HomeMy WebLinkAboutAUDUBON HILLS BLK 2 LT 6AAudubon Hills Block 2 Lot 6A #015-235-02 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 PHONE J'-I UPGRADE AI',.GADD.ESS 9.o,%o LEGAL DESCRIPTION tlq. ca acit in gallons Inside length Width ~ ~ DISTANCE TO: I Well k ~ I Dwelling PERMIT NO. g ~ ~ Manufacturer [ ~ ~ Material Liquid capacity iff ~ ~ ~ T~ of tiZe to finish grade i Materiel beneath tile 0 ~ I ~ ti ~ I ~ il Total elf~ti~absorption are~ inches OTHER m I ~ ~~ ~ ''~ '~ 'I~ Lo / PERMIT NO. RF'F'L I C:RNT LOC:AT I ClN LEGAL ' I'-ILII'-,I T C: 1. t-- -:IL ][ T"-r' C~F DEPARTMENT O~ ,.-IEALTH AND ENVIRONMENTAL F,.JTE'C:TION '=":" P;,_, ~ ._ '"L '" STREET., ANCFIORFIGE., BK. .... ¢: _,4-'4 ,' .-'0 L-J E-- L L. R r'4 []' I_.~1 r'4 -- ."S 1. ':: 780586 ) B. E.C. CONSTRUCTION AUDUBON CIRCLE L6 B2 AUDUBON HILL PO BOX 6-502 LOT SIZE 54800 SQUARE FEET 'T'YPE OF SOIL RE:SORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SO I L RAT I I'.,IG ,.'. SQ FT,-"BR ) = 125 THE REQLIIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:, E F' -r H = L-~: L E I'-~ t_3 T H = 4 7 t]i R R '-.-" EZ L [:, E F' 1- H = -4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET]:, OF THE TRENCH OR DRFtlNF!ELD. THE DEPTH OF R TRENCH OF.'. PIT IS THE DISTANCE BETWEEN THE SURFFICE OF THE GROUN[:, AND THE 80TTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WI[:,TH FOR TRENCHES. 1-HE GRR'v'EL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F:E(::!LI I F-:E[:, SEF'T I mS: T R !'-,I k:: S :[ ZE = i ES FI L, L. C~ l'q F'ERMI]" APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DLIRING 'THE INSTALLATION INSPECTIONS FIF AN'~ WELLS ADJACENT TO THIS F'ROPERT'¢ AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SER',,,'E. ......... -|-I---iCI ( 2 _':, I I'-.ISF'EC:T I I_~II'-.I S FIF-:E F-:E-:L::!!J I I~:E[:, BACKFILLING OF ANY S'¢STEM HITHOUT FINAL INSPECTION AN[:, APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL.~ OR 250 TO 200 FEET FF.'.OM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WE[_[... WELL LOGS FIRE REQUIRE[:, AND MUST BE RETURNE[:, TO THE DEPFIRTMENT WITHIN ~:0 [:,FLYS OF' THE WELL COMPLETION. OTHER REQUIREMENTS MA'¢ APPL'¢. SPECIFICATIONS AND CONSTRUCTION DIRGRAMS ARE R'v'AILRBLE TO INSURE PROPER INSTALLRTION. F' E< F-': !.1 1. -F E :~-:: F' 1' F-: E S; E:, E C: E M E: E F.' _-~-:: 1... 19 7' :.~: I CERTIF'¢ THAT i: I BM FAMILIAR WITH THE F.:EQUIREMENTS FOF.: ON-SITE SEWERS AN[:, NELL'_--; RS SET FORTH B'T' THE MLINICIPALI T'¢ OF ANCHORAGE. 2: I HILL INSTALL THE S'W:;TEM IN RCCORDANC:E WITH THE CO[:,ES. 3:: I LINDEF.':STAND THAT '['HE ON-SITE SEWER SYSTEM MA'T' F.:EQUIRE ENLARGEMENT IF THE RE'-:';I[:,ENCE IS F.:EMODELED TO INCLUDE MORE THAN ]: BEDROOMS. "," }]:. 2 GARY PLAYER VENTURES CONSULTING GEOLOGIST BOX 476-M, STAR ROUTE A · ANCHORAGE, ALASKA 99507 · PHONE 344-707t SOILS LOG Performed for g~-- ~%~-~[~ Date -~ /~/~ ~ Location q~' ~ ~ ~'~ N0-f~vx ccr~j ~d~--~j ~_~ soil Type Water Level Remarks 16 18 20 Total Depth of Excavation Groundwat er ( ) Not Reached Depth, if Reached /~"! Classification Hethod ~isual ( ) Sieve Analysis () Material at Total Depth Bedrock ~'~'ot Reached Depth, if Reached Gary F. Player, ConsultinE Geologist 2833 East 72nd Avenue DALLY DRILLING LOG PENN JERSEY DRILLING CO. Anchorage, Alaska 99502 344-2612 OWNER OF LAND ............. ~1t~%~..]~.Q.~...~...n. .................................................. ADDRESS ........ ~ ~.~....~ ~.e.~.~.~.. J).l~.~.~.q~ .......................................................... WELL--SITE....~.°..~...~ ...... ~..]:. ~ ........~.... ~t ~ .u..~..u..~..~,~...~.-J:--]'.~...~.,u...~..: ................... DATE--STARTED ................... .~..~.p.~ ~ .m..~. ~..]~....~ ~.~ ....~..~ 7..~. .............................. DATE--ENDED ......................... ~ .~. ~ ~..~. ~.e.~...~ ?.....~. ~.7...~.. .............................. DEFTH OF WELL ........................... ..~.~..*. ................................................................ STATIC LEVEL OF WATER FT ............... 2.~.*. ........................... : .................... DRAW DOWN FT ................................................................................................... GALS. PER ~!~ ............................ ]~.~......~.1~. ....................................................... KIND OF CASING .......... .~ ...... .S..~.~...~.~.~..~.~....C...a..$..~..