HomeMy WebLinkAboutAUDUBON HILLS BLK 3 LT 2Audubon Hills
Block 3
Lot 2
#015-231-61
Municipality of Anchorage ;;:;;;:: ;•,
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page I of 2
will ci.anchorage ak us (907) 343.7904 '
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: S&001901413 PID Number: 01,5"-221 -,</
Na" —j S,+/lr i-r+rr
Wastewater System: E3 New ® Upgrade
Joa Fra e
A�.ss
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ABSORPTION FIELD
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LEGAL DESCRIPTION
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SEPARATION DISTANCES
[]Septic ❑ Holding ❑ S T.E P. ® Other:
To
Septic
Absorption
Litt
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ubnUPnvate
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Engineers Stamp
Insp tlonsperformedby:rl4rkp Ttch S:�C Dates: 1" 8/22/08
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Development Services Department Approval
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- 49 9TH G`H , :
Conditional Approval Date:
F^ 4r
tt
. ThVcODOZE F. M0011 •: n C
�' '`� •• CE 3537
" �/ t' Date:
- r, .-
Reviewed and approved b
,R� wwl
PERMIT NO: SWO80143 N
------------------------------------------------------------
PID NO: 015-231-61
SWING TIES:
FROM: COR. "A'
COR. "B"
TO:
DBL. C.O. "C"
11'
32'
TANK C.O. "D"
15.5'
39.5'
CTR. POD "E"
16.5'
44'
TANK M.H. "F"
21'
46.5'
LIFT STN. "G"
25'
50'
BED M.T. "H'
33'
47.5'
BED M.T. "1"
46'
43'
NEW 1500 -GALLON
"ADVANTEX"TANK
"ORENCO" AX -20 POD
"ORENCO" LIFT STATION
15'x 20' SOIL ABS. BED
.49W �14 l .
1.E••� F•A14,�fr
;'
490
... ............. 0......
♦ • THEODORE F. MOORE i 1
��.•'•_ CE -3589 * $Ar
FINAL GRADE 99.0+/ -
POD.
•
1500 -GAL ON
ADVANTEX TANK`
1
INV.
94.4'
1
PROFILE VIEW
NOT TO SCALE
PAGE 2OF2
NEW 1S" DIA. HDPE CULVERT
' R=100'
,
,
,
,
3
LD BED I
sJll /
/ T.H.
PLAN VIEW
SCALE: 1" = 30'
FINAL GRADE 102.4'+/-
5. S'
2.5'
'y�irrrmF-- 5' --
DID
P: 1'1
I
Inspection Report
Municipality of Anchorage, Building Safety Division
4700 Elmore Road
INFO 6 HELP t9on 343 e21 t
INSPECTION: VOICE (907) 343.6300 • FAX (907)249.7777 • www.rnuni.org
Name eds electric
comparry
Address 12300 AUDUBON OR
Grid SW2739 ' .
Subdivision AUDUBON HILLS
k Description Septic lift station
Technician STULLER. GRETCHEN J..
Directions am can to meet on site
dtlon Type Electdcal:Retro Electrical
Comments (for inspector use only)
Permit 0 09.9013
Inspection Date 29 -Aug -2008
Phone 2724591
LOT 2 BK3 TR Wit
Inspector � ��
Date fpl
SEP-2-2WS TUE 09:40AM ID: PAGE:1
Municipality of Anchorage
L:O. Ik)s 1!N 674 • Anehomgc, Alaska 99519UM - 470O Elmo,, Raul
Oaicc: (!N)7) 343 -SM • I'a<: (!M)7) 3bidiE(M) hup:/Alm mmiLoig
Mayor Mark Begich Development Scr%iccs Dquirtntent
December 9, 2008
Ted Moore, P.E.
Flattop Technical Services
Subject: Waiver Request for Audubon Hills; Block 3; Lot 2
Waiver Request Number: WR080080
Parcel ID: 015-231.61
Permit Number: SW080143
Dear Ted Moore, P.E.:
Your request for the waivers listed below;
1. 40 foot absorption field to surface water separation distance.
2. 7 foot absorption field to south property line separation distance.
has been approved.
Ment
c t.
a
Department
This waiver approval applies to the items listed above only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Ja es "Jay" Crewdson, P.E.
Civil Engineer
On -Site Water & Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
• Building Safety Division
On-Sitc Water and Wastewater Program
/ 4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorageak.us
(907)343-7904
Waiver Review Worksheet
WR# 0800080 PID# 015-231.61 Permit# 080143
Date Received: July 15, 2008
Legal Description: Audubon Hills Block 3 Lot 2
Engineer. Ted Moore, P.E.
Applicant: Joe & Faye Sullivan
Waivers Requested: 40' absorption field to surface water, 7' absorption field to property line
Criteria: Geology Points:
A. Water Table
Waiver Is Granted: X
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver Is not Granted.
List Conditions or Reasons for above (mitigating factors):
• Subject surface water is at a higher elevation than the absorption field.
• All surface water lower than the absorption field is greater than 100 feet away.
• The septic system is Category III nitrate reducing.
• Location of absorption field does not Interfere with adjacent septic systems.
Date: 12/9108 By: Jay Crewdson
Name of Reviewer
.........................................................................
Rec#: 110493 Amount: $1150 Date Paid: 7/15108
MUNICIPALITY OFANCHOR4GE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
OIS2.1oe
1 � gyp: 3va�r
Date Issued: Jul 25, 2008
Expiration Date: Jul 25, 2009
Permit Number: SWO80143 Parcel ID: 015-231-61
Legal Description: AUDUBON HILLS BLK 3 LT 2
Design Engineer: 0019 FLATTOP TECHNICAL SERVICES Site Address: 012300 AUDUBON DR
Owner Name: JOE & FAYE SULLIVAN Lot Size: 48312 SO. FT.
Owner Address: 12320 AUDUBON DRIVE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, AK 99516 -
This permit is for the construction of:
❑V Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
One additional foot of sand to be added to the designed two feet to make for a total of three feet of filter sand beneath
proposed absorption bed. �
812 Z/o8 5 Ys TFk <exan ,,) Pa o u r- � ve roux . T vi- d r 6D Hl-_ sni L
oPL-Y H)sv ro Pur 3 ' ox sp,,d 14, 60-1
Received By:
Issued By.
Date: F
Date: 2 S Og
Parcel LD
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519.6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
615- A51 -
Property owner(s)
L7 -ye It
%c,,,. Su/l,i,c,,,
Day phone
3Vr-vSZ7
❑
Mailing address
17-300
Ako1u � c, L) r i —c
Zip Code
9 9S f G
Site address Serme Zip Code
Legal description (Sub'd., Block & Lot) Lof 2,r 1310r k 3 ; /41!/1
Legal description (Township, Range & Section)
Lot Size u8,, 1rl Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
Septic Tank (�
Holding Tank ❑
Privy ❑
Private Well ❑
Water Storage ❑
Number of Bedrooms
THIS APPLICATION IS AN:
Initial
❑
Upgrade
to
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
.< qktq�"
(Signature of property owner or authorized agent)
cc c
Permit/Rush Fees: y60 — Waiver Fees: l/SO
Date of Payment: -711 /06 Date of Payment: -7/ /S /Gec'
Receipt Number. ' 1 W yt? 3 Receipt Number. t7 '7119
(Rev. 11/05)
F'.L'AT.TOP TECHNICAL SERVICES
CIVIL b ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION 8 ANALYSIS
TED MOORE, P.E. 14530 ECHO CANYON ROAD
PHJFAX: (907)345.1355 ANCHORAGE, AK 99516
E -Mail: tgmoore@gci.net July 15, 2008
M.O.A. DSD
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for a
permit to upgrade the wastewater disposal facilities on Lot 2, Block 3, Audubon hills S/D, located at
12300 Audubon Drive. The original soil absorption bed is operating in a surcharged condition. We are
also requesting a waiver allowing the system components to be installed as close as 40 feet from
persistent surface water in the roadside ditches within the public right-of-way on both sides of Audubon
Drive. A soils log, site plan, design drawings and construction specifications are enclosed for your
review.
The original wastewater disposal system (designed by Michael E. Anderson) was installed in December
of 1990 and according to the inspection report consists of a 1500 -gallon STEP tank that pumps effluent
up into a 25 -foot wide by 46 -foot long soil absorption bed containing 0.5 feet of sewer gravel and 2 feet
of filter sand under the distribution pipe network. According to the property owners the system operated
without problems for a number of years, but now the high-level alarm goes off frequently. 1 inspected
the system several times during March, April and May of this year and each time found the bed
surcharged above the distribution pipe network with excess fluid draining back into the STEP tank.
