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Home My WebLink AboutCROSS VIEW ESTATES BLK 1 LT 26Cross View Estates Block 1 Lot 26 #015-221-57 MUNICIPALITY F ANCHORAGE 4i Development Services Department " Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-221-57 1. GENERAL INFORMATION Expiration Date: (; Z 2 Complete legal description Cross View Estates Sub, Block 1 Lot 26 Location (site address) 5771 Heritage Heights Drive Current property owner(s) Tanner Trust Day phone (907) 317-0449 Mailing address 5771 Heritage Heights Drive, Anchorage, AK 99516 Real estate agent Day phone 2. TYPE OF DWELLING: ■❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well FEI 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 $_ 659 Date of Payment Z� Receipt Number COSA #_ D5(-7-21 II30 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 3/19/21 kl i `�'• -�•{ 9 Mfr 49 6. DSD SIGNATURE _ • . �• • • d System #1 Approved for -S bedrooms BenjamtruSchiller System #2 Approved for bedrooms� •.. CE 12592 •0�� Disapproved�1 FV " ' p��r� 11 ROFESSION4.�. Conditional approval for bedrooms, with the following stipulations: SER ER o CDJ �/JJ UENT S 1�1))It�i��111�1 B Original Certificate Date:_��2 2/ 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 Sub, Block 1, Lot 26 Parcel ID: 015-221-57 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ON Well log is filed with Onsite (or attached) Date drilled 11/15/09 Total depth 281 ft Cased to 281 ft 0 Sanitary seal is functioning correctly ❑W Wires are properly protected Casing height (above ground) 20+ in. Date of flow test for COSA 3/8/21 Static water level at beginning of test 238 ft. Comments B. TANK DATA Age of tank(s) 12 years Tank type/material Septic/Fiberglass Measured operating fluid level in septic tank 65 ❑® Standpipes/foundation cleanout per record drawing Date of pumping 6/1/20 Around the Clock D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 11/4/2009 W ALL standpipes present per record drawing Total measured depth from grade 13.8/14.3 ft (max) Measured depth to pipe invert from grade 6.2/6.6 ft (min) ❑ N/A — pressurized field Fil Monitor tubes go to bottom of effective. If not, state depth into effective 7.6/7.7 ❑® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Structure served by this system Well production at time of test 5.5 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ N OR Coliform bacteria is Negative Nitrate 2.35 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 3/3/21 C. LIFT STATION uired maintenance completed Age of lift sta� years Lift station material Comments: Adequacy test date 3/8/21 Results ❑✓ Pass For 5 bedrooms Fluid depth prior to test 0/0 in Water added 808 gal New depth 011 in Elapsed time 1440 min Final fluid depth 0/0 in Absorption rate >750 gpd Any rejuvenation treatment (past 12 months) _ If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft 7 Yes if No ft Neighboring Tank > 100' Fv-� Yes if No ft Private Sewer/Septic Line > 25' Fv-1 Yes if No ft Absorption Field on Lot > 100' 7 Yes if No ft Holding Tank > 100' Z Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 7 Yes if No ft El Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Fv-J Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' M Yes if No ft Water Service Line > 10' 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' U Yes if No ft If absorption field is under driveway comment below Property Line > 10' Fv� Yes if No ft Wells on Adjacent Lots: Water Main > 10' El Yes if No ft Private Wells > 100' El Yes if No ft Water Service Line > 10' Fv� Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100'✓� Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet OF A�.'qc.�S�� 49 T-" • Benjani6,Schiller �� • CE 125923/19/21 AMW •��`�� F��pROfESS1ONP�.®'A