HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 4 LT 1
Municipality of Anchorage
On-Site Water and Wastewater Section - (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251284 PID Number: 017-023-01
Dwelling: E Single Family (SF) n with ADU n Duplex (D) F] Two Single Family Project: El New 0 Upgrade
Name
HEADLEY KEVIN J
ABSORPTION FIELD
E] Deep Trench E Wide Trench El Bed n Mound
Site Address
12800 FOSTER ROAD, ANCHORAGE
E] Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
1 3
0.6 GPD/SFI
7 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3 Ft.
Gravel depth beneath pipe
4 Ft.
Subdivision Block Lot
MOUNTAIN PARK ESTATES 4 1
Fill added above original grade
VARIES 1.78'— 2.10 Ft.
Gravel length
(TWO 40') 80 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To' Septic Absorption Holding i Sewer
1
i Lift Station
Total absorption area
Number of trenches
Dist. between trenches
From Tank Field Tank Line
. .. .. . ....
800 Ft2
2
8+ Ft.
Well 100,+ 100'+ 25'+
TANK 0 Septic El S.T.E.P. 171 Holding [I Other
Manufacturer
GREER
Capacity
1500 Gal.
Surface Water100,+100'+
;
Material
HDPE
Number of compartments
2
Lot Line 5'+ 10'+ NA
Foundation10'+ 10'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Deep-burial septic tank.
Alarm location
Electrical installed by
Tank to
PIPE MATERIAL House to tank 3034 drainfield 303114111
Installer ZOLLINGER CONTRACTING
Drainfield 3034 CO/MT 3034
Inspector FWC
BENCH MARK (Assumed elevation) 100 ft
Inspdates: ection 1" nd 9/6/2025
Location and description
2nd
3`d 9/8/25 41h 9/12/25
TOP OF MANHOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
OF A
Conditional Approval: Date
---- - -_ ----
TH
- -----
. .........
SepticSyst
i
Approve/-
CurtisHuffman ow
CE 128991
Dae
Q9/17/2 5.
PROFESSO AMW
Note: this approval does not include well permit requirements..
(Reif 05/02/18)
FIRST WATER CONSULTING
PID:017-023-01 PERMIT: OSP251284
MOUNTAIN PARK ESTATES #2 B4, L1
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP251284
Work Type: Septic Upgrade
Effective Date
Expiration Date:
Tax Code Number: 01702301000
Site Legal Address: MOUNTAIN PARK ESTATES #2 BLK 4 LT 1 G:2839
Site Mailing Address: 12800 FOSTER RD, Anchorage
Owner: HEADLEY KEVIN J &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Lot Size in Sq Ft:
Total Bedrooms:
a��nt
l)cirart�nc�nt
8/19/2025
8/19/2026
20130
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: Locate existing field to verify that horizontal separation distances are met. If connecting to
old field, locate CO/MT and extend above grade to match inspection report drawing.
Received By:� �" Date:
Issued By: Date: 115 ) � 5
MUNICIPALITY OF ANCHORAGE
0 '4
. .. ............ Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 017-023-01
Property owner(s) KEVIN & SHARON HEADLEY
Day phone
Mailing address 18295 E TWINHILLS LANE, PALMER, AK 99645
Site address 12800 FOSTER ROAD, ANCHORAGE, AK 99516
Legal description MOUNTAIN PARK ESTATES #2 BLOCK 4, LOT 1
Number of Bedrooms 3
Engineering Firm FIRST WATER CONSULTING
Building Permit Number
APPLICATION IS FOR:
(N all that apply)
Disposal Field nx
nx
0
n
n
n
Septic Tank
Holding Tank
Privy
Well
Water Storage
Not Applicable RN
APPLICATION IS AN:
Initial
EJ
Upgrade
Renewal
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Permit/Rush Fees: Oqf
Date of Payment: V600-1
Permit No. 05/)
2-512-5
May 2025
Waiver Fees:
Date of Payment:
Waiver No.
Distance:
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
August 6, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: MOUNTAIN PARK ESTATES #2 BLOCK 4, LOT 1
The property owner has requested we obtain a permit to upgrade the failed, aged septic system of
the above referenced lot. We propose to install two shallow trenches and a 1000-gallon deep-
burial HDE tank to serve the existing 3 -bedroom residence. A 1500-gallon septic tank may be
considered for current functionality and future consideration or flexibility.
