HomeMy WebLinkAboutAUDUBON HILLS BLK 2 LT 4Audubon H il Is
Lot 4
Block 2
¢015- 231-54
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Name:~ L:"/~ ~ ~)/~L : '~:, ~;~'~H Wastewater System:D New ~'Upgrade
Addres~. '~ <'~ ABSORPTION FIELD
Phone:
Bedrooms:
_ ~ ... ,~ eepTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION SoilRating: ~ ~-- GPD/Sq. Ft. Total Depth from original grade:~ ~.-~
~ ~umber of linos: Distanco ~etween
Classification (Privato, A,B,G): Total Depth: Cased To: Total absorption area: ~S Pipo material:
Driller: DateDrilled: StaticWaterLevek Installer: ¢7 / Dateinstalied~', ~ _ ~ /,~.~
Yield: GPM ~ Pump Set at: Ft. Casing Height Above Ground:Ft. TANK
I
SEPARATION DISTANCES ~ septic ~ Holding D S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines
Material: Number of Compartments:
Surface
Water ~ ---- ~ LIFT STATION
LineL°t ,~..~ ~ ~ Size in gallons: ~ Manufacturer:
I
Curtain ~ . ~ Pump Make & Model I Electrical Inspections pe~ormed by:
Drain
I
Remarks: BENCH MARK
Assumed Elevation:
ENGINEER'S SEAL
Department of .ea~nd .uma~ervices appr~al/
Reviewed and approved by: ~~ ~~Date: ~[[~ [~ '-~-
72-013 (1/91) MOA 25
TU~BEN SPURKLAN~ F~.F, LOT 4 BLOCK 2 AUDUBON HILLS
~o~ ~ 15T~,
ANCH, AK, 99501 SEC, ~ ~l~N R3W 3ATE, JULY ~ i993
~7~ ~7~-2~1h JDSEPH KUYKEN~ALL. P.~ ~gZ ~30688 SHEET: 8/3 GRID, 8739
~ ~7
,
~ l~oni~or Clean £uL ~~
Cern
3 ~ DIYE~TI~N ~AL
3~ ~/de
' ~ LonQ
10~ Deep ~ .
4~ ~e~er Rock
5,5~ Cover
Cleonouts ~Non~or
93,4 , ~3, -
~/ro~/ 140 --;; ~ :: ~ :: ~ .~ .~
/
~250 gal septic tank
EX[S
NO SCALE
82
TB~EN SPURKL~N~ P,E, LD~ 4 3LDCK 2 AU3U3DH HILLS s~c s~s~.
~03 WlSth ~ve SECTION ~7 T~N ~2~ ~TE: JUL T
Anchorage Ak 99501 JDSEPH KUYKENDALLr AD BDX ~30688 SHEET:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE , 1 OF 1
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMB~R:SW930188
DESIGN E~GINEER:TOBBEN SPURKLAND~ P.E.
OWNER NAME:KUYKENDALL JOSEPH L &
OWNER ADDRESS:P.O. BOXY230688
ANCHORAGE AK 99523
DATE ISSUED: 6/28/93
EXPIRATION DATE: 6/28/94
PARCEL ID:01523154
LEGAL DESCRIPTION: AUDUBON HILLS BLK 2 LT 4
LOT SIZE: 51100 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT:
3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENGINEER MUST PROVIDE SLOPE INFORMATION ON THE AREA WHERE
THE REPLACEMENT TRENCH IS BEING CONSTRUCTED. THE EXISTING
SEPTIC TANK MUST BE EXPOSED AND INSPECTED FOR INTEGRITY AND
MUST BE .
REPLACED IF FOUND TO BE I~ POOR CONDITION
RECEIVED BY: ~
ISSUED BY: ~'~-~ ~%d~.~
DATE:
DATE:
LOT
T- SPURF~LAND F'- E-
205 W 15th. Avenue, Suite 206
ANCHORAGE, ALASKA 99501 (907) 279-5916
SEPTIC SYSTEM DESIGN
4 BLOCK 2 AUDUBON HILLS
JOSEPH KUYKENDALL
Ground Water at 15 Ft
Use Standard Trench
Soil Rating. From test June i7, 1995
I min/in =1.2 gal/ft.sq.
