HomeMy WebLinkAboutCROSS VIEW ESTATES BLK 1 LT 12Cross View
Estates
Block I
Lot 12
#015-301-60
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: sw2010034267 PID Number: 015-301-60
Name:
Brettand Laura DuFour Wastewater System: [] New [] Upgrade
Address:
P.O. Box 112415 Anchorage, AK 99511 ABSORPTION FIELD
Phone: Number of Bedrooms:
5 [~' Deep Trench [] Shallow Trench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION Soil Rating: Total Depth f ..... iginal grade:
.6 GPD/Ft2 11-12 Ft.
Block: 1 Lot: 12 Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe:
Cross View Estates 5.5-6.0 Ft. 6,0 Ft.
Township: Range: Section: Fill added above odginal grade: Gravel Length:
2-7 Ft. 140 Ft.
Well: [] New [] Upgrade Grava~ width: Number of lines: Distance between lines:
3 Ft. 2 > 12 Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Private 187 Ft. 187 Ft. 1,680 Ft2 ASTM D3034 PVC
Driller: Date Ddlled: Static Water Level: Installer: Date installed:
M-W Drilling 7/28/10 130.27 Ft. PCN, Inc. 7/30/2010
Yield: GPM PumpSetat: Ft. Casing Height Above Ground:
15 2 Ft. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
T~To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity:
From%
Tank Field Station Tank Sewer Line Anchorage Tank 1,500 Gal
Material: Number of Compartments:
we, >100' >100' N/A N/A >25' Steel I Two (2)
surface water >100' >100' N/A N/A ~ / LIFT STATION
Size: Manufacturer:
Lot Line >5' > 10' N/A N/A Gal.
"Pump on" level at: "Pump off" level at: in. High water alarm at:
Foundation >5' >10' N/A N/A in. in,
Curfain Drain None Noted Pump Make & Model Electrical Inspections performed by:
Remarks:
BENCH MARK
Location and Description:
Garage Slab
Assumed Elevation:
100.0 Ft.
Inspections performed by: A. Harala Dates: 1st 7/30/2010
Development Services Department Approval . ... ~.=.,.u ~-~ :~,
~,~.~-,~,...~...o~..~.,¢'~.o ·; · .,~
Conditional Approval Date:
~.~'. CE
Municipality of Anchorage
DFVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 -343-7904
Permit Number: SW2010034287
CROSS
VIEW
LOT
2006-171
ESTATES SUBDIVISION
12, BLOCK 1
49.615 S.F.
N 89'47'24" E
159.28'
.... 10.~_' T &:E Eo___seme___nt
S1 1~.1' 4134.8.
Alternote Site
Advonte× Treotment System S2 126.2'] 39.1'
w/53' Long x 3' Wide C4 42.0' 27.3'
x 6' Effective Depth ~,
Absorption T~ C6 192'6'155.9'
M1 45.7' 24.8'
M3 93.4'154.4'
~TH2 FSV 54.5' 31.6'
M5
C6=
M4
Retolnln Woll M2
LOT 11
_Retolning
Woll
FSV
C4
Five
House
LOT 15
Page 2 of 3
PID NO.: 015-301-60
20'
N 89'54'15" W
HERITAGE HErGHTS DRIVE
10' x 40'
--Oos Eosement
Fd. 1 I/4" Yellow
Plostic Cop on
5/8" Rebor (Typ.)
PLAN
AS-BUILT
SCALE 1" = 40'
LEGEND
s1 - Septic vent
M1 - Monitor Tube
FCO - Foundotion Cleon Out
TH - Test Hole
C5 - Cleon Out
FSV - Flow Splitter Volve
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW2010034287
85.9
F
/--- 99.2
Existing I ~' Finished 1/ G d Il ....