The design is based on the recent test hole conducted in August 2025. No groundwater was
observed at test hole excavation or monitoring. If groundwater is encountered during installation
that may affect this septic system upgrade, an epoxy coated steel septic tank or other action may
be required.
The slopes are moderate at 5-10% at the proposed upgrade location. The lot and area are served
by private water. The design will not impact any of the neighboring properties. Please contact
us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251284, Curtis Townsend, 08/19/25
FIRST WATER CONSULTING
MOUNTAIN PARK ESTATES #2 B4, L1
DESIGN CALCS:
NO SLOPES >25% WITHIN 50'OF PROPOSED FIELD.
STAKE PROPERTY LINES, WELL RADII, ESMTS,
OR OTHER SEPARATIONS... PRIOR TO CONST.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251284, Curtis Townsend, 08/19/25
FIRST WATER CONSULTING
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC TANK OR
FIELDS.
DESIGN DETAILS:
MOUNTAIN PARK ESTATES #2 B4, L1
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251284, Curtis Townsend, 08/19/25
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: MOUNTAIN PARK EST #2 B4, L1
PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 8/6/2025
DEPTH
FEET OG
SOILS
1 ORG/OL
2
3
4
5
6
7
8
SM/GM
9
10
11
12
13
14
15
16
17
BOH
18
19
20
Reading Date Gross
Time
Net Time Depth to
Water
Net Drop
8/5/25 30 min 6” 2 4/16”
30 min 6” 2 3/16”
30 min 6” 2 3/16”
PERCOLATION RATE 14 (MIN / INCH)
TEST RUN BEWTWEEN 4 & 5 FT
PERC HOLE DIAMETER 6”
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: DRY
DATE: 8/5/2025
TESTHOLE # 25-1 DATE PERFORMED: 07/25/2025
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: KEVIN & SHARON HEADLEY
08/06/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251284, Curtis Townsend, 08/19/25
I
O
SOUTH PARK DRIVE
rX x x x x x x x �
x
TT---�IN 8 9 *5 6) 06"E 183.00)
X o p,
GgRq GE o
X
3 PAVED
N DEW M WELL
X 8. p .�
O" O
' O
o �
X Cn RoQ
w 50.1' O
SEPTIC�,, �,�' h ry
X F— PIPE �K
CK
L- (tYP)
� � �` �� °J LOT 1 `n �
0 0 0� , �o, BLK 4 0
(� O O LL_
O �`O O
Z �2 O
.01 Z
01
L I
N
30--------------
N89°56'06"E 183.00'
I
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
MOUNTAIN PARK ESTATES Not
LOT 1 BLOCK 4 PLAT P-561
�� �U�
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a /! 0F A• • . i L ti LN D
physical survey of this property as shown on this drawing and that the10' • , o s ✓
improvements situated hereon are within the property lines and no ' � L
i ' �� 1
enchroachments exist other than noted. Under no circumstance should 4 9TH �
any information on this drawing be used for construction of fences, • ; • • • • • • , • • , , , • , • • • , • ; • ° �, r
structures, improvements, or for establishing boundary lines. / � Olt) c n
EXCLUSION NOTES: It is the owners responsibility to determine Vj .. ' :;/'� ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' '
the existence of an easements covenants or restrictions which co .JOHN L. SCHULLER.•
Y , ` �` LS-10408 "'-
do not a ear on the recorded subdivision lat. ••w�"'
pp p •'•'.�J� / 1831 Talkeetna Street
WORK ORDER NUMBER: DATE: SCALE: E-MAIL: ' �0, ` �• , ,t! a i Anchorage, Alaska 99508
JULY 2, 2025 1 =30 schullerakOgmail.com , Ar O� / _
DRAWN BY. CHECKED BY GRID NUMBER: BOOK AGE: `\ O f eS noN \' �► (907) 227 1455 office
25�-071 JLS SW2839 250226 ,�\�5���~� (907) 274-4992 fax
~ ~[UNICIPALITY OF ANCHORAGE f ....
