HomeMy WebLinkAboutROSEBUD HILLS BLK 1 LT 4Rosebud Hills
Block I
Lo1- 4
#017-381-37
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP151154 PID Number: 017-381-37
Dwelling: 0 Single Family (SF) ❑ Duplex(D) [' Multiple (SF and/or D) Project: El New ❑ Upgrade
Name:
Eric Trevithick ABSORPTION FIELD
Address
3121 Latouche Street Anchorage AK 99508 ❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound
[' Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
301-5359 4 1.2 GPD/SF 5.4 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 1.2 Ft.4.2 Ft.
Rosebud Hills 1 4 Fill added above original grade Gravel length
Township Range Section 4,2 Ft. 54 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 5 Ft. Ft.
To' Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 540 Ft2 1 Ft.
Well >100' >100' N/A N/A >25' TANK ❑r• Septic ❑S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface Water >100' >WU i N/A N/A i Anchorage Tank 1250 Gal.
Material Number of compartments
Lot Line >5' 10' N/A N/A Steel 2
NA
Foundation >5' >10' N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain None i Noted Gal.
Remarks 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 tankD3034 Tank to
Installer drainfield D3034
Alaska General __ Drainfield D3034 CO/MT D3034
Inspector Mike Anderson BENCH MARK (Assumed elevation) 100 ft
Inspection dates: •' 7/01/1 5 20d Location and description
3rd 45 Garage Slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVALIllibEVIrlaq� ,
Conditional Approval: Date :-'• :r
r 41.•
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Inspection Report_9-1-12.doc
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: OSP151154
Tax Code Number: 01738137000
Work Type: WellSeptic Initial
Permit Effective Dates: June 16, 2015 to June 15, 2016
Design Engineer: ANDERSON ENGINEERING
Subdivision: ROSEBUD HILLS
Site LegalAddress: ROSEBUD HILLS BLK 1 LT 4 G:2837
Owner/Address: JOY AUSTIN J & REGENA S
PO BOX 111073 ANCHORAGE AK 995111073
Site Mailing Address: 5531 RIDGEVIEW DR, Anchorage Lot Size in Sq Ft: 52220
Total Bedrooms: 4
~enr
This permit is for the construction of:
Y Disposal Field Y SepticTank 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 By:
MUNICIPALITY OF ANCHORAGE
Community Development Department ~ Phone: 907-34~
Development Services Division ~ Fax:
On-Site Water& Westewater Program
ON-SITE SEWER~ELL PERMIT APPLICATION (~-~ JUNO 1 Z015
Parcel I,D. 017-381-37 ~ k~
Properly owner(s) Austin & Regena Joy ~ Day phone 250-1~~~
Mailing address P.O. Box 111073 Anchorage, AK 99511
Site address NHN Ridgeview Drive Anchorage, AK 99516
Legal description (Sub'd, Block & Lot) Rosebud Hills, Block 1, Lot 4
Legal description (Township, Range & Section)
Lot Size 52,220 .Sq. Ft. Number of Bedrooms Four
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
([~ all that apply)
Absorption Field [] Initial [] Single Family (SF) []
(w/wo ADU)
Septic Tank [] Upgrade []
Duplex (D) []
Holding Tank [] Renewal []
Multiple Dwellings []
Pdvy [] (SF and/or D)
Private Well []
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,
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No. O~1¢1~
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Permit App_9-1-12.doc
ANDERSON ENGINEERING
P'O, BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
June 1, 2015
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 4, Block 1, Cross View Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 4, Block 1, Rosebud Hills Subdivision intends to construct a new four-
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 septic system and well or septic systems and wells on adjacent
lots. Drainage arrows and ground surface contours 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.
Two test holes were placed on the lot in the area of the absorption trench and alternate
site. The logs indicate silty sand (SM) in the zone specified for the absorption trench.
The percolation rate of the soil was determined to be 1-5 minutes per inch. No
groundwater was found during the placement of the test holes and none was noted
during the monitoring period. An application rate of 1.2 gallons per day per square foot
was used in the design of the absorption system. We are proposing to place a new
1,250-gallon septic tank and a 50' long by 5' wide by 4' 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 2' below the surface and the total depth
will be 6'. 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 southwest.
The new trench will be constructed parallel with the contours of the slope as much as
Lot 4, Block 1, Rosebud Hills Subdivision
June 1, 2015
Page Two
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.
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.
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.
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.
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,
Michael E. Anderson, P.E.
Attachments
ROSEBUD HILLS SUeDIVISION
LOT47,2994, BLOCKs. F.