Required Area per Bedroom:
150/1.2 = 125 sq.ft..
Testhole Total Depth 15.5
Less 6 feet 9.5
Less 4 ft. Cover 5.5
Rock Depth 5.0
Number of Bedrooms 3
Length of Trench 3 x 125 / i0 = 37.5 Ft.
SYSTEM CONF I GUR~T I ON
STANDARD TRENCH
TOTAL LENGTH
TOTAL WIDTH
TOTAL DEPTH
ROCK DEPTH
COVER
40 FT.
3 FT.
10 FT.
5 FT.
5 FT.
SEPT. IC TANK 1250 GAL. EXISTING
INSTALL DIVERSION VALVE TO EXIST-
ING TRENCH
The installation of this septic system will not prevent wells
from be installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage
courses on this or the adjacent lots.
The proposed septic system will not change the general slope of
the area. Ponding and/or concentration of surface runoff will not
result from this installation.
The existing system was installed in 1978. It has failed and the
tank is being pumped every 5 days. The design of the system was
based on a soil rating of 85. Testhole excavated in the vicinity
of the existing trench showed a dense silt with a very slow
percolation rate. Three other testholes did identify a stratum
of sand with a percolation rate between I and 2 minutes per inch.
The three testholes defined a location for an upgrade and veri-
fied that the sand was present all through the area to be used.
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)
DATE PERFORMED:
Township, Range, Section:
SLOPE
SITE PLAN'
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT
DEPTH? I p
Depth to Water Alter~ __..,
Monitoring? ~_~ Date:
Gross Net Depth to Net
Read i ng Date Ti me Ti me Water Drop
PERCOLATION RATE >~1~'~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN __
FT
PERFORMED BY: ~j, r- i
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)'.
DATE PERFORMED:
LEGAL DESCRIPTION: L~"~ ~ [~:~[L ~)~ Township, Range, Section:
1
2
3
4
5
6
7
8
9
10 WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
12 DEPTH? ~ p
E
rlepth to Water Alter
13 Monitoring? ! ~:~ Date:
14
15
16
17
18
19
2O
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __
TEST RUN BETWEEN __
(minutes/inch) PERC HOLE DIAMETER __
FT AND __ FT
COMMENTS
PERFORMED BY: i
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)
PERFORMED FOR:
LEGAL DESCRIPTION: L~ L~
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
S;t+
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER N ~.~
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth to Water Alter
Monitoring? Date:
Gross Net Depth to Net
Read i ng Date Ti me Tim e Water Drop
~ .~o
~ 7 'I~
PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ ¢?- FT AND ~ FT
COMMENTS
PERFORMED BY: 4"~ ~"~ I ~t't~-'~
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
(ENGINEER'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
Township, Range, Section:
2
4
o
12
14
~7
18
19
2O
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
Depth to Water Alter
Monitoring? Date:
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN __ FT AND __ FT
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY~AT THIS TEST WAS PERFORMED IN
I I
SPURKLAND
P,E,
803 W ~STH, ~VENUE
~NCH, AK, 9950~ ~EC. ~3, TJ~N ~3~ ~ATE, JUNE ~4. l~3
f,flT~ 27~-2~1~ JOSEPH KUYKEN~ALL, P,~ BOX 230588 SHEET~ I/3 GRIB, ~739
I I I I
r ~.. EXIST, TRENCH --~\. ~erc g4 :
I,
Tn~BEN SPU~KLAND P,E, LOt 4 ~ ~ ~ON HILLS SEPTIC SYSTEM DESIGN
~03 V I~TH, AVENUE
ANCH, AK, 99501 SEC 2~ rlBN ~3~ DATE, JUNE 24, 1993
(qnT~ ~-~]h JOSEPH KUYKENJALL. P.O BOX ~30688 SHEET: ~/3 GRID: ~739
Monitor Cleon £u~_
'~ C/eon Out
--j- ,,
3 9IVE~TI~N VALVE
Y W/de
40' Long
10' Beep ~ --.'-' -
4.5' Covem , ..-:-...'
