The URL can be used to link to this page

Home My WebLink AboutAUDUBON HILLS BLK 3 LT 3Audubon Hills Block 3 Lot 3 #015-231-62 i ALPINE DRILLING & ENTERPRISES i Permit Number: #SW Date of Issue: Parcel Identification Number: Date Started: Date Completed: Is well located at approved permit location? ❑ Yes ❑ No Legal Description: Audubon Hills Lot 3 Block 3 Property Owner Name & Address: Chad Gasaway 1.940 Marthas Vineyard Unit 1 Anchorage. Alaska 99507 Borehole Data: I Depth (ft) Method of.Drillin� b ®air rotary ❑Cable tool Soil Type, Thickness & Water Strata From To Casing Ye: stsal _ stick-up 0 2 Wall Thickness: .025 inches organics 2 10 Diameter: 6 inches Depth: 80 feet organics & silt 10 15 Liner Type: gravelly silt 15 45 Diameter: inches Depth: feet Casing stickup above ground: 2 feet gravelly silty sandy H2O 45 51 Static water level (from ground level): 2 feet gravelly silt 51 75 Pumping level: 45 feet after bedrock 75 82 2 hours pumping 50 gpm Recovery Rate: 50 gpm j Method of Testing: air lift Well Intake Opening Type: ❑ Open End ® Open Hole ❑ Screened Start feet Stopped feet ® Perforations Start46 feet Stopped 48 feet Grout Type: cement Volume: 5_g Depth: Start 0 feet Stopped 32 feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: chlorine tablets Comments: Well Driller: Alpine Drilling & Enterprises P.O. Box 110496 i i Anchorage, AK 99511-0496 Attention: The well driller shall provide I well log to the property owner within 30 days of completion and the property owner or the well driller shall provide a well log to the Development Services Department within 60 days of completion. STATE OF DEPT. OF ENVIRONMENTA DIVISION OF WATER ASKA SEANPARNELL, GOVERNOR 555 CORDOVA ANCHORAGE, AK 99501 ALPhone: (907) 269-7519 CONSERVATION Fax: (907) 269-3487 http://www.state.akus/dect :ORIZATION PROGRAMS April 23, 2010 Lars Spurkland, P.E. Spurkland Engineering 203 W 15th Avenue, Suite 203 Anchorage, Alaska 99501 Re: Domestic Wastewater Holding Tank -Audubon Hills Subdivision Block 3, Lot 3, -South Anchorage Hillside Area -Final Operational Approval for 4,000 gallon Wastewater Holding Tank System-ADEC Plan Tracking Number 7168 1 Dear Mr. Spurkland: On April 22, 2010 the Department received the record drawings and the documentation; a 4,000 gallon septic Holding Tank with Dual Alarms that will provide wastewater storageito meet the needs of a 4 bedroom house and an auxiliary dwelling unit. The lot is served by a Class C Public Water System having a separation distance of over 150 feet from the source well to the holding tank. The soils present on the lot consist of 5 feet of peat, which would not percolate and ground water was encountered beneath the peat layer. The engineer has determined the use of a holding tank instead of an onsite wastewater system will best serve the needs of chis development. The new 4000 gallon holding tank is produced by Anchorage Tank and their dual alarm type controls are being used. If this item is changed, please advise this office for concurrence. E The Department has reviewed the record drawings and the documentation submitted for the Wastewater Holding Tank System and per the Wastewater Regulations 18 AAC 72.240 Final Operational Approval for the above described wastewater system is hereby issued. A completed "Certificate to Construct' for the wastewater system is enclosed. Please use the above plan tracking number with any correspondence regarding this system. This approval does not imply the granting of additional authorizations nor obligate any state, federal of local regulatory body to grant required authorizations. Any person who disagrees