HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 1 LT 5
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S 89050'24" W 330.02'
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EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (82-313) ARE NOT SHOWN HEREON.
THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEYAND
IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT
BOUNDARY SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE
USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR
ESTABLISHING PROPERTY BOUNDARIES.
THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY
PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION
SURVEY STANDARDS.
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WELL W/CAP
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BUILDING
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LOT 4
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AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 5, BLOCK 1, PROSPECT HEIGHTS SUBDIVISION
ADDITION No. 5
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
DATED THIS 12th DAY OF JUNE, 2026, AT ANCHORAGE,
ALASKA.
FIXED HEIGHT, LLC C.O.A.122554
Land Surveying Services WWW.FIXEDHEIGHT.COM
600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949
JOB # 26161 I NO CORNERS SET THIS DATE I SCALE 1" = 60'
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Name: ~)L..O ,-~ ~ ~ ~ 5 Wastewater System: ~New D Upgrade
~d~: ~.~o ~o~ ~. ~~ ABSORPTION FIELD
Phone: ~ -- ~ ~3~ ~ No. of Bedrooms:
~ ~DeepTrench D Shallow Trench D Bed ~ Mound O Other
Total Depth f[om original grade:
LEGAL DESCRIPTION SoilRating:t, ~ GPD/Sq. Ft. /~* I
Lot: ~ Block:/ ~~~ Subdiv~ion:~ ~ =Depth to~,plpe~boffom/~fr°m~.°rigin~l/grade: Ft.Gravel depths, ~eat~ pipe Ft.
Fill added ~bove original grade: Gravel length: /
Township~ Ran~ Sectio~ , ~ ~0 Z.%' Ft. ~1 Ft.
Number of lines: Distance~n lin~:
WELL: ~ New D Upg ride Gravel width: ~ ~ Ft. / ~/~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Date Drilled: Static Water Level: Installer: Date ins~alle~:
Yield:
I Casing Height Above Ground:
GPM Pump~ Ft. ~O~ Ft.
TANK
SEPARATION DISTANCES ~septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding >ublJc/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank SewerLines ~ . ~ J
Wel~ J~/+ /~D~ ~/~ ~ j~/ Material: Number of Compa~ments:
SudaCewater JO0I+ ~/~ ~oo~+ ~ LIFT STATION
Line lie I+ ~ ~l~ Size in gallons: Ma
Remarks: BENCH MARK
[~ b~ I l O~ ~ ~ ~ Location and Description:
Assumed Elevation:
Depa~ment of Health and Human Se~ices approval ~,.-.~-~, u ..,,-
/ i!: :-. 7'/::::.\..:'.,.i ':.'i?,, ,..
CO ~ , '.~/ ..','~:-'t~ :~'~: ' :~ . :', ..
~' :' .' ' : .. '': , .'t '" :' :~: 7 :"
~
~""t:. ":'- '~ - .:.~
TH ~Z
3DU3LE
~1500 6ALLDN ~EPTIC TANK
F~C~D TO FOUNDATION = 1.0 WT TD
F~C~O TO A = 14,5 ~T TO C = 67~5
B TO ~1 = 89~5 C08 TO A = 69~0
C TO ~1 = 49,5 CD8 TO C = 57~5
B TO S8 = 35.0
C TO ~8 = 55.0
COl TO B = 65~5
CO1 TO C = 78.5
DATE: 11/~6/97 DRAWN, GARNESS SCALE,
AS-SUTLT SRAWTNG
ANCHORAGE TANK. INLET INV,
98,63, OUTLET INVERT : 98,40
TANK SET LEVEL
C ))IA, PVC LINE FROM HOUSE
GRBUND ELEV, AT TANK 96,8
DOVER = 3,1 FEET,
2 INCHES OF INSULATION
./ --BOARD PER THE CONTRACTOR, COLONY
BUILDERS.
4 INCH DIA, PVC (93034)
GROUND ELEV. OVER
TRENCH IS 95,0+
MINIMUM COVER : 8,8 FEET
FOR LOCATION DF M,T SEE PLAN DRAWING
---FILTER FABRIC & INSULATION OVER DRAINRDCK
,~ '4 INCH DIA., ASTM FSlO, PERFORATED PIPE
A. INVERT DF DRAINPIPE = 91,58
B. DDTTDM OF TRENCH = 84.0P
C, NO GROUNDWATER TO DEPTH DF 17 FEET IN TEST HOLEs,
D. TRENCH LENGTH : 51 FEET
E. TOTAL ABSORPTION AREA : 770 SQ, FT, +
]]ENCHMARK IS GARAOE FLOOR
ASSUMED ELEVATION = 100,43
SEPTIC SYSTEM AS-BUILT: LOT 5, BK 1, PROSPECT HTS ~5
~REPARED FDR~ COLONY BUILDERS
ALASKA WATER & WASTEWATER
PROSPECT
82-313
HEIGHTS SUBD., ADDN.
