `i°u°" vt c ook a I v 0 P o N N I N lJ Nto I I N n N I Pm 6Wroom C-41 0I Nom. o 0 z I N FLR• EL. 'w 121' z I I 120 x I ®vw�vo.w � I 4zWl I — — l— 10—do T. E. ESMT. ---- N 87215'41"E 206.15' 14� [HOD, srlq� OF ON SITE P . 4 1 49 h��, SCALE 1" = 40' 5.._..... .... i r'�twaaEt �� E uloEnsw 3: `•. No. EE• 381 !� LOT 7, SHANGRI-LA SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Five Bedroom House 5' Wide Trench System Perc. Rate: 1 Min./Inch 1,500 Gallon Septic Tank Application Rate: 1.2 GPD/SF 4' Drainfield Rock 5 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate1= 625 SF Absorption Area 625 SF/5 SF' .5 (Red. Factor) = 62.5 LF Trench Length THEREFORE: Construct a 63' Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be 6' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. 1'6" 6" 4'0" Natural Backfill 5' Fabric 4" Perforated PVC (Holes Down) Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION0,..•�•t., (NO SCALE)�� E........,!q( 0. k.' . , NOTE: Grade Area Over Trench to Drain Away. ppa /' Minimum 6' Separation From Bedrock. S,„../ , 49U „ Minimum 4' Separation From Groundwater. �. Minimum 100' Separation From Wells in the Area. t uKw ELe .HOERson Minimum 100' Separation From Surface Water or Streams. �i� mak. No CE4m, 1LyNJI,d/ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 1:1 SOILS PERCOLATION TEST Performed for Earl Ford pate performed Project Lot 7 Shartgrila MTHOLE R Depth 16• 17- 18 19- 20- 08/04/00 00.11 ORC - rootmat SEE ATTACHED SITE PLAN I GP—brown randy gravels w/ I FOR HOLE LOCATION aibblesto24" Was Ground waterencountered? NO Whatdepth? NA Depth to waterattermontonng? NA Date? 08/14/00 1, Kenneth M Duffus, cer* that this test was performed m accordance with all State and Mumapal gwdehnes in effect on this date L._ Readmg Date Gross Net Depth to Net Time Tune Water Trop SP -Mod deux rand 1 8/10/00 1100 - 9' - 2 1105 5nun 312/16' 54/16' GP—brown sandy dense gavel 3 • 1106 - 9' 4 1111 5mm 314/16' 52116' 5 • 1112 - 9' _ 6 1117 5mm 41/16' 415/16' 7 • 1118 - 9' _ 8 1123 Smm 43/16' 413/16' 9 1124 - 9' - BOM 10 1129 5mm 43/16' 413/16' 11 • 1130 - 9' - 12 1135 5mm 4 3/16' 413/16' • Water Added HOLE PRESOAIMD Percolation Rate -UL, (mm/m) Pert Hole Irameter_¢_ PRIOR TO TEST Test Run Between 3 feet and 4 feet 1, Kenneth M Duffus, cer* that this test was performed m accordance with all State and Mumapal gwdehnes in effect on this date L._ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.a.anchorage.sk.us (907) 343-7904 714tdI.A.L EQ,.,,A. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020493.25 HAA # O)-� Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 7 Shanart La Subdivision Location (site address or directions) Sandpiper Drive Current Property owner(s) Crown Pointe, Inc. Day phone 3454277 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 112313 Anchorage AK 99511 Unless otherwise requested, HAA *771be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Five (5) 3. TYPE OF WATER SUPPLY: Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Indiyidual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System u is ewer 1: 1:r The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional Civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with newwate"ampte-msufts-iess-than30-days-old.'(Certificates-may-be-relssued fora Teriod-of trp4o-one -year.-with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Health Authority 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. 1 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 _Anderson Engineering Phone 522.7713 Address P.O. Box 240713 Anchorage. AK 99524 Engineer's Printed. Name Michael E. Anderson, P.E. Date 1211012004 *1 49th.. ��Mxaua c eracRms�� )��. 