There was no evidence of septage daylighting onto the ground surface at any time.
The original design engineer reported that the native material in the area of the bed consisted of poorly
graded gravel and sands with a water table at 5.5 feet on 6/25/1990. The approved design was based on
an absorption rate of 150 square feet per bedroom. The system was constructed on a slope and
additional material was placed on the downhill side to create a 25% slope from the final grade. The
design engineer reported that the horizontal distance from system components to surface water was
greater than 100 feet. He showed a replacement site located the west of the original system.
In preparing to design an upgrade to this failing system I first looked at the designated reserve area. The
entire area is very poorly drained. I found what appeared to be one of the original test hole sites for the
reserve area; groundwater was within a few inches of ground level in the monitor tube leading me to
conclude that this area is not suitable for wastewater disposal systems. In an effort to assess the soil
conditions for a possible new disposal site located east of the existing system I had test hole # 1 excavated
at the location shown on the site plan. The soil conditions encountered there consisted of 3 feet of peat
overlying dense gravelly silt. Water seeps were encountered in a silty sand lens at 4.5 feet and the long-
term stabilized groundwater level is 3.0 feet below ground level. Persistent surface water was observed
standing in the roadside ditches on both sides of Audubon Drive, the closest of which is approximately
20 feet from the test hole.
Based on these observations the only viable approach appears to be to rebuild a new absorption system
within the confines of the existing system and size it using the soil information from the original design.
In an effort to create a longer -lasting system we propose to install a Category III Advanced treatment
system with the treated effluent being pumped up into a conservatively designed soil absorption bed.
The log for the original engineer's Test Hole A (which is the one at the location of the existing bed)
reports SP soil with a percolation rate of 12 minutes per inch and groundwater at 6.5 feet. Given this
reported perc rate, we propose to conservatively design the residual disposal bed for an application rate
of 2 gallons per day per square foot. Thus, a 4 bedroom residence would require (4 x 150)/2.0 = 300
square feet, which is accomplished by the proposed 10 foot wide by 30 foot long soil absorption bed. In
order to increase the vertical separation from groundwater we propose to use filter sand to raise the
bottom of the bed an additional 1.5 feet.
This configuration will be created by excavating all of the gravel and 6 inches of the underlying sand
material from a portion of the original bed to expose a 10 foot by 30 foot area of uncontaminated base
soil. Then, we will place a minimum of 2.0 feet of MOA in the excavation to create a new base surface
for the new residual absorption bed.
The natural topography in the area of proposed construction slopes generally down towards the west at 3
to 25%. The existing mound protrudes above the natural slope, and the final grade after construction
will be approximately 1.5 feet higher over the residual disposal bed.
A surface water separation distance waiver is being requested allowing the system components to be as
close as 40 feet from surface water in the roadside ditch on the west side of Audubon Drive. As I
discussed with Dan Roth on June 12, 2008 the mitigating factors in support of granting the waiver are
(1) the fact that the proposed system is a Category III Advanced Treatment System which produces
effluent that is far cleaner than a conventional septic tank, and (2) the fact that the existing and future
topography around the system is such that were effluent to daylight onto the ground surface it would
tend to flow away from instead of towards the surface water. Final grading around the system will
ensure that any surface flow path between it and surface water exceeds 100 feet.
The cover sheet of your department's on-line data base also notes that the existing well is leaking water
out the top and is located in a creek. The leaking water has already been stopped by the installation of a
proper artesian well seal. As part of this project we propose to install a new culvert that will carry
surface water from the roadside ditch 10 feet past the well before allowing it to rejoin the existing ditch.
Because this is an advanced treatment system I am requesting the property owner/builder to come in to
your office in order to execute the required maintenance agreement.
Please give me a call at 345-1355 if you have any questions on this submittal
Sincerely,
Ted Moore, P.E.
cc: Joe and Faye Sullivan
I
i
LOT 7, BLOCK 3
AUDUBON HILLS HOLDING TANK
ADDITION #1 To
BE E
INSTALLED)
N- -----------
LOT %/-' SINGLE-FAM
AUDUBON HILLS ' RESIDENC�!�/
ADDITION #1 w. A.D.U.
`-------------------------------- --------------------------
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 0 '0.�_
__
r-----------------------------------0'0.�_
INSTALL 30 -FOOT LONG x 15" DIA.
CMP w FLARED END SECTION TO
CARRY WATER FROM ROADSIDE
DITCH TO A POINT >10- PAST WELL
INSTALL NEW
LOT 2, BLOCK 3 1500 -GALLON
AUDUBON HILLS "ADVANTEX"TANK
"ORENCO" AX -20 POD
LOT 1, BLOCK 3
AUDUBON HILLS
----------/=------'
/
"ORENCO" LIFT STATION
w.
CONSTRUCT NEW
10'x 30' SOIL ABS. BED
POORLY DRAINED FOREST �2S%� i .i.. .
w. MARSHY PUDDI FS
3/0
o - EXISTING
SOIL ABS. BED
25% T.H.
GG
i .•
dr A
*'49111
.........................
THEODORE F. MOORE i
•
(� • CE - 358944 ,' NA�
.LOT 3,BLOCK 3
'AUDUBON HILLS
D�RM /
use /
DRIVE 40�/
%BANDON
19A00GALLON
FTTANK OJ/:
•-3% //
EXISTING n 40'* 4
"BIOCYCLE"---"'�\�
SYSTEM
HOUSE I Sf is
g! �0
PRIVATE WELL II`
I � I
I
I
LOT 2, BLOCK 3, AUDUBON HILLS SID
SEPTIC SYSTEM UPGRADE
T- SITE PLAN
FLATTOP TECIINICAL SERVICES 1 INCH = 50 FEET
. 41530 ECI10 CANYON ROAD DRAWN BY TFM
ANCHORAGE, ALASKA 99516 - JULY, 2008
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
4
INSTALL"ORENCO"
LIFT STATION
1.25" DIA. HDPE _
OR SCHED40 PVC
4" DIA. D-3034
FROM HOUSE %
FOOTPRINT OF EXISTING :LL�. r `J
SOIL ABSORPTION BED
1.25DIA. SCHED. 40 PVC w
3/16" HOLES IN BOTTOM @18 ;: ilj:AX-20
_INSTALL"ORENCO"
TREATMENT POD
INSTALL1500-GALLON
10
M.T o
"ADVANTEX'TANK
U
'MT
'`
I : •.A., 30
so
CONSTRUCT 30 -FOOT LONG x 10 -FOOT WEID
RESIDUAL DISPOSAL BED w. 0.5' GRAVEL
PLAN VIEW
& 2.0'+ FILTER SAND UNDER DIST. PIPES
SCALE: 1" = 10'
_
� • i • • • •
N T �� lT •� jf..O.ti,
n G� :IT' VIS
...
. .•...•.•••
•^• .i.N6
ORIGINAL SOIL ABS. BED
y.�:••''.�..�;;;,��•�
FINISH GRADE
a�xF
MONITOR TUBE
,' CE-�5B9 •; ,!
\
3
3' SOIL COVER 1
FILTER FABRIC
3 2.5 I
5 12.5
4.5 •8
1.25" DIA. SCHED. 40 PVC w.
I : 2 � FILTER SAND `
3/16' HOLES IN BOTTOM C 18"
.
0.8' WASHED SEWER GRAVEL
i
ORIGINAL SOIL ABSORPTION BED GRAVEL
LOT 2, BLOCK 3, AUDUBON }TILLS S/D
SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
CROSS-SECTION "A - All rLATTOP TECHNICAL SERVICES SCALE: AS SIIOR'N
SCALE: 1" = S' 14530 ECI10 CANYON ROAD DRA%kN BY: TEM
ANCIIORAGE, Ak, 99516 JULY, 2008
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99518
TEST HOLE # 1 SOILS LOG — PERCOLATION TEST
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH
(feet)';
1
` Pt.
2
Lot 2, Block 3, Audubon Hills S/D
May 29. 2008
Faye and Joe Sullivan
3 ML Gray gravelly silt
4
SM/ML Silty sand
5 with water seeps
ML Gray gravelly silt
6 B.H.
7
8
9
10
11
12
13
14
15
16
17
18
SLOPE
I
N _ WELL
Depth to Groundwater Date
Water @4.5' 5/29/08
Water @ 3.0' , -6/5/08 SLOPE 3%
Date Reading
Clock Net Time
Time (minutes)
Percometer Net Drop
Reading (inches)
19 .. ..