~ .......................... KIND OF FORMATION: FROM ......... ..0. .............. FT. FROM ......... .~ .............. FT. FROM .......................... FT. FROM ...... ]. 8 ......... FT. FROM ......................... FT. FROM ......... ..qO. ........... 1~'. FROM ....................... FT. FROM ~4 ~ .......... FT. FROM ........................ FT. FROM .............. FT. FROM .......................... FT. FROM .......................... FT. TO ......... ..3. .............. FT...T..o.p.s...o..'.t...t. .................... TO ......... ..1..~ ........... FT...D....a~... p_.~.~..!.~ ~.._~.o..wn TO ........................ FT...s.a..~_..~...PL.ay.e..~ .... TO ......... ..~fl ........... TO ......................... FT.. fi.r..a..y..e..-1-. ~....d...a.mp- ...... TO .......... .~.~ ........... FT.. ~.r..a..v..e-..!.,....~..a..n.d.....a.. TO ........................ FT._.a..17. ~.~ ~.~.e....~.a..~..F. .... TO . .q..3. ......... FT...G..[a..v~.]:.....~ TO ........... FT..r ,.~7...~ ....................... TO .......................... FT TO ......................... leT FROM .......................... FT. TO .......................... FT ......................................... FROM ......................... FT. TO ......................... FT ......................................... FROM .......................... FT. TO .......................... FT ......................................... FROM .......................... FT. TO .......................... FT ......................................... FROM .......................... FT. TO .......................... FT ......................................... FROM .......................... FT. TO .......................... FT ......................................... FROM .......................... FT. TO .......................... FT ........................................ FROM ..... FT. TO ...................FT ............................... FROM ......................... FT. TO .......................... FT ........................................ FROM .................... FT. TO .................. FT ............................ FROM .......................... FT. TO .......................... FT ......................................... FROM .......................... FT. TO .......................... FT ......................................... MISCL. INFORMATION: DRILLER'S NAME...L..~. S~.,...Lar. r.y...J.r.,.,....&...~ancy..~c, hac. hl.e. ........ ~U~ICIPAL, ITY ~? ANCHORAGE ...... 'DEl)Ti 0:'~ .... LT' & · MUNICIPALITY OF ANCHORAGE EI'-~VIRONi;.LNTAL ,,--:£CTION " ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 82D L Street-Anchorage, Alaska D9501 APR ~ 9 I ~Jr ~ g ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Gomplete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing. PROPERTY OWNER J PHONE 1. PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE 4. R~LTOR/AGENT J PHONE' MAILIN~DRESS STREET LOCATION 6. TYPE OF RESIDENCE )~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] 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.) 8. SEWAGE DISPOSAL SYSTEM ,~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. /~ ~'-~2 ~, r/ ~/?/C 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 I NSPECTI ON APPOI NTM ENTS ~.~. 'IME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I N DI V l DUAL/ON -SITE F-IPUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tank IAbsorption Area I Sewer Line [] OTHER INearest Lot Line 5. COMMENTS ~" APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE LEGAL DES~.RIPTION 72-010 (Rev. 3/78) April 23, 1979 b.E.C. Custom Builders Post Office Box 6502 Anchorage, Alaska 99502 SubJect~ Lot 4 Block 2 Audubon Hills Subdivision Lot 6 Block 2 Audubon ~ills Subdivision Approval for your individual sewer and water facilities will not be granted until the following items have been completed: (1) A well log is submitted to this department for each lot. (2) The water analysis report be delivered to this office fr~ Chem Imb, 563] B Street, for our review. If there are any further questions, please contact this office at 264--4720. Sincerely~ Robert C. Pratt, Associate Specialist P P/ljw Cc: Alaska Mutual Savings Bank 1503 West 31st Avenue 99503 % Alan Ward Alaska Mutual Savings Bank Post Office Box 8--9093 99508 % Carmen C. am4L 8 .EOLOelC4L L rOmEs 0F AL4 V , P.O. BOX 4-12'/6 ANCHORAGE, ALASKA 99509 4649 BUSINESS PARK BLVD. Drinking Water Analysis RepOrt for Total Coliform Bacteria TELEPHONE (907) 279-4014 TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM: I.D. NO. Publ/,C. Water System Name City SAMPLE DATE: stats Mo. Day Year Zip Cods SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no._ [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 2 LOCATION Time .. "Collected Collected By TO BE COMPLETED BY LABORATORY LABORATORY: NAME ADDRESS Date Received Time Received CITY Analytical Method: [] Fermentation Tube C~Membrane Filter Lab Ref. No. Result* A_nalyst I I No. ol colonies ! 