He~ and Environmental Prote' ~n
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
INSPECTION REPORT ONLSITE SEWAGE DISPOSAL SYS~-EM
SEPTIC TANK:
DISTANCE
FROM WELL ~¢'~:)O
INSIDE LENGTH_
MANUFACTURER
INSIDE WIDTH
MATERIAL
NUMBER OF
COMPARTMENTS
LIQUID DEPTH
LIQUID CAPACITY/~-~E:2g:J)GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL ./_~)_~) ,''/'-. FOUNDATION ~'~' /NEAREST LOT LINE
ABSORPTION AREA~ ?~Z~ SQ. FT. LENGTH OF EACH LINE ~ ~''
DEPTH OF FILTER
DEPTII: TOP OF TILE TO FINISH GRADE '~' MATERIAL BENEATH TILE_ ~ .,Id~,. ABOVE TILE '~ IN.
SEEPAGE PIT:
Log Crib Rings
BUILDING FOUNDATION
DIAMETER ._ OR WIDTH ., ILENGTH__, DEPTH
Crib Size:! DIAMETER____DEPTH_ . DISTANCE FROM: WELL
TOTAL EFFECTIVE
, NEAREST LOT LINE ABSORPTION AREA (WALL AREA)
SQ. FT.
Class: ~ Depth:
Well Distance To: Lot Line .
Bldg: Sewer Line:
Pipe Materials:
# of Bedrooms:.~?~_
Installer:
Remarks: /
May 26, 1977
R&M No. 751166
Glenn Goodman
8426 E. Duben
Anchorage, Alaska
Re: Soils Investigation for Sanitary Sewer System, Lot 1, Block 4,
Mountain Park Estates Subdivision, Anchorage, Alaska
Dear Mr. Goodman:
At your request of May 23, 1977, we conducted a subsurface soils investi-
gation at the proposed location of the sanitary sewer system on the
subject lot. The investigation complied with those procedures required
by the Municipality of Anchorage, Department of Health and Environmental
Protection.
This investigation, which was accomplished on May 24, 1977, consisted of
a test hole drilled to a depth of 20 feet below the existing ground
surface. The location of the test hole is shown in attached
Drawing A-01. Drilling took place with a rotary drill rig using
continuous-flight solid-stem auger-with an outside diameter of 6 inches.
Samples were taken at depths shown on the soils log in attached Drawing
A-01. These will be held in storage at our lab for approximately six
months. In addition, all material brought to the surface by the augers
was continuously monitored by an experienced engineering geologist.
The topography at the drilling site is generally horizontal. At the
time of the investigation the site had original vegetation and ground
cover. The top of the test hole was located at original ground surface.
The soils encountered in the bore hole are shown in the test hole log in
Drawing A-01. Groundwater was encountered in the test hole while drilling
at a depth of 9 feet. Bedrock was not encountered. Subsurface conditions
may vary in o~k parts of the lot.
A percolation test was performed within the bore hole at the depth shown
in the attached Table 1. All depths were measured from the top of the
hole. The data in Table 1 show average infiltration from the depths
indicated to the bottom of the hole. The measured percolation rate was
480 minutes per inch.
May 26, 197.7
Glenn Goodman
Page -2-
We appreciate this opportunity to be of service to you.
us if you have any questions concerning this letter.
Very truly yours,
R & M CONSULTANTS, INC.
Stephanie M. Hoag
Staff Geologist
SMH:JMB:gld
Please contact
James McCaslin Brown, Ph.D.
Head, Earth Science Department
Attachments: Drawings A-01, B-01, B-02, B-03, Table 1
xc: Dept. of Health & Environmental Protection
LOCATION SKETCH
Lot 1, Block 4,
Mountain Park Estates
Poindexter' Path
35'
35' O'
Not to Scale.
Distances shown are approximate
and have nOt'been measured by
surveying methods.
TEST HOLE LOG
Scale: 1"=3'
0.0~
1
ORGANIC SILT (PT)
Soft, Slightly Moist
SAND W/S0~ SILT (SM)
2
Dark Brown, Coarse Sand,
Moist, Medium Dense
3.0~
6.5~
SAND W/TRACE SILT (SP
Grey, Moist, Medium Dense
SANDY CLAYEY SILT (~-CL)
Light Brown, Wet, Soft
Low to Medium Plasticity
4
Trace Organic Material
(roots & stems) at 9-10'
20.0'T.D.
This log depicts subsurface soils
observed in the test hole at the
location shown.
See Drawings B-01 and B-02 for
explanation of symbols.