20
PERCOLATION RATE (minutestinch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS: No percolation test conducted because 2' of unsaturated native soil not found.
PERFORMED BY FLATTOP TECHNICAL SERVICES. 1 „/ .—.( "i� CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: –711&-
/ G�
��P nY AF AtVC}tpiE,�I
. MEACTH L
PAOTECrM MunidWty of Anchorage
DEPARTMENT OF HEALTH L HUMAN SERVICES
9 84 OV Street, Anchorage. Alaska 99=.vs?
RECEIVED SOILS LOC— PERCOLATION TEST
PERFORMED FOR: ef/Qre, l e -^,,//I7
DATE PEA
UCAL D�EsC.R�IPnDN:_L 2 R3 l Mtj po+/ N, /S Township, Range. Section:
I
O
1 4 I oR"sitcs %//A
2
.I
i I SP W/$0/1JE S/47-
4
/LT
4
5W
6
6.
SM
7-
9-
"T 9OT
i
12-
2131t
:87
13-
14-
18I
19
20
CCMMENTS
WAS CACUNO WATLA
"COUNTERED? _ 11rr,
PERCOLATION RATE ,�.(? tilwrnno1l PEAC HOLE DIAMETER
TESTRUNnET M ?•S RANO y6 R ,
PEADORMED91^. W. M�1'Aphgu
101"iA.a
�.L''�'CEATWV THAT TMST��EffST WAS PVFORME:D IN
ACCCROANCE"TN ALL STATE AND MUNICIPAL CIAOEGNES IN EFFECT ON THIS DATE DATE -- s 9170
TICG Ipw. Qe61
0
,
7
ll2 O LOT 7, BLOCK 3/RESIDENCE
;
AUDUBON HILLSOLDING TANK
ADDITION #1O BE]
STALLEO)
---------
AUDUBON
----LOT 8, BLOCK 3
AUDUBON HILLS AMILY
ADDITION #1
`---------------- ___________---------------
INSTALL 30 -FOOT LONG x 15" DIA.
CMP w FLARED END SECTION TO
CARRY WATER FROM ROADSIDE
DITCH TO A POINT >10- PAST WELL
INSTALL NEW
LOT 2, BLOCK 3 1500 -GALLON —\
AUDUBON HILLS "ADVANTEX•' TANK
"ORENCO" AX -20 POD
I
LOT 1.BLOCK 3
AUDUBON HILLS
"ORENCO" LIFT STATION
.LOT 3,BLOCK 3
AUDUBON HILLS
WELL"
CONSTRUCT NEW
10' x 30' SOIL ABS. BED r� S eXlsnN°OGN
POORLY DRAINED FOREST � ,��
W. MARSHY PUDDI ES � i. is `�-3%
X25%
3%- EXISTING - --
SOIL ABS. BED _ .
AP
Q.�E..q
,IF 49
.........................
7- ..........
THEODORE F. MOORE i
CE - 3589 •; • cW A
°i •• 7/O�i' �i
25%ZT.H \ / .!-25% ` 1 2k
EXISTING -, -40L
BIOCYCLE' ----
SYSTEM
I�\ o
HOUSE
o .
I� , W
O I
' 11
i PRIVATE WELL
i
LOT 2, BLOCK 3, AUDUBON HILLS SID
SEPTIC SYSTEM UPGRADE
T— SITE PLAN
1•. FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET
•• IJ530 ECHO CANYON ROAD DRAWN BY TFM
••• AN'CI IORAGE, ALASKA 99516 JULY, 2008
• NOTE THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SFInwN ear: A000nv,...t,
Municipality of Anchorage Page / of
_2-
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 900 Z q3 PID Number: p/s
Name:
Jo
Wastewater System: 0-ge-w ❑ Upgrade
Address;
u
ABSORPTION FIELD
Phone:
No. of Bedrooms:
it
❑ Deep Trench ❑ Shallow Trench W-1�_ed O Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
ISO . GPD/Sq Ff.
/'
Lot: Block: ? Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
Township: Range: 3 W Section: 2 ,6
I Z !,i
Ff.
Fill added above original grade:
r J� Ft.
Gravel length:
Ff,
I
.2 ee Ft.
WELL: B-New ❑ Upgrade
Gravel depth:
Number of lines: Distance beheen liner
Classification (Private, A,B,C): Total Depth: Cased To:
/ FL
Total eDsorption area:
7 G Ft.
e pe material:
PipPri
t/ FL S(�
Driller.
/ISO SO. Ft.
t) -303
Date Drilled: Stabs Wafer level:
el
L nE /-Iq-9lIAM,0FR.
Installer.
NARrEu Con Sr.
Date installed:
/s-zl-4o
Yield:Pump
Set et:
Cuing Height A00011a
Grnd:
5 d- GPM
5 Ft.
If Ft.
TANK
SEPARATION
DISTANCES
❑Septic
❑Holding S.T. E. P.
To
From
splic
Tank
Ab"tlon
Field
4a
slslion
Holding
Tank
bhc/Pdvats
Manufacturer. Capacity in gallons:
4"CY6
sever Lies
E/ OO
well
I DO
/ 0.3
/Q B
N
Ices
Malarial: Number Of Compartments:
STEF._ L 2 + G /,r-r -�7-A77eal
Surface
Water
/�/�'
/20,
//G
,CFS
LIFT STATION
Lot
Line
Or
I
•
Size in gallons:
Manufacturer.
,33
A114
)/CFS
/50
4Ale4. TANK
Foundation
f
/0
I
2 S
I er
"Pump on level at:
"Pump off" level at:
High water alarm at:
1
f7
Mlles
Curtain
Drain
NA
Nig
NA
Nig
N A
Pump Make 8 Model
Electrical Inspections performed by:
Remarks: E sf T
BENCH MARK
_
Location and Description:
me
Assumed Elevation:
' NGI_NEER'; SEAL
�a
..` OFA I`.,�
1
�•- ~ ^' as
/
i ��kDe
�••��1"A
Inspections performed by: IA. m'FsD-u Dates:lst lz-zlqo�I' ly
`�1
2nd t �fogT
C-el
A'dchad E. Andcron
Department of Health and Human Services approval
-E
s,��.., •,1�
� �Lu
.4131
a'
Reviewed and approved by: GY Date: `�- 9 -9 /
`".a��-�
n-017 (1/91) MOA 25
Permit No. 9'00 Z •/3
Page 2 of Z
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage,. Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
..1
Begat uescnption: v.3 'i/(/D 0 Hi l /5 PID No.: OIL 3 /-L
I
7,C& 77
8 CREF_
_o -r3
VAcAuT,
1)
I /
.., 1A PIES
eAaioircN � I
--_;o0
I
C �eEK�
I
I
RADIUS
1)
I /
.., 1A PIES
eAaioircN � I
RESERVE
AREA
¢IVE�y
ORGMAIAL I /
..
VAGATEST HOLE
wT �
j
-- SCALE. -1,1= 30'_
---
� I
I
ii -01]A 1)/011 UM 1[
AVDUBoN.____I
Drz1VE
of
Michael E. Andomn
0. 431 • E
--_;o0
C �eEK�
RADIUS
/ I
\/
_ co, yf
RESERVE
AREA
¢IVE�y
ORGMAIAL I /
..