100 mi. M No. ol Positive portions. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE :orm No. 18-310 (3-78) 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source Date Received Time Received i:).m. Lab. No. Presumpt Ive 1Omi ).Omi 1Omi 1Omi 1Omi 1.0mi O.lml 24 Hours 48 Hours Confirmatory 24 Hours - 48 Hours EMB Broth 24 hours: Multiple Tube Rebort: Membrane Filter: Direct Count Verification: LTB Final Membrane Filter R esult~r~ Reported By Broth 48 hours: 10mi Tubes Positive/Total /Omi Portions Coliform/100mi BGB ~Z:, ,l~ , Coliform/100ml Time:Date --/S'~~--)2'~ a.m. O 0') r- r- cy')co coNa- Iq co I— ti CD CD W c o � L NQN Li. O i U Z LL \lOil J Q �o O U U L L Z o � U L U C E 0- 0 O > Cf) a) c . •, N 0 Q Q Q cn cn -I.- C/,5 C: O 0 a) ca U a) LOQ N O N 0 cY) CID N cu 0 c O .Q X w 0 0 O N O Y J M N LO Q U cu 0- II U) a_ U) 06 U) W Q U O a) C O Q O Q N U M M O 0 Q CL m c O 0 C: 0 I. E 0 N C) N N rn ai cu 0 a) N U () U (6 C 0) L) 0 0 0 m �+ CL +_>'+ Y w aa) a CL O 3 r O c0 Nc O U L O O c CL O O CL cn > >, o 4)V •� ^ md c Q > > N0 U) .- �: O aQ N O ._ .0 N cnc O •3 a 0 .N �zQ — N > C CL 'a 0 m 'C 0 c Q L C W Q 0 0 Co (n " 0 x d r� iC= O M L 0 cn O N c .Q 0 •->0 C? y E m 'a c O Q c O' > C 0 Oc > +' U Q U) (1) U � 0) V 0 Ia A -/ F-rr<^ �~ — c Z VJ Q , ^L` Q) C .c N E O N ca O = Q O (j N N v Q. v Q H Q a N CD -q- CY) CY) N � M M M M rnrn a) cn ❑O L O 4- M U Q Q Q O L QL QL U) U) a) C O O a) a) A T- U a) cu a) C O m U O J r1, Al 1411 (D a) LL V I O a) cn 0 0 U n L C) a) N O =_ (n (Q a) O a) U) U >, N _Q .O L O 0) E _ ) _ _ E � O U c G 3 U U O >+ ❑ N CO C O cn U O > V _ =3 O ❑ C. in •! d V y ca C ❑ El 0)3 O (D O (1) -aLL cu+ QC: U) ^^L CO cu a) C O ❑ N A d >"a O © '> W 0 = C: t a) O O co J ❑ O EI CL M I j Q O +r � U O U)cu o- a O v a) cu L- c LL ❑ Q Elm LU J o t IL z S2 V5 Q =) cn cn ?� CO cu 0 aa) ) a >, W ❑ a) W y v W W H a) r^ L% a) L L r H U) V/ VJ L L 3 yr z O - cn Q � �° W LL U- a) M a) I_ a) a) O O /H� V tea/ L� L cn W W O a) •� t� W CY) m m O I— I-- in Q Q >_ a) X > > c0 > > N M ui W m 1411 (D a) LL V I O a) cn 0 0 Audubon Hills Block 2 Lot 6A 015-235-02 6 9/11/1978 43 43 28 9/13/24 25 7.39 None 9/12/24 45”* *Design specs for this 1250 fiberglass tank unavailable. Effluent levels were 10” from top of tank prior to pumping. 8/30/24 Arcterra Consulting 7/28/1978 9 5.1 45” 9/13/24 27 450 33 300 27 450+ 46 28 18 47” 48 20 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. Arcterra Consulting Kenneth Duffus (907)-696-6111 94’** ** Waiver OSP121179 approved 7/12/12 �- C: Z p LU •� u F- N N a °1 w ro N N LU w U tp � Lu N 0 F- � aA z W a� O fE OJ41 a, UjLLJ in 3 0 0 3 i - Q N E M N C N Q) N N N V L X O_OU N M L co LnL fp Ln 4� O fB S (Ij > c+a u N E N L a1 � N N o 4- +� N N U ro LL O � + Z U }, c/) C O .a m U i U +•+ v N a . Q, +-) C� cm -I0 NW N 0 i� 0 0O CL V) C a) N }' c O Q1 mN O J cV m vi _ Q 0M O Ln t~o � u + C co _W > 2 Q N L w Q ui A U v bA Q 0 4. N 4- d +0+ 0) C C: O • L > LuU H O 0 �O U > v 41 f0 C Ov O m bA - N ° U O ="O N O N m N 41 Q +O 0) = -0 � O Q C 0 m EQJ _O i t 3 C le 41 M u N a—L., c/) vi QJE � M > L 4— V) N E v >. .— � 4. +, L O O >•• 4- � ._ -O CO bA 0 O C 4 .— O N O — fD O � m + V) E i N H O 4 ii U C Q� Lu Lu Q) Lo S u N a 4„j ro r , on J m s c LL W ~ E i z E O LL ° .� ° ° }' E .0 }' L N j O L ro L +' N �- C O p 41 w C ro OJ LA bA u +� a) > U to C a) L O a) ..Q O _O � U in � a-+ t c V� IO C w OL 3 t- N a) N i A 4. E O a) U O Q_ a) 3 a) fO v a) O Q a) m E v a) o V, co ° a) bo +, "-&- > U 0 3 -p aJ L C10 = m T, C :p Y a1 C +�- M E a' a) E w +' L Q) t C +J (B fo 'L m Q) L- d 4 0 m a) +1 a) C f6 L y = C Y 4- {; a) ro . 4- O O — 4_ O a) 2 O > O Y4- C f6 v 41 InC a--+ t10 Y u `-' ai an Q) u 3 +� c, — Ln — v V) C m L p f6 aaii L a) a C > O E° a) E a) a) C Q 4_ '� Lpi 4-- o o o O E s f0 => 3 E 4._ O ao .