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HomeMy WebLinkAboutCROSS VIEW ESTATES BLK 2 LT 1Cross View
Estates
Block 2
Lot 1
#015-221-63
Development Services Department
Building Safety Division
• On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Mark Begich Anchorage, AK 99507 s A E T r
Mayor www.muni.org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW 121255 Date of Issue• 8/9/2012
Parcel Identification Number: 01622163000
Legal Description
Block 2, Lot 1
Cross View Estates
Property Owner Name & Address:
Harding Homes
5771 Heritage Heights Dr.
Anchorage, AK 99516
Pump Installation Date: 2/8/2,13
Pump Intake Depth Below Top of Well Casing: 282
feet
Pump Manufacturer's Name: Grundfos
Pump Model: 15 SQE-15-290
Pump Size 1 1/2 hp
Pitless Adapter Burial Depth: N/A feet
Pitless Adapter Manufacturer's Name: N/A
Pitless Adapter Installer: N/A
Well Disinfected Upon Completion? Z Yes ❑ No
Method of Disinfection:
Comments:
Pump Installer Name: Aarow Pump & Well Service, LLC
P.O. Box 110496
Anchorage, AK 99511-0496
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP121225 PID Number: 015-221-63 ❑✓ New ❑ Upgrade
Name:
Harding Homes of Alaska, Inc.
ABSORPTION FIELD
❑✓ Deep Trench ❑ Shallow Trench ❑ Bed El Mound
Address
5771 Heritage Heights Drive Anchorage, AK 99516
El Other
Phone
Number of Bedrooms
Soil Rating Total depth from original grade
350-1860
5
-8GPDISF 12 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4 Ft.
Gravel depth beneath pipe
8.OFt.
Subdivision Block Lot
Cross View Estates 2 1
Fill added above original grade
Gravel length
Township Range Section
0-i Ft.
62 Ft.
Gravel width
3Ft.
Beds: Number of Lines
Distance between lines
SEPARATION DISTANCES
Ft.
TO
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
992
One
Ff
Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Surface Water
>100'
>100'
N/A
NIA
Anchorage Tank 1,50OGal.
Material
Number of compartments
Lot Line
>5'
5'**
N/A
N/A
Steel
Two
NA
Foundation
>5'
>10'
N/A
N/A
LIFT STATION
Capacity
Curtain Drain
None
Noted
Gal.
Remarks "See Lot Line Waiver
EManufacturer
at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPEMATERIAL Housetotank Tankto D3034
D3034 drainfeld
Harding Homes of Alaska, Inc.
Drainfield HDPE CO/MT D3034
Inspector MEA
BENCHMARK (Assumed elevation) 100.0ft
Inspection1si
dates: 8/24/12 2- 8/25/12
Location and description
s" 8/26/12 a'"
Garage Slab.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
I
OF t
Conditional Approval: Date
���(E.•••••:QIq�f,
49it1
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Date a( a
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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: OSP121225
DC7
98.1
U) r� U U
PID No. 015-221-63
v e Ln
62' (Trench Length)
PROFILE RS -BUILT
No Scale
92.0
01.1 :Alpine Drilling
FAX N0. :907 345 0202 Feb. 12 2013 09:56AM P1
Alpine Drilling & Enterprises
Well Log
Permit Number: #SW12 25 Date of Issue: 8-9-12 Parcel Identification Numbe : 163000
Date Started: 10-8-12 Date Completed: 10-10-12 is well located at approved permit locatio Yes N
Legal Description: CI•ossvlew Estates Block 2 lot 1
Property Owner Name & Address: H2L Investments, LLC
633 E 81a1 Ave
Anohorape, Alaska 88518
Borehole Data:
Soil Type, Thickness & Water Strata
Depth (ft)
From To
Method of Drilling x air rotary ❑ cable tool
Casing type; steel
Stick-up
0
2
Wail Thickness: .250 inches
silt
gravelly silt
2
7
7
74
Diameter..6 inches Depth: 294 feet
Liner Type:
Diameter: inches Depth: _feet
silly gravel
74
111
Casing,stickup above ground: 2 feet
Static water level (from ground level): 22afeet
gravelly silt 111 144
silt
144
194
Pumping level: 290 feet after
194
239.