with this decision may request an adjudicatory hearing in accordance witli 18 AAC 15.195- 18 AAC 15.340 or an informal review by the Division Director in accordance with 18 AAC 15.185. Informal review requests must be delivered to the Division Director, 555 Cordova Street, Anchorage, Alaska 99501, within 15 days of receiving the decision. Guidance information on the informal review process may be found at hearings requests must be delivered to the Commissioner of the Department of Environmental Conservation, 410 Willoughby Avenue, Suite 303, P.O. Box 111800, Juneau, Alaska 96801, within 30 days of the decision. If a hearing is not requested within 30 days, the right to appeal is waived. I Thank you for your cooperation. If you have any questions please do not hesitate to contact me at 269-7519. Respectfully, William R Rieth, P.E. Environmental Engineer Enclosure: As stated cc: William Smyth, WW, w o enc. STATE OF ALASKA A. DEPARTMENT OF ENVIRONNcNTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE —' for fw:,ws�r DOMESTIC WASTEWATER DISPOS41- SYSTEMS AuWootJ /�IL�LS svCiDlvtstorJ� 43�66ckV— L6713 A. APPROVAL TO CONSTRLIG�0OO 6RLGo�J tU,457'ewAVER Hotbtwe; T;4MK' ADS !°LAN r!RACKttvc• VOM19£t2.1!68 Plans for the construction or mod'rficatlon of ALA (I"S AND 110WER6bg Folz A 4000 P,/1OnlW�/�Aviw T vk domestic wastewater-�+speaj+system --�` located In - 1+N6H0►2Fr, F' , Alas a, submitted in accordance with 18 AAC 72.225, EfJGi�RtNG by. 'Jr Aa5 5 pUi� 37'yt2KZANAave beeh reviewed and ara ❑ approved. conditional! a I µ � r pproved (see a..ac„ed conditions). 6Y TITLE DATE , It corstructiori has not startsd within two years at Lha approval date, this cerflfrcata is veld aid new plans and specMc.atfons must be submittad for review and approval before construction. 3. APPROVED CHANGE ORDERS Change(contract ardarno. ordasedp9varefersnea) Approved by - Date APPROVAL TO OPERATE The 'APPROVAL TO OPERATE' Department before this system Is n must be completed and signed by the available for. use. The construction of the . ��-�' �A'�a�Ga�, •�c� domestic wastawatsr disposal system was cqm laced on .�%r-�'� z z4 I O y p —.� i � (data). The sys;am is hereby granted interim approval to operate for oo.days following tha'completion date. BY I TITLE DATE As-bulit plans submitted during the Interim approval period,.cr an Inspection by the Department, has confirmed the system was constructed according to the approved plans. . The system Is hereby granted final approval to cpq�--te. /i•��tr.�J � �� . I �.�2�2c�7"aa�;�a/'�:�7, /9�0,� j Z� �D/O Ey TITLE �` CATE Due Received STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION 1i1 DOCUMENTATION OF CONSTRUCTION 1 1. GENERAL F A Legal Description of the Location Submitted by: (Chock onc) {� l- AUQH6f1 WA1.5 �A3 W 3 Cl fJ Certified Installer ❑ Approved Homeowner I. ;< Registered Engineer Installer Name•./(�� Onsite Wastewater System Serves: c6A �raSaWdJ "� Single Family. Number of Bedrooms Jr Mailing Address �t jj ❑ Duplex. Number of Bedrooms Mw A4C110r\ Drive ❑ Small Commercial Facility With Estimated Design Flow of less than 500 GPD. A ne-tip acre . AK 99516 I' I 11. WATER SUPPLY SYSTEM SECTION II IS OPTIONAL 5omce of water and Conta nntent (Check all that Apply) Type of Water Supply Systan Ttatment of Water (a=k all that Apply) Will (Dri!ld wDn'ren) [3Surface (ldmdy) SF/DuplaNone [3 Chlorination ❑ RoofCatchmen Filtration ❑ Mineral Reovil ❑ Holding Tank ❑ Other (IdendA) ❑ Public 0 Othc. Will Duty Is the height of the will casing orae the 12' above the 1pou 41 Yet ❑ No Is a unitary sol or well cap instilled on the veli min, Yes 0N It "nage directed