4~1,500 Gallon I% ~
Septic Tank I/
¢ 94.25
.97.8
/ Finished Grade
Existing Grade
-7-
73.5
NO Groundwater
91.5
Geotextile Fabric
Drainfield Rock
79.9
70' (Trench Length)
Page 3 of 3
PID NO.: 015-301-60
SOUTH TRENCH
85.9
85.1
94.8
Finished Grade
Existing Grade
73.5
NO Groundwater "%
E
91.5
/
/
NORTH TRENCH
PROFILE'AS-BUILT
No Scale
85.9
Geotextile Fabric
Drainfield Rock
79.1
70' (Trench Length)
LOT 12, BLOCK 1, CROSS VIEW ESTATES SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom Home Deep Trench System
Perc. Rate: 16-30 Min./Inch 1,500 Gallon Septic Tank~
Application Rate: .6 GPD/SF 6' Drainfield Rock
5 Bedrooms X 150 GPD/.6 GPD/SF (Application Rate) = 1,250 SF Absorption Area
1,250 SF/12 SF/LF = 104.17 LF Trench Length
THEREFORE: Construct 2-53' Long x 3' Wide x 6' Effective Depth Absorption Trenches at the Location
Shown. Flow Line Elevation in Trenches to be 7' Below Original Ground Surface. Total Depth to be
13' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trenches. Maintain 100' Separation from Wells in the Area.
1611
1011
Natural
Backfill
Geotextile
Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL DEEP TRENCH SECTION
(NO SCALE) . ~.~,,
NOTE:
20' X 4Q'
CAS ESMT. ' -
20' STORM
DRAIN ESIdT. - -
2006-171
CROSS VIEW ESTATES SUBDIVISION
LOT ~2, BLOCK ~
49,615 S.F.
N 89'~-7'24'E 160.00'
10' T. z, E. ESIdT.
Alternate Site
Adya.n, tex Treatment System
w/53 Long x 3' Wide
x 6' Effective Depth ~
Absorption Trench' //> 2-53' Lonc, I x 3' Wide
// x 6' Effecbve Depth
//'~TH2 ~ Absorption Trenches
1,500 C-~llon
Septic T~nk
M~x. Bury 4'
Pro po~ed Well
160.00'
HERITAGE HEIGHTS DRIVE
[-~'~E].EVA'I]ONS BASED ON 1972 NGS DATUM O'YP)
SITE
PLAN
SCALE 1' = 50'
Municipality of Anchorage
ONSITE WATER & WASTEWATER PROGRAM
CHANGE ORDER
PERMIT # SW2010034287
PID No: 015-301-60
SUBD Cross View Estates
TRACT BLOCK 1 LOT 12
CONTACT PERSON Michael E. Anderson, P.E. PHONE 522-7773
FAX 677-7766
PLEASE GIVE A DESCRIPTION OF THE CHANGE: The property has changed owners. The new owners requested
additional test holes on the property to verify the previous work. We found some discrepancies in the previous
test hole work including the depth of the test holes and the percolation rates. The septic system was redesigned
based on the field information obtained. The attached documentation indicates the new owner and the
modifications to the septic system along with the new test hole and percolation data. The well location has been
revised to reduce cost and eliminate any conflicts with adjacent lots.
CUSTOM ER SIGNATU RE '~~J~- ~~
On-Site
RevieT~//
APPROVED (date)
Comments
:Issued
(date)
Review
Time
(hours)
Permit Number:
Tax Code Number:
WOrk Type:
On-Site Wastewater Disposal System
SW2010034287
O153O16OO0O
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 EImore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Initial
Permit Effective Dates: May 20, 2010 to May 20, 2011
Design Engineer: ANDERSON ENGINEERING
Subdivision: CROSS VIEW ESTATES
Site Legal Address: CROSS VIEW ESTATES BLK
Owner/Address: DUFOUR BRETT D & LAURA
PO BOX 112415 ANCHORAGE AK 995112415
1LT 12 G:2737
Site Mailing Address:
Lot Size in Sq Ft: 49615
Total Bedrooms: 5
This permit is for the construction of:
Y Disposal Field Y SepticTank N Holding Tank N Privy N 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.
Special Provisions: Change Order #1' New owner, engineer and design.