2 }tours pumping 15 gpm
Recovery Rate; j 4 gpm
silt
239
280
Method of Testing: air lfit
silty water sand &gravel
280
294
Well Intake Opening Type;
x Open End ❑ Open Hole
0 Screened . Start. feet Stopped _ feet
❑Perforations Startfeet Stopped_feet
Grout Type: bentonite eranules Volume: 2 bPs
Depth: Start 0 &ot Stooped ?feet
Pump: Intake Depth _ feet
Pump size _ hp Brand Name
Well Disinfected Upon Completion? x Yes © No
WATER QUALITY TESTING
Coliform- Ne wi Vf CoU100ML
Nitrates N 1J L
Arsenic 1 S
Method of Disinfection. chlorine tablets
Comments:
WellDriller. Alpine Drilling &Enterprises
PO Box 110494
Anchorage AK 99511
Pump Installation Date: 2/8no13
Intake Depth Below Top of Well Casing: 262 feet
Pump Manufacturer's Name: Grundtos
Pump Model: 15 see -15.290
Pump Size 1 112 hp
Pitless Adapter Burial Depth: N/A feet
Pitless Adapter Manufacturer's Name: 01A
Pitless Adapter Installer: N/A
Well Disinfected Upon Co letiQn? 91 Yes F1 No
Method of Disinfecrc
f�
1,loN:�.¢-TabIC�SA u
nts:
Comme_ �r�x7•
Pump Installer Name: Aarow Pump & Well SeMce, LLC
P.O. Box 110496
Anchorage, AK 99511-0496
Attention: The pump installer shall provide a pump installation log to the ASD within 30 days of pump installation.
Development Services Department
Building Safety Division
•
a ra
On -Site Water & Wastewater Program
a`p6�
4700 Elmore Road
P.O. Box 196650
Mark Begieh
Anchorage, AK 99507
Mayor
wwwrnuni.org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number 121255 Date of Issue: 61912012
Parcel Identification Numb
01 zl6s000
Legal Description
Property Owner Name & Address:
Bloch 2, Lot 1
Herding Homes
Cross View Estates
5771 Hedlage Heights Dr. '
Anchorage, AK 99516
Pump Installation Date: 2/8no13
Intake Depth Below Top of Well Casing: 262 feet
Pump Manufacturer's Name: Grundtos
Pump Model: 15 see -15.290
Pump Size 1 112 hp
Pitless Adapter Burial Depth: N/A feet
Pitless Adapter Manufacturer's Name: 01A
Pitless Adapter Installer: N/A
Well Disinfected Upon Co letiQn? 91 Yes F1 No
Method of Disinfecrc
f�
1,loN:�.¢-TabIC�SA u
nts:
Comme_ �r�x7•
Pump Installer Name: Aarow Pump & Well SeMce, LLC
P.O. Box 110496
Anchorage, AK 99511-0496
Attention: The pump installer shall provide a pump installation log to the ASD within 30 days of pump installation.
SGS
SGS Ref.#
1130597001
Client Name
Anderson Engineering
Project Name/#
Ll, B2 Cross View Estates
Client Sample ID
Lot 1 Block 2 Cross View Eats
Matrix
Drinking Water
Sample Remarks:
Printed Date/Time
02/22/2013 13:09
Collected Date/Time
02/15/2013 12:15
Received Date/Time
02/15/2013 12:15
Technical Director
Stephen C. Ede
Parameter
Results
LOQ
Units
Method Container ID
Allowable
Limits
Prep Analysis
Date Date
Init
Metals by ICP/M3
Arsenic
25.0 *
5.00
ug/L
EP200.8
C
(40)
02/19/13 02/20/13
SCL
Waters Department
Total Nitrate/Nitrite-N
ND
0.100
mg/L
SM21 4500NO3-F
B
(<10)
02/15/13
AYC
Microbiology Laboratory
E. Coli
Negative
1
IOOmL
SM21 9223B
A
02/15/13
LCE
Total Coliform
Negative
1
100mL
SM21 9223B
A
02/15/13
LCE
2 of
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage Alaska 99519-6650 s (907) 343-7904 • Fax (907) 343-7997
http://www.muni.or-q/Onsite
Development Services Division
On -Site Water and Wastewater Program
picric
1� arS
ems.