LOT 5, BLOCK 1
106,160 S.F.
NO.
5
LOT 1
PROPOSED ACCESS EASEMENT --
ACROSS LOT 1
ZERMATr
CIRCLE
1 "=50'
EXISTING
W£U.
LOT 5
10' T. (( E. ESMT.
N 89050'24"E 330.02'
LOCATION OF WELL
STATE OF ALASKA
DEPARTMENT OF NATURAl RESOURCES
DIVISION OF WATER
WATER WELL RECORD
BOROUGH
SECTION
SECTION
TOVVNSHIP I RANGE
[]N []E
ElS []W
MERIDIAN
LOCATION/SKETCH:
DEPTHS MEASURED FROMp'~asing top []ground surface
80REHOLE DATA: Depth
Material Type and Color From To
/
RECE]
DEC ~!997
Mun~olp~l~ty ~ ~-\iiGrIo/~
Dept. Health & H
] WELL OWNER:
WELL DEPT~'/" / ~
I. Oepth o, h~~'~, ,t
of casing:/~ ? ft
Depth .
DATE OP COMPLET,O.
DEPTH TO_.STATIC WATER LEVEL:
,/~/~/ ft beloved' top of casing I-I ground surface
Dat.: /~ ~ // , ~' ~'
METHOD OF DRILLING: /J~'~ir rotary [] cable tool
[] other
USE OF WELL.~domestic [] irrigation li monitor
[] public supply [] other
CASING STICK-~[p:. ~. ft. Diam: ~__in.
Casing type: ~ . ~ in. to/'~.~/ft
OPENING TYPE: [] open end [] screened
l-'l perforated/~'open hole
Depths of openings: to ft
SCREEN TYPE: Diam: in.
Slot/Mesh Size: Length: ft
GRAVEL PACK TYPE:
Volume used: ,Depth to top:
GROUT TYPE: ,;~~
Depth: from ft to ft
DEVELOPMENT METHOD:
Duration: ~- ~
PUMPING LEVEL AND YIELD: ~
~/~ ft after ~ hrs pumping ~ gpm
PUMP INTAKE DEPTH: ft Horsepower:
WELL DISINFECTED UPON COMPLETIONT'~ YES [] NO
CONTRACTOR INFORMATION: REMARKS:
PLEASE IVIAIL WHITE COPY OF LOG TO:
DNR/DIVISION OF WATER
Signatu(e of Authorized Respresentative Date PO BOX 772116
EAGLE RIVER AK 99577-2116
PAGE 1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970182 .
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:ONEY JOHN ANTHONY & RITA GAE
OWNER ADDRESS:3820 LAKE OTIS PKWY, SUITE 204
ANCHORAGE, AK 99508
DATE ISSUED: 7/10/97
EXPIRATION DATE: 7/10/98
PARCEL ID:01513505
LEGAL DESCRIPTION:
PROSPECT HEIGHTS ~5 BLK 1 LT 5
LOT SIZE: 106160 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT:
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 (182LAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SA_ME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
q-/7- ?A
DATE:7--//'9?
Water & W tew ter
June 26, 1997
8471 Brookridge Drive - Anchorage - Alaska 99504
(907) 337-6179 - Fax (907) 338-3246
Consulting Engineers
Municipality of Anchorage
Department of Health & Human Services
Division of Euvironmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Well & Septic System for Lot 5, Bk 1, Prospect Heights #5 S/IX
To whom it may concern:
The subject property is currently undeveloped. The Peterson Group is proposing to build a 5
bedroom home on the site, wtfich will require the installation of a well and a septic system.
Comments regarding the proposed systems are summarized as follows:
1. SOILS: Attached is a copy of the soils logs. Test hole #1 had the most consistent profile,
with well graded gravel from 1' to and average depth of 11.5'. Test hole #2 had sandy gravelly
soils from a depth of 1.5' to 12', however the profile between 5' & 8' was a silty soil, with lenses
and pockets of sand. All of the perk tests indicated rates faster than 1 minute per inch; however,
there are tighter underlying soils Milch will negate the need for a sand filter.
2. TRENCH DESIGN:
f.
g.
h. Reduction Factor = N/A
i. Width: 2 feet minimum
j Minimum Length: 50 feet
k Effective absorption area = 625 fi2
Percolation Rate: <l minutes/inch.