Received By: ,/~ ~'/~ /
Issued /
'~-¢Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www. muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-301-60
Property owner(s). Brett and Laura Dufour
Mailing address 7143 Theresa Mae Circle Anchorage
Site address Heritage Heights Drive
Day phone
Zip Code 99516
Zip Code 99516
Legal description (Sub'd., Block & Lot) Cross View Estates, Block 1, Lot 12
Legal description (Township, Range & Section)
Lot Size 49,615 Sq. Ft. Number of Bedrooms Five (5)
THIS APPLICATION IS FOR ([~ all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
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:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
Performed For:
Legal Description:
TH 1
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20~
MUnicipality of. Anchorage
Development Services Department
Building Safety Divisien
On-Site Water and'Wastewater Program
4700 Elmcre Road
PiO. Box 196650 Anchorage, AK 99507
www. ci.anchora.qe.ak us
(907) 3497904
Soils Log- Percolation Test
Brett and Laura Dufour
Cross View Ests., B 1, Lt 12
Slope
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT DEPTH?
Depth to Water After
Monitoring?,
Date Performed: ~
Township., Range, Section:
Site Plan
Reading Date Gross Time Net Time Depth to Water Net Drop
V
PERCOLATION PATE I~ (minutes/inch)
COMMENTS The percolation cavity was presoaked on
PERC HOLE DIAMETER
1 FT
PERFORMED BY: ~'~,r' . i I CERTIFY TH/~T THIS TEST WAS
PERFORMED IN ACC6RDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
MuniCipality~' of Anchorage
Development Services Department
Building SafMy. Division
On-Site Water and 'Wastewater Prc~jram
4700 Elmore. Road
P.O. Box* 196650 Anchorage; AK 99507'
www. ci.an choraqe.ak, us
(907) 343~7904
Soiils' Logi -. Percolation: Test
Pe~rormedFo~ and Laura Dufour Date Performed:~
,eg~ D~s=*ption: Cross View Ests., B 1, Lt 12 _ Township, Range, Section:
Slope Site Plan
1.6-
17-
19,
20-
WAS GROUND WATER
ENCOUNTERED?
IF YES~ AT WHAT DEPTH? ~
Monitoring?,
Date:
Reading . Date Gr~sS Time. i Net Time Depth to Water Net Drop
I~',~¢ ~o ~ ~,8~'~ ~,~"
PERCOLATION RATE J/~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~. ~ FT
COMMENTS The percOlation cavity was Presoaked on'
PERFORMED BY: I · CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage
Development Services Department
Building Safety Division
O~-Site Water and Wastewaler Program
4700 Elmo~e Road
P.O. Box 196650 Anchorage, AK 99507
ww~v ci anchoraqe liku.~
(907) 343-79O4
Soils Log - Percolation Test
Slope
3-
4-
5-
7-
8-
12-
16-
20-
COMMENTS
r ~ At~C~iA~L N. A~DtilSC~
~.. c[-~4,~ ..~.~.-~
~ li[~ j:: ..... 'A'~¢2z
To. ship. ~e.
Site Plan
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT DEPTH?
Reading Date C~oss Time Net Time Depth to Water Net Drop
, ;1(
~ " ~,~ ',
PERCOLATION RATE (m,~ae-.an~) PERC HOLE DIAMETER
TEST RUN BE'PAtEN ~ FT AND ~, ~"'-FT
PERFORMED BY: ~ ~ & I CERTIFY THAT THIS TEST V~tAS /
PERFORMEDINACCORDANCEW1THAI.LSTATEANDMUNICIPALGUiDELiNESINEFFECTONTHISDATE. DATE: ~/~ .~,~)
PROPOSED SEPI1C Finn ~ ~ t
PROPOSED RE;SE~VI[ Finn i ,.,._..~,.~--DCUBLE CO
~ PROPOSED 1.$00
PROPUSED ~ FCO~'""'*'""-- DOUBLE COI VACANT LOT
HOUSE
i'- ~ PROPOSED
/ DRY,WAY LOT 13
~ BLOCK I
LOT II t
BLOCK 1 20' SD EASEUENT r'-
_ _-_ -I-- ,
~ ~PROPOSED 100' W~LL
-HERITAOEx~H£1OHTS DRIVE-
CROSS VIEN ESTATES BLOCK 1, LOT 12 ~-c~x'..''' a
Anchorage, Alaska "~..'~'-~.' .,-,~ ~'-/i~ -'..-7..~.