LOT ~
Existing
(~) Well
LOT 3
N89'41'17"F~
158..~6~"
10' U__t~ Easement
ROSEBUD PJJLLS SUBDIVISION
L/CrT 4, BLOCK 1
/ 47,299 S.F.
/
Four Bedroom
Home
~ ~ ~ 50 Long x 5~Wir~e
\ Y
LOT 4 ~
BLOCK 1
Proposed 12' Drive
~Proposed
i~/ell
/
/
/
/
/
158.26'
S89'59'43"W
SITE PLAN
SCALE l' = 40'
RIDGEVIEW DRIVE
MT%- Monitor Tube
FCO' %. Foundation Clean Out
TH -Test Hole
CO - Cle~ O~t
2C0 -- Bauble Ole~cLOut
FSV - Flow Splitter Vol~- --
NOTE:
No Areas of Excesslve Slope or
Sudace Water are Within 100' of
Any Par[ of the New Septic
System,
~. 7~ ~ MICHAEL E. ANDERSON ,'.~
LOT 4, BLOCK 1, ROSEBUD HILLS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home 5' Wide Trench System
Perc. Rate: 1-5 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
4 Bedrooms * 160 GPD/Bedroom = 600 SF Absorption Area
600 SF/1.2 GPD/SF/5 SF (Width) *.5 (Red. Factor)= 50 LF Trench Length
THEREFORE: Construct a 50' 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 3' Cover Over Absorption Trench and 4' Cover Over
Septic Tank. Maintain 100' Separation From All Wells and Surface Water in the Area.
..........~eotextile Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
59
TYPICAL 5' WIDE TRENCH SECTION
-- -- -- ~CALE--'ET~ ~**.~%..~. ......
· . ......
NOTE Grade Area Over Trench to Dra~n Away ~ ~ '~'
Minimum 6' Separation From Bedrock. ~.....~.~..~.~.......~.....,~..~
Minimum 4' Separation From Groundwater. ~~
Minimum 100' Separation From Private Wells in the Area ~ ~,~A~
Minimum 100' Separation From Su~ace Water or Stream~: ~
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
BRAGAW STREET ANCHORAGE, AK 99519-6650
t, 700
[ SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT ~, BLOCK I, ROSEBUD HILLS
PERFORMED FOR: ,JAY JOy
DATE: 5/Ig/15
PARCEL ID#:
PROJECT No.:
TECHNICIAN:
W. ROBERTS
DEPTH ] TEST HOLE 1 [
(feet)
OB/OG SLOPE
1
2
3
4
5 ~
6
7
8 S~LTY GRAVEL
GM/ML
9-- sM
WAS GROUND WATER ENCOUNTERED? NO
11
20
SITE PLAN
SEE SITE P[ AN
5% ~
B0H @ 15'
DEPTH TO
DATE READING GROSS TIME NET TIME WATER NET DROF
(MINUTES) (MINUTES) (INCHES) (INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
5/12 1 11:02 0.75"
2 11:32 30 9.13" 8.38"
3 11:33 1.00"
4 12:03 30 9.50" 8.50"
5 12:04 1.00"
6 12:34 30 9.50" 8.50"
PERCOLATIONRATE:3.50(MIN/INCH) PERC. HOLE DIA. 6" (INCHES)
TESTRUN BETWEEN: 4.0 FT. and 5.0 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. l, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES 1N EFFECT ON THIS
DATE:, 6/I/15
&700
[
MUNICIPALITY Of ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
BRA(SAW STREET ANCHORA(SE, AK 995~9-6650
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: 5/12/15
PARCEL ID#:
DEPTH
(feet)
OB/OG
2
3
4
5
6
8 SILTY GRAVEL
GH/ML
9 sm
11
B0H @ 12'
20
SOILS LOG - PERCOLATION TEST
LOT Z+, BLOCK I, ROSEBUD HILLS
JAY JOY
PROJECT No.:
TECHNICIAN:
W. ROBERTS
SLOPE
NO
WAS GROUND WATER ENCOUNTERED?