away from or around the ca-sing witlin a radius of 10 fat of the well casing' Yes ❑ No is will wire enrdosed in conduit? iii Yes ❑ No Date Drilled utl�lY�Uih Depth of Weil (Feet) $� Static Water LeW(Fen) n K Yidd (lfa jhzble)� Pump Rate(/fawUab/e) Squiranor, Dstance'rfran the Weil Casing m each of the Following Sou cm of Cmtaminatinm SepmMol(ling Tank on I.at 1 ICO 4 Sneer Lina on Lm Absorption Ara on Lot �1 N A Fes f: Feer Fm Closet Sepdc/Holmng Tank on Adjacent Lot 1+ ICO Closest Sewer Lines m Adjacent lel ICD'I" Closest Edge of an Absorption Arca on I n1I,F Fon n. Fee Ad'aeent c Feet Inmate sep"m duunce thrum aeric materials inducting fud tanks; paints, lubncants and other On Lot N On Adiacent Lo pmm,laim basal materials, tieitim fim'cida or hnbicida to w11 covin. Feet DOS} Feet ` S I_a a Water Sample Taken by: (Name) Lzis tAA ar+ Samplerjz 6- Buyer �Enginoer 1 ❑ Banker ❑Govemmem Official Address a03 W, 15'k AI, s &L �!A or k 94501 Water Sample Results: Artach Corry ❑ Satisfac6ry - Date ❑nsatisfatt ate Comments/Recommendations: ! I certify that the *hove nnd that nrnyj Si°""j` p Sur ° ;d in rettinn IV is rarrect- TypeNPnmed Name 1L" s Title Date E inrOr 3 3i ZAIu W!5 u�! 4rN4J Now 1. This srcdai should be signed bya Cedflod bsualler. Ptemional EngAmr, D£Crraj.. a p rneBW Wer s Z Allpublicwlwsystansnutrreaiw AD£CFlanapprowlprlornanrrrucrim- See l8AAC80SkueofA1aska Drinking Wares itauladansfaspedficrepuiren M 111. WASTEWATER DISPOSAL Legal Description: A%Ad.A n IT,% goo 3 Lot Type of Wastewater System: ❑ Septic Tank with Conventional Soil Absorption System ❑ Package Treatment Plant (requires engineered design) Holding Tank: MatcrialType: STEEL SizeinGallons: �pw Manufacturer. AA(AmTL AnfL ❑ Other- Specify Typc ❑ Alternate Onsite (requires engineered design) ❑ Small Commercial System (<500 GPD) With (Estimated Daily Wastewater Flow of: Gallons Per Day (GPD) i Criteria Used to Estimate Daily Wastewater Quantity. I! t� NEW SYSTEM ❑ REPAIR TO EXISTING SYSTEM Certified Installer Installation Notification Date: Name of Installer. GW Ga .t..X. i' Date Installed: .1'.. "' 2CO9 System Installed: ❑ By a Registered Engineer With Inspection by a Registered Engineer ❑ By Approved Homeowner attach copy of a val letter ❑ By a Certified Installedlnstaller Number Septic Tank: Material: Manufacturer., Size (Gallons): Number of Compartments: l Type of Soil Absorption System: J A ❑ Deep Trench ❑ Shallow Trench ❑ Seepage Pit ❑ Bed N I/1 ❑ Mound ❑ Other, Specify Soil Classification: Soil Rating: 1' DimensionslSize of Absorption Arm: Grading/Size of Distribution Rock: 1= ThicknessfDcpth of Distribution Rock: Percolation Test Results, Attach Copy of Report: is PercolationTest Performed by: Minutes per Inch S R per bedroom pamlatim tat rout¢ must be scale&signed by a registered wgin List ground cover in feet over. SepticTank i�� I Absorption Area ./�/ Sewer Pipes�{ t Cleanout Pipes/Caps Installed: Foundation iCleanout: Septic Tank: Y Monitor Tubes: indicate separation distances from septic tank or absorption area, whichever is closest, to all nearby: Public drinking water sources within 200 feet: ,1:- Private drinking water sources within 100 feet: q Nearest water bodies see ISAAC 72.020(b)): t t : ei CO + Lot line: 10 4 - Separation Distance from Onlot Sewer Lines to: I'r Public Drinking Water Sources: ZM + Private Sources: 100I•t Separation Distance From Bottom of Distribution Rock to: "/A Groundwater Table: JV/A Bedrock: "/A Separation Distance from Absorption Area to Slope exceedin 25%: Comments(Recommendations !i ;i i I. i 1 certify that the above information and that provided in Section IV is correct: Si atum TZf+bpj� T nnted Name Ii Title, Reg./Cert No., Inst. No. I Date e( S Ur and C -E- 115M 3 3l Zo10 N .