Allowable Application Rate: 1.2 gallons/day/fi2
Number of Bedrooms: 5
Design Flow: 750 gallons per day
Minimum Absorption Area: 625 fi2
Total depth: 10.5 feet
Effective Depth: 6.25 feet (7.5 feet of rock, but 1.25 foot neglected to account
for silt/sand las)er encountered in TH #2)
-MUNICIPALITY OF ANCHORAGI~
ENVIRONMENTAL SERVICES DIVISION
dUN 2 7 1997
.RECEIVED
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
4. TOPOGRAPItY: Attached is a topography map which shows the contour of the subject lot.
According to this drawing, there are some localized slopes, near the north end of the trenches,
that are at a grade of approximately 35%. Given the porosity of the receiving soils, it is highly
unlikely that any wastewater will migrate laterally, and daylight. In short, it will move downward
rather rapidly. The majority of the topography, within 50 feet of the proposed trenches, is
moderately sloped at less than 25%. Given the soil conditions, it is my recommendation that the
required separation distance of 50 feet to a slope greater than 25% be waived in this case.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, 244-9612, or on my digital
pager at 1-800-481-1162. Thank you for your assistance.
' j REVISED--1
~'~ ~ ~ ~ ~ ] CDT 3,
~:~ ~ ~ I PROSPECT HTS
~ '~ ~ % ~ ~ / ~5, VACANT,
~ ~ ~DUNDATIDN C/D
PROPOSED 1500x L4 INCH PVC (93034) / / /
G~LLON ~EPTIC SLGPE~ ~T 1/4 INCN / / I
TANK PER FOOT,
~ELL
LOT 6~ BK i PRO~RECT HEIGHT~ ~5,
PRIVATE ~ELL AN~ ~EPTIC ON LOT,~
NO S~PARATION Dt~TANCE CONCERNS
AND STRUCTURES IS APPROXIMATE, THE CONTRACTOR SHALL VERIFY THAT ALL REQUIRED""~*~i~
~ELL & SEPTIC SYSTEM~ LOT 5. BK 1, PROSPECT HTS, ~ 5 ' : . ~.~.,
...........
PREPARED FOR, PETERSDN GRDUP 'U
' ' ~a~*~~ ~ ' ........
DATE: 9/17/97 DRAWN: GARNESS SCALE~ 1" = 100'
LOT 1, DK 1, PROSPECT
HEIGHTS #5. VACANT
PRIMARY TRENCH
50 FEET
WELL
o
LUT ~,
HEIGHT~
PRnSPECT
PRIVATE
SEPTIC,
RESERVE TRENCH
50 FEET LDNS,
PRDPOSE~ 5
BEDROOM HOUSE
PRDPO~ED
TH WELL
i C/O
PROPOSE9 150D 4 INCH PVC (93034)
GALLON SEPTIC SLOPED AT 1/4 INCH
TANK PER FOOT.
LOT 4, ~K 1,
PROSPECT HTS ~5
RESERVE
\\
LOT G, BK I PROSPECT HEIGHTS ~5.
PRIVATE WELL AND SEPTIC ON LOT.
NO ~EPARATION DISTANCE CONCERNS
LOT 3, 9K1
PROSPECT HTS
#5. VACANT.
EXISTING
WELL
o
NOTEj THIS IS NOT A SURVEY. THE LOCATION Of ALL WELL~, SEPTIC SYSTENS,
AND STRUCTURES IS APPROXIMATE, THE CONTRACTOR SHALL VERIFY THAT ALL REQUIRED
SEPARATION DISTANCES ARE MAINTAINED.
WELL & SEPTIC SYSTEM~
PREPARED FOR:
PREPARED BY:
DATE=
LOt 5, BK 1, PROSPECT HTS, # 5
PETERSON GROUP
ALASKA WATER & WASTEWATER
6/26/97 IDRAWN~ GARNESS ISCALE~ 1' = 100'
RESERVE TRENCH
TH # 1/
TRENCH
PRDP~$E9
WELL.
~BUBLE
PROPDSED 1500 GALLDN
~EPTIC TANK.
C/D
INCH PVC SLDPED AT 1/4 INCH PER F00T,
WELL & SEPTIC SYSTEM:
PREPARED FDR:
PREPARED BY,
DATE~
LDT 5, BK 1, PRDSPECT HTS #5
PETERSDN GRUUP
ALASKA WATER & WASTEWATER SERVICES
6/26/97 DRAWN~ GARNESS SCALE~ 1' = 30'
I
/
I-
5
't4,
~.17
~O& ~ $.~. f..-...-
.dC. /
54~ 0
847..0 ---
I
TRENCH LENGTH
,= 50' i~EET.