~Mon, t or
5 ~t o~ Septic Rock /
1250 ~ L septic ~onk
EXIST]N5
ND SCALE
TDg~EN SPURKLAND P.E, LOT 4 ~LDCK ~ AUdUbON HILLS SE.nC
~03 ~Sth Ave
Anchorage Ak 9950] ~ECT~Dfl ~7 T]~N ~3~ DATE, JUNE ~4~ I~3
~"-~1~ JDSEPH KUYKENBALC P,~ 9OX ~30688 SHEET, 3/3 6R~, ~739
i ~' MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
LEGAL DESCRIPTION
LOCATION ,~ ~::)Xk ~ C,
I~ell ~ AbsorPtion area Dwelling
~ ~)' Material .... . No. of compartments
Liq. capacity in gallons Inside length Width Liquid depth
~ DISTANCE TO: Well ~5' j ~ Dwelling PERMIT NO.
~ -- ~ Manufacturer Material Liquid capacity in gallons
Q ,Well Foundation Nearest lot line PERMIT NO.
~ Z DISTANCE TO:
~ ~ ~ No. of lines Length of each line Total length of I nes . _ Trench width Distance between lines
~ Top of tile to finish grade ~ Material beneath tile Total effective absorption area
Width Depth PERMIT NO.
Length
~ ~ Type of crib i meter Crib depth Total effective absorption area
m II Building foundation Nearest lot line
~ DISTANCE TO:
~lass Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OT H E R
PIPE MATERIALS
~1~ ~ST ~TI~
INSTALLER
REMARKS ~ . / ~!'~ I 'C~
..~ ~ ..,~
'~.'~
_~,., ¢~ -
APPROX. ~ < ,', ,~ATE, LEGAL
%% '..-',
72-013 (Rev. 3/78)
F'ERMIT NL].
P1 L! ~4 I F: I II~ L I -I- "'r' L--! F F! ~-~ C: H
DEF'RRTMENT O~IIR4ERLTH RN[: EN, IF_NMENTHL
,'---,':--"5 "L" STREET, RNCHOF.'.FtGE, B~.'::.
264-4?20
[-I E L L. ~---~ t-~ E:. C~ t-I ---
,:: ? :--: FI F, ::: ? ',
RF'F'L i CFIN'I"
LOL':RT I ON
LEGFIL
B. E.C. CI]NSTRLIC:TION
FtLIDUBON L-: I RF:LE
L~ E:2 ~UDLIBF~N HILLS
F'O BOX 6-502
LOT SIZE
ST ! ON
Y' F.£ F-." hl I -r~. -7 .j ~ _.?,~
[;_.: ? ~ ?.":,.-:, .--x----'
540R0 SC!LIRF.:E FEE"F
TYPE IEIF SOIL RE:SORE:TION SYSTEM IS' TF.:ENE:H
f'lFl::.:: t MUM NUME:ER OF BEDR_- OMS = 3:
SOIL F..HTIN.~ (SQ FT,--"BR:: ........
THE REC!LIIF.:ED SIZE r'~F THE SOIL RE:'=;nF. tF'TInN S'T'C;TEM IS'
r:, E F' '1'- 1-4 = :1_ ¢---~ L E N g T H = 2 '2 L3 F-: Ft '-.-' E I_ E:, E F' -r ~4 =:
THE LENGTH DIMENSION lC; THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE D ISTRNCE E,'ETWEEN THE SUF.'.FRCE OF THE
GROUND RND TFIE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
'THE GRRVEL DPPTH IS THE f'IlNIfdLIM DEPTH OF GRRVEL BETHEEN THE OIJ'rFRLL F'IF'E
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
Fi: [--:: C! L! I F-: E [:, S E F' T I ,:: T FI !'-.I i<: S I Z E = -~ nZ~ F~ L_ IL_ ,.CB
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPFIRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RN'¢ WELLS R[:,JRC:ENT TO THIS PROPERTY RND 'rilE
NUMBEF.'. OF RESIDENCES THRT THE WELL WILL SERVE.