1F YES @ WHAT DEPTH?.__
DEPTtt OF WATER AFTER MONITORING: NONE
DATE OF MONITORING:. 5/20/15
SITE PLAN
DEPTH TO
DATE READING GROSS TIMEINET TIME WATER NET DROF
(MINUTES) (MINUTES) (INCHES) (INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
5/12 1 1:15 2.25"
2 1:45 30 10.25" 8.00"
3 1:46 2.38"
4 2:16 30 10.38" 8.00"
5 2:17 2.00"
6 2:47 30 10.00!' 8.00"
PERCOLATION RATE:3.75(MIN/INCH) PERC. HOLE DIA. 6" (INCHES)
TESTRUN BETWEEN: 4.0 FT. and 5.0 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED 1N ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE 6/I/15
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP151154 PID Number: 017-381-37
Dwelling: 0 Single Family (SF) ❑ Duplex(D) [' Multiple (SF and/or D) Project: El New ❑ Upgrade
Name:
Eric Trevithick ABSORPTION FIELD
Address
3121 Latouche Street Anchorage AK 99508 ❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound
[' Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
301-5359 4 1.2 GPD/SF 5.4 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 1.2 Ft.4.2 Ft.
Rosebud Hills 1 4 Fill added above original grade Gravel length
Township Range Section 4,2 Ft. 54 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 5 Ft. Ft.
To' Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 540 Ft2 1 Ft.
Well >100' >100' N/A N/A >25' TANK ❑r• Septic ❑S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface Water >100' >WU i N/A N/A i Anchorage Tank 1250 Gal.
Material Number of compartments
Lot Line >5' 10' N/A N/A Steel 2
NA
Foundation >5' >10' N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain None i Noted Gal.
Remarks 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 tankD3034 Tank to
Installer drainfield D3034
Alaska General __ Drainfield D3034 CO/MT D3034
Inspector Mike Anderson BENCH MARK (Assumed elevation) 100 ft
Inspection dates: •' 7/01/1 5 20d Location and description
3rd 45 Garage Slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVALIllibEVIrlaq� ,
Conditional Approval: Date :-'• :r
r 41.•
A a- ..v ist
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ra:-7-3 ''........ -. V
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Inspection Report_9-1-12.doc
ROSEBUD HILLS SUB, BLOCK 1 LOT 4
PERMIT # OSP151154 PID # 017-381-37
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT: 343-7904
4700 ELMORE RD, ANCHORAGE, AK 99519-6655
WASTEWATER DISPOSAL SYSTEM OR WELL INSPECTION REPORT
O CV
0
o > > 0
LL U) U) cV
- - /_96.2 - - -
INSULATION 93.2
93.0 J 92.7 I 1250 GAL 92.6k 92.5
SEPTIC TANK
J !
88.21
97.7 FINISH GRADE
O7/-93.5 ORIGINAL GRADE
U
92.3��_----`= . ; -,. ,PAIMDRAINFIELDROCK - „ _.. �. --- .., 92.3
88 1
54'
81.5
(V
= NO GROUNDWATER 5/20/15
I—
Pte•••
i ." ,-•:Fy+0,
;"*I49 TM )• .* �/
PROFILE AS-BUILT j • Ben in Schiller
PFp•. CE 12592 .•ate
�`` df•.• Nw 13.2017 . r
(NO SCALE) 11�;F�pROfE5S10NA���
ROSEBUD HILLS SUB, BLOCK 1 LOT 4
PERMIT # OSP151154 PID # 017-381-37
CONTOUR ACRES I
LOT 3
17 LMdiry Easement
LOT 4
WELL —\31
O 4-BDRM HOME
FCO
1250-GAL SEPTIC TANK . QQ LOT
CO1 •
•
SV
S� 2C0 DTH 1
•MT1 •
LOT 3
ABSORPTION TRENCH
54'x 5'x 4'EFFECTIVE s • -.
ALTERNATE SITE — • ‘•.TH 2
•Oa'
t)
A B C
FCO - 7.0 20.0_
$ ' CO1 58.3 28.1
SV1 58.4 30.8
PROPOSED ERNE SV2 56.4 35.0 -
2C0 55.2 38.5 -
0O2 54.6 43.1 -
MT1 56.8 46.7
CO3 76.4 91.3
i
RIDGEVIEW DRIVE
4 \‘kio
-
j*: M * 6 LEGEND
... MT-MONITORING TUBE
/ Benj in Schiller ' FCO-FOUNDATION CLEANOUT
9ec
•
+ •. A L 12592 � � TH-TEST HOLE
TiNor`1FRf �pNOF5.2017NA`•+•� 0 50 100
SV-SEPTIC VENT
\\\ � FEET CO-CLEANOUT
1"=50'
Development Services Department
Building Safety division
On-Site Water & Wastewater Program
4700 Elmore Road r. _
P.D. Box 196650 .17
1
Mark Begich Anchorage, AK 99507 s ' ' `
Mayor www.muni.or /orsitz
(907)343-7944
Pump Installation Log
Well Drilling Permit Number: 0 sp J 5 J 1 S-1 Date of Issue: i lilt t 1 fl 2016-
Parcel
01SParcel Identification Number: �-
Legal Description Property Owner Name& Address:
Rost bat 14 U') bitd LOA' q 'Tee v; gt.,i 1deYS
G; A37 e oa, x..3053`(
Pen vtin. 9 )3
~Pump Installation Date: b— 42,-17
Pump Intake Depth Below Top of Well Casing: 330 feet
Pump Manufacturer's Name: Lk kr* l
Pump Model: 5 51)",
Pump Size ) hp, • i
Pitless Adapter Burial Depth: /L0 feet
r
Pitless Adapter Manufacturer's Name: C G *it "! 0
Pitless Adapter Installer: VA.