- Meat U signed by a COafied lmmlle, Proffmso l Engined, DECsw . o App,o d Ha mer. /frngintenng sml bevt prinud tnmt. qutroiim number. andU sig�.sOrm�t �s or bt co pltred for engintdtd submRmis. Vu A;rfis f Profen��.aagqpr•o TH ,. sPi:at(LA:.�. (10 k Q) O 1NSTAULD 4000 =ON H"/Wm TANK W/ HIGH WATFR AIARVANpIOR£D TANK AGAINST fLOALot 7 / !1' D e $WAV )7a J,: r —Ar -B-11 C 52.0 6.0' D !SS 1.10 C 31.5 21.0 Cot 3 y 25 0 25 50 jy 75 100 125 150 SCALE: 1' = 50 FL W177C ARV 49th_ IW' 203NW 157H.LNUINUKIN AVENUE U1LOT 3 BLOCK 3 AUTUBON HIUSI I SEP77C SYSTEM DESIGN I ANCH. AK 99501 '• CHAD GASAWAY DATE. APRIL 22, 2010 /907) 279-3916 i 12160 AUDUBON DRIVE SHEET.• 1/3 GRID. 2739 ADEC TRACK # 7168 li ABHBX3D2.BV6 I 1 y 25 0 25 50 jy 75 100 125 150 SCALE: 1' = 50 FL W177C ARV 49th_ IW' 203NW 157H.LNUINUKIN AVENUE U1LOT 3 BLOCK 3 AUTUBON HIUSI I SEP77C SYSTEM DESIGN I ANCH. AK 99501 '• CHAD GASAWAY DATE. APRIL 22, 2010 /907) 279-3916 i 12160 AUDUBON DRIVE SHEET.• 1/3 GRID. 2739 ADEC TRACK # 7168 li ABHBX3D2.BV6 I Parcel I.D. 015-231-62 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: R `.2, 3!� Complete legal description Audubon Hills, Block 3, Lot 3 Location (site address) 12260 Audubon Drive " Current Property owner(s) Darrell and Shelli Koontz Day phone Mailing address 12260 Audubon Dr. Anchorage, AK 99516 Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class- Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request Received by: __A COSA to be released to the unless otherwise requested by the engineer. COSA Fee $ . 52-1(0— Date of Payment /.S Receipt Number bbN2.(A COSA # 0sc16-12 31 Date: S/aQ/26/S Waiver Fee $ _ Date of Payment Receipt Number, Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address PO Box 100217, Anchorage AK 99510-0217 Engineer's Printed Name Steven R Pannone Phone (907) 272-8218 Date 05/08/2015 -n 6. DSD SIGNATURE System #1 Approved for bedrooms §leve k. ESonr System #2 Approved for _bedrooms Disapproved `•.,C��S149P i1 Conditional approval for bedrooms, with the following stipulations: By: Q Original Certificate Date: -6--.242— / Theni ' Ity f A o ge 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 COSAbluesheett c Nitrate Advisory _ Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Audubon Hills, Block 3, Lot 3 A. WELL DATA Parcel ID: 015-231-62 Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Tota) depth 82 ft. Cased to 80 ft. Casing.height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Rate of test Unknown 5/7/2015 Static water level 2 R 2 ft. Well production 50+ g.p.m. 4.5+ g.p.m. WATER SAMPLE RESULTS: Coliform Neg oolonies/100 mL Nitrate 6.4 mg/L Arsenic ND ug/L Date of sample: 5/7/2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Holding Tank/Steel Tank size 4000 gal. Number of Compartments Foundation cleanout (Y/N) Y Date of pumping 05/08/15 C. ABSORPTION FIELD DATA Date installed Length ft. Total depth ft,. Date of adequacy test Fluid depth in absorpti Elapsed Tirana - / Collected by: PES Date installed 07/07/2008 Cleanouts(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Pumper Isaac's Pumping Soil rating (g.p.d./ft2 or */bdrm) Width ft. /'Gravel below pipe ft. tube _ Depression over field _ Eff. absorption area _ Results(Pass/Fail) For bedrooms test in. Water added gal. New depth in. min. Final fluid depth treatment (past 12 mo.) (YIN & type) in. Absorption rate >= If yes, give date I D. LIFT STATION Date installed �in-gelfb�s "Pump on" le in. "Pump off level at um Cycles tested Manhole/Access (Y/N) _ in. High water al level at in. Meets nn & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: hh Septic tank/lift station on lot 6 U On adjacent lots Absorption field on lot A On adjacent lots Public sewer main 5 4 Public sewer ma a/cleanout DO k Sewer /se ' service line 2 5 Holding t `� � 44 1� A ' al containment areas 5 h M re/animal excrete storage areas . i `'y 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 Building foundation Water main Water Service Surface water Driveway, parkin ide storage Curial rain Wells on a.311'cent lots F. COMMENTS As Built on file *Well plugged at 2 feet G. ENGINEER'S CERTIFICATION -4S?"!1P. AI tI- 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 thl date. Engineer's Printed Name Steven R. Pannone Date 05/08/2015 COSA canary sheet_2-6-15.doc Municipality of Anchorage 0`- .y. Community Development Department Development Services 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 # 151236 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 3 of Audubon Hills subdivision. This inspection revealed a nitrate concentration of 6.4 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. Isaacs Pumping Service 6218 Quinhagak Street Anchorage, AK 99507 Phone # 907-563-3300 isaacspumpingwgmail.com Fax # 907-562-5473 Statement 5/8/2015 $145.00 12/31'2014 Balance torward 145.00 01/08/2015 INV #247404. Due 01/08/2015. 145.00 290.00 -Holding Tank $145.00 01/13/2015 PMT #5420. -145.00 145.00 02/13/2015 PMT #4246. -145.00 0.00 02/17/2015 INV 4247484. Due 02/17/2015. 145.00 145.00 -- Holding Tank $145.00 03/03/2015 PMT #8576. - -145.00 '0.00 03/10/2015 INV 4247532. Due 03/10/2015. _ 145.00 145.00 - Holding Tank $145.00 04/06/2015 PMT #7477. -145.00 0.00 04/08/2015 INV 4247613. Due 04/08/2015. 145.00 145.00 -- Holding Tank $145.00 04/27/2015 PMT #1797.. -145.00 0.00 05/01/2015 INV 4247681. Due 05/01/2015. 145.00 145.00 - Holding Tank $145.00 0.00 145.00 0.00 0.00 0.00 $145.00 \ 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 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 'COSA# GSC/O/O 8.3 Expiration Date: q —17 —/ a 1. GENERAL INFORMATION 1 Complete legal description Auk, 1 1on Ni115 61ocL 3 tot -3 Location (site address) 1a�160 AwL6 Drive, Current Property owner(s) tic sawzj Nar Day phone 1990 Mailirib address 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: S 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank El 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 seat 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 Address 203 W. 15t" Engineer's Printed Name 5. DSD SIGNATURE Approved for S bedrooms. Disapproved. Phonea4-31JU Date 6 T Zo10 OF ACgs�l i .2. l 9 �� ls�u�xu�ao.� If('� •, ftp (1j�0'PR `t�'�= Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report >— Other By: ! Original Certificate Date: (Rev 11105) Municipality of Anchorage ° • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore 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: AuA46 u ills 910 Ld 3 ' Parcel ID:_ D / S -Z 3 2 A. WELL DATA Well type AlAl If A, B, or C provide PWSID # = Well Log (Y/N) y Date completed + . own Sanitary seat (YIN) Y Total depth —2—Aft fL Cased to A-0—ft FROM WELL LOG Date of test 1unl r»wn Static water level a ft. Well production 50 g.p.nt. WATER SAMPLE RESULTS: Coliform _ 1V/ colonies/100 mL Nitrate _ 3.01 mg/L Arsenic: QG ug/L date of sample: 2010 B. SEPTICIHOLDING TANK DATA 1 Tank TypelMaterial _ Ancl orq� _ TAn o ap- ` Tank size Lim ' gal. Number of Compartments' I Wires properly protected (YIN) i Casing height (above ground) 4-1`5 n. AT INSPECTION 29 2010 2,5 ft. 1.3 g.p.m. Other bacteria IV