-l- I..-,.i C~ ,:: 2 ::, I f-J S F' E C: T I C, f-~ S FI F-: E F-: E C-! !_! I F-: E [:,
BRC:KFILLING nF RN"r' SYSTEM HITHF~UT FINRL INSPEC:TION FtND RPF'Rn'v'FIL E,'"r' THIS
[:'EF'RRTMENT WILL BE SLIB..TECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RN9 ON-SITE SEHRGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE WELL~ OR
±50 TO 200 FEET FROM R PUBLIC WELL DEPEN[:,ING UPON THE TYPE OF PUBLIC WELL
WELL LOGS RRE REQUIRED RN['., MUST 8E RETURNED TO THE DEPRRTMENT WITHIN .--;0 DRMS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY RPF'L'¢. SPECIFIC:RTIONS RND CONSTRUCTION [:,IRGRRMS RRE
FI',,,'RILRBLE TO INSURE PROPER INSTRLLRTION.
F' E F-: f-1 I T E >:: F" I F-: E S [:, E C: E M E: E F-' ":~< :1_ _. 1. :9- 7'
I CERTIFY THRT
±: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWEF.'.S RN[:, HELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNE:E WITH THE CODES.
2:: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 2: BEDROOMS.
-?]PPLIr:RNT B. F_/C:.~ CnNSTRLICTION
I SSLIED E,'. -~~-__~~ '_E:,FtTE_7- 7'~' ?~'
CONSULTING GEOLOGIST
BOX 476-~4, STAR ROUTE A · ANCHORAGE, ALASKA 99507 · PHONF 344-7071
SOILS LOG
= 1_0
-,-I
~ 12
14
16
18
20
Soil Type Water Level Remarks
Total Depth of Excavation
Groundwater
~ot Reached
Depth, if Reached
Classification Method
~Visual
( ) Sieve Analysis
()
IG
Material at Total Depth
Bedrock
~)~Not Reached
Depth, if Reached
Gary F. Player, Consulting Geologist
d
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
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-231-54
COSA# C~F'O ~-' '1 ~ \ :~'¢~~
Expiration Date: / -~' ~,- i/
GENERAL INFORMATION
Complete legal description Lot 4, Block 2, Audubon Hils Subdivision
Location (site address) 12361 Audubon Circle Anchorage, AK 99516
Current Property owner(s) Michael and Laura Dagon
Mailing address 12361 Audubon Circle Anchorage, AK 99516
Day phone
Lending agency
,Mai,ling address
Rea'l E~tate'Agent
,: i. Mailing Add'ss..
UnleSs oth¢rwis& requested, COSA will be held by DSD for pickup.
2. 'NUMBER OF'BEDROOMS:
3. TYPE" OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class Well []
Public Water System []
Three (3)
Day phone
Day phone
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 period 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-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.
DSD SIGNATURE
¢,~ Approved for
Disapproved.
bedrooms.
Date 8/21/2011
· ' ee~,
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ! ~ ;~?~- - / /
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmora Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 4, Block 2, Audubon Hills Subdivision
A. WELL DATA
Well type Pdvate
Date completed 9/78
Totaldepth 211 ff.
Bm
Date of test
Static water level
Well production
Parcel ID: 015-231-54
If A, B, or C provide PWSID # ~
Sanitary seal (Y/N) Y
Cased to 63 ft.
FROM WELL LOG
9/78
69 ft.
5 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: N/D ug/I
SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Fiberglass
Tank size 1,250 gal.
Foundation cleanout (Y/N) Y
Date of pumping 8/26/2011
ABSORPTION FIELD DATA
Date installed 6/93
Length 57 ft.
Total depth 10 ft.
Nitrate N/D mg/L
Date of sample: 7/15/2011
Number of Compartments Two
Depression over tank (WN) N
Pumper Isaacs Honey Wagon
Soil rating (g.p.d./ft= or ft2/bdrm) 1.2 GPD/SF
Width 3 ft.