Well Disinfected Upon Completion? Yes 1— No
Method of Disinfection: cAt
Comments:
Pump Installer Name: ...),Lt-47
•
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
development Services Department
Building Safety Division
�''-. On-Site Water & Wastewater Program -
4700 Elmore Road =
P.O. Box 196650 Anchorage, AK 99507
: - r
Mark Begioh www Muni arg!nrsste x
Mayor ,,
Y_
Well Log
Permit Number:O5P151154 Date of Issue:June 16, 2015
Date Started:06-24-15 Date Completed:07-01-15 Is well located at approved permit location?U Yes L No
Legal Description: Rosebud Hills blockl lot4 G:2837
Property Owner Name&Address: Joy Austin J & Regena S
P.O. Box 111073
Anchorage,AK 99511
Borehole Data: Depth (ft) Method of Drilling Di]air rotary L cable tool
Soil Type,Thickness& Water Strata From To .
T _ _ Casing type:steel
stickup 0 2 Wall Thickness:,250 inches
silt w/rock 2 18 Diameter: 6 -inches Depth: .138_feet
—_ __.--_..-__--- Liner Type:
silt&gravel 18 80 Diameter: inches Depth: _ __ feet
silt 80 95 Casing stickup above ground: 2 feet
moist silt w/gravel 95 120 Static water level(from ground level): __120 feet
wet gravel 120 126 Pumping level: feet after
dry silt & gravel 126 138 hours pumping gpm
-- — Recovery Rate: 1 gpm
-
bedrock • 138 345 Method of Testing: airlift
Well Intake Opening Type:
7 Open End n Open Hole
❑ Screened Start feet Stopped feet
El Perforations Start feet Stopped_ _ __feet
- - — Grout Type: Bentonite Volume:granules
Depth: 20' Start 0 feet Stopped 20 feet
• Vi t-ii QUALITY TESTING Pump: Intake Depth feet
C_'-u;i1Orrn Col/QQ Pump size hp Brand Name
LY Well Disinfected Upon Completion? n Yes n No
1 r-;"rti ----___D__ -/AA_ ' . Method of Disinfection:chlorine tablets
-.-.__ _ Comments:
--- _ Well Driller: Hefty Drilling, Inc.
--______-- 3540 Akula Dr.
Water Sample Results: -__._._._._ ___ ___ __ _.._.
Anchorage,AK 99516
Arsenic: ugIL
Nitrates: _mg/L
Total Coliform Bacteria: ____colonies/100mL
Other Bacteria: coil100mL
Attention: The well driller shall provide a well log to DSD within 30 days of completion.
•, � Municipality of Anchorage ''' �� u°
.j: On-Site Water and Wastewater Prograrrwu,� t; Z017 `
(907) 343-7904 SAF F,.
Certificate of On-Site Systems A { r !d�ijyyd
g
Parcel I.D. 017-381 -37 Expiration Date: 2."2 r(
1. GENERAL INFORMATION
Complete legal description Rosebud Hills, Block 1 Lot 4
Location (site address) 5531 Ridgeview Drive
Current Property owner(s) Eric Trevithick Day phone 301 -5359
Mailing address 3121 Latouche St, Anchorage, AK 99508
Real Estate Agent Day phone
2. TYPE OF DWELLING:
O Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: „` ,; ' ) Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ �vl gr "I
" l�� 1 II, bh Waiver Fee $
Date of Payment //' 7-1-17 Date of Payment
Receipt Number an 12-D Receipt Number
COSA# CI6C-11151 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Forge Engineering Phone 522-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, PE Date 11/15/17
1:19. ...* °° 49TH }•4� °
6. DSD SIGNATURE . 'f.• ••
System#1 Approved for bedrooms • r. �ll`•'��0 B
System#2 Approved for bedrooms 40¢t°°. �C • oo°11d
�,. 111 l 6•,".G° A.