VAGATEST HOLE
wT �
j
-- SCALE. -1,1= 30'_
---
� I
I
ii -01]A 1)/011 UM 1[
AVDUBoN.____I
Drz1VE
of
Michael E. Andomn
0. 431 • E
CASING: Stick-up ft. Diam{{:� in
WELL INTAKE: ❑ open end escreened
❑ perforated ❑ open hole
Depths of openings i to e�Lft
SCREEN TYPE:,yr.I,�r Dia�j
,+ +r� m: in
Slot/Mesh Size:S Length: F ft
Set Between_'Z! and / ft
y.n ( 11.1• w 01 Oc)'�(-•bt _ GRAVEL PACK TYPE: '—
Volume used Depth to top
R F r GROUT TYPE: Volume:
�! Depth: from ft to-. :_ ft
DEVELOPMENT.METHOD:_ Q/!,
Municl alI of An hors Duration:_
REMARKS: ea uman ervicai
PUMPING LEVEL AND YIELD:
`�ft after tj�hrs pumping 6S �gpm
CONTRACTOR INFO TION:
Registered BusinessNaame
c
Signature of Authorized AAepresentative
-1- z 11-- 1?/
Date
PUMP INTAKE DEPTH: ft Horsepower:
Date Pump Installed - -
WATER CHEMISTRY SAMPLE TAKEN? 0 yes []no
PLEASE MAIL WHITE COPY OF:LOG WITHIN 95
DAYS TO:
DGGS
PO BOX _77-2 j 1'6
EAGLE RIVER, AK.*' 99577
STATE OF ALASKA
-
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF GEOLOGICAL AND GEOPHYSICAL SURVEYS
WATER WELL RECORD
LOCATION OF WELL
BOROUGH SUBDIVISION LOT
BLOCK SECTION QTR°�- TOWNSHIP RANGE MERIDIAN
wUu �a �
�
❑N ❑E
DIRECTIONS:,
S W
WELL OWNER: n iC �Q`•CX �. r %lh.%`•P Ki
MEASURING POINT: top of
casing
WELL DEPTH:DATE OF COMPLETION:
Depth of hole:�ft
❑ ground surface ❑ other:
Depth of casing: �6ft--�
BOREHOLE DATA:
Material type and color
Depth
From I To
STATIC NATER LEVEL: -0_ft. Date./_:_2 _
'I
`
Z
THOD OF DRILLING: Rair rotary
❑cable
tool ❑other:
=�•`•
�%
USE OF WELL:;:domestic []irrigation ❑monitor
'I J1
❑public supply rl other:
CASING: Stick-up ft. Diam{{:� in
WELL INTAKE: ❑ open end escreened
❑ perforated ❑ open hole
Depths of openings i to e�Lft
SCREEN TYPE:,yr.I,�r Dia�j
,+ +r� m: in
Slot/Mesh Size:S Length: F ft
Set Between_'Z! and / ft
y.n ( 11.1• w 01 Oc)'�(-•bt _ GRAVEL PACK TYPE: '—
Volume used Depth to top
R F r GROUT TYPE: Volume:
�! Depth: from ft to-. :_ ft
DEVELOPMENT.METHOD:_ Q/!,
Municl alI of An hors Duration:_
REMARKS: ea uman ervicai
PUMPING LEVEL AND YIELD:
`�ft after tj�hrs pumping 6S �gpm
CONTRACTOR INFO TION:
Registered BusinessNaame
c
Signature of Authorized AAepresentative
-1- z 11-- 1?/
Date
PUMP INTAKE DEPTH: ft Horsepower:
Date Pump Installed - -
WATER CHEMISTRY SAMPLE TAKEN? 0 yes []no
PLEASE MAIL WHITE COPY OF:LOG WITHIN 95
DAYS TO:
DGGS
PO BOX _77-2 j 1'6
EAGLE RIVER, AK.*' 99577
M U N I C I P A L I T Y O F A N C H 0 R A G E
Department of Health & Human Services
025 L Street, Anchorage, Alaska 99501 343-4720
ON-SITE SEWER & SEPTIC TANK & WELL PERMIT
Permit Number: 900243 lulaf�IL-i
Date Issued: 00/14/90 Engineer Designed
Owner Name: JOSEPH SULLIVAN
Owner Address: 4000 E 04TH AVE
ANCH, AK 99 507
Day Phone:
Parcel Id: 015-231-61
Lot Legal: Subdivision: AUDUBON HILLS Lot: 2 Block: 3
Section: 23 Township: 12N Range: 3W
Lot Size 40312 (sq.ft. or acres)
Max Bedrooms: This Permit: 4 Total Capacity: 4
SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons. Each septic
tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0
feet requires insulation over tank(s).
WELL: Log must be submitted to Municipality of Anchorage Department of Health
.and Human Services within 30 days of well completion.
01IS SYSTEM MUST BE INSTALLED AS SHOWN ON THE ENOINEER'S DESIGN
DAZED 0/14/90. DHHS MUST BE NOTIFIED PRIOR TO ALL INSPECTIONS. A
LIFT STATION INSTALLATION MUST HAVE: AN ELECTRICAL INSPECTION.
1HE WELL SITE MUST DE A MINIMUM OF 100' FROM ANY ON-SITE DISPOS-
AL SYSTEM. THIS PERMIT IS FOR A 4 BEDROOM SINGLE FAMILY
RESIDENCE ONLY, AND EXPIRES ON 12/31/90.
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back:
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 4 bedrooms. 1
also understand that the capacity of the total system is 4 bedrooms and
any enlargement/will require an additional permit.
Si
(Owner) JOS PAOUPILI
lszued By
DATE: // q
-- DATE:
tiJOM: NsuLArio11
Rego ovE2
,BE'D iF 7—oUl _
Col/E,z Quer
PI A//%/ G 15
LESS TNAN 41
25'
F/N/SNCG (,e4DE
TD DRAIN EX/SriMG
C]RADE—
L y'
Y N9Ti�6 .�
2' F/,lTrR SAA/.6
`% WATER TABLE
SED SE -C -7-10A]
L 2 63 AvDueo,v 14111--, SvBD.
fE'0 CALCUGArl0AJ:
/50 SF1BDR X y6DR X /,S = 9ooSF
Qz = 2-1xyz' ger:-,
USE z 5' X '51
FILTER FABRIC
/Z' W.4SNED
5EWEL /LOCAL
�Ct� 8.ie
OF s
its,
*�•dC
/. •, eN.rw..�.w.��1. fwd u •
Michael E. Anderson
.. A381 -E
MtPO IPALFTY OF ANCHORAGE
DEPT. OF HEAIf- g
ENVIRO.`WWAL PROTECTION
! 9 1990
RECZ7! ;' LED
= \ 4
U) JDEVELOPED
More: Sro a�
I
r"v�O IV KSS "ho I t
125% PAI OL -M gyro Sco E 1
. I C.CN STav C71Oa• >ZS'e NeR
I mRy,QEp��,�6 ,v I I
</FT5774r/o'er
.� • I I I
V
I I �
OO' sr -T llG K
�W TNS I
I:N..
I 100
$faEE se/ ?As OR,4""nrteN
GooO S C-
RESER a
�ss
,q�PEq
3.
o°
m
U�7DEVELopED
I ,� SF7SEACK
I;
I `'
J
0 �Q'
,II 1
.tom
I - I
I I
�
Michaol L Anderwn
y_ 4381-E
RECEIVED
Municipatlty of Anchorage
DEPARTMENT OF HEALTH d HUMAN SERVICES
8251' Street. Anchorage, Alaska 99502-0850
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:. {�WZrfvit/ Cpr/c-T Cn DATE
Michael E. Anderson
., 4381 . E
LEGAL DESCRIPTION:_e 2 45 Avnvpo./ All//!; Township. Range. Section:
OE►TH SLOPE SITE PLAN
1 0R6A�IICS
TN A
2
.r—r S P I v
3 5ome Sicr
4
SW
5
6 SM
7
6
9
10
it
124 1
13
14
is
18
17
18
19
20
WAS GROUND WATER
ENCOUNTERED?��
IF YES. AT WHAT
DEPTH?
Orem a war AEr ,
lle• 1 7 _ �157 lim 9-5'-90
R•Wily
o•r.
W
T•n•
°wT�
wa
O o
0
Z
/0
r.
2/
/..
It
04;
L� PERCOLATION RATE IZ (nwn4A l•.uq PERC HOLE DIAMETER [e'1
TEST RUN BETWEEN 2#5' FT AND y O FT .
COMMENTS —Z. F'S 1 /" 0.I Pb R /RD ❑'
PERFORMED 8Y: V). M' ;7*A btu Ent 1 '111 LOW- C 1.126 24FITIFY THAT T IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE - s%9I 90
72-008 JR". •,es) I
MUNK.TPALITY OF ANCHCRAGE (��• ;`,`; :Q';
.�P; • ••.
f HEALTH 6 / �•� �, %
E � AL PROTfCT10N Municipality of Anchorage J ' �9�H
DEPARTMENT OF HEALTH b HUMAN SERVICES po. • :•.• • �• ,•••••••••••
9 8251' Street. Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST O 1 Michael E. Anderson
RECEIVED 4381-E •:
DATE PERFORMED:a,••••..' �
PERFORMED FOR: h,.VA27-,C*w GoiIST /n a`'ORO F 5 •6
LEGAL DESCRIPTION: 4 Ze- fy,00E0O,V .N; //s Township, Range, Sectiom
1
2
3
4
5
6
7
8
9
10
it
12
13
14
15
16
17
18
19
20
ics
SM
SILTY SAW
SP w1surs
OrrOM
RES EQ v 4
14 KEf1
7 11,6
SLOPE
PLAN
WAS GROUND WATER ";/ E !F
ENCOUNTERED?