Eft. absorption area 570 fi2 Monitoring tube
Well Log (Y/N)
Wires propedy protected (Y/N)
Casing height (above ground)
AT INSPECTION
5/11/2011
47.6 ft.
3.6 g.p.m.
Date of adequacytest 5/11/2011 Results (Pass/Fail) Pass
Fluid depth in absorption field before test 46
Elapsed Time: 1,248 min. Final fluid depth 46
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Y
Collected by: B. Hippe
Date installed 7/78
Cleanouts (Y/N)
High water alarm (Y/N)
Y
Y
>18
in.
N
System type Deep Trench
Gravel below pipe 5 ft.
Y Depression over field N
For 3 bedrooms
in. Water added 512 gal. New depth 53 in.
in. Absorption rate >= 450 g.p.d.
N If yes, give date
LIFT STATION
Date installed
"Pump on" level at~
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off' level at ......
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankJlift station on lot >100'
Absorption field on lot >100'
Public sewer main N/A
Sewer/septic service line >25'
Animal containment areas >50'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >1oo'
On adjacent lots >lOO'
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
Absorption field >5'
Surfaco water >1oo'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main >10' Water service line >10'
Wells on adjacent lots >lOO'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >,~' ~'" Building foundation >10'
Water Service line >10'
in.
Curtain drain None Noted
F. COMMENTS:
N/A
> 100'
Surface water >100'
Wells on adjacent lots
>100'
Water main >1o'
Driveway, parking/vehicle storage
>10'
G. ENGINEER'S CERTIFICATION
' certify that l have determined through field inspections and
review of Municipal taco.s that the above systems am in
confo~ance with MOA COSA guidelines in effect on this date.
c.~ .... '= D~.+=a ~m= Michael E. Anderson, P.E.
Date 8/21/2011
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
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10' UTILITY EASEMENT
NOO°O3'24"W 301.59
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CHICKADEE SLOPES SUBD.
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Municipality of Anchorage
P.O. Box 196650 · 4700 Elmore Road
Anchorage, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997
..ht. tp:llwww.muni.or,qlOnsite
Development Services Department
On-Site Water and Wastewater Proqram
~epartment
**** VARIANCE/WAIVER REVIEW ****
WR#: osp111282 HA#: osc111322
PID#: 015-231-54
Legal Description: Audubon Hills BIk. 2 Lot 4
Engineer: Anderson Engineering
Permit#:
Applicant: Michael and Laura Da.qon
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 4.0 feet.
This waiver approval applies to the existing absorption field to property line separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
Waiver is Granted: X Waiver is not Granted:
Date:____10/7/2011 Ap provedby: ~/~/~ ,./~O~
.. .... ....................................... ~..~.~°.?.v.'5~.r..................
ReCl, f¢: Amount:///,/O Date Paid:
**** VARIANCE/WAIVER REVIEW ****
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
September 2,2011
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject:
Lot 4, Block 2, Audubon Hills Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
The existing absorption trench on Lot 4, Block 2, Audubon Hills Subdivision was
constructed approximately 4' from the southwest lot line in 1978. The trench may be
used in the future for effluent absorption. No conflicts exist between the absorption
trench and wells on this or neighboring lots. We hereby recommend a lot line waiver be
issued allowing placement of the absorption system within 6' of the south lot line.
Sincerely,
Michael E. Anderson, P.E.
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 01 5-231 -54
1. GENERAL INFORMATION
Complete legal description
Expiration Date:
Lot 4, Block 2, Audubon Hills
Location (site address or directions) 1 2361 Audubon Circle
Current Property owner(s)
Mailing address
Tom and Naida McGee
12361 Audubon Circle
Day phone 345 - 301 8
Anchorage, AK 99516
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Three
Well
(3)
TYPE OF WASTEWATER DISPOSAL:
::~ Individual On-site
[] Individual Holding Tank
[] Community On-site
[] Public Sewer
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority 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 less than 30 days old. 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.