Deptment
**** VARIANCEIWAIVER REVIEW ****
Waiver#: OSP131019
PID#: 015-221-63
COSA#:OSC131055 Permit#:OSP121225
Legal Description: Cross View Estates, Block 2. Lot 1
Engineer: Anderson Engineering
Applicant: Harding Homes of Alaska. Inc.
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 5.0 feet.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
® Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
......................................................... a . . . . . . . . . 0...........
Waiver is Granted: X Waiver is not Granted:
Date: a a� !3 Approved by
Name of Reviewer
..............................................................................
Rec#: 06406G Amount: $200.00 Date Paid: 2/25/2013
**** VARIANCEMAIVER REVIEW ****
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
February 24,'2013
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Lot 1, Block 2, Cross View Estates Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
The east end of the absorption trench recently constructed on Lot 1, Block 2, Cross
View Estates Subdivision was inadvertently placed 5' from the south property line. The
lot line is heavily treed making site distance difficult and was not clearly marked at the
time of construction. The trench does not impact the property to the south as it is more
than 50' from the absorption trench on this lot. In addition, soils in the area are very
good for the absorption of septic effluent and the migration to the south is unlikely. We
recommend a waiver be issued allowing the trench to remain 5' from the south property
line at its east end.
Sincerely,
Benjamin {chiller, P.E.
�?' � '•.may ,
4g T -H
6enlain 1 Schiller;
C� 1 92 �'�z
E►
ANDERSON ENGINEERING
O. BOX 240773
A1►10RAGE, K 99524
6221773 � _ 4766 (FAX)
February 24, 2013
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Lot 1, Block 2, Cross View Estates Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
The east end of the absorption trench recently constructed on Lot 1, Block 2, Cross
View Estates Subdivision was inadvertently placed 5' from the south property line. The
lot line is heavily treed making site distance difficult and was not clearly marked at the
time of construction. The trench does not Impact the property to the south as it is more
than 50' from the absorption trench on this lot. In addition, soils in the area are very
good for the absorption of septic effluent and the migration to the south is unlikely. We
recommend a waiver be issued allowing the trench to remain 5' from the south property
line at its east end.
Sincerely,
Michael E. Anderson, P.E.
49th
AEL E. ANDERSON
No. CE -43a1 1
Individual Acknowledgement
State of N U-sga
Judicial District 3 r a SS.
On this 14n day of �@ for X in the year X13. ,before ?fie, the
undersigned notary public, personally appeared: -Jr
known to me to be the person(s) whose name(s) is/are subscribed to the within instrument
and acknowledged that he/she/they executed the same for the purposes therein contained.
In ' egg -Whey o set my hand and official seal.
Ct:ar!yPju% (Si nature)
Oz'te ` 1, N O2 or
(Notary's printed name) p 4
My commission expires d 1 � Idol a
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: OSP121225
Tax Code Number: 01522163000
Work Type: WellSeptic Initial
Permit Effective Dates: August 09, 2012 to August 09, 2013
Design Engineer: ANDERSON ENGINEERING
Subdivision: CROSS VIEW ESTATES
Site Legal Address: CROSS VIEW ESTATES BILK 2 LT 1 G:2737
Owner/Address: H2L INVESTMENTS LLC
633 E 81 STAVE ANCHORAGE AK 995180000
Site Mailing Address: 5796 HERITAGE HEIGHTS DR, Anchorage Lot Size in Sq Ft: 45568
Total Bedrooms: 5
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
Issued By:
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. 015-221-63
Property owner(s): H2L Investments Day phone: 350-1860
Mailing address : 6393 East 81st Avenue Anchorage, AK 99516
Site address: -5010 Heritage Heights Drive Anchorage, AK 99518
Legal description (Sub'd., Block & Lot): Cross View Estates, Block 2, Lot 1
Legal description (Township, Range & Section)
Lot Size: 45,568 Sq. Ft. Number of Bedrooms: Five (5)
THIS APPLICATION IS FOR: THIS APPLICATION IS AN:
(® all that apply)
Initial X
Absorption Field X
Upgrade ElSeptic Tank X
Renewal
Holding Tank ❑
❑
Privy ❑
Private Well X
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
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/Rush Fees: 47-50 Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: 01025 G Receipt Number:
Permit No. OSP 121225 Waiver No.