IF YES, AT WHAT
DEPTH? R'
Tam is war Aar
X17 S'G"
PERCOLATION RATE (rwmewmenl FERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT .
COMMENTS TEST NoLF_ FOR REeE2VF- AFEA
PERFORMEO BY: V)- ME SAD b E1J I M ICFI M,7- F j f TIFY THAT THIS TqST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THS DATE DATE Awn
72-008IRw. ue51
,Co; z 6�
/4�/DyBON nGS �JBOv
L.CJ/yf/J!CN% S
6/% is ✓'e�-�Ovs CDocer.� w��Li f�ae a�4
d�fi,.�a✓Cq 4S �d00 JF mac. �✓C obh 7111
plp �lpw.� r�so-�S /:
A� C sr 1.54A.L t fr/nr�✓�5 O/ ,esu GGS� stir .
T�l-t /S GIJGII� f%-U'IrJ/il �n- 0. o�<ci�lif! dr�C�
Q6� 7 f /�-fL�? Ct eJA
a,70
su•-14u o/ho�ps a�,v ��•a��
14' /1 � a/
6Gol ./t, 1e/,' 741-& /s/p<o�o��
�j/-0w7CCVu. e�n �/f�ii ��GU✓�- �a0i7`+C�'i
/S 7`Od .9eOs- /y/ ✓V�GGC �� /!�-a O�eC
CD'lSidvf�N AS /e�Y<v�f oma .
/4 yieW 491 40-00 c 6ev� Q
isnVt l-
CA4S.P feC40-2
/y G .tar
bo Z- C� c.� -�� .= S3'
wCe x,1_0 = 7-%
71-7/w
LOT Z BLocK 3 AUDvBoN NI lls ;
_ o
V
A
N
UN pEV E LoprD
h
.o .h
a
l sh� L 4 BDR
2s•
f RESEItvE7
1
I
I
. I
l
I.
i
I
.O
015TALL 1250 GALLor
SEpTG
ITANKAmD z7X
�f5"BEDSy3rE�+1 ASPE
SNEET 2 oF2
�c
*49
t
VNDEVELOPED
,,,I L Andenon
4381•E
?ROFESSO—"P
bd.
1
2 6P
Poorltj
3 GRADED
4 GRAVCL -SA#4bs
5
W Are 9-
s4
6
7
8
9
19
'y0
0
Municipality of Anchorage
'
��t.�
13
U&
DEPARTMENT OF HEALTH S HUMAN SERVICES
�L A. t
;,
\�/
825'L' SVeeL Anchorage. Alaska 99502-0G50
%%,��,,•��,,j,,'�%%��,»
P
SOILS LOG — PERCOLATION TESTP
`-, I,haol E. Andenon
4%6.1
, 4381.E
• 1s
PERFORMED FOR:HWrFA/
CLQ///tT,
DATE PERF_ '`t °CC
LEGAL DESCRIPTION:
/� ,'
G Z 6g /YV71(/%rO.V Al, I15 Township, Range. Section:
n�1 .
_ _ _ _ SLOPE
SITE PLAN
1
2 6P
Poorltj
3 GRADED
4 GRAVCL -SA#4bs
5
W Are 9-
s4
6
7
8
9
19
SM
S 1 LTJ
SAW D
Sorrom
o F NOLI;
it
12
13
14
15
16
17
• 1s
19
20
WAS GROUND WATER
ENCOUNTERED?
11
IF YES. AT WHAT
DEPTH? 5.5�
Al
beam is weer wrSS z q o
Pau"? n bw L" S_
PERCOLATION RATE tmw, "w4nl PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS Of "111n/1.n01 EFA �ci5rF-l" F71P_ ISD CII,lRnp--
PERFORMED BY: I I M L rA D r�, 1- IJ t 44,umirt. E' AJJOUo CEiTIFY THAT T IS/TEST WAS PERFORMED IN
-71
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE - JG / 9D
72-M IR•.. VIIS1
rIity
Di 1 a'f
I � f
January 10, 1986
TO: Permit Applicant
P.O. 3GX 6650
ANCHOFAG ALASKA 99502-0850
(907) 264-4111
rJNy.NOnLES.
1-04 YrR
DEPARTMENT OF HEALTH 6 HUMAN SERVICES
Subject: Permit 6 850147
Lot 2 Block 3 Audubon Hills Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as -built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
f .
i"l4Jt� I C I AL I TY �9 f�t+1Cf n- C,:)
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
025 L STREET, ANCHORAGE, AK 99501
264-4720
E3E L%1EZF:Z WE L_L E_f2f 4 I T
PERMIT NO: 050147
DATE ISSUED: 05/01/05
�'E6[itA-rro••/r t+.v a2q,,JA-riE
APPLICANT: ALMOND INC S%fou,V O.✓ Scj/L Lo[�•
ADDRESS: P 0 BOX 112247
ANCHORAGE, AY 99511 xi, Co.
CONTACT PHONE: 345-3021
LEGAL'DESCRIF: SUBDIVISION: AUDUBON HILLS 'LOT: 2 BLOCK:
SECTION: 23 TOWNSHIP: 12N RANGE: GW
'.LOT SIZE: 40312.
MAX BEDROOMS: 4 (SQ.FT. OR ACRES)
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
]cc CD- - - CJ _ nr1A = W- - - - - - - -- - -
.DEPTH TO FIFE BOTTOM (FT.) 3.0 ** 3,0
GRAVEL DEPTH (FT.) 0,5 1.0
TOTAL DEPTH (FT.) 3.5 4.0
GRAVEL WIDTH (FT.) 25.0 5.0
GRAVEL LENGTH (FT.) 50.0 149.0 **
GRAVEL VOLUME (CU.YDS.) 46.3 41,4
TANK SIZE (GALS) 1,250.0 ** 1,250.0.**
SOIL RATING (SQ.FT./BR) 205 ^12
** DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION
** DEPTH TO FIFE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION
+* GRAVEL.LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT.' EACH)
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that: ,
1. I am familiar with the requirements for on-site sewers and w:21is as set
forth by the Municipality of Anchorage (MOA) and the State of'Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the 'set bac":
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 4 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED.BY MOA BUILDING CODES,
THEN (1)' AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-DUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED ---- DATE -
APPLICANT ALMOND INC �('"`�(
ISSUED BY --------^------ DATE:
�.�,_-___ --fig- -----
1'tUN I C I F�FIL I TY �C�F fiNCHOFZF=IGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 '1�STREET, ANCHORAGE, AK. 95'1
rp 264-4720
ON—S I TE SFEE WEFZ F?EFZM I T
PERMIT N0. C 830168 >
APPLICANT GLORIA BOWMAN PO BOX 6502 99502 274-3222
LOCATION
LEGAL L 2 B 3 AUDUBON HILLS SID LOT SIZE 99999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING CSO FTIBP,>= 205
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
E>EPTH= 5 LENGTH= 115 GFZF1k,rEL [7EPTH=
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THE TFiEt+IGH t4 I GTH I S 5. OOc=+ FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
FRECMU I FRED SEPTI C THt4K S I ZE= 125Q iGnLLONS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TWO <;2> I NSFECT I ONS F7fFZE FZEQU I FRE09 ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND 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 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F='EFRM I T E:XF} I FRES E>U CEMF= EFR C 1s 1:3103:
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SE14ER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED
APPLICANT GLORIA BOWMAN
ISSUED BY ----------------------------'--=utd
pI RLQ eSV V4.0
jT �3o1�g
fi, --• t!F1Pc1� ����% PO��i 6-650
\ ANCHORAGE. ALASi<A 93502-0650
(907) 26:-41 11
�}'� (1 ��..10�.. TONY KN ..'l !.