Prepared Dy · ...................................... :.....~
~ICIt~l. N. AI~ERSON, P.~. ,...:..t..,~.z.:~..t.~.:.:~..:.~. ......
~'~UICHAEL N. AND£RSON.-"~.
4640 SHOSHONI DRIVE ~{ No. C~. 94£9
SCALE: 1"=50' MAy 14, 2009
)-~±
~ SEPTIC
PEoPOSED sE~c .E~~ ' ~; ' 1
PROPOSED R~E~E gE~ ~xx. ~z "~~ DOUBLE CO
m~ ~ PnOP~Ep
TANK co~~K~ ~
VACA~
LOT
PROPOS,D ~/ ~ m
= ~~/ m
LOT [2 ~// k X
-- iI ~
~o~ ~ ~ ,- ; Z .... L ..... / ,
BLOCK 1 / ~ ~ 20~SD ~E~E~
~ ~k ' ii
,~ k~ ~PROPOSED 1~ WELL
~/ / ',~ ~.~us .,
~ ~ v/ - H ERITAOEX~H EIO HTS DRIVE-
- - .-~ .......... I- -I .... ~-~_~: -
/
/ c~oss ~¢w ~stz~s s~oc[ z, ~o~ z3
~O~O SHOSHO~ DR~ ~MICHAEL N. ANDERSON~'~
(oo~) 3~o-33w / ~ (oo~) 3~o-~ooz
~;~...~~...'~.~
CO'1
Performed For:
Legal Description:
5-
6-
7-
8-
9-
12-
13-
14-
15-
16-
18-
19
20-
COMMENTS
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
~NW.Ci.anchoraqe.ak.us
(907) 343-7904
Soils Log - Percolation Test
Slope
Date,
'-k:'49LH-
N. ANDERSON
9469
ee.e®ee
Site Plan
ENCOUt g O
S
IF YES DEPTH? L
0
I~~---'~E P
Date: o~/~, ~/~F
~//~eading Date Gross Time Net Time Depth to Water Net Drop
#
b" ~,~,,
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND "~ FT
PERFORMED BY: ~/tI 4 ~ I CERTIFY THAT THIS TEST ~/AS ~'
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ ! ~//! ~
Performed For:.
Legal Descdption:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 EIn'~'e Road
P.O. Box 196650 Anchorage. AK 99507
www ci anchoraqe akus
(907) 343-7904
Soils Log - Percolation Test
L~. I~ I
1-
2-
3-
4-
5-
6-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
20-
COMMENTS
Dale'Performed: ~,~ .
Slo~ Site Plan
WAS GROUND WATER
ENCOUNTERED? ~ O
IF YES, AT WHAT DEPTH? L
Reading Date Gross Time Net Time Depth to Water Net Drop
611
~," O, -~"
PERCOLATION RATE (rnmu~es,',n~) PERC HOLE DIAMETER
TEST RUN BETWEEN ~'~ FT AND ~ FT
PERFORMED BY:,~J ~ ~ I CERTIFY THAT THIS TEST ~/AS ~'
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON ThIS DATE. DATE: ~ ! '~,//~
Performed For:
Legal Description:
5-
6-
7-
8-
9-
20-
COMMENTS
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 EImore Road I
P.O. Box 196650 Anchorage, AK 99507
wv~.ci.anchoraqe.ak.us
(907) 343-7904
Soils Log - Percolation Test
Slope
CE- 9469
Date Performed:
Township, Range, Section:
Site PI
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
Depth to Water After
Monitoring?
S
L
O
P
E
Readi Date Gross Time Net Time Depth to Water Net Drop
W
~ ~" ~,~,,
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER ~'
TEST RUN BETWEEN (,,~ FT AND ~_~, ~'"'- FT
PERFORMED BY: ~ '~J'~ J CERTIFY THAT THIS TEST V~/AS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
•
• Municipality of Anchorage Qr
On-Site Water and Wastewater Program ml I ;
(907) 343-7904 5 E T r
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 015-301-60 Expiration Date: /O 2-I O
1. GENERAL INFORMATION
Complete legal description _CROSS VIEW ESTATES BLK 1 LT 12
Location (site address) _5287 HERITAGE HEIGHTS DR ANCH AK
Current Property owner(s) _BRETT DUFOUR Day phone
Mailing address _SAME
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:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver/Variance request for: Distance:
Received by: OA Date: 7/2/V
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ C:2-6-' • Waiver Fee $
Date of Payment G/8/(B Date of Payment
Receipt Number „(45-1°6 Receipt Number
COSA# OSCMt V 3 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 MIKE N ANDERSON,P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON,PE Date 5/8/18
rte•\>•:-0, 9� ,
9
0.
