HomeMy WebLinkAboutCROSS VIEW ESTATES BLK 1 LT 11Cross View
Estates
Block 1
Lot 11
#015-301-59
Municipality of Anchorage
On-Site Water and Wastewater Program •(907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP161075 PID Number: 015-301-59
Dwelling: ❑■ Single Family (SF) LI Duplex(D) ❑ Multiple(SF and/or D) Project: ■❑ New ❑ Upgrade
Name:
Crown Pointe Homes, Inc. ABSORPTION FIELD
Address ❑■ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
P.O. Box 112313 Anchorage, AK 99511 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
229-1886 Four (4) .6 GPD/SF 11.9 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 3.9 Ft. 8.0 Ft.
Cross View Estates 1 11 Fill added above original grade Gravel length
Township Range Section 1 Ft. 63 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 3 Ft. Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 1,008 Ft2 1 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 N/A 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 Noted Gal.
Pump on level at Pump off level at High water alarm at
Remarks
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank D3034Tank to D3034
Installer drainfield
Sanders and Sanders Drainfield D3034 CO/MT D3034
Inspector J. Millette BENCH MARK (Assumed elevation) 100.0 ft
Inspection 1s' 3/23/16 �, 3/23/16 Location and description
dates: 2
3rd 4th Garage Slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL :: ;�:3*;;
i'4)..bc.OF•AL 411
Conditional Approval: Date ,`P.• • •
r*: 49TH '-57. to
,.MICHAEL E. ANDERSON •'tic a
','.• CE-4381 �`• �.:
ve v.--..._ Date 7-(711 ,i
Appro0 , .. ss ��
‘VI.
Inspection Report_9-1-12.doc
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 -343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP161075 PID No. 015-301-59
91.4
IU v) v) CJ
Finished
OG
______ ili ,
1,250 Gallon 4
Septic Tank 1
86.4 86.25
U 2 Q U
I
90.2 89.2
Finished Grade
Original Grade
Geotextile Fabric
85.3- 77-3 Drainfield Rock 85.3
77.31
II
63'(Trench Length)
71.2
J No Groundwater
5/1/2016
!^♦ob•,rlJt �u,r,�
•
i •' . 4 th %\ .*O$
_IL
PROFILE AS-BUILT 0., •MICHAEL
No, CE-438RSON pfr
No Scale .� 7,;f 7-i.1....a�c,:i,
1 � _%,:„,... •
Municipality of Anchorage Page 2 of 3
DEVEOPMENT SERVICES DEPARTMENT
Permit Number: OSP161075 4700 Elmore Road Anchorage, AK. 99519-6655-343-7904 PID No. 015-301-59
CROSS VIEW ESTATES SUBDIVISION
LOT 1 1 , BLOCK 1
50,166 S.F.
N 89'47'24'E 172.22' •
10' T. & E. ESMT.
7 r -
I r
r r
LJ
Alternate Site A B
S1 34.0' 36.7'
® S2 40.9' 43.9'
THA C4 62.2' 58.1'
C5 82.1' 90.4'
M1 62.9' 59 8'
u1
C4 2C0
S2
51
N f`
O p
�
0
a 25.5'
0
os
0
u Four Bedroom Z
Home 28.6'
4001110111111111111....
La
/ w
o!
10' X 40' • I t
ELL
GAS ESMT. —I——
I
20' STORM I
DRAIN ESMT.
L=19.07; S 89'54'15"E 131,92'
83180.00
O
r)
HERITAGE HEIGHTS DRIVE ♦*���•� 11
11.LEGEND 49th �`
MT — Monitor Tube 1); = r
FCO — Foundation Clean Out
TH — Test Hole • MICHAEL E. ANDERSON
CO — Clean Out ♦`r' No. CE 4381 '~�
FSV — Flow Splitter Valve PLAN AS - BUILT ••; -
SCALE 1` = 50' #4,10EFES;i 04�
•:
. 03/22/2017 22:01 907-345-0202 ALPINE DRILLING PAGE 01/02
e■
•Y.■ Alpine Drilling & Enterprises
Well Log
Permit Number: #SW161075 Date of Issue: 5-23-16 Parcel Identification Number: 01530159000
Date Started: 10-15-16 Date Completed: 10-16-16 Is well located at approved permit location?x Yes ❑ No
Legal Description: Crossview Estates Block 1 Lot 11 ,
Property Owner Name&Address: Billy Reynolds CIA 0 k 1
5231 Heritage Heights Drive
Anchorage, Alaska 99516
Borehole Data: Depth (ft) Method of Drilling x air rotary ❑ cable tool
Soil Type,Thickness &Water Strata From To
Casing type: ,steel
stick-up 0 2 Wall Thickness: Z52 inches
silt 2 6 Diameter: ¢inches Depth: 201 feet
Liner Type:
gravelly silt 6 21 Diameter: inches Depth: feet
silty sand 21 27 Casing stickup above ground: 2 feet
silt 27 40 Static water level(fi'onik ground level): 135 feet
gravelly silt 40 102 Pumping level: 200 feet after
silty gravel 102 142 2 hours pumping 50 gpm
Recovery Rate: 50 gpm
silt 102 158 Method of Testing: air lift
silty sandy 1120 158 167 Well Intake Opening Type:
silt 167 174 x Open End ❑ Open Hole
gravelly silt 174 195 ❑ Screened Start feet Stopped feet
water sand&gravel 195 201 LIPerforations Start feet Stopped feet
Grout Type: bentonite granules Volume: 2
Depth: Start 0 feet Stopped ?feet
Pump:Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? x Yes ❑ No
WATER QUALITY T .:>TlN,, ## Method of Disinfection: chlorine tablets
Collform IV*e3 Col/10lJmL !