C:\Users\AndEng\Desktop\MikelCross View Estates\PennitApplication Lot 28 H2L.docC:\Users\AndEng\Desktop\Mike\Cross View
Estates\Permit Application Lot 28 H2L.doc
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
July 30, 2012
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 1, Block 2, Cross View Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer
The owner of Lot 1, Block 2, Cross View Estates Subdivision intends to construct a new
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 accommodate the home. The attached
Site Plan and backup documentation identify the location and configuration of the
proposed well and septic system along with the alternate site. Also identified on the
plans are the existing wells and septic systems on surrounding lots. No conflicts exist
between the proposed well and septic system and wells or septic systems on adjacent
lots. Drainage arrows are shown on the site plan showing the grade and direction of
flow on the lot. The drainage pattern will not be changed as a result of this project.
The test hole placed on the lot in the area of the absorption trench and alternate site
indicates silty sand (SW/SM). The percolation rate of the soil was determined to be 6.1
minutes per inch. No groundwater was found during the placement of the test hole and
none was noted during the monitoring period. An application rate of .8 gallons per day
per square foot was used in the design of the absorption system. We are proposing to
place a new 1,500 -gallon septic tank and a new 59' long by 3' wide by 8' effective depth
absorption trench to treat and dispose of the effluent generated in the house. The
elevation of the distribution line in the absorption trench will be 4.0' below the surface
and the total depth will be 12.0'. A minimum of 3' of fill or 2" of insulation and 2' of fill
will be placed over the absorption trench and 4' over the septic tank.
The ground surface on the lot in the area of the septic system slopes to the north at a
shallow grade. The new trench will be constructed parallel with the slope as much as
possible in conformance with Municipal requirements. The new septic system will be
constructed a minimum of 100' from all wells and any surface water and 10' the
proposed and existing water services in the area.
Lot 1, Block 2, Cross Point Estates Subdivision
July 30, 2012
Page Two
If the system is constructed in accordance with our design the following statements
apply:
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,
W �-;- dL-,
Michael E. Anderson, P.E.
Attachments
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.. BIRCH ROAD
LOT 1, BLOCK 2, CROSS VIEW ESTATES
DESIGN FACTORS: SYSTEM REQUIREMENTS
Five Bedroom Home DeepTrench System
Perc. Rate: 6-15 Min./Inch 1,500 Gallon Septic Tank
Application Rate: .8 GPD/SF 8' Drainfield Rock
5 Bedrooms X 150 GPD/.8GPD/SF (Application Rate) = 937.5 SF Absorption Area
937.5 SF/16 SF/LF = 58.6 LF Trench Length
THEREFORE: Construct a 59' Long x T Wide x 8' Effective Depth Absorption Trench at the
Location Shown. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth
to be 12' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Maintain 100' Separation from Wells in the Area.
3'6"
Natural
Backfill
Geotextile
Fabric
6"
O
4" Perforated
PVC (Holes Down)
8 0 I I ----\--4— Drainfield Rock
3'
TYPICAL DEEP TRENCH SECTION ,..•••_•���,
(NO SCALE)•��0P,CE......