L �1.h®?� 'i/� VAYOR
{/��11�/
C-,
DEPART0.'FNT OF HEALTH AND ENVli?ONMENTAL PROTECI io!i
cPermit #: 820394
-January 31, 1983
TO: Permit Applicant
Subject: Lot 2 Block 3 Audubon hills Subdivision
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerel
Q :Za-R
C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
enc: Copy of Permit
SWP/057
t•11_I H r_ I F n L- I T' -o O F Fi t4 C H O F n o3 E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL a OTECTIOM �I
S25 '.STREET, ANCHORAGE, AK. 9
`•'. 264-4720
aro—E I TE noEl4EFQ F"EF:M I -jr
PERMIT NO. C 520394 )
APPLICANT GLORIA BOWMAN PO BOX 6502�,
LOCATION 274--,,«2
LEGAL 63L2 AUDUBON HILLS LOT SIZE 48312 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING {SQ FT/BR)= 205
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
F?EF�TH= �, LEt-iGTH= 11!Z3 GF:F=l :'EL C�lEF='TH=
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THE I-F?Et+lr H 14I FCtiTH I S a. 4-ICIC+ FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
F? ECA J I F?EE> EEFlT I C TF04K SIZE= 12i r=i GFjL_L_C r_4a
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
-- Tt4n to ^ I ty1SF=`ECT I 4t -7S FiF`E REG[I_I I F:E[]
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND 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 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER.. LINE IS 75 FEET.
OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F�'EF:M I T EXF} I F.ES E>ar_'Et-l@EF? 2 1r
I CERTIFY THAT
1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SI
ISSUED
1S74C'-In
AND WELLS AS SET
ENLARGEMENT IF THE
APPLICANT GLOP..IA BOWMAN
---------- I °t P3
BY----=�` ------DATE---
J ti4. 0
Yea/83
PERFORMED
LEGAL
1
2
3
4
5
6
7
s
9
10
11
12
13
14
15
16
17
is
1s
20
(� UG SOILS LOG
MUNICIPALITY OF ANCHORAGE
` Vs -D / 9'
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
825 L. Street, Anchorage, Alaska 8950/ 2644720 TEST
SOILS LOG - PERCOLATION TEST
(0L)-0rganic,5i1f
black
(5N)-si hy,sands
50rAe 9? rove
(MO—SNI
(GM) -:5i 14y, grovels
COMMENTS / \lA I G� LL
PERFORMED BY: Cr'ee h
72-008 (6/79)
DATE PERFORMED:_ c:!;T-2t-542
SLOPE
WASGROUND WATER S
ENCOUNTERED? _ RQ L
O
P
IF YES, AT WHAT E
DEPTH?
lana - i7"Y 17"
PLAN
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
t -H20
SrZ
1
t hZ0
12:3
-e
O.
O.
3
1z:53
10
O.
d.
2-
y
:03
I
0.(,8
o.v
H2.0
1:13
-9
0.(07 T
-&
PERCOLATION RATE is ((minutes/inch)
TEST RUN BETWF,EN 2_ FT AND 1_ FT
IED
DATE:
MUNICIPALITY OF ANCHORAGE
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. 016-231-61
1. GENERAL INFORMATION
Expiration Date: (?r2 'Z -I
Complete legal description AUDUBON HILLS BLK 3 LT 2
Location (site address) 12300 AUDUBON DR, ANCH AK
Current property owner(s)
Mailing address
Real estate agent
MARY JANE LANG
SAME
2. TYPE OF DWELLING:
FxFl Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
Private Well
0
Water Storage
❑
Community Well
❑
Public Water System
❑
Waiver request for:
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Private Septic
El
Holding Tank
❑
Community
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 55y Waiver Fee $
Date of Payment Date of Payment
Receipt Number 01'Z660 Receipt Number
COSA # 06 Ca 1122�1Waiver #
Distance:
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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 5-10-21
�r YP•• �� �r_',A
Jr 1Eo9iPi •• ?
6. DSD SIGNATURE e...., ......... ;
System #1 Approved for 4 bedrooms �' • • • .. ...........
• • • �
t,` �•F MICHAEL N. ANDERSON a4%
System #2 Approved for bedrooms t,<;,�•CE-94 9 ••;�t- .,
Disapproved tai ti l 2•I ,��
. • SS, sw
Conditional approval for bedrooms, with the following stipulation�►yv�,��.
vv� Original Certificate Date: 2 .Z
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
Legal Description: AUDUBON HILLS BLK 3 LT 2
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1/21/91
Total depth 61 ft
Cased to 55 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 4/23121
Static water level at beginning of test 0 ft.
Comments Artesian well
B. TANK DATA
Age of tank(s) 13 years
Tank type/materia! AdVe"`ex
Measured operating fluid level in septic tank 48
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 4/23/21
D. ABSORPTION FIELD DATA Advantex
Which system tested (date installed) 8/25/0e
❑ ALL standpipes present per record drawing
Total measured depth from grade 3.25 ft (max)
Measured depth to pipe invert from grade 2.75 ft (min)
❑ N/A —pressurized field
❑ Monitor tubes go to bottom of effective. if not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 2 -gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
of
Parcel ID: 015-231-61
Structure served by this system
Well production at time of test 5+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ N
❑ Coliform bacteria is Negative
Nitrate 3.68 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by MNA
Date of Sample 4123121
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 4/23/21
Results Rl Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600+ gal
New depth 0 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate 600+ 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'
0 Yes
Yes
Community Sewer Manhole/Cleanout > 100'
❑✓ Yes
if No
ft
❑✓ Yes
if No ft
Neighboring Tank > 100' ❑✓ Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100' [Z] Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No ft
Neighboring Absorption Fields > 100'
�✓❑
❑✓ Yes if No ft
Water Main > 10
Animal Containment > 50' Q Yes
if No ft
Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Water Service Line > 10'
Community Sewer Main > 75' [✓ Yes
if No
ft
❑✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0 Yes
Yes
if No
ft
Surface Water > 100'
Q Yes if No ft
Property Line > 5'✓❑
ft
Yes
if No
ft
Wells on Adjacent Lots:
ft
Absorption Field > 5'
0
Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Main > 10
Q
Yes
if No
ft
Community Wells > 200'
❑✓ Yes if No ft
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'
0 Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10
❑ Yes
if No *7
ft
Wells on Adjacent Lots:
Water Main > 10'
0 Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No ft
Water Service Line > 10'
❑✓ Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Surface Water > 100'
Q Yes
if No
ft
F. ENGINEER'S COMMENTS
* see waiver, waiver also for open water but code revised to 50'
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.
COSA Checklist yellow sheet
le�=:fit °
MICHAEL N. ANE)LkSCN
g `" CE - 9469 +
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this 27th Day of _ May of 20 21 , by and between
Todd Davis , herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as 12300 Audubon Drive, Anchorage, AK 99516
located at (legal description)
Audubon Hills L2 B3
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
_j_.:,,,, Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
'Tj) Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
-. J-1 - ) Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Pagel of 3
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
T Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: ,6�(signature) Date:
2—,DD S (print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this Oppay of Mau,
20a, by 1 Z)o'-C
NO VARY PUBLIC FOR ALASKA
My Commission expires:
MUNICIPALITY-
_ �
BY: Pi , (signature)
Date: 6 Z -Z_ L
(print name) Title:
(rev. 05/18/2018) Page 3 of 3
t r 1 LULU QW. Lu WUUUr rU HI LU,.7 I "\JL- U-1
365191pill E
om lam 111 AIN go
INSINIiIN
N
am In o
om pill IN101110111 son s
Field*varffex aice WWI AnchorageTank
Annual inspe( ;tion
Fmporty ownern?Kktng W .. -
Wendell Brower
n
Skb Addrann -
12300 Audubon Dri% Anchorage AK 99515
];;��A
66;
AAX X-119342
Retrieve O&M info Measure ,.
Dally flow_ -
1 at Complart
Recire ratio --
Timer settings: 2nd Comped'
odor.
Perform Field Sampl ng/Observations slemat
NTU (1 S x NTUs) pi (6-91 00 (2-6) Bridging/Pooping'; .jLNone/Minor ❑ EX0659iVe
3
Odor of Sample
Typical Must ❑ Earthy ❑ Moldy
Non-typicalSullw e ❑ Cabbage C1 Decay
Oily film In U C ) Yes 11YQ
Foam in tank ( ]Yes No
Check Control Pane
Reciro Amps Discharge Amps
Audible and visual 21: n»s OK /No
Dial tone (telemetry C rly) ❑Yes
InspectfClean Pum - Systefn
Inspect Glean
Risertl.ld ......... ... . .......
Splice l30x ........ . • • ..... .