Comments:
Nitrates mg/L
Arsenic, V Ug/L
J Well Driller: Alpine Drilling&Enterprises
PO Box 110496
Anchorage AK 99511
IR U 1' E)
6'46 1997
03/22/2017 22:01 907-345-0202 ALPINE DRILLING PAGE 02/02
Development Services Department
' •
Building Safety Division
mt
® ;i1= On-Site Water & Wastewater Program QP;, `i ` "�L,�
,�„ 4700 Elmore Road " ¢µ .ca: a`S�lli
L.
/
r„ -'." P.Q. Box 196650 6 'Nr.5 d1 C T Y
Mark Begich Anchorage,AK 99507
Mayor wwwunLor /onsit'e
(907)343-7904
Pump Installation Log r,,
15
Well Drilling Permit Number: SW r �P Date of Issue: 20(`i"
Parcel Identification Number:0.1✓3°1.51 00
Le Des rlption Loi. t t: V t Pope Ow -Na & Address:
eil(06,4 ia6 W-774kt l , , .i.
,.. .-61,731f), y.,<
-------iwiTryi 40‘00,
rump Installation Date: b,;
Pump Intake Depth Below Top of Well Casing: 11). feet
Pump Manufacturer's Name: ( OU 145
Pump Model: 14- o1
Pump Size 3qhp
Pitless Adapter Burial Depth. feet
Pitless Adapter Manufacturer's Name: 11) IA
0 Pitless Adapter Installer:Pi
Well Disinfected Upon Completion? kYes ❑No
Method of Disinfection: /� j
Comments: 643L 6 ok 1.0 `.1
.........._ -
Pump Installer Name: Aarcrw Pump&Well Sol''
P.O.Box 11096
stage, AIS 99511-
r
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
1
IF �`‘
utamar LLD
Permit Number:
Tax Code Number:
Work Type:
On-Site Water & Wastewater System Permit
OSP161075
01530159000
WellSeptic
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
Initial
Permit Effective Dates: May 23, 2016 to May 23, 2017
Design Engineer: ANDERSON ENGINEERING
Subdivision: CROSS VIEW ESTATES
Site LegalAddress: CROSS VIEW ESTATES BLK 1 LT 11 G:2737
Owner/Address: REYNOLDS BILLY
5231 HERITAGE HEIGHTS DR ANCHORAGE AK 995160000
:)artment
Site Mailing Address:
Lot Size in Sq Ft: 50166
Total Bedrooms: 4
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: ~ ~-~ ~ Date: ~'%~-~'~(~
Issued By: ,,~..¢~ _~~'...¢.~------~ Date:
MUNICIPALITY OF ANCHORAG APR 9
Development Services Division
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-301-59
Property owner(s) Crown Pointe Homes, Inc.
Mailing address P.O. Box 112313, AK 99511
Day phone 229-1886
Site address Heritage Heights Drive Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Cross View Estates, Block 1, Lot 11
Legal description (Township, Range & Section)
Lot Size 50,166 .Sq. Ft. Number of Bedrooms Four (4)
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 []
Privy [] (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: ~;(0~¢'~/~'''~
Date of Payment: ~.o-/~
Receipt Number: O~ Ib~,~
Permit No. 0~ ¢'1 b Io75'
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Permit App_9-1-12,doc
April 19, 2016
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Su~e~:
Lot 11, Block 1, Cross View Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 11, Block 1, Cross View Estates 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 the proposed septic system along with the alternate site. Also
identified on the plans are the existing wells in the area 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.