... •��i1
NOTE: Grade Area Over Trench to Drain Away. -07
Minimum 6' Separation From Bedrock. 49th
Minimum 4' Separation From Groundwater. •.� e
Minimum 100' Separation From Wells in the Area. ��.%. MICHA1. EL E. ANDERSON
Minimum 100' Separation From Surface Water or Streams: %' ,�., No. CE4381
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1-
2-
3-
4-
5-
6-
7-
8-
9-
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION• LOT I, BLOCK 2, CROSS VIEW ESTATES
PERFORMED FOR: HARDING HOMES
DATE: 7/20/2012 PROJECTNo.:
PARCEL ID#: TECHNICIAN: JKB
TEST HOLE
OG/OL
Sand with Silt
SW/Sm
Dry
N
0
WAS GROUND WATER ENCOUNTERED? No
10 IF YES @ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING: None
1 1 DATE OF MONITORING: 8/8
1
1
1
m
0 49th
E. ANDERSON
2%
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
7/23
1
4:10
5.3811
2
4:40
30
11.3811
6.0011
3
4:41
4.8811
4
5:11
30
9.75"
4.88"
5
5:12
4.00"
6
5:42
30
8.8811
4.8811
PERCOLATION RATE: 61 (MIN/INCH) PERC. HOLE DIA. 9 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 8/8/12
MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section
Certificate of On -Site Systems Approval
Phone: 907-343-7904
Fax: 907-343-7997
Parcel I.D. 015-221-63 Expiration Date: `30 `Zd� o
1. GENERAL INFORMATION
Complete legal description Cross View Estates, Block 2, Lot 1
Location (site address) 5796 Heritage Heights Drive
Anchorage, AK
Current property owner(s) Gulshan Kumar & Parveen Lata Soni Day phone 907-227-6972
Mailing address 5796 Heritage Heights Drive, Anchorage, AK 99516
Real estate agent Shari Boyd
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone 907-229-0132
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
E
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ �# 912. Waiver Fee $
Date of Payment 6/2 517-0 Date of Payment
Receipt Number. 06 `{Z9D Receipt Number
COSA # Q.S C 2012gg 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 Michael E. Anderson, P.E. Date 5/22/19
l
Original Certificate Date:" 3 d — ?_V 2_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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
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6. DSD SIGNATURE
r ot••••• •: •'••••••e
c
System #1 Approved for
0............... ....... .........................
bedrooms , � ".MICHAEL E. ANDERSON :
System #2 Approved for
�.
06-
� No. CE -4381 r��� i
bedrooms ®®s'F`•.. 6/25/20 ,.•••<�®
®�
Disapproved
®�®�@
®°O"RO.......'Inta
Conditional approval for
bedrooms, with the following stipulations:
l
Original Certificate Date:" 3 d — ?_V 2_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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Cross View Estates, 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 10/10/12
Total depth 294 ft
Cased to 294 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) '18 in.
Date of flow test for COSA 5/9/19
Static water level at beginning of test 238 ft.
Comments
B. TANK DATA
Age of tank(s) 7 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 5/24/19 - McDonald's Pumping Service P
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 8/24/12
❑ ALL standpipes present per record drawing
Total measured depth from grade 13.5 ft (max)
Measured depth to pipe invert from grade 5.5 ft (min)
❑ N/A — pressurized field
❑ 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 NA gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 015-221-63
Structure served by this system
Well production at time of test 3.6 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic 10.5 ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 3/18/20 --
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: NA
Adequacy test date 5/9/19
Results ❑✓ Pass For 5 bedrooms
Fluid depth prior to test 5 in
Water added 800 gal
New depth 14 in
Elapsed time 1440 min
Final fluid depth 5 in
Absorption rate 750+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
010-A
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'
0
Yes
Community Sewer Manhole/Cleanout > 100'
ft
❑✓ Yes
if No
ft
1-7 Yes
if No
ft
Neighboring Tank > 100' FV -1 Yes
if No
ft
Private Sewer/Septic Line > 25' 177� Yes
if No
ft
Absorption Field on Lot > 100' F/71 Yes
if No
ft
Holding Tank > _100' 0 Yes
if No
ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ❑✓ Yes
if No
ft
7 Yes
if No
ft
ft
If septic tank is under driveway
comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes
if No
ft
1`71 Yes
if No
ft
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 ft
Property Line > 5'✓❑
Water Main > 10'
Yes
if No
ft
Wells on Adjacent Lots:
❑✓ Yes
Absorption Field > 5'
E
Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Main > 10'✓❑
Yes
if No
ft
Community Wells > 200'✓Q
Yes if No ft
Water Service Line > 10'
F/I
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'
121 Yes
if No
ft If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No
5* ft Wells on Adjacent Lots:
Water Main > 10'
F-11 Yes
if No
ft Private Wells > 100' Yes if No ft
Water Service Line > 10'
❑✓ Yes
if No
ft Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'
0 Yes
if No
ft
F. ENGINEER'S COMMENTS
Lot line waiver issued.
Waiver
No.
