HomeMy WebLinkAboutAUDUBON HILLS BLK 2 LT 9Onsite File
Audubon Hills
Block 2
Lot 9
#015-231-59
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241112
Work Type: SepticTank Upgrade
Tax Code Number: 01523159000
Site Legal Address: AUDUBON HILLS BLK 2 LT 9 G:2739
Site Mailing Address: 12320 AUDUBON CIR, Anchorage
Owner: HANSON RYAN THOMAS &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
�i»cnr
r.
r,
i�
t)ijmrtl>>ctit
Lot Size in Sq Ft:
Total Bedrooms:
6/3/2024
6/3/2025
41079
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Issued By:
Date:
Date: c 3 Z
4
ON -SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-231-59
Property owner(s) Ryan Hanson Day phone
Mailing address 12320 Audubon Cir, Anchorage, AK 99516
Site address 12320 Audubon Circle
Legal description (Sub'd., Block & Lot) Audubon Hills Block 2 Lot 9
Legal description (Township, Range & Section)
Lot Size 41,079 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) ❑X
Septic Tank
❑X
Upgrade
(w/wo ADU)
Holding Tank
El
Renewal❑
(D) ElRenewal
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
1V
`u
(signature of property owner or authorized agent)
Permit/Rush Fees:.-4360 Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: Receipt Number:
Permit No. 05 P?, 2 - Waiver No.
Permit App__'- : - : -.,:c ;
May 30, 2024
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Audubon Hills B2 L9 – 12320 Audubon Circle
Septic Tank Replacement
Dear On-Site Services Engineer:
The septic tank on the above lot has collapsed due to pressure from surface runoff, so we are
submitting this permit application for its replacement. The attached site plan identifies the location
of the home as well as the wells and septic location. No conflicts exist between this proposed
system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing
the septic tank with the same size designed for 4 bedrooms, but a steel one that will withstand
future water pressures.
The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to
the attached plan for the septic design. If this design is followed, there will be no adverse impacts
to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241112, Curtis Townsend, 06/03/24
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=50'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
FEET
0 50 100
SEPTIC PLAN
5/29/24
4-BDRM HOME
TH1
PERMIT # OSP241112 PID # 015-231-59
AUDUBON HILLS, BLOCK 2, LOT 9
A
U
D
U
B
O
N
C
I
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C
L
E
AUD
U
B
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N
D
R
I
V
E
10' x 30' GUY EASEMENT
880
885
875
870
WELL
EXISTING WELL
EXISTING 1500 GAL GREE
STEP TANK TO BE REMOVED
INSTALL NEW STEEL 1500
GAL STEP TANK
50' LONG ABSORPTION TRENCH
TO REMAIN IN SERVICE
FCO
ELEC.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241112, Curtis Townsend, 06/03/24
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201473 PID Number: 015-231-59
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: W New ❑ Upgrade
Name
Alexander Homes, LLC
ABSORPTION FIELD
❑ Deep Trench ■❑ Wide Trench ❑ Bed ❑ Mound
Site Address
12320 Audubon Cir., Anchorage, AK 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-830-6211
4
1.2 GPD/SF
6.1 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2'0 Ft.
Gravel depth beneath pipe
4.0 Ft.
Subdivision Block Lot
Audubon Hills 2 9
Fill added above original grade
1.3 Ft.
Gravel length
50 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
5500 Ft2
1
N/A Ft.
Well
>100'
>1 00'
N/A
N/A
>25'
TANK ❑ Septic❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1,500 Gal.
Surface Water
>100,
>1 00'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Greer
Capacity
250 Gal.
Remarks
Alarm location
ENTRYWAY
Electrical installed by
DEPENDABLE SERVICES
Installer
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Northern Excavation
Drainfield D3034 Co/MTD3034
Inspector L.Tidwell
BENCH MARK (Assumed elevation) 100 ft
Inspection 1m 12/1/20 12/1/20
Location and description
nd
dates: 3`d 12/2/20 4,,12/2/20
To of foundation at SE corner of home
p
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
+�®+ossa � r ♦e
....
Date"
:qS®0♦♦
•,�
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s
f = 49th ° ♦♦
w
..... �� ..}�....}'}'.h.....®
0.