� cu U Vf u fp ° aj U ai E •E a) >- - s v O tw a- a o U U a 4- O U C O 4- co N C N M �-1 L a� a) L C 3 C O C U 3 O L 3 �n 3 - C L O Q L O a) i _ 4- L ++ r L -a a; C C t �' '3 v ro O u w ,, C — a) C> E u Ln a) c 3 +� o c oA a) a) c„ O cLo a) v t m EO 41ro O v p 0 V) -a E u a0 ti N s a) C ,. a) 3 ° a) M *' V) +' ° a) L - a) °A C L E a) — E Q ,� ai a) f0 o fL6 CO C ° a) a OL 'C t f > _ +' O L +• C -6 C p a a) a) Y U 0 E E O N O v O — 3 E L °) c n o ai a) 'n c— T L +� +� O O f0 41 7 u .- C a, U L C o C } co O U a) _ a) N m U V C L ut L v 0 7 t1 M 0 ° _ O o :0M of C t v.� a) C O a) C +' >. C_ U a) L O c ° V) ° 3 La @ `n O -a u v c O a) U p v f D v on c E 3 �n p 4� E a) Cl) v C U v o p 4-1 -0 °) E w °c° w a) 0 0 0 0 Q E 0 a--� � W . . v 0� 4-1 L1 _ � '' x O E ° u 0 0 C 4° + 4-' 3 4J fo 3 OA c L a p u `—° O� -Q v ac) C ° v L a)) O V) f�6 0 (O E � � O� o C a) rCo 0 j C C 0 C N E u ai c a) _ C v r° E E U = r u E +� pp + L L L i--+ (U �" > C VI O CL r O O a) U V) -p 4-1 (O fl- L a�-1 O '� �; C u L to '�, O O C E c Ln 'n V) +-+ rLo '° C X OJ L V7 •>. 3 Qcu L +� to O L N — U Ln > a) V) Q C Vf O E L a) a) 4- E O (o O V) a) C Q) fO C O L N O 4' ,c M 'O m C 'v C 3 a) +� u H '�", O n3 L O m L +J +--- VI °° aJ 3 C ro f6 to +� a) +� +' n3 V, a) C co v ° m n u v > �o > C: >, m v tin a) a) Q a)c C V) 4- v a) +� :+� v ' 7 °) a) +� U V) fO6 n -O tLp v LE O C U E U a) ° @ +J E, C n v ° co +, z '3 L cu v L° °: o E '� L @ v z o o o v z ° O V; o '� v z tea p C Q � o Q L u m m " a) t " L w a) m t a) L + U O N U OA E c c m H L O N a) C Z L U L rp of 4+ o E o c m oa u E Q v — 3 0 H u c0 a) c c O E a o O L O x p° `o v v 0 w Q sLn ° tin V) ro 0 4 r M >, ,, 0 0 U F- 3 E 42 4� P- o c +� E co • • Municipality of Anchorage On-Site Water and Wastewater Program Q' (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-235-02 Expiration Date: of' i 7 1. GENERAL INFORMATION Complete legal description AUDUBON HILLS BLOCK 2, LOT 6A Location (site address) 12336 AUDUBON CIRCLE,ANCHORAGE,AK 99516 Current Property owner(s) MARK &MARY GREBY Day phone Mailing address 12336 AUDUBON CIRCLE,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: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: A.4.0. Date: 4/3e//.7 COSA to be released to the engineer,unless 0/ le requested by the engineer, COSA Fee $ 5 Z(o Waiver Fee $ Date of Payment 4-/2 3 // 7 Date of Payment Receipt Number O 78 (p D Receipt Number COSA# d S C 17/ .5 ` 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/22/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen +'"'."\ encroachments,deficiencies or discrepancies exist. ‹sp OF 91 ,{, 6. DSD SIGNATURE *49Tf11 �* System #1 Approved for bedrooms. 1:4, KENrETH H. DuErtr r System #2 Approved for bedrooms. + `� 7t16 Disapproved. 1k'NI.Nkb:1111:11PAir Conditional approval for bedrooms, with the following stipulations: s.,=72-( 1 Z- � i S -Pa W :E -G{ p .�� l� -2z3 Pat/' -0 OF AAt u�" V :2 wO ON-S(I`t � . WATER AND WASTEWATER oz PROVKAM 0,34,5„ �p By: v�-� Original Certificate Dat : --2,S5'Cl 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_1 O-10-12.doc 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: AUDUBON HILLS BLOCK 2, LOT 6A Parcel ID: 015.235-02 A. WELL DATA Well type PRVT If A. B. or C provide PWSID # Well Log (YIN) Y Date completed 91.1111978 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 43 ft. Cased to 43 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 9111/1978 6112117 Static water level 28 ft. 37 ft. Well production 15 g.p.m. 6 _ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/1 00 mL Nitrate _ 5.58 mg/L Arsenic: ND ugIL Date of sample: 6/9/2017 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/FIBERGLASSDate installed 711978 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 7/12116 Pumper A+ C. ABSORPTION FIELD DATA Date installed 711978 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 System type DEEP TRENCH Length 49 _ _ ft. Width 2.67 ft. Gravel below pipe 4 ft. Total depth 9 ft. (Measured 6/12/17) Eff. absorption area 392 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/12/2017 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 17 in. (BELOW INVERT) Water added 545 gal. New depth 0 in. (B.I.) Elapsed Time: 1350 min. Final fluid depth 16 in. (BELOW INVERT) Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) _N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot _94'(WAIVER) On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ _ Holding tank 100'+ 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: Property line 10'+ Building foundation _10'+ Water main 10'+_ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS Monitoring tube did not extend fully into the effective depth(ED)and was extended to wfin 1'of the bottom of the ED. Field is operating in the top 1.5'of the 4'ED. G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance tea` with MOA COSA guidelines in effect on this date. OF AL,4 Engineer's Printed Name KENNETH M.DUFFUS �Q' ` Date 6/22/2017 *49 TH7( 7LSI * COSA canary sheet_2-6-15.doc / • � KENNETH . /7i IC �� ��` 1 t� •%z, L S,1 � / MMort7Sn rVd9€FD IDDM l \ v4ed(AASSAle o) rafcy( Mo COINER • ZONING ruedcr f N\ IRONY!MOM SERAot 1(/\ �� 1 LOC BIaMGINa$CreAGx 6\ MAR WILDING ZMCJI i ?Ot. JON 9 1g1� ��,sd!Fn\` 0. .v / ,r/ �// �• • FXISTING b HOUSE f h • �� ...caber..•.::: 3A Lu ‘11 Z z y0 7 ? 1ti6 b in -44 L ° TD'UTIL ESMT rw0 589°53'55"W 167.02' LO HUFFMAN ROAD UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION CR FOR ESTABUSHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. ❑ LOT SURVEY SURVEY TYPE SYMBOLS ❑ FOUNDATION AS-BUILT • SET REBAR ASPHALT 14711 Tft ❑ FINAL SICT1RE AS-MALT DRAINAGE ❑ PLOT PLAN . .. As-BUILT. . . ROT SURVEY. . . ToraCB Y ��o�� FOUND REBAR tee. WOOD FENCE 1.'e.'"°'%:'�1 CONCRETE iEr AS-BUILT, NO CORNERS SET❑ RECERTIFICATION AS-BUILT, ,. NO CORNERS SET `LJI. ASSUMED ELEV. x x N METAL FENCE R Fi WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS. SEPTIC CLEANOUTS, SIDEWALKS. DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY, SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION ++���imu�,R Prepared by PLOT PLAN .♦♦.6E•oF• q(to.� Robert E. Johns, Jr. & Assoc. I nraby ardy mot!Rom MlyalaaMy*arum.' �.�,�P,.• • "• ������ Professional Land Surveyors d,.tot Oran owl 400rtw nr.n,and Fat I 'y naw found r wRcaMaAw ml er ae tat menial ad1700 Brink Drive. oe.ho..an ma N�loon.,Rot to M.toot of my ; I, ANCHORAGE, ALASKA 99504 Ina.iad rid reed*.dl eliminate..hero Men M �• a ma.•uradd woo nd aa.wt. Y ,tM /� Scale: 1" II _ 60' Rec. Lot S.F. Rec. Plot Fifa No. FOUNDATION AS—BUILT • ••• L Robert O.4aMa,Jr"Imlay certify as I �• i Dote Surveyed: Drawn b Checked h nam. n AarL.dt surrey of M+. Y JMK y J • y' +I fevMat�Nn ar UU lot and Mat all tea * • • �J! 19!1 2 R E� aananafana.nd(Mormatten as 416.1 Iran • ROBER E.'• NS, an w.and.a emmadrnntt INN unit.. n..+a..rf... .� . Data Drown: 6/20/12 Grid: 2739 W.O. 12-192 e 4 21—S -\� FINAL STRUCTURE AS—BUILT Rsr Legal Description: I.Rot i L Joan.Jr..hear Dryly coati e 9 P nay.M.rfonn VI an Mt-WE array Of as ♦, rethed '••••......•••••• �jy:•� Lot 6A Black 2 414otm14,.ude and Nlfonnoo0Mn II d Run 4,a...aroma �� Afo o nnrwtivanh.d.Rrrdaaa t��1�*;��.�.' AUDUBON HILLS • • Municipality of Anchorage � Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # OSP171254 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 6A of Audubon Hills subdivision. This inspection revealed a nitrate concentration of 5.58 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. OIS- 235 - Da Expiration Date: a °� 1. GENERAL INFORMATION Complete legal description (kdal3gog NIwS Svt3 -19 cAe a 1.o -r 6A Location (site address) +233u AODuaod euzeve A++caoaacF , Ar g4S16 Current Property owner(s) a AINTAe C0a57QJY7oP_S t+ -e- Day phone Mailing address GIS t;PST -Tuovu- t2p 5viT6til Ai&40erws,A-k gg5v-7 Real Estate Agent Day phone 2. TYPE OF DWELLING: - - [vj' Single Family (wlwo ADU) ❑ Duplex Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4.. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System y ❑ Public Sewer ❑ r' - Received by t,� C� �- Date: .COSA to be relea4ed to the engineJJ , less otherwise requested by the engineer. - COSA Fee $ qVO Date of Payment Receipt Number 002-d? CT COSA# 0SQ laro�s^� Waiver Fee $ _ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affbwd hereto and as of the validation date shown below, I verify that my investigation, based :on procedures outlined`iri the. Certificate of On -Site Systems Approval Guidelines for. this application; - shows that the on-sitewater 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 WoGesor.) C vt e w Phone .SO,) --7773 Address Po %0o vioZ73 AAcfol A&-, Aic c14534 Engineer's Printed Name tlx44o i, til Pr; Date Kjas'1) q<�s®v . ti DSD '$IGNATURE 4NETH System #1 Approved for bedrooms. System #2 Approved for bedrooms. 