The test hole placed on the lot in the area of the absorption trench and alternate site
indicate silty sand with gravel (SM/ML). The percolation rate of the soil was determined
to be 28.3 minutes per inch. No groundwater was found during the placement of the
test hole and none was noted during the monitoring pedod. An application rate of .6
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 63' 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 2' below the
surface and the total depth will be 10'. 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 northwest
at a shallow grade with some cross sloping to the south. The new trench will be
constructed parallel with the contours of 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
Lot 11, Block 1, Cross Point Estates Subdivision
April 19, 2016
Page Two
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
LOT 5
.~ ~-'-7 [ .................................. Yf ! .~
j LOT g X ~ ~ LOI ~0 ~ II
/ I l j ~~~ ~ / ~, '--
~ J ~ ~ j
~ ~ 49~h ~4 ~ ~
'~'"C ~ ~__ cross v, ew estates su~,ws,o~
?.~..;.;~;.....~...~~ ' LOT 11, BLOCK 1
~.....~...)~ , mm x~m , m mm ~m
'~ESS~** SCALE 1' : 100'
CROSS
PLAT NO. 2006-171
VIEW ESTATES
LOT 1 1, BLOCK
50,166 S.F.
N 89'47'24"E 72.22'
SUBDIVISION
1
NOTE:
NO Ground Surface Slopes >25~; are
W~thin 50' of the Absorption Trench.
No Ground Water is Within 100' of
the Septic S~stem,
HERITAGE HEIGHTS DRIVE
SITE PLAN
SCALE 1' = 50'
LEGEND
MT - Monitor Tube
FCO - Foundation Clean Out
TH - Test Hole
CO - Clean Out
FSV - Flow Splitter Valve
LOT 11, BLOCK 1, CROSS VIEW ESTATES SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: 16-30 Min./Inch 1,250 Gallon Septic Tank
Application Rate: .6 GPD/SF 8' Drainfield Rock
4 Bedrooms X 150 GPD/.6 GPD/SF (Application Rate) = 1,000 SF Absorption Area
1,000 SF/16 SF/LF = 62.5 LF Trench Length
THEREFORE: Construct a 63' Long x 3' Wide x 8' Effective Depth Absorption Trench at the
Location Shown. Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth
to be 10' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Maintain 100' Separation from Wells in the Area.
Natural
Backfill
Geotextile
Fabric
4" Perforated
PVC (Holes Down
Drainfield Rock
3~
TYPICAL DEEP TRENCH SECTION
~NO SCALE~
NOTE: Grade Area Over Trench to Drain Away,
, . , .
M~mmum 6 Separahon From Bedrock. ...~..~.~..~...~....:~
_ Minimum 4' Separation From Groundwater.
' Minimum 100' Separation From Wells in the Area. ~'"~',~'~'~~
Minimum 100 Separation From Su~ace Water or Streams.- a.
4700
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
BRAGAW STREET ANCHORAGE, AK 99519-6050 ·
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: 4/16/16
PARCEL ID#:.
DBPTH
(feet)
OB/OG
1
3--
4--
,5--
6--
?
8 SILTY SAND
WITH GRAVEL
9 SM/ML
SOILS LOG - PERCOLATION TEST
LOT II, BLOCK I, CROSS VIEW ESTATES SUB.
11
20,
BOH @ 18'
CROWN POINTE INC.
PROIECT No.:
TECHNICIAN:
MEA
SLOPE
NO
SITE PLAN
SEE SITE PLAN
I ("NUTES) I("NUTES) I ('NO'ES) I
I TEST HOLE PRESOAKED PRIOR TO TESTING:
4/16 1 2:10 2.25"
2 2:40 30 3.38" 1.13"
/3 2:41 2.13.
] 4 3:11 30 3.19" 1.06"
/ s 3:12 2.25"
[ 6 3:42 30 3.31" 1.06"
PERCOLATION RATE:28.3 (MIN/INCH) PERC. HOLE DIA. 10" fiNCHES
TEST RUN 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 IN ACCORDANCE WITH ALL STATE AND MLrNICIPLE GUIDELINES 1N EFFECT ON THIS
DATE:. 7/11/2012
GARNESS ENGINEERING GROUP, Ltd. ~""z ~[[~ "-...~.~l~
JSOIL LOG - PERCOLATION TESTJ
LEGAL DESCRIPTION: HERITAGE HILLS SUBDIVISION ~1; TRAOT O~D (PROPOSED LOT ll)
PERFORMED FOR: PROFESSIONAL TECHNICAL SE~ICES DATE: 8/31/2005 ~j~/.~j~
1
~LOAM SOIL C~SSIFICATIONS '
2 ~ , .~
tlfllllll ~ GM ~ CL
~T~tlllJl ~GC ~ OL
~T~ ~ SW m~J HH
ItTtTIIIII ~ SH :~'~5 OH .............