Disapproved �9 *'�i''i N..• ‘�
Conditional approval for bedrooms, with the following stipulations:- _
ON-SITE
1)1'.,,,,
= WATER AND
c1 WASTEWATER o
o PROGRAM
O
2r"IT SER\AC'��, .
.� Original Certificate Date: 1 (" 2I —! 7
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 Arsenio Advisory - -
Well Flow Advisory Other . .
COSA blue sheet_c '- 0
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: Rosebud Hills, Block 1 Lot 4 Parcel ID: 017-381 -37
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (YIN) Y
Date completed 7/01/15 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y
Total depth 345 ft. Cased to 138 ft. Casing height(above ground) >24 in.
FROM WELL LOG AT INSPECTION
Date of test 7/01/15 New
Static water level 120 ft. ft.
Well production 1 g.p.m. g.p m
WATER SAMPLE RESULTS:
Coliform ND colonies/100 mL Nitrate 1 .77 mg/L
Arsenic
ND D ug/L Date of sample: 9/7/2017* Collected by. Forge Eng
*Second sample collected 9/18/17 for choliform after disinfecting well
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic / Steel Date installed 7/01/15
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping Pumper New Construction
C. ABSORPTION FIELD DATA
Date installed 7/01/15 Soil rating (g.p d./ft2 or ft2/bdrm) 1 .2 System type 5-Wide
Length 54.0 ftWidth 5.0 ft. Gravel below pipe 4.2 ft.
Total depth 9.6 ft. Eff. absorption area 540 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New 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 Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100' On adjacent lots >100'
Absorption field on lot >100'100' On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
>5' >5' >5'
Building foundation Property line Absorption field
Water main
>10'10' Water service line >10'10' Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10Building foundation >10 Water main >10
Water Service line >10Surface water >100 Driveway, parking/vehicle storage >10'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION jAbit.,Or df,4,4 to
or I certify that I have determined through field inspections and III III. •• - -' ;,,r '•;¢•rt
review of Municipal records that the above systems are in i
LOT 3 if-Found existing 5/8"
Rebar (Typ.)
N89'41'17"E _ ..._
g j 158.26'
10' Utility Easement
i�
0 0
Well
—27.8'
. 19.3q.! 12.3 Bay Window
cv,E 'a o. 7.1'
3.
0
' �i _
•
In24.7
co 2.82.8, ;
I .re)
j �,
&.I
X27.8'— 510.5' , Wood Pad
11-f: o,r;; 14.3' _I r.K
N 6. Covered,!i 23.0'
;IWood Deck;: 6.0'
0 r 15.8 -
3.3' 9.2 3.3' N6.0'. w
1
Window 52.3' ol±—4
Case __- - . ,. r__ . .
Concrete/
Walk Asphalt
ri, Pad
z -_-. w
-in \ -0, n
M
LOT 3 0 ! In N Riser Pipe LOT 5
0 (Typ.) 0 •
0
0
z
Recycled
Drive
LOT 4
BLOCK 1
j .
N
Dirt
9
a
0
SCALE : 1 " = 30'
2: plIIMIII
co
0' 15' 30' 60'
158.26'
S89'59'43"W •
o b •
ro "D
_ RIDGEVIEW DRIVE
_ _ _
NOTE: PREPARED FOR:
Dimensions are measured to the wood trim.
ERIC TREVITHICK
I hereby certify that an accurate survey of the following described
property: AS - 3UILT
, c. ........A( *t ROSEBUD HILLS SUBDIVISION (74-187
/ SifP
B
' •• ��•.P,F LOT 4,BLOCK 1
: ***:57-4 was made on October, 11, 2017 and that the improvements OWN. DATE GRID
*F49TH
„" �0 situated thereon are within the property lines and do not overlap or JSP 10/21/2017 SW 2837 x
Ma
encroach on the property lying adjacent thereto, that no
to AV. Lee'Knrnbelnikof. improvements on the property lying adjacent thereto encroach on FILE NO. F.B. JOB NO.
0, ;A,if the premises in question and that there are no roadways, 1716 2016/2017 1731
• No, 3143-S••= .. transmission lines or other visible easements on said property except PG. 32 iv
t1 ••'••.......••''l9 �w as indicated hereon. Easements other than those shown on the I� p /� • N
Mkt ...."S13414-ik �s'� record plat may not appear on this drawing. I"\ ARADELI V I KOFF
/AAi/31017 Anchorage Alaska. this 21th day of October 2017. SURVEYING (907) 337-3434
V)