/................................................ ..
i♦�n ; MICHAEL E. ANDERSON
Zo
Septic System
Appro - -� ( Date♦♦�TF,p•••.,,
♦ No. CE-43 at ;'
Ar
10/12/21 ,,.• <� 4V
♦�
♦♦q '°ROSS 10�Po++o
44., FFESS\6\\
Note: this approval does not include well permit requirements.
kRev uo/uu i u/
PERMIT # OSP201473
98.3
PID # 015-231-59
101.6 FINISH GRADE 100.3 ORIGINAL GRADE
2" FOAM INSULATION
DRAINFIELD ROCK 98.3
94.3 94.2
50'
86.5 GROUNDWATER 10/29/20
cN N\— 85.3
ENGIN!! RING
PROFILE AS -BUILT
(NO SCALE)
°0 49th
,% MICHAEL E. ANDERSON
sT�1 NO. CE -4381
10/12121
ESS\�®\®
Ea
Benjamin Schiller
CE 12592R
E
GISTEREDPROFES S I O N A L E N GINEER
Jun 03, 2024 1"=50'
4-BDRM HOME
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH1
PERMIT # OSP201473 PID # 015-231-59
AUDUBON HILLS, BLOCK 2, LOT 9
A B
FCO 23.7
ELEC.28.9
MH1 32.1
A
B
C
C
MH2 32.9
MT1 12.4
MT2 56.1 79.9
3.6
11.2
14.4
18.2
38.4
A
U
D
U
B
O
N
C
I
R
C
L
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FEET
0 50 100
AUD
U
B
O
N
D
R
I
V
E
10' x 30' GUY EASEMENT
TH2
880
885
875
870
WELL
EXISTING WELL
1,500 GALLON
S.T.E.P. TANK
50' LONG x 5' WIDE x 4' EFFECTIVE
DEPTH ABSORPTION TRENCH
ALTERNATE SITE: CATERGORY III
SYSTEM w/ 25 LONG x 5' WIDE x .5'
EFFECTIVE DEPTH ABSORPTION
TRENCH. APP. RATE 5 GPD/SF.
FCO
MH2
MH1
MT1
MT2
PLAN AS-BUILT
ELEC.
Alpine Drilling & Enterprises
Well L®
Permit Number: #SW201473 Date of Issue: 11-4-20
Date Started: 12-16-20 Date Completed: 12-18-20
Legal Description: Audubon Hills Block 2 Lot 9
Property Owner Name & Address: Jeanette Tessore - Alexander Homes
2625 Arlington Drive 650 W 58th Ave Suite D
Anchorage, Alaska Anchorage, Alaska 99518
Borehole Data: Depth (ft) Method of Drilling x air rotary ❑cable tool
Soil Type, Thickness &Water Strata From To
Casing type: steel
Wall Thickness: .250 inches
Diameter: 6 inches Depth: 81 feet
Liner Type:
Diameter: inches Depth:
Casing stickup above ground: 2 feet
Parcel Identification Number: 01523159000
Is well located at approved permit location? x Yes ❑ No
stick up
gravel fill
silty peat
silt
silty sandy gravel H2O
silt
gravelly silty H2O
silt
bedrock
0
2
4
19
52
54
67
68
78
2
4
_ln
52
54
67
68
78
327
WATER QUALITY TESTING
Coliform C01/100ml-
Nitrates 4 M911 -
Arsenic .D u9/L
feet
Static water level (from ground level): 0 feet
Pumping level: 320 feet after
2 hours pumping 2 gpm
Recovery Rate: 2 gpm
Method of Testing: Air Li
Well Intake Opening Type:
❑ Open End x Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: bentonite granules Volume: 2bgs
Pump: Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? x Yes ❑ No
Method of Disinfection: Chlorine tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
PO Box 110496
Anchorage AK 99511
)i'.,/ 054 1 0i: 15 Stir -3 4 5 - ---12 [12' ALPINE DRILL.71--IG PAGE 01/01
MUNICIPALITY OF ANCHORAGE
pnone: g.C)7-34.3-7904
Developmer,t_,-ervjces Departn-jent
r -*ax: 907-343-7997
on-S'ite. Water & Wast6w2tel- 30cti0t!
Pump Installation Log 11 �4
We ell: 201473 Date of Issue.
'11 Drilling pernlitNumb
015 -231 saw.
parcel Idenfificatiolt
B31 ek Lot Pruperty OW"ey'Naw4�, & Address:
Legal -Description leannelte Teli5or5
Audubon Hils 2 9 Alexander Hornes
.PU.jl,P Installation Oate:,6 2`2
i;jg! 272 fa
I purlip Intake Dept h'sellow Top of Well CPS.
Myers
:fumy MoLnuftichlrer-s Name' '
pra.j5jp,Mode1:2NFL102-'--P4-01
PuIrp size: 1 ---hp
ritiess Adapter.Burial Depth; N/A foW
11tiess Adapter - N/A
well 1110afeeted I Too, COT11pleflon! No
iletlncrd Chlorine table"
of .01sinfeelhOM
complents.
PLEASE SAVE FOR COSH.