7~1~1111l~7J11111 DEPTH TO DATE
I I lllll j
It+~*lllll ~**~ ~.~.~,. CLOCK I NET T~ME WATER LEVEL NeT DROP
*~1ff~lllll "~'~ ~""~ TIME J (MINUTES) READING ~ (INCHES)
,~d*~IIIIII ' ' ~ ' - - ~" -
If~NIIIII
PERCOLATION RATE ,~.~7 (MIN./iNCH) PERC. HOLE DIA. 6 (INCHES)
I I TEST RUN BETWEEN 5.5 FT. AND 6.5 FT.
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORHED BY: CALEB GALL
COHHENTS: · RECOMMEND USING A 0.6 APPLICATION
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTI~ THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: l~/~J ~(~
DEPTH TO
GROUNDWATER DATE
DRY 8/31/2005
DRY 9/19/2005
GE Qp
• Municipality of Anchorage °
On -Site Water and Wastewater Program _Oct
(907) 343-7904 S a F E T Y
Parcel I.D. 015-301-59
Certificate of On -Site Systems Approval
Expiration Date
lo--i7-t 7
1. GENERAL INFORMATION
Complete legal description Cross View Estates, Block 1, Lot 11
Location (Site address) 5259 Heritage Heights Drive Anchorage, AK 99516
Current Property owner(s) Crown Pointe Homes, Inc. Day phone 229-1886
Mailing address P.O. Box 112313 Anchorage, AK 99511
Real Estate Agent
2. TYPE OF DWELLING:
Fx1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Four
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
F-1
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
Date of Payment 7 -13 _17'
Receipt Number 010g
COSA # DSC- t 7/ ZS�
Date:
Waiver Fee $
Date of Payment
Receipt Number
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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 7/12/2017
�e_
.......
.`.. ;45
..1-4
L2Y 69:- •"� V
6. DSD SIGNATURE 0. % e,' � '�A-41'0-1
System #1 Approved for LI bedrooms MICHAEL E. ANDERSON :
CE-4381
System #2 Approved for bedrooms �3 ��� .•,?-rZ +7 .• <.?,:s"'
Disapproved ��$ tia®q: �'` '
Conditional approval for bedrooms, with the following stipulations:
�sCY Or Args. G
y t�
IOl4 Sl-TE Grp
WATER AND
rt WASTE
y PROGRAM WATER
B . � �. Original Certificate Date: 7 - 7-17
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 blue sheet S c
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 Estates, Block 1 , Lot 11 Parcel ID: 015-301-59
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (YIN) Y
Date completed 10/16/16 Sanitary seal (YIN) Wires properly protected (YIN) Y
Total depth 201 ft. Cased to 201 ft. Casing height(above ground) >18" in.
FROM WELL LOG AT INSPECTION
Date of test 10/16/16
Static water level 135 ft. ft.
Well production 50 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 0.835 rnq,L
Arsenic ND ug/L Date of sample: 6/20/2017 Collected by: And. Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 3/23/1 6
Tank size 1 ,250v
gal. Number of Compartments Cleanouts (Y/N)
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 3/23/16 Soil rating (g.p.d./ft2 or ftZ/bdrm) .6 GPD/SF System type Deep Trench
Length 63 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth 12 ft. Eff. absorption area 1,008 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Const. Results(Pass/Fail) For 4 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(YIN)
"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'
>1Absorption field on lot 00' On adjacent lots 100'
Public sewer main >75' Public sewer manhole/cleanout X100'
Sewer/septic service line X251 Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5 Absorption field >5
Water main
>10' Water service line >10' Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
, >10'
Property line ��0 Building foundation X10 Water main
>10'
Water Service line 10 Surface water 100 Driveway, parking/vehicle storage
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION ,��.6,��101%%i 1
th
I certify that I have determined through field inspections and ;+.�S•••••••.�,4 N..
review of Municipal records that the above systems are in r�Q;.• *•.Q.,..i.,...%'• s
conformance with MOA COSA guidelines in effect on this date. r G7. •y
Michael E. Anderson, PE i 49 rH �`
Engineer's Printed Name • ' '.'• a. ••
•
Date 7/12/2017 / :MICHAEL E. ANDERSON :4:
*I♦�Jl.• CE-4381 •.• \.`"=o%
,�f•?-I 7-1 7 ... , ..
e
COSA brown sheet 10-10-12.doc
PLAT NO. 2006-171
CROSS VIEW ESTATES SUBDIVISION
LOT 1 1 , BLOCK 1
50,166 S.F.
N 89°47'24"E 172.22'
a
10' T. & E. ESMT.
- - - 7 --
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