OSP131019
G. ENGINEER'S CERTIFICATION
I 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
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49 th a®
0!098 Y ORaHaR 0080 Ota 0000■ HHlH at0000tt ,gyp
aaaa0a00alsacQaataaccastaaazalaRQRaavasana9ta99 0
a MICHAEL E. ANDERSON V Ay
^ea No. CE -4381
eeeQ 05/26/19 0.0p�
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PROFESS
MUNICIPALITY
DEVELOPIVIENT -SERVICES DEPARTMENT907-343-7904
Can -Site Water and wastewater Section Fax: 343-7997
WAJVIJ.r 111ni.org/onsite -
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC201288
Subdivision: Cross View Estates, Block 2, Lot 1
A water sample revealed an arsenic concentration of 10.5 micrograms per liter
(ug/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Information on arsenic is available from the On -Site Water and
Wastewater Program website (WWW.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
ressto
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• '� Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904;
Certificate of On -Site Systems Approval
Parcel I.D. 015-221-63 Expiration Date: S a /3
1. GENERAL INFORMATION
Complete legal description Cross View Estates, Block 2, Lot 1
Location (situ address) 5796 Heritage Heights Drive Anchorage, AK 99516
Current Property owners) Harding Homes of Alaska Day phone 350-1860
Mailing address` , 5771 Heritage Heights Drive Anchorage, AK 99516
Real Estate Agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Five
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:,
l r
Received by: Ar i) ,i �. Date P ` J
COSA to be releasel to the,,engineer, unless otherwise requested by the engineer.
COSA Fee $ I WgVgA
Date of Payment dh5//� .
Receipt Number 0/ ;�, V& 6-
COSA # C?S C 1314 SS'
Waiver Fee $ d0o lad P,, Xs4
Date of Payment5- /3
Receipt Number 006 4 iT
Waiver# 0 -WI -sl o%
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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Phone 522-7773
Engineer's Printed Name Benjamin J. Schiller, P.E. Date 2/24/2013
6. DSD SIGNATURE
L/ System #1 Approved for 5 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the
Bv��.2AtiU&L-7 Original Certificate Date: ?
7 /, unicipality 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 bNe sheet° . -
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: Cross View Est. Sub., Block 2, Lot 1 Parcel ID:015-221-63
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 10/10/12 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 294 ft. Cased to 294 ft. Casing height (above ground) >18 in.
FROM WELL LOG AT INSPECTION
Date of test 10/10/12
Static water level 229
Well production 15 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate N/D mg/L
Arsenic 25 ug/L Date of sample: 2/15/13 Collected by: J. Anderson
B. SEPTIC/HOLDING TANK DATA
TankType/Material Septic/Steel
Tank size 1,500 gal. Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (Y/N) N
Date of pumping New Pumper Construction
C. ABSORPTION FIELD DATA
Date installed 8/24/2012
Cleanouts(Y/N) Y
High water alarm (Y/N)
N
Date installed 8/24/12 Soil rating (g.p.d./ftZ or ftzlbdrm) • 8 GPD System type Deep Trench
Length 62 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth 12 ft. Eff. absorption area 992 ftZ Monitoring tube Y Depression over field N
Date of adequacy test New Const. Results (Pass/Fail) 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 & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons _
in. "Pump off' level at
E. SEPARATION DISTANCES
171k1j:114It@P1I[0]a03
Cycles tested
Septic tank/lift station on lot >1 00'
Absorption field on lot >100'
Public sewer main N/A
>25'
Manhole/Access(Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout N/A
Sewer /septic service line Holding tank N/A
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5r Property line >51
Water main > 10, Water service line >10'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
5'*** >10'
Property line Building foundation
Water Service line > Surfacewater >100'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
*** See Lot Line Waiver
G. ENGINEER'S CERTIFICATION
I 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.
Engineer's Printed Name Benjamin J. Schiller P.E.
Date 2/24/2013
COSA brown sheet 10-10-12.doc
Absorption field >5'
Surface water > 100'
Water main >10'
Driveway, parking/vehicle storage >10'
4���aaastt!
OC G:.OF"Q4 041
A �r ,, • `F9 TH� •s�y}°°�
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;r,� ,Eenjami Schiller „
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•.�faSt.�•
Municipality of Anchorage
• Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC131055
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 1 of
Cross View Estates Subdivision. This inspection revealed an arsenic
concentration of 25 micrograms per liter (ug/L) for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 ug/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Information on
arsenic is available from the On -Site Water and Wastewater Program
website (www.muni.org/onsite or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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