5. DSD SIGNATURE No. CE -42M �%%I�.� Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ONSITE^ Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other Certificate Date: / ;a — I k/ —O q (a•v.12M) Municipality of Anchorage • Development Services Department Building Safety Division On-Ske Water 6 Wastewater Program 4700 South Bragaw St P.O. Box IMW Anchorage, AK 995196650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type PrIviS4 N A, B, or C provide PWSID # _ Date completed 4 Sanitary seal (YIN) Y Total depth _M_tL Cased to eft FROM WELL LOG Date of test er512004 Static water level 84 fL Well production 2 g.p.m. WATER SAMPLE RESULTS: Well Log (YIN) Y Wires property protected (Y/N) Y Casing height (above ground) 24 n. AT INSPECTION {i4 Coliform J—oolonies/100 ml. Nitrate • 4th mg.A. Other bacteria JL colonies/100 mi. P71 --Z-j 1=1 r1111111ii 1,4;rt4o- B. SEPTICIHOLDING TANK DATA Tank Type/Material SeoticFbol Date installed 619@004 Tank size 1.500 gal. Number of Compartments Y Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) fI High water alarm (YIN) N Data of pumping C. ABSORPTION FIELD DATA Length 65 fL Width 5 fL Gravel below pipe 4 R. Total depth $-9 It Eff. absorption area Mfe Monitoring tube if Depression over field N Date of adequacy test Results (PesstFail) For _ bedrooms Fluid depth in absorption field before test _ In. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) N If yes, give date D. UFT STATION Date installed Size in gallons Manhole/Access (YM) 'Pump on' levet at _ in. Datum E. SEPARATION DISTANCES 'Pump ofr level at _ in. High water alar levet at in. Cycles tested Meets alarm b dreuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanM R station on lot ir0p r Absorption field on lot >ro0 r Public sewer main Sewer /septic service Ane On adjacent lots 7/DO r On adjacent lots 1400 Public sewer manhole/cleanout 4 A Holding tank NI4 SEPARATION DISTANCES FROM SEP71CJHOLDING TANK ON LOT TO: Building foundation >T Property One >�' Absorption field >5- Water SWater main >10' Water service Ane Mr Surface water >IW Weiss on adjacent lots >IW SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line MV Building foundation NP Water main >10' Water Service line >70• Surface water >100' Driveway. paWnghmehide storage >S Curtain drain None Noted Wells on adjacent lots >IW F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Munkypal records that the above systems are in conformance wltri MOA HAA guidelines in effect on this date. Engineer's Printed Name Michasi E Anderson. RE .. J .(e:_ HAA Fee S 5"1 5—V Waiver Fee $ _ Date of Paymena—/'fl — Q$✓ Date of Payment Receipt Number A Zy _ \And, Receipt Number Rft. 12MM Nn. c ANDCUW Na a -rad. t Z 2002-118 SHANGRI-LA SUBDIVISION LOT 7 48,309 S.F. SANDPIPER DRIVE 0 t7 S 89'57'08"E 205.94' AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYEE THE PROPERTY DEPICTED ABOVE AND THAT N GASTALDI LAND SURVEYI ENCROACHMENTS EXIST EXCEPT AS INDIC14TED. JEFF A. GASTALDI, R.1 -3 1T IS THE RESPONSIBILITY OF THE OWNER TO 4726 WEST 88TH AVENI IDETERMINE THE •EXISTENCE OF ANY EASEN ENTS, ANCHORAGE, ALASKA 99 ODVENANTS OR RESTRICTIONS WHICH DO qOT PHONE 248-5454 APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID PATE HEREON BE USED FOR CONSTRUCTION OF FOR 3239 t1/22/2ooa ESTABLISHING BOUNDARY OR FENCE LINE . ANCHORAGE RECORDING DISTRICT, ALAS,A F.B. JOB N0. 04-14 NOTE: NO CORNERS SET THIS DATE. 1 "= 40' OF JW * -- •49 ••'t e . Jeffery b Caetaldl .• o t 'I •. LS -6091 ,:Ar e ••o11�/%**'*