Float Cords ....... . . ...... .
Floats ............ ...........
Pump............ ...........
Biotube'l Filter . . .. .. ........ .
alotdbC Pump Vault ........ , , -
RecirculatingSplif9 VatVe.......
Comments --AY,
Signature
InspectfGlean Discharge PUMP SYstem
Inspect
Rlser/Lid C/
/,
Splice Box tt�J!'
Float cords .SCJ
-
5-5555
t9on
'1 S
• � 'ravious
. �ev�oUs
, uuudm
Intake vent
Floats
Pump
sect Clean
Inspect Clean
inspecttService other system Components
insp ct Goan Inspect Clean
Olsinfectlon Equipment Dispersal t.aterals./orifices'�("V\'�
Observations
Additional Services Rendered
❑ Cleaned textile sheets? ❑ Replaced UV items?
❑ Seplaced/Used other items?
parts Used: W . Warranty, B = sillable (.1 appropriate sMaction)
air o !teen Mtmtbrar nesorlotion
Final/Safety inspection
RSV minstailed Lids bolted on
Manifold reconnected; flush valvtss closed jt3 Controt panel reactivated
$umrrwo Recommendations
❑ System performing; no further action needed ❑ Tank needs pumping
❑ Cali for service ❑ Other?
Fax compiewtty Torinttl za -P-aaao-+ago**- • -9—v
• Municipality of Anchorage t
. On -Site Water
raand
�Wastewater Program a
(907) 343- 904 AA ETT'
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. CJ l f — 23 I — 15,1
Expiration Date: 7
1. GENERAL INFORMATION
Complete legal description I of 2� Li %ac 3 AY ice, i rsGn } ► 0 S/Jj
.Location (site address) 12-3 00 Aubfu b oma' h r
purrentPropertyowner(s)j-oe Fa4o Sufi va Dayphone
Mailingaddress 1%836/ Aperr,4� Dr ProdmL,,Af Ok 730-76-45i904
Real Estate AgentC{ R k ,_ D vn u:n a 1' Zr Day phone 26 /
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
Multiple Dwellings (Single Family andlor Duplex)
S. NUMBER OF BEDROOMS:
4.. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Received by J > Dater t'
-� ..
.COSA to be released to the engineer, unless otheWm requested by the engineer. P le u e ee,1 f 0,- -m a 1 R to ({e
wken 6OSA It., reerory Ivr p,ck -i p. bobrrn k C0 �la�l�a. neE-
COSA Fee $ Y9 O G1G Waiver Fee $
i
Date of Payment �f /I / 3 P Date of Payment
Receipt Number OSS gn Receipt Number
COSA#{ OSC 15 h 0 -1 Waiver #F
. 5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as- of the validation date shown below, I verif)r that my investigation,
based on procedures outlined kif the. Certificate of On -Site Systems Approval Guidelines for, this application;
'.;stiows that the onsitewater supply ardor wastewater disposal system Is (are) safe, functional, and adequate
for the;numbei of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage flies and. from my investigation andinspection, 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 1=f�sFlr✓P ItcGtn�c«l S�rv;cv Phone ..3ys f3ss
Address G 5e 4,* 4!�* iXC n ®.. 6-^ c4 arufe ",s" al '
Engineer's Printed Name Date 3129 / "tor
G. DS,1 $I/GNATURE
System #1 Approved for 1 bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By. Original Certificate Date:
The M opal' orago Development Services Division (DSD) issues Certificates of Onsite 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
Munidp8lity of Anchorage is not responsible for errors or omissions In the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
ff more than I septic system is on the lot:
COSA Checklist #_of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: _ Ln,f 2, i3& c k 3, 14) Nl S/�. Parcel ID: o i 5. - ?-31
A. WELL DATA
Well type Pv f If A, B, or C provide PWSID # — Well Log (Y/N) Y .
Date completed 117_q/91 Sanitaryseal (YJN) Wires properly protected (YIN) Y
Total depth _ 6 I ft . Casedao .SS ft.. Casing height (above ground) r & f in.
FROM WELL LOG AT INSPECTION
Date of test I / z y /9 / 3/7 / Zai Z
Static water, level Q ft O ft
Well production r S g.p.m.F-
g.p:m..
WATER SAMPLE RESULTS:
Coliform : O colonies/100 mL Nitrate 5: 5'7 mg/L
Arsenic < s ug/I: Date of sample: 3/21 cj Collected by-Fraffao ecti Sic
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matedai Ad ya n• f t ') / V e 6, / Date installed / z s/ 0,6
Tank size L;GU 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) Y
Date of pumping HTS ,rs/, 7/s/iZPumper A -r- Ar'. e
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2 orfe/bdrm)2� System type Oed
Length 20. ft. Width t S ft Gravel below pipe O: it -
F :. Total depth '1.2.f ft. Eff. abso tion area 3oy +3S' field r sa HoJ
rp ftz . Monitoring tube �_ _Depression over field _moi
Date of adequacy test 31-71172- Results (Pass/Fail) /'ate For 1✓ bedrooms
Fluid depth in absorption field before test Q_ in. Water added 461 y . gal. New depth G in.
Elapsed Time: 60 min. Final fluid depth O in. Absorption rate >= 6 aG g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N• If yes, give. date
D. LIFT STATION
Date installed 2r/DSize in gallons x l vr, fiManhdeaocess
"Pump on' level at M in. `Pump off" level at 2-2- in. High water alar level at 36 in.
Datum Ro i fa r Cycles tested / D 't Meets alarm &,dreult requirements? Y
' E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tankAift station on lot ) d ri On adjacent.lots ..> 1610 '
Absorption field on lot l ab ' On adjacent lots > t oa '
Public sewer main Ili • k. Public sewer manhole/deanout IV..A .
Sewer /septic service line > 2SHolding tank N• A .
Animal, containment areas Ak_A > taG ' Manure/animal excrete storage areas AAe ne
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 17. Property line •-3 2r Absorption field .r�'
water main - /N • A• Water service line ��2t to ' . Surface water
Wellsonadjaoeriflots
-ABSORPTION FIELD ON LOTTO:
Property line 7 Building foundation 2 Y ' Water main N• /}.
Water Service line > ICJ r Surfacewater 'f3' 4- Driveway, parldnoeNde storage d D r
Curtain drain Nb ne Seen Wells on adjacent lots tCGe
F. COMMENTS
istund l2 /9 %dB
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. E :ftGlPc�r d`S
Engineers Printed Name 1 Aa 4,.e
Date _3/29
CE-35SP a?
COSA brown sheet 10.10-12.doc
Municipality of Anchorage
�E e�
Community Development Department pa x
Development Services Division E r:
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 # 131107
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 2 of
Audubon Hills subdivision. This inspection revealed a nitrate concentration
of 5.57 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.
The location of struoture(s)as
shown on this record drawing
(as-cl;R) compiles Wth Title 21, AMC -
j �1 L,L_
(i( iI
LOT I
00
(J1
00
O
V
RE
TRACT 8
149.11"
10' UTILITY EASEMENT
LOT 2
BLOCK 3
AUDUBON HILLS (77-307)
Wood Fence
3 Lid Waco
2.5' Dia. Stairs `
(TYP )tic ?
11�.
.0. J Ig 1 ao
ryry �. S
—46.7' 9 6 • 0�k
6.2' x 9.8' 3g•1
Lean—To 6
a2 Level Wood
Frame House
--43.3'
283' o
in Conc.
o• Wolk oy Q9B/
70 D pea/f B° 60 ./
�.i9 Window
Shed
10' x 1
10'x30'
6 ),
'� Cantilever
/ Well
9p��8ofV \
I hereby certify that an accurate survey of the following
described property:
LOT 2, BLOCK 3
AUDUBON HILLS (77-307)
was Wade on August 7 2009- and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property tying
adjacent thereto, that no improvements on the property
lying adjacent thereto encroach on the premises in
question and that there are no roadways, transmission lines
or other visible easements on said property except as
indicated hereon.
Anchorage Alaska, this 30th day of December
2009,
Z�—
SCALE: 1"=30'
LEGEND
W Natural Gas Meter
1D Electric Meter
0
F
r
m
D
m
m
m
Z
y
LOT 8
1
Power Pole
LOT 7
PREPARED FOR:
Joe & Faye Sullivan
AS -BUILT
OWN. DATE GRID
JSP 1280/2009 SW 2739
FILE NO. F.B. JOB NO.