TOTAL ABSORPTION AREA
625 SOUARE FEET (MIN.).
BACKFILL WITH NATIVE SOIL AND MOUND.
FABRIC SILT BARRIER.
2 INCHES OF BOARD INSULATION IF SOIL
COVER IS LESS THAN 3 FEET. INSULATION SHALL
COVER THE ENTIRE WITH OF THE TRENCH.
--4 INCH DIA. PERFORA TED PIPE, WITH HOLES
DOWN. SHALL BE LEVEL WITHIN .01 FEET.
PLACE 2 INCHES OF DRAINROCK OVER TOP
OF PIPE. TOP OF DRAINROCK SHALL BE AT
THE SAME ELEVATION OVER THE ENTIRE
TRENCH WIDTH,
TUBE (TYP),
PERFORATED IN DRAINROCK.
FEET MIN.
NOTE:
1. TRENCHES SHALL RUN PARALLEL TO THE
SLOPE CONTOURS.
2. FOR LOCATION OF MONITORING TUBE,
SEE SITE PLAN.
3. CONSTRUCTION PRACTICES, AND MATERIAL
SPECIFICATIONS SHALL COMPLL Y WITH
ANCHORAGE MUNICIPAL CODE 15.65, "WASTE-
WATER DISPOSAL REGULATIONS".
4. INSTALLATION SHALL COMPLY WITH SPECIAL
PROVISIONS AS NOTED ON THE SEWER PERMIT.
5. SMEARED BOTTOM AND SIDEWALLS SHALL BE RAKED.
6. DRAINROCK SHALL BE SCREENED PER M.O.A.
SPECIFICATIONS. DIRTY DRAINROCK WILL BE
REJEC TED.
TRENCH DETAIL: LOT 5, BK 1, PROSPECT HEIGHTS #5.
PREPARED FOR: PETERSON GROUP
ALASKA WA TER & WASTEWA TER SERVICES
DATE: 6/27/97 DEN: GARNESS SCALE: NTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
7
8
9
10
11
12
13
14
15
16
17
18"
19-
20-
WAS GROUND WATER
ENCOUNTERED? f~ O
COMMENTS
,./¢
Township, Range, Section:
SLOPE SITE PLAN
//~ s
IF YES, AT WHAT OL
DEPTH? ~'~ p
E
Depth to Waler A,erJ,~ ~,/~///~
Monitoring? t'Jr. Dale: ~
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~' / (minutes/inch) PERC HOLE DIAMETER
TEST RUN ~ETWEEN ~ [TAND ~' -~ FT
PERFORMED BY: ~.~_.,~1~: ~-,.Z...'~'t~--~ I '~--'~ ~'~::;'~"¢ CERTIFY THAT)'HI~,,TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/':~/¢:~""
72-008 (Rev. 4~85)
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG
PE"FORMED FOR:
1
2
3
4
5
6
7
8
9
10
11
12
13
14-
15-
16-
17
18
19
20
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ~',~ O
S
IF YES, AT WHAT O
DEPTH? ~ p
E
Monitoring? t,J f,,,~-- Dale:
Reading Data Gross Net Depth to Net
Time Time Water Drop
oJ.G-- io.o
PERCOLATION RATE ~' / ' (minutes/inch) PERC HOLE DIAMETER'
TEST RUN BETWEEN ~',~- FTAND /O ET
PERFORMED BY: , 4~c~ ~7~--~'~-~ I d~---~'¢:~~4 CERTIFY THAT THIS TEST WAs PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '~ / '~/~:~ ~7'"
72-008 (Rev. 4185)
MUNICIPALITY OF ANCHORAGE
Alw
Development Services Department Phone: (907)343-7904
On-Site Water &Wastewater Sectiont
Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC261218
Parcel ID 015-135-05 Expiration Date: 6/6/2027
Legal description PROSPECT HEIGHTS #5 BLK 1 LT 5
site address 10100 ZERMATT CIR
Current property owner(s) FAUST SUSAN M
X The On-site system(s) is/are approved for 5 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
By;
Original Certificate Date:
7/6/2026
L '
T Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(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
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory X Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
AW
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 I.D. 015-135-05
Complete legal description
Location (site address)
PROSPECT HEIGHTS #5 BLOCK 1 LOT 5
10100 ZERMATT CIRCLE ANCHORAGE, ALASKA 99507
Current property owner(s) SUSAN M FAUST
2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: M 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: FMf Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