4 m :Benj m' J Schiller; �o�Iss�'• 1592 Disapproved. L Conditional approval for bedrooms, with the following stipu t1FESs1oN Original Certificate Date: g �a 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 Septic System Advisory Well Flow Advisory COSA blue.heet_9-1-12.&a Nitrate Advisory Arsenic Advisory Other 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 015 -.935 - oa Legal Description: Audubon Hills Sub., Block 2, Lot 6A Parcel ID:G+5--23t--52 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 9/11/78 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 43 ft. Cased to 43 ft. Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 9/11/78 6/28/2012 Static water level 28 ft. 25 ft. Well production 15 g.p.m. 6.8 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 5.98 mg/L Arsenic N/D ug/L Date of sample: 11 /2/12 Collected by: MEA B. SEPTIC/HOLDING TANK DATA TankType/Material Septic/Fiberglass Date installed 7/78 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping: 7/5/12 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA N Date installed 7/78 Soil rating (g.p.d./fly orftZ/bdrm) 125 SF System type Deep Trench Length 49 ft. Width 2.67 ft. Gravel below pipe 4 ft. Total depth 8 ft. Eff. absorption area 392 fe Monitoring tube Y Depression over field N Date of adequacy test 6/28/12 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 480 gal. New depth 13 in. Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >=- 450 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at in. Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots >1 00 Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >51 Water main >10' Water service line >10 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: i Property line > 0 Building foundation >10 Water Service line > Surface water >100 Curtain drain None Noted Wells on adjacent lots > 100' F. COMMENTS **See Separation Distance Waiver. G. ENGINEER'S CERTIFICATION i 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. Engineer's Printed Name Benjamin J. Schiller, P.E. Date 11/27/2012 COSA brown sheet 10-10-12.doc Absorption field >5' Surface water >100' Water main >10' Driveway, parking/vehicle storage >10' �F OF q�gS�i MV 4"TH p� � IZ�PB jaS 11er;'1� ,t''IE� 0o::�` 1, TO Municipality of Ancho P.O. Box 196650 s 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (90 7) 343-7997 http://www.muni.oM/Onsite Development Services Division On -Site Water and Wastewater Program mcnt C t s' " r Department **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP121179 COSA#:OSC121257 Permit#: PID#: 015-235-02 Legal Description: Audubon Hills, Block 2. Lot 6A Engineer: Anderson Engineering Applicant: Capitol Constructors, LLC Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 94.0 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not GGrraanntteeedd::� Date: !a Approved It /y�l Name of Reviewer ................................................................................ Rec#: 08056G Amount: $1,050.00 Date Paid: 71612012 **** VARIANCEIWAIVER REVIEW **** ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 577-7766(FAX) July 5, 2012 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Attention: On Site Services Engineer Subject: Lot 6A, Block 2, Audubon Hills Subdivision Separation Distance Waiver Well to Septic Tank Dear On Site Services Engineer: asp The well on the subject lot was constructed in September of 1978 approximately 2 months after the septic system was installed. Little documentation exists concerning the well and septic system, but measurements in the file state the well is at least 100' from the septic tank. A recent surveyed as built completed on the property indictes the well is only 94' from the septic tank. A waiver is therefore necessary for the current owner to obtain a Certificate of On Site System Approval (COSA). The well is 43' deep with casing the entire depth. The well is drilled through what appears to be layers of clay with gravel and silty sand the entire depth. The aquifer level is not encountered until 41' below the ground level where the pu is obabl placed. The static water level was found at 28' below the surface and more th 14 be ow the ttom elevation of the septic tank. T er MA /� The original ground surface on the lot slop from the well d toward the septic tank at an approximate 7% slope. The ground elevation at t is is approximately 7' lower than the well head. We assume the water gradient slopes away from the well at