+
It
�fO9CL •
0.7 990v JL Cu . .
6. DSD SIGNATURE el..0 9 C.D9>
System #1 Approved for bedrooms. �'.'c;->, CF: 9.69.
System #2 Approved for bedrooms , / ^,Y
. '�5 /Ya
Disapproved. i.._
w�=
Conditional approval for bedrooms, with the following stipulations:
-\N /1/
j ON-SITE
WATER ASD
WASTEWATER
PROGRAM
c.
~
By: t^^^- Original Certificate Date: 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 Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.00c
r
- 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 BLK 1 LT 12 Parcel ID: 015-301-60
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (YIN)Y
Date completed 7-28.10 Sanitary seal (Y/N)Y Wires properly protected (Y/N)Y
Total depth 187 ft. Cased to 187 ft. Casing height (above ground) 24"+
FROM WELL LOG AT INSPECTION
Date of test 7-28-10 5-1-2018
Static water level 130.27 ft. 130 ft.
Well production 15.0 g.p.m. 5.0+ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate �.(4g/L
Arsenic: ND ug/L Date of sample: 5-4.18 Collected by: Mike Anderson
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material_STEEL _ Date installed 7-30-10
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping 5-1-18 Pumper AROUND THE CLOCK
C. ABSORPTION FIELD DATA—
7-3 C9 (.0
Date installed - Soil rating (GPD/SF) 0.6 System type DEEP TRENCH
Length 140 ft. Width 3.0 ft. Gravel below pipe 6.0 ft.
Total depth 12 ft. Eff. absorption area 1680 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 5-1-2018 Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test 4 in. Water added 800+gal. new depth 8 in.
Elapsed Time: 1440 min. Final fluid depth 4 in. Absorption rate >=_800_g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-301-60
COSA # O
Expiration Date:
GENERAL INFORMATION
Complete legal description Lot 12, Block 1, Cross View Estates Subdivision
Location (site address) ...q~ '[ Heritage Heights Ddve Anchorage, AK 99516
Current Property owner(s) Brett and Laura DuFour
Mailing address P.O. Box 112415 Anchorage, AK 99516
Lending agency
Day phone
Day Phone
Mailing address
Real..Estate'Agent
Mailing Address
Unless otherwise Zequested, COSA will be held by DSD for pickup.
NUMBER'OF BEDROOMS: Five (5)
Day phone
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class __ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 new water sample results. (Certificates may be reissued for a pedod of up to 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 Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-sitter supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number~c~n'~ and type of structure indicated herein. I further verify theft based on the information
obtained fr[n~.:t~J~/~cipality of Anchorage files and from my investigation and irisPE~cti~on, the on-site water
supply ar~i~as~ewater disposal system is(are) in compliance with all applicable Munic~al,and State codes,
ordinances, ~nd regulations in effect at the time of installation. "~ ~
Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, p.E.
DSD SIGNATURE
~' Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 522-7773
Date 10/31/2011
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: //'"
(Rev, 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Lot 15, Block 1, Cross View Estates Subdivision
Parcel ID: 015-301-60
IfA, B, or C provide PWSID #__
Sanitary seal (Y/N) Y
Cased to 187 ft.
FROM WELL LOG
Legal Description:
A, WEL~ DATA
Well ~pe Private
Date C,0mpieted 7/28/2010
Total depth 187 ft.
Date of test 7/28/2010
Static water level 130.27
Well production 15
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: N/D mg/I
B, SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,500 gal.
Foundation cleanout (Y/N) Y
Date of pumping New Construction
C. ABSORPTION FIELD DATA
Date installed 7/30/2010
Length 140 ft.
Total depth 13-18 ft.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) __
AT INSPECTION
g.p.m.