FUMP Installer N111we.,
Aarow Pump & Well Service, LLC
company:
Mailing Address" P.O. Box 110496
CRY: Anchorage P.
iL)g - on-sitemitbin 30 day� of pump'installatiOR.
sjj�.fll "iovidta plimp installation log to
11/4/20
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
November 2, 2020
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Audubon Hills, Block 2, Lot 9 – 12320 Audubon Circle
Well and Septic System Design
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 4-bedroom home on the property. We are submitting
this application for a permit to construct a new well and septic system. The attached site plan
identifies the location of the home and the proposed well, septic location and alternate site. No
conflicts exist between this proposed system and any other well or septic system, whether on this
lot or adj acent lots.
The ground surface on the lot slopes to the west at grades up to 25%. There are no slopes greater
than 25% within 50’ downslope of the proposed absorption trench. Ground contours are shown
on the site plan showing the grade and direction of flow. Storm water drainage will not impact this
septic system. The new trench will be constructed parallel to the slope as much as possible.
Wells on this and adj acent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank. The alternate site is located
more than 16’ away.
Please refer to the attached test hole logs and plan and profile sheets for the septic design. If this
design is followed, there will be no adverse impacts to adj acent properties.
Sincerely,
Michael E. Anderson, P.E.
11/2/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201473, Rebecca Carroll, 11/04/20
1"=50'
4-BDRM HOME
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH1
AUDUBON HILLS, BLOCK 2, LOT 9
A
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D
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B
O
N
C
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C
L
E
11/2/20 FEET
0 50 100
AUD
U
B
O
N DRIV
E
10' x 30' GUY EASEMENT
TH2
880
885
875
870PROPOSED WELL
EXISTING WELL
1,500 GALLON
S.T.E.P. TANK
50' LONG x 5' WIDE x 4' EFFECTIVE
DEPTH ABSORPTION TRENCH
ALTERNATE SITE: CATERGORY III
SYSTEM w/ 25 LONG x 5' WIDE x .5'
EFFECTIVE DEPTH ABSORPTION
TRENCH. APP. RATE 5 GPD/SF.
FCO MH
MH
MT
MT
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201473, Rebecca Carroll, 11/04/20
AUDUBON HILLS, BLOCK 2, LOT 9
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 1-5 MIN/IN
APPLICATION RATE: 1.2 GPD/SF
5' WIDE TRENCH SYSTEM
1,500 GALLON S.T.E.P. TANK
TYPICAL TRENCH SECTION
(NO SCALE)
1" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
5'
6"
6"
1'6"
4'
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF TRENCH: 6.0' BELOW GRADE
FLOW LINE ELEVATION: 2.0' BELOW GRADE
TOP OF TRENCH: 0.5' ABOVE GRADE
600 GPD / 1.2 GPD/SF /5' WIDE * .5 (RED. FACTOR) = 50 LF TRENCH REQUIRED (50 LF SPECIFIED)
11/2/20
2" INSULATION
& GEOTEXTILE FABRIC
30 - 3
16" HOLES @ 1.7' SPACING
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201473, Rebecca Carroll, 11/04/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)✏
PROJECT No.:
TEST HOLE 1
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
A U D U B O N H I L L S B 2 L 9 ⌥
1 0 /2 0 /2 0
L . T I D W E L L ⌥
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? -
1 .7 6
4 5
0 1 5 -2 3 1 -5 9
T E S S O R E J E A N N E T T E ⌥
1:55
10/22
1
2
3
4
5
6
0 0
16 / 6 0
16
2:00
2:12
2:23
2:34
2:46
1' OB
Professional Engineers Stamp:
11/2/20
4:49
N O ⌥
1 1 .0 '⌥
1 0 /2 9 /2 0⌥
GM (SILTY SANDY GRAVEL)
7 2:57
8:51
10
10
10
10
10
0 0
16 / 6 0
16
0 0
16 / 5 15
16
0 0
16 / 5 14
16
0 0
16 / 5 14
16
0 0
16 / 5 14
16
0 0
16 / 5 14
16
6 0
16
6 0
16
5 15
16
5 14
16
5 14
16
5 14
16
5 14
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201473, Rebecca Carroll, 11/04/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)✏
PROJECT No.:
TEST HOLE 2
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
A U D U B O N H I L L S B 2 L 9 ⌥
1 0 /2 0 /2 0
L . T I D W E L L ⌥
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? -
2.9 6
4 5
0 1 5 -2 3 1 -5 9
T E S S O R E J E A N N E T T E ⌥
1:53
10/22
1
2
3
4
5
6
0 0
16 / 6 0
16
2:04
2:15
2:27
2:39
2:50
1' OB
Professional Engineers Stamp:
11/2/20
4:49
N O ⌥
1 3 .8 '⌥
1 0 /2 9 /2 0⌥
GM (SILTY SANDY GRAVEL)
8:51
10
10
10
10
0 0
16 / 6 0
16
0 0
16 / 5 15
16
0 0
16 / 5 14
16
0 0
16 / 5 14
16
0 0
16 / 5 14
16
6 0
16
6 0
16
5 15
16
5 14
16
5 14
16
5 14
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201473, Rebecca Carroll, 11/04/20