72-025 (Rev, 01/00)'
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 Health Authority Approval Guidelines for the Health Authority Approval
application show that the on-site water supply and/or wastewater disposal system is 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 in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
NameofFirm Anderson Engineering
Address P.O. Box 240773 Anchoragar AK
Engineer's Printed Name Michael E. Anderson, P, E,
DHHS SIGNATURE
P-'" Approved for ~ bedrooms.
Disapproved.
Conditional approval for
Phone 522-7773
99524
bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date:
Original Certificate Date:
Reissue Date:
75-025 ~Rev. 01/00)'
OCT ~
Well Legt ¥
ff
g;p,m
8/2.6/O0
4'5
ff
g~p~m
...: :.~:~.:at~....~m:
Pumper ': '"~" :'"' aa~o .... Rooter
in.
g.p.d.
if yes~ give.~', N/A
· :2,-026 (Re~.~t,,/e~)}
D. LIFT STATION - N/A
Date installed
Size in gallons __
Manhole/Access
"Pump on" level at __
Datum
in "Pump off" level at __ in
Cycles tested
E. SEPARATION DISTANCES
High wat~ alarm level at __ in
Meets alarm & circuit requirements
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot > 1 0 0 '
On adjacent lots > 1 0 0 '
Absorption field on lot
> 1 0 0' On adjacent lots > 1 0 0'
Public sewer main N / ~.
Sewer/septic service line > 25 '
Public sewer manhole/cleanout
Holding tank N/A
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation > 5' Property line > 5'
Water main N/A Water service line
Drainage > 1 00' Wells on adjacent lots
Absorption field
Surface water
>5'
>100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 1 0 ' Building foundation > 1 0 ' Water main N/A
Water Service line > 1 0' Surface water > 1 0 0' Driveway, parking/vehicle storage > 5 0 '
Curtain drain None Noted Wells on adjacent lots > 1 0 0 '
F.
COMMENTS
Bottom of Monitor Tube is 4.5'
Diversion Valve With Original
ENGINEER'S CERTI'FlCA33ON
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson ~ P.E.
Date 1 0/23/00
HAAFee $ ~ ~ --'Zr'~
Date of Payment ,/D/~-- ~--~/~
Receipt Number ~'(~ ~'..~ ~/~/
Below Distribution' Line._~__ .~e~m~~has a
Absorption Trench On~~~~~
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 01/00)*
September 6, 2000
Tom and Naida McGee
12361 Audubon Circle
Anchorage, AK 99516
Subject:
Lot 4, Block 2, Audubon Hills Subdivision
Well and Septic System Inspection and Certification
Dear Tom and Naida:
We recently completed the inspection and testing of the well and septic system on Lot
4, Block 2, Audubon Hills Subdivision. Prior to the inspection we reviewed the files on
both systems and found the original septic system and well on the lot were placed in
September of 1978. The original septic system was composed of a 1,250-gallon
Sunset fiberglass septic tank and a 25' long by 2.5' wide by 6' effective depth
absorptiOn trench. This system apParently failed in 1993 and was upgraded in June of
1993 with a new absorption trench. The septic tank was not replaced and no
information could be found as to whether the tank was uncovered and inspected during
the upgrade in 1993.
The as built for the absorption trench placed in 1993 contains conflicting information
regarding the dimensions of the trench. The summary sheet indicates a gravel depth
beneath the distribution line of 4'. The actual drawing of the trench and the permit
issued for its construction state 5' of gravel beneath the lateral. My survey of the trench
indicates the monitor tube elevation is approximately 4.65' below the lateral, which
probably means the effective depth of the trench is closer to 5'.
A flow diversion valve was placed in the system in 1993, which allows use of the
original and new trenches depending on the orientation of the valve. It appears the flow
has been continuously to the new trench since 1993. At the time of my inspection I
found 3.65' of water in the trench indicating the trench is approximately 78.5%
submerged. I then pumped 450 gallons of water in the trench to check the absorption
rate of the remaining free board on the sidewalls. The water level in the trench rose to
4.5' after the water was injected. An hour later the water level had dropped to 4.15' and
the next day the level was back to its original level of 3.65'. The trench is therefore still
capa'ble of absorbing ~at least 450 gallons of water I~er day, which is required for a
three-bedroom house.