TIME
2:00
2:01
2:02
2:03
2:04
2:05
2:06
2:07
2:08
2:09
2:10
2:15
2:20
2:25
~2:30
2:40
2:50
3:00
ELAPSED
TIME
0
1
2
3
4
5
6
7
8
9
10
15
20
25
3O
4O
5O
6~D
TABLE 1
PERCOLATION TEST
GLENN GOODMAN
R & M NO. 751166
FEET
.45
.65
.85
1.05
1.15
1.25
1.3
1.35
1.4
1.5
1.6
1.8
1.95
2.05
2.15
2.3
2.4
2.45
DROP IN FEET
0
.2
.2
.2
.1
.1
O5
05
O5
1
1
2
15
2
.2
.15
.1
.05
24 INCHES TOTAL DROP
2.5 MINUTES/INCH
TIME
3:00
3:01
3:02
3:03
3:04
3:05
3:06
3:07
3:08
3:09
3:10
3:15
3: .20
3 :.25
3:30'
3:40
3':50.
4:00
ELAPSED
TIME
0
1
2
3
4
5
6
7
8
9
10
15
20
25
30
40
5O
60
PERCOLATION TEST
GLENN GOODMAN
R & M No. 751166
May 25, 1977
DROP IN
INCHES INCHES
70% 0
70% 0
70% 0
70% 0
70% 0
70% 0
70% 0
70% 0
70% 0
70% o
70% 0
70% 0
70% 0
70% 0
70%.~ 0
70 5/8 1/8
70 5/8 0
70 5/8 0
1/8 Inch Total Drop
480 Minutes/Inch
July 11, 1977
R&M NO. 751166
Glenn Goodman
8426 E. Duben
Anchorage, Alaska
Re: Soils Investigation for Sanitary Sewer System Lot 1,
Block 4, Mountain Park Estates Subdivision, Anchorage, Alaska
Dear Mr. Goodman:
On May 24 and 25, 1977, we conducted a subsurface soils investigation at
the proposed location of the septic system on the subject lot. That
investigation is described in detail in our letter to you of May 26,
1977.
The percolation test performed on May 25 showed very poor results. We
suspect that this was due to "plugging" of the sides of the test hole by
clayey material which was brought up by the auger.
At your request another test hole was dug, adjacent to the original
hole, to a de~th of 3.5'. Organic material was encountered in the hole
to a depth of 1' with fine, brown sand with some silt (SM) extending
from 1' to 3.5'.
A percolation test was performed in the second hole on July 8, 1977.
This test complied with those procedures required by the Municipality of
Anchorage, Department of Health & Environmental Protection. The percola-
tion test results are shown in Table I. All depths were measured
from the top of'the hole. The data in Table I show average infiltration from
the depths indicated to the bottom of the hole. The measured percolation
rate was 2.5 minutes per inch.
We appreciate this opportunity to be of service to you. Please contact
us if you have any questions concerning this letter.
Very truly yours,
R & M CONSULTANTS, INC.
Staff Geologist
Jim McCaslin Brown, Ph.D.
Head, Earth Science Department
SH:JMB/sl
Attachments: Table I
ANCHORAGE FAIRBANKS JUNEAU VALDEZ ~¥ASILLA
· - MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT,ON
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
IPHONE
"P"OPERTYOWNER6LEz//? &O¢/) ~/~/b' ~
MAILING ADDRESS
PROPERTY RESIDENT (If different fro'm above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION I PHONE
I
MAILING ADDRESS
I PHONE
MAILING ADDRESS
S. LEGALDESCB,PT,ON /-,{PT ! g~.C~c[; zF /~/?/~./~/ p/u~ ~-'4~-uA
STREETLOCATION /£~ST~A .~ '~OVT/4' p/,L/~ ~
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four
[~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
[] Other
7. WATER SUPPLY
[~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE~*
[] PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMpANy EACH REQuEsT BEFORE PROCESSING CAN BE INITIATED.