a slope similar the original ground surface. A recent water quality test taken from the well indicated a small amount of nitrate content (4.89 mg/L). The absence of nitrates above the allowable limits would indicate no contamination of the well water from septic effluent from either the septic tank or the absorption trench on the lot. No coliform or bacteria was found in the water further indicating contamination is not present in the well. ADEC POINT ANALYSIS Bottom of Tank to Highest Water Table — 11' 2.33 Points Soil Absorption Type — Clay and Sand Equal 4.50 Points Permeability — Silt or Sandy Clay 2.00 Points Lot 6A, Block 2, Audubon Hills Subdivision July 5, 2012 Page 2 of 2 Water Table Gradient - +7% 5.25 Points Horizontal Separation — 94' 2.76 Points TOTAL POINTS 16.84 Almost sure to be free from any form of contamination from household sewage. Attached are the well log, water quality results and other drawings showing the proximity of the existing septic system to the well. We hereby request the waiver be issued and the Certificate of On Site System Approval (COSA) be approved. Sincerely, r � Michael E. Anderson, P.E. Attachments Municipality of Anchorage a f, • "� Community Development Department Development Services Division a SA £TY On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC121257 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 6A of Audubon Hills subdivision. This inspection revealed a nitrate concentration of 5.98 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 14 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. 015-235-02 COSA # aS 6121: t3 T Expiration Date: Z O ` /3 " / Z 1. GENERAL INFORMATION Complete legal description Audubon Hills Subdivision, Block 2, Lot 6A Location (site address) 12336 Audubon Circle Anchorage, AK 99516 Current Property owner(s) Capital Constructors LLC Day phone Mailing address 1515 East Tudor Road, Suite 4 Anchorage, AK 99507 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: Three (3) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well✓❑ Individual On-site ❑✓ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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, 1 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 Arirlracc P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/3/2012 se:B MIDI. iZi 5. DSD SIGNATURE #j CE94381 � Disapproved. clforbedrooms. ♦r,/� i�R`` Sa ' ���� Conditional approval for bedrooms, with the following stipulations: Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By. Original Certificate Date: 7 (Rev. 1IM5� 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 Legal Description: Audubon Hills, Block 2, Lot 6A - Parcel ID: 015-235-02 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 9/11/76 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 43 ft. Cased to 43 ft. Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 9111176 6128/12 Static water level 26 ft. 25 ft• Well production 15 g.p.m. 6.8 g.P.m. WATER SAMPLE RESULTS: Coliform 0 colonies/t 00 mL Nitrate 4.89 mg/L Other bacteria colonies/100 mL Arsenic: N/D mg/l Date of sample: 6121112 Collected by: J. Serkram B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sep6c/Fibergless Date installed 7176 Tank size 1,250 gal. Number of Compartments TWO Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 7/5/2012 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA Date installed 7178 Soil rating (g.p.d./ft2 or ft2lbdrm)125 GPD/BDRM System type Deep Trench Length 49 ft. Width 2.67 ft. Gravel below pipe 4 ft. Total depth 6 ft. Eff. absorption area 392 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/26/12 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 460gal. New depth 13 in. Elapsed Time: 90 min. Final fluid depth 0 n. Absorption rate >= 459 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at_ in. "Pump off' level at' in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES h•• I SEPARATION DISTANCES FROM WELL ON LOT TO: �"if �� C9. Septic tankllift station on lot sa"` On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank NIA Animal containment areas >50' Manurelanimal excrete storage areas >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5 Absorption field >5' Water main N/A Water service line >10' Surface water >IOU Wells on adjacent lots >1W SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >19 Water Service line >10' Surface water >10b' Driveway, parking/vehicle storage >26 Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: "See Separation Distance Waiver. G. ENGINEER'S CERTIFICATION*' x I certify that 1 have determined through field inspections and MW s *- review of Municipal records that the above systems are in to 14 conformance with MOA COSA guidelines in effect on this date. h•• I Engineer's Printed Name Michael E. Anderson, P.E. �"if �� C9. Date 7/32012 I1._,P#6r COSA Fee $ Date of Payment 2 Receipt Number ©d (Rev. 11105) Waiver Fee $ _ Date of Payment Receipt Number ( OSU) nNMO fLWR pEV. (ASS.IYED) \ mo mm NG Cp m \( ZONING DISTRICT MONT BULONG SErBAN V SIDE BNLONG SEVB REAR MILANO StEAO( 9 �y,I. Sra 23, Ojj. os tiro / m / 8 V m N J ago EXISTING a HOUSE p...........CO 5A o 21 s2 s Z 7 F I do �I aI �I m I 6N^ p1� 1� I----------------------ya To' unL ESM1r a S89' 53' 55"VV 167.02' HUFFMAN ROAD ------------------------------- UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LJ LOT SURVEY SURVEY TYPE SYMBOLS ❑ FOUNDATION AS-BUILT ❑ RNAL STRUCTURE AS-BUILT EnsNc Rxp ' SET REBAR 7m � DRAINAGE 0 ASPHALT ❑ PLOT PLAN ... AS-BUILT ... LOT SURVEY ... TOPOGRAPHY zi:.: O FOUND REBAR �B-6' WOOD FENCE ""' CONCRETE AS-BUILT ... NO CORNERS SET 71 RECERTIRCATION AS-BUILT ... NO CORNERS SET DDA ASSUMED ELEV. T METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION ..r""♦�r•• Prepared by PLOT PLAN OF i q•• Robert E. Johns, Jr. & Assoc. I hWMy. Ffy M.t i hew phyto ly �,wyee M. W amn ewttOM h.. oat I ��.10, '•. Professional Land Surveyors ma ma h... mune a ..m MM aI .r M. tat came ��,`P,•.•••• : • �1. 1700 Brink Drive. ...seen m M. pm me M M. Ip.t 0.1 AV I-- .. ANCHORAGE, ALASKA 99504 tn.Ms]a ma WNItl al a Wn B here E a �t Scale: 111 _ 60, Rea Lot S.F. Rec. Plot File No. m.,W w. ma smecl. •_--' t -- �••.n•:._•••• FOUNDATON AS—BUILT I. RW at E.. nm Y. IImDY eerN7 Mat 1 .••e••••••••• •••.• '-r — Date $Yrve d: �` 6/19/12 Drawn by REJ Checked b h.r. palam Bmt.ffi.f M. mmddt let M.t m U. r . . ,. . ,, ,•,r 1 ..... ' m PbMY me aMlmxana ma tT atl as .h hwe � f MK me n. mama U m.t ml.w � ROBER E HNS, � Date Drawn: Grid: W.D. m..n .MpNes 0 P a •# •• 4 21-5 6/20/12 273n J 12-192 FINAL STRUCTURE A$—BUILT I. fi M E b.. h.Ny Ify Mat :' aeA� s �. z`e •••'•.,• Legal Descr ptlon: .lMn4 a he ,.a.n.,mt ditawy.,M. ��BaA ........... •••,.•' ya��� Lot 6ABlock 2 Nin.. mal Nf..k �m Ma M. h— an,.• �• rofessionat .• �mwatlme neo mammMm"""'°"'°" •1111% �••• AUDUBON HILLS a PROPOSED FlNISHfD ROCR flEV. (ASSUMED) \ PROPOSED WW) G COflNER EI£V. (ASSUMEa) Z MNG DISURCT ! V•J \ fRMT BUIWNG SETBACK 40E BUIUNNG SETBACK REAR WRONG SoBACK / b hh / ice/ 8 2ry�A, ra/ J// 'y90 V ph EXISTING HOUSE / ° h 5A N I I SWELL. 91 soy z wl I yo I 7 N �I \ / 10' UTIL ESMT 889° 53' 55' W 167.02' HUFFMAN ROAD ---- ------------------------------- UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. _11-LOT SURVEY SURVEY TYPE SYMBOLS ❑ FOUNDATION AS-BUILT ❑ FINAL STRUCTURE AS-BUILT SET REBARD ASPHALT DRAINAGE ❑ PLOT PLAN ... AS-BUILT ...LOT SURVEY ... TOPOGRAPHY 0 FOUND REBAR .eg WOOD FENCE '''°"'- CONCRETE AS-BUILT... NO CORNERS SET RECERTIFlCAnON AS-BUILT... NO CORNERS SET p0Il ASSUMED ELEV.-X--1F—k METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS. TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION� OF Prepared by Robert E. Johns, Jr. & Assoc. PLOT PLAN q<�� IA.m°y..ByAoLlhaw d0odly.wwd u• le Hawn, .,e mot I m m..,, and..Ne.d ��.•�� 4W`P.••' j •• �. Professional Land Surveyors n.w f.. a esWIA. m of Ne tat _.a N;. Adm A. to A. t at my Arc,) ; f ••: 1700 Brink Drive. ANCHORAGE, ALASKA 99504 o. m Flan wd Mwd a°ONn . A dMmxmt II°w b.n °.I mww,.d we .w coma ; `• •f Rea Lot S.F. Rec. Plat File Na. !: 49th Scale u — 1 — 6OI FOUNDATION AS-BUILT ................................................i Date Surveyed: 6/19/12 Drawn by. REJ Checked by^ n K J1V' I, B E. m n., x., n.Ay araty mm 1 now pU.on mNandP mwy°f M. tnx lot and W aI of h— PW / / ,,, 0 on dMAxw. and nt.mmbn w Ao.. n..w : ROBERT E. JOHNS, JR. / Date Drawn: 6/20/12 Grid: 2739 W.O. 12-192 me we ane no Aer A..f. a u .M. A ^-� :• ••♦ s••••. 4121—S dj� FINAL STRUCTURE AS-BUILT • ;' �. A'a� •••'•... Legal Description: I, RMa a d '. ✓.. n.Ar aa.uy not I Bnw ParamM „ A._Buyt w,wy aI Bw ...' 0� �1 �� Bd •.......... • Lot 6A Block 2 awcWre m W. lot and V.at di Um m. we and nd .nnoommmt. .a.t ux® .� xmµaanry M.m°`Ian a. . n.an A ��p��:���:••� AUDUBON HILLS