MUNICIPALITY OF ANCHORAGE
~'DI~PARTMENT OF HEALTH AhlD ENVI P, ONMENTAL PRO'IECTION
f~uch ~6§O,~J~nch~r~Ue- /~laska 99502 ~76-~22
SOItS k.O~ rE RCOLAI'ION TEST
SOILS LOG
FE t~ERFOFIMEI):. ~~' ' "
SITE PLAN
1D
11-
13-
14
15
16
18
19
PER(~OLATIO N RATE
Net
Time
L
(minutes/inch)
Net
Drop
FT AND FT
DATE:
P-0\� U S N
UH CC '= A L0T 7 OF '-` HC H 0R
Development Services Department ,/ Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-231-59 Expiration Date:
1. GENERAL INFORMATION
Complete legal description Audubon Hills, Block 2, Lot 9
Location (site address) 12320 Audubon Cir, Anchorage, AK 99516
Current property owner(s) Alexander Homes LLC Day phone (907) 830-6211
Mailing address PO Box 110344, Anchorage, AK 99511
Real estate agent
2. TYPE OF DWELLING:
M Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well®❑
Private Septic
❑®
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $_ 75 + -0 y �
Date of Payment I q -Z %
Receipt Number 3 ro 7 26
Waiver Fee $
Date of Payment
Receipt Number
COSA # ()�2 G 21 19 1 y Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 10/12/21
41,R�� • OF q��sse
LF' �'• 49th •' � +e.
6. DSD SIGNATURE ^ """ =a Z,t%;,
System #1 Approved for bedrooms :�n ;MICHAEL E. ANDERSON
_�'' NO. CE -4381 AV
System #2 Approved for bedrooms ®e��FP 10/12/21 ••..••'���',�
Disapproved ®® t� s0&"SS= ®®wOe
Conditional approval for bedrooms, with the following stipulations:
J
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Original Certificate Date: f d
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
s
Legal Description: Audubon Hills Block 2 Lot 9
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
Q Well log is filed with Onsite (or attached)
Date drilled 12/18/20
Total depth 327 ft
Parcel ID: 015-231-59
Structure served by this system 1
Well production at time of test 2 gpm
Water storage tank volume NIA gallons
Well disinfected for coliform test? ❑ Yes ❑ No
Cased to 81 ft 0 Coliform bacteria is Negative
0 Sanitary seal is functioning correctly Nitrate mg/L 0 Nitrate less than MRL (ND)
®❑ Wires are properly protected Arsenic ug/L R Arsenic less than MRL (ND)
Casing height (above ground) '24 in. Collected by Forge Engineering
Date of flow test for COSA *12/18/20 Date of Sample 10/8 & 14**
Static water level at beginning of test 0 ft.
Comments *New well w/ flow test *Well retested for bacteria, disinfected after initial positive test
B. TANK DATA
Age of tank(s) 1 years
Tank type/material Plastic
Measured operating fluid level in septic tank New
❑® Standpipes/foundation cleanout per record drawing
Date of pumping New Construction
D. ABSORPTION FIELD DATA 5' Wide
Which system tested (date installed) 12/1/21
®❑ ALL standpipes present per record drawing
Total measured depth from grade 7.4 ft (max)
Measured depth to pipe invert from grade N/A ft (min)
❑® N/A — pressurized field
W Monitor tubes go to bottom of effective. If not, state
depth into effective
an Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies: Absorption Trench constructed 1212/20.
COSA Checklist yellow sheet
C. LIFT STATION
❑ Required maintenance completed
Age of lift station 1 years
Lift station material Plastic
Comments: New Construction
equacy test date N/A
Resu ❑ Pass For bedrooms
Fluid depth for to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Yes
Community Sewer Manhole/Cleanout > 100'
✓0 Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25' Yes
if No ft
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' Yes
if No ft
0✓ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' MV Yes
if No
ft
Q Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water > 100' p Yes if No ft
Property Line > 5'✓0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100' Yes if No _
Water Main > 10'
Yes
if No
ft
Community Wells > 200'✓0 Yes if No.
Water Service Line > 10'
❑✓
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' E✓ Yes if No ft If absorption field is under driveway comment below
Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots:
Water Main > 10'✓0 Yes if No ft Private Wells > 100' 0✓ Yes if No
Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' 0 Yes if No
Surface Water > 100' 0 Yes if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION `�,0F..�C
1 certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with 49th
MOA COSA guidelines in effect on this date. �. :.•.•._7....1—.... ••.•�p•�,°•..�
COSA Checklist yellow sheet
MICHAEL E. ANDERSON g i
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