colonies/100 mL Collected by: t AQ5 i=$Q9 1ArJ Date installed 7.1}12cul?, Cleanouts (Y/N) y Foundation cleanout (Y/N) _ Depression over tank (YIN) ./I/ High water alarm (Y/N) Y Date of pumping 2 2010 Pumper 750res P4Mn,,,;, S�n,1ce. C. ABSORPTION FIELD DATA Dale Installed Soil rating (g.p.d./fe or ft2/bdrm) — System type Length — fl , ' Width ft.. Gravel below pipe — ft. Total depth = ft. Elf. absorption area =fe Monitoring tube = Depression over field = Date of adequacy test — Results (Pass/Fail) — For =bedrooms Fluid depth in absorption field before test = in. Water added= gal. New depth= in. Elapsed Time: _--min. Final fluid depth = in. Absorption rate >= — g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhote/Access (YM) 'Pump on, level at in. -Pump ofr level at in. High water alarm level at in. Datum Cycles tested Meets alarm ti cIr equirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot IVLA Absorption field on lot -A-11A Public sewer main /V/q Sewer /septic service line 75 r+ Animal containment areas FO t+ t On adjacent lots .100 f On adjacent lots 1 m + Public sewer manhole/cleanout Holding tank 1100 r+ Manurelanimal excrete storage areas 100 '*- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r � Building foundation $ + Property tine 5 + Absorption field N Water main 64LA Water service line 10 �+ Surface water 100 r Wells on adjacent lots 00 r+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: N/A Property line -- Building foundation Water main _ Water Service line Surface water — Driveway, parking/vehiGe storage _ Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION �p'��'"F •.'gS%1111 I certify that I have determined through (old inspections and i h 9TH review of Municipal records that (he above systems are in '0-7 .... 1 conformance with MOA COSA guidelines in effect on this date. i .. . , FtSibppUR{LAND; / Engineer's Printed Name LABS Snvr lel z, 11111 cJ . '" y ",'j -p �> Date GII I 2ot0 I I I�F�giOCE COSA Fee $ 0 Waiver Fee $ Date of Payment Date of Payment Receipt Number O %o I(n a` Receipt Number (Rev. 11ID5) 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 IC Certificate of On -Site Systems Approval # 101083 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 3 of Audubon Hills subdivision. This inspection revealed a nitrate concentration of 7.01 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. SCS Reta 1101306001 Client Name Spurkland Engineering Project Namef# Audubon Hills B3 L3 Client Sample ID Audubon Hills B3 L3 Matrix Drinking Water Samplc Rcmarks: Printed Date rime Collected Date/time Received Date/time Technical Director 04/05/2010 13:38 03/30/2010 12:10 03/30/2010 12:33 Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Contains ID Limits Date Date !nit Metals by ICP/MS Arsenic 5.00 U 5.00 ug/L EP200.8 C (<10) 03/31/10 04/02/10 KDC Waters Department Total Nitate/Nitritc-N 7.01 0.100 mg/L SM20450ONO3-F B (<10) 03/30/10 LCE Microbiology Laboratory Total Coliform Negative I IOOmL SM209223B A 03/30/10 DLC E. Coli Negative I IOOmL SM209223B A 03/30/10 DLC GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI. R.L.S. 2000 E. DOWLING RD.. SUITE 8 ANCHORAGE. ALASKA 99507 PHONE 248-5454 GRID I DATE 2739 1 3/17/2010 F.B. 08-10 I JOB N0. AHS33 PLAT NO. 77-307 AUDUBON HILLS SUBDIVISION LOT 3 BLOCK 3 47,489 S.F. S 70.04, c I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT. ALASKA NOTE: NO CORNERS SET THIS DATE. LEGEND FOUND ALCAP ON 5/8" REBAR FOUND 5/8" REBAR OFA. A4,1 ♦ : '•. i o iin *7' 41H ...............•: ......... ... .................a A . Jeffery A. Gustoldl c g : LS -6091 w1 AV °. •.......• •/1 \ musO 111=30'