Lot 4, Block 2, Audubon Hills
September 6, 2(t00
Page Two
The absorption trench is therefore operating in conformance with Municipal standards
and eligible for a Certificate of Health Authority. It must be noted, however, the trench
has been subjected to heavy use and is nearing the end of its useful life. The trench
can be rejuvenated, however, and its useful life extended if the diversion valve is
reoriented to allow flow to the original trench for an extended period of time. It is not
possible to determine if the rejuvenation of the new trench will be total or partial, but
some extension of its useful life will occur.
The as built of the septic system completed in 1993 indicates the presence of a
foundation cleanout and a monitor tube at the end of the original absorption trench. I
could find neither of these vents during my inspection. These vents must be found or
replaced before the certification can be issued. I have enclosed a copy of the as built
for your use in the finding or replacement of these vents. Please let me know when
these vents are located so I may verify their presence.
The static water level in the well was measured at 45' below the surface. Water was
then allowed to flow through an exterior hose bib at unrestricted flow. The flow rate
was initially measured at 6.9 gallons per minute and continued at that rate for the
duration of the test. The well production rate is in excess of the Municipal requirement
of .31 gallons per minute for a three-bedroom home.
In summary, the absorption trench is nearing the end of its useful life, but is still capable
of absorbing the required 450 gallons of water per day. The trench can be revived if the
flow from the septic tank is diverted to the original trench for at least a year. The old
trench should be monitored during that time to assure it is absorbing the water. The
new trench should also be monitored for signs of drying out and rejuvenation. In
addition, the foundation cleanout and monitor tube for the old trench must be found and
replaced if necessary. A copy of the as-built showing the location of these vents is
included for your use. Please let me know if you have any questions.
Sincerely,
Michael E. Anderson, P.E.
Attachment
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska
343-4744
99519-6650
CERTIFICATE OF HEALTH AUTHORITY
.............. .. ,APPROVAL FOR A SINGLE FAMILY DWELLING
1.- GENERAL INFORMATION
' Complete, legal'description
A,J'bo~5o~ ~1 L.LC..
'~'~ E~O~ati~ (?e address or directions)
~' : ':¥ ~,~,,~:~,~:~2'. ': ' t : . ' t:'~ ":'::": ?'~'~":~'? 7~
. .: .-,,.:.:::.,~ ........ written confirmation from State ADEC attest-
-5:':~7' ':;~'::'-: NOTE::~' If community"w~stewater system, provide written con
5. STATEMENT OF INSPECTION BY ENGINEER *." *
'~ ' .... ~ ati Wn Iven~that
As ce~ified by ~y seai h;~et° andas of the valid on date she below.
investigation of this Health Authori~ Approval application .shows that the on-site water supply
an d/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
an d type of structure indicated herein. I fu~her veri~ that based on the information obtained from
the Municipali~ of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Address ~LO
Engineer's signature
Phone
Date
.Conditional
:,,~. , ............ ~;~ ~.~.:~ bedrooms, w~th the follow,no ::stmulat~on~~~
Date -
~; ~e, Muh~p~.. of ~'.o/age Depa~ment of Health and Human Se~mes DHH) ' ' ~ _:
, . ( S ~ssues Health Auth~r~ .....
· "A~oroval C~flcat~ased only upon the repr~entations, iven-in .... ' ....
~ . ,.~ -,~,..... ,,- .%w.¢ :.~... ................. · g . paragraph 5 above b an ~nde endent~-:-.~
... ,pr~i~9~l engr~r~,ste~ in the s~te 0f AI~a'' The'DHHS'~0~s this as a c°U~e~*~ ~..~--- ~
. an~,~,r~nUmg ~st~t~t~ons m orderto ~t~ce~in f~deral and stato m uimmenB ..........