Nitrate 1.12 mg/L
Date of sample: 10/18/2011
g.p.m.
Collected by: MEA
Number of Compartments Two..
Depression over tank (Y/N) ~
Pumper
Date installed 7/30/2010
Cleanouts (Y/N) Y
N High water alarm (Y/N) N
Soil rating (g.p.d./~ or ~/bdrm).6 GPD/SF
Width 3 ft.
Eft. absorption area 1,680 ft2 Monitoring tube
Date of adequacy test New Const. Results (Pass/Fail) __
Fluid depth in absorption field before test in. Water added
Elapsed Time: ~ min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
>24
Y
in.
System type Deep Trench
Gravel below pipe 6 ft.
Y Depression over field N
For bedrooms
~ gal. New depth in.
in. Absorption rate >= g.p.d.
If yes, give date
LIFT STATION
Date installed
"Pump on" level at
Datum
in.
Size in gallons
"Pump off" level at
Cycles tested
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station ,on lot >1oo'
Absorption field on lot >1oo'
Public sewer main N/A
On adjacent lots >1oo'
On adjacent lots >1oo'
Public sewer manhole/cleanout
N/A
Sewer/septic service :line >25' Holding tank N/A
Animal containment areas >50' Manure/animal excrete storage areas
SEPARATI(
Building fou~
Water main
Wells on aC
SEPARATI~
Property line
Water Servi~
Curtain drai~
COMMEN1
ENGINEEI
I certify the
review of
conformanc
Engineer's
Date
COSA Fee $
Date of Payme
Receipt Numb{
(Rev. 11/05)
~N DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
ldation >5'
N/A
acent lots >1oo'
Property line >5'
Water service line' >1o'
)N DISTANCE FROM ABSORPTION FIELD ON LOT TO:
>10' Building foundation >1o'
~e line >1o' Surface water >1oo'
None Noted Wells on adjacent lots >1oo'
S:
>1oo'
Absorption field >5'
Surface'Water >1oo'
Water main >10'
Driveway, parking/vehicle storage >25'
I have dete~in~ though field inspe~ions and
~unicipal m~s that the above systems am in
w~h MOA COSA guidelines in effe~ on this date.
Name Michael E. Andemon, P.E.
'anted
Waiver Fee $
~t IO[ 3 ~ ~ [ ~ Date ~ Payment
~r O~[~ ~ Re.apt Number
LOT 11
b
N 89'47'24" E
159.28'
10' T & E Easement
LOT 12
BLOCK I
CROSS VIEW ESTATES (2006-171)
Clea (myp.
/-- Retaining
Cone. Block C~
Retaining Wall ~
~ ............................ 0 0
o
0
... PCC
~2.9~ 5 5 2.3
Fo/;-'- X~:' , 367
?~"~ 2 Level Wood
Frame Residence on
:: Concrete Foundabon
~ ~,.~ w/Pa~ a Day Light
~::~, ~.7' Basement
/
wing b o
W~il ~
20'
.~- -.~.--~Step ~ i Decorative
/' Sidewalk
covered
Entrance
Storm Drai Easement /
N 89'54'15" W
HERITAGE HEIGHTS DRIVE
SCALE: 1"=30'
O' 15' 50' 60'
LOT 13
10' x 40'
Gas Easement
Fd. 1 1/4" Yellow
Plastic Cap on
5/8" Rebar (Typ.)
NOTE:
Distances are to the house trim.
I hereby certify that an accurate survey of the following described
property:
LOT 12, BLOCK 1
CROSS VIEW ESTATES (2006-171)
was made on October 19, 2011 and the[ the improvements
improvements on the property lying adjacent thereto encroach on
the premise~ in question ~nd that there are no roadways,
transmission lines or other vis~ble easements on said prope~y except
as indicated hereon. Easements other than those shown on the record
plat may not appear on this drawing.
Anchorage Alaska, this 23rd day of October ,2011.
PREPARED FOR:
BRETT & LAURA
DUFOUR
AS--BUILT
OWN. DAT~ GRID
~ 10/23/2011 SW 27,.t'7
FqLE NO, F.B. 201'$ JOB NO,
1152 :PG, 46 1145
KARABELNIKOFF