72-010{3/78) ~~
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSP ECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
EIb/SING LE FAMILY [] ONE I~" THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
E~/ INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED 2/2
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
iNWAGE DISPOSAL SYSTEM PERMIT NUMBER
DIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic T~an~. or [] Holding Tank
Size: ]('")~)CJ If Tank is homemade SOILS RATING
give dimensions: //
TYPE OF TANK~ MANUFACTURE~..j~.~
TOTAL ABSORPJI'ION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
I~APPROVED FOR .~'~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE '
LEGAL D~-C~FT C~N////~7 ~-~ BY~
72-010 (Rev, 3/78)
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
OSC251434
Parcel ID 017 -023-01 Expiration Date: 9/23/2026
Legal description MOUNTAIN PARK ESTATES #2 BLK 4 LT 1
Site address 12800 FOSTER RD
Current property owner(s) HEADLEY KEVIN J &
X The On-site system(s) is/are approved for 3 bedrooms
By:
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
Original Certificate Date:
10/1/2025
T4rs6ertificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
sdstem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory X
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other ___
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 Application
1. GENERAL INFORMATION
Parcel 1. D. 017-023-01
Complete legal description MOUNTAIN PARK ESTATES #2 BLOCK 4 LOT 1
Location (site address) 12800 FOSTER ROAD ANCHORAGE, ALASKA 99516
Current property owner(s) HEADLEY KEVIN & KARWOWSKI �': Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑N Private Well serving # 1 dwelling units
❑ Other Non-public well as regulated by MOA ❑ Water Storage
❑ Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑N Plastic ❑ Concrete ❑ Fiberglass
Age NEW - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench 0 Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 210
Date of Payment
COSA# 05C2-5114iq
Waiver Fee $
Date of Payment
Waiver #
COSA Application_Ap2025.doc
COSA Checklist.docx
COSA Checklist
Legal Description: MOUNTAIN PARK ESTATES #2 BLOCK 4 LOT 1 Parcel ID: 017-023-01
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 7/6/1977 Total depth 182 ft
Cased to 56 ft (TO BEDROCK)
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 09/23/25
Static water level at beginning of test 121 ft.
Well production at time of test 0.3 gpm
Water storage tank volume 300 gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by & SULLIVAN Date 9/9/25 & 9/23/25
Comments
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NA
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. DISPOSAL FIELD DATA
Which system tested (date installed) NA - NEW
ALL standpipes present per record drawing
Total measured depth from grade 9.1 ft (max)
Measured depth to pipe invert from grade 4.8 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date NA - NEW
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – NEW FIELD
Effective depth (per record drawings) 48 in (MOA 4’ ED)
Effective depth used 0 in
Effective depth remaining 48 in
Comments/Deficiencies:
COSA Checklist.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Disposal Field on Lot > 100’ Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10’ Yes if No ft
Field to Foundation > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main/Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 09/22/2025
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
09/22/25
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT � s� 907-343-7904
On -Site wafter and wastewater Section Fax: 343-7997
www.muni.org/onsite -
Well Water Advisory
Certificate of On -Site Systems Approval # OSC251434
Subdivision: Mountain Park Estates #2, Block: 4, Lot: 1
This well's productivity was determined to be 0.3 gallons per minute. The
recommended well productivity under (AMC 15.55) for a 3 -bedroom residence is
.31 gallons per minute or 150 gallons per day per bedroom. Water storage may be
necessary to accommodate your needs.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
0
1"=30'
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ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
MOUNTAIN PARK ESTATES No2
LOT 1 BLOCK 4 PLAT P-561
AMW ®®® SUR V
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a + O FI A ®� SAP L L A N r,
AWphysical survey of this property as shown on this drawing and that the ® �' ' • ' ' q,�,
improvements situated hereon are within the property lines and no • . y�
enchroachments exist other than noted. Under no circumstance should .' 49TH '•'� ,
any information on this drawing be used for construction of fences, ®'� ........... n ° °p � r
structures, improvements, or for establishing boundary lines. a c n
EXCLUSION NOTES: It is the owners responsibility to determine ' ' ' ' ' ' ' ' " ' ' ' ' ' ' ' ' : ' •i
the existence of an easements covenants or restrictions which '.JOHN L. SCHULLER. ®- t
Y � `� �• LS -10408 10'
+'
do not appear on the recorded subdivision plat. �r ' • '' J� ,; % . 1831 Talkeetna Street
WORK ORDER NUMBER: DATE: SCALE: E-MAIL: �°0, �-: 1.7 .- a Anchorage, Alaska 99508
SEPT 17, 2025 1 =30 schullerak®gmail.com Ar 4�
DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: �® ' f Q� ® (907) 227-1455 office
25-071-2
e s s i o n ��• 274-4992 fax
JLS SW2839 250330 ®�®®®`�• (907 )