., cOqauc~n mspecaons, or.~ anm~e~aa~a,....~...~,-,.~f°m.., a ce~ificate is i~ued The Municipali~ of Ancho~ge ~s' not '
- ... ~s~ or emotions ~n ~,be professorial engin~¢s work. ',::~:. :;:: : ",.. ,.: ;,: .... · : .,.
Mun,ci~ai~i~ ~ Aflchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
Health Authority Approval Checklist
Legal Description:
A. WELL DATA
Well type ~
LoT W~
If A, B, or C. attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date completed
Cased to ~, .~ ~
Casing height (above ground)
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date oftest I°/z-/Zg
Static water level ~ ~ ~,
Well production ~-~ g.p.m. ~, ~
WATER SAMPLE RESULTS:
Coliform ¢
Date of sample: ~.///¥/qd"
Nitrate
Collected by: ~ ~ ·
B. SEPTIC/HOLDING TANK DATA
Date installed ! ~37oe~ Tank size /c~:.,~,O Number of Compartments ~ Cleanouts (Y/N). 7~/
Foundation cleanout (Y/N) ~ Depression (Y/N) IX{ High water alarm (Y/N)
Date of eumping ¢¥/qa~/ Pumper d~)/td4~7/~ ~vq~//4
ABSORPTION FIELD DATA
Date installed {"/4/~ ~ Soil rating (g.p.d./ft: or ft:/bdrm) /~ ~- System type '--~--~
Length ~' .~ Width ff.._ Gravel thickness below pipe ~'/ Total depth
Effective absorption area
Date of adequacy test ~/5//q6'- Results(Pass/Fail) ~ For
Fluid depth in absorption field before test (in.); / iD Immediately afterD"~O gal. water added (in.):
Fluiddepth ~- ¢~ Minutes later: ~)~b9 ~) Absorption rate = >~t5"O-(23 g.p.d.
Peroxide treatment (past 12 months) (Y/N) Ix'~ If yes, give date
Monitoring Tube present(V/N)& Depression over field (Y/N) /%/
bedrooms
II
Fo
LIFt STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Size in gallons
"Pump on" level at*
*Datum
"Pump oft" level at*
· On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation o9--{5) Property line oQ (~ Absorption field
Water main/service line ~/o-C> Surface water/drainage N/[O Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ~ Water main/service line ~>
Surface water f /"/t/rD Driveway, parking/vehicle storage area
Curtain drain r'-{/C> Wells on adjacent lots
ENGINEER'S CERTIFICATION
records~t
I certify that I have determined thrufield inspections and review of Municipal
in conformance with MOA [-LdA guidelines in effect on this date·
Signature
HAA Fee $
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHOP~GE
' ~ DEPT. OF i:~.**LT;-{ &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONI~VIRON/~'E
825 L Street ~ Anchorage, Alaska 99501 . ' .'.ENTAL', P::.O ':.'£CTION
' ENVIRONMENTAL ENGINEERING DIVISION APR 1 9 1979
Telephone 264-4720
DIRECTIONS: Complete a lipa,. PROPERTY OWNER rts on page ,. lncomplete
MAILING ADDRESS
PROPERTY RESIDENT (If different frCm above) PHONE
2. BUYER PHONE
M~I LING ADDRESS
MAILING ADDRESS ' % - ~ - -
4. REALTOR/AGENT
~ PHONE
M~ILI~G ~DD~fiS8
5. LEGAL DESCRIPTION
STREET LOCATI OKI
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
1~ SINGLE FAMILY [] One [] Four
[] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
8. ~EWAGE DISPOSAL SYS, EM
\
[] Other
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attaCh log if available.)
~ INDIVI DUAL/ON-SITE** **If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
[] PUBLIC UTILITY by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SiX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic_Tank or [] Holding Tank
Size: J~3-~-~) If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTUR ER~L~~
MATERIAL
5. COMMENTS
[~;~PPROVED
FOR ~" BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
LEGAL DESCRIPTION
' BY (Title)
72-010 (Rev. 3/78)