2919 2008/2009 2927
PG. 46
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PAGE 07
4nchorage7ank & Welding, Inc.
907-272.3543
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Fax completed form to 1-806.384-7404
MUNICIPALITY OF ANCHORAGE
• �- Department of Health & Human Services a
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel l.D.#HAA# WCNq 1 r11111n
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
_L Z B3 .QUolI8w //I,//$ SdAo S Z 3 T /2 IU R 3 l j
t
Location (address or directions)
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
(d)Beawtate ;ern6any-and-A!
Address
Telephone
— Telephone: (home) Business
Q.ae_, qqs/S- .3330
Telephone
(e) Mail the HAA to the following address: (or check here Er; if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE �1 \ .
Single -Family � Number of bedrooms
3. WATER SUPPLY
Individual Well Lel Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting'to th legality and status.
4. SEWAGE DISPOSAL
On-site Lha" Public ❑ Community ❑ Holding Tank ❑
Note: If community welt system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72 -MS (R".7/") Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the Information obtained from the Municipality of Anchorage files and from my investigation and
Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this Inspection.
Name of Firm 4irjbERSO.J QGiLC Telephone F.3 8f5557
Address �t7 �Ox Zt4077.? A"woX.AUe QIC. 9QSZ./
Date
>A Engineer's Seal
t.:;cha_! E. Anderson
ast.E
6. DHHS APPROVAL
Approved for W) bedrooms by �" "'�' �u`' 6'`'Lt Date
Approved X Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
Institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
In the professional engineer's work.
72-0M (A v. 7/88) Ba<k Page 2 of 2
J MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
3434744
Ewr PQM 1 ``�Q Legal Description: LZ BL 3
!`` Aut�uBou Nulls
A. WELL DATA��+
Well Classification PKIVATE If A. B. C, D.E.C. Approved (Y/N) A114
Well Log Present (Y/N) _Date Completed Yield S goer; t
Total Depth lel Cased to S�" Depth of Grouting A!D rrRouri At
Static Water Level 0 A 2rr3 ra N Pump Set At 58
Casing Height Above Ground IP" Sanitary Seal on Casing (Y/N) y
Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N) IJ
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /Oo , ;On Adjoining Lots 230 r
To Nearest Edge of Absorption Field on Lot -s 163' ; On Adjoining Lots .?20'
To Nearest Public Sewer Line M11-1-5 To Nearest Public Sewer Cleanout/Manhole /r1.L Es
To Nearest Sewer Service Line on Lot 90 I
Water Sample Collected by A4 /Y7 drAD b s-" ; Date
Water Sample Test Results 54ris�Acs-ozy�,e CoLrFORrn ; f / ��/L .Viraar�
Comments GdE'tG is AOFnc„a FiQOT /A/,ccL 146k /Do&1eD A5 PES
_fkDEt FgpVirrrnewTsTIYPurv.(� ort 1� ES50KE'j/}µ�( Jµ RoJSp-
B. SEPTIC/HOLDING TANK DATA
Date Installed 1/6,6& Size Isoo No. of Compartments 2 r- Liar stun=.✓
Standpipes (YIN) y Air -tight Caps (Y/N) _ Foundation Cleanout (Y/N) _
Depression over Tank (Y/N) AJ Date Last Pumped -u Ew CousTKVc rro.r
Pumping/Maintenance Contact on FileY/N u 6 ��
( ) ;for LrOnSTRUCT(OrJ
Holding Tank High -Water Alarm (Y/N) ul,0 Temporary Holding Tank Permit (Y/N) &6&9
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well ADo' To Building Foundation /O r
To Property Line so, To Disposal Field G r
To Water Main/Service Line (0 5 r /
To Stream, Pond, Lake or Major Drainage Course x2y' le6
Comments /5 .401JA7-17
n -M 01". YIN) F,o t Page 7 of 2
C. ABSORPTION FIELD DATA
Solis Rating in Absorption Strata /SO Type of System Design EEo
Date Installed 12, Z4 he Length of Field SO �
rucLvnn�G F.I�erSANnI
Width of Field 251 Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area /250 Statndpipes Present (Y/N) y
Depression over Field (Y/N) til Date of Last Adequacy Test AfELII
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well /elm a To Property Line %4F" 7
To Building Foundation 21r' To Existing or Abandoned System on
Lot AI/OA/F_ OA/ Gor —;On Adjoining Lots 2 50�
To Water Main/Service Line 70 To Cutback
o(f present) M D A1F_ PRF seu r
To Stream, Pond, Lake, or Major Drainage Course �Za r'•�
To Driveway, Parking Area, or Vehicle Storage Area 30
Comments 49-6041 07-70.r/ SUSr EM iS /tOEpv.¢ f£
STATION
Date Ins
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
—"Pump Off' LeJel at
Vent(Y/N)
**Check Permitted Bedroom Rating Against HAA Request"
Pumping Cycles during Adequacy Test.
certify that I have checked, verified, or conformed to all MOA and HAA
oo
Inspection. Soo,
Signed °•., J
Am oc'RSo•J FSG 2G •
Company. iir�7^�• I,-,
•'a ..:.w..a....... a..........
Date `ATI �
.......................•.W
vot.l.:tchoel E. AndCcson h,
�C •,� 4191-E0
�3 -?. •. �•. •(�rmr
effect on the date of this
MOA No.
Receipt No.
Date of Payment r�/��1 1
Amount: $ y- od
Receipt No.
Waiver Fee: $
Date of Payment
nose (A". siva) Back Page 2 of 2
1
Engineer's Seat
N. .
ado
MI Oo . a _ c;•. .
INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
3500 EAST TUDOR ROAD
INSPECTIONS` 19071563-3464 INFORMATION (907) 786.8271
NAME
t a\
STREET ADDRESS J/[��� O 1
LOT / BLOCK / SUBDIV. QJ'""'�' �t � ATL�✓�q'�
FOOTING ❑ ELEC. TEMP. ❑ PLBG. UNDGR. _ ❑
FOUNDATION O 'ELEC. SERVICE ❑ PLBG. ROUGH _ M
BOND BEAM ❑ ELEC. ROUGH ❑ •, GAS TEMP. ❑
FRAMING ❑ ELEC. FINAL GAS ❑
INSULATION ❑ OTHER MECHANICAL ❑
SHEETROCK ❑ MECH. FINAL ❑
STRUCT. FINAL ❑ FIRE FINAL ❑ PLBG. FINAL ❑
OTHER ❑ ZONING ❑ OTHER ❑
O NONCOMPLIANCE OBSERVED ❑ CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW
❑ WILL REEXAMINE AT NEXT INSPECTION O DO NOT CONCEAL UNTIL REINSPECTED
COMMEP
sealmog uuwnH V y=IeBH •)dD0
-
add
S
INSPECTOR DATE
WHEN CORRECTIONS ARE MADE. PLEASE CALL FOR IN SPEC ION
DO NOT REMOVE THIS NOTICE
_1 � ":
Municipality of Anchorage
At.
Department of Health and Human Services
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
April 9, 1991
Mr. Michael Anderson, P. E.
Anderson Engineering
P. O..Box 240773
Anchorage, Alaska 99524
Subject: Lot 2, Block 3, Audubon Hills S/D
Waiver request WR9100015
Dear Mr. Anderson:
Your request for a three
the subject property has
will remain in effect so
cations to the existing
Sincerely,
Susan Oswalt
On -Site Services
/so
(3) foot lot line waiver on
been granted. This waiver
long as there are no modifi-
absorption field.
Concur,
000ddd���WWWWWW11�4��4�� '
phn Smit11�,` P. E.
V
rogram Manager
On -Site Services
gvov
4 4e/vC-
0 ?� �• / s3
\ J I t' d• .4„�. M 43.11'
i �•t � , qty C � p r'c L
0
RECEIVED
APR 81991
ti'IpU'age
N I ''�' Haa'ah K Human Sery ces
N
•.
'3 a':0"m cn tw, sure(.-•)
b 'lln r:
cr rf ew;a
tk� Witil
21, AMC.
- - - - ,✓0 02 z4 w 14211' - - - -
/ Aereoy crti/y that on eco roto survey at the
/o//w/np dower/bed propw/y-
OF 4C
so* jr 9j� t * �� was w:odi onb/l4! and that the
.. ..F• •«. .......}.., 6npmwommis s/taated /hereon ore r//hh7 the
n
property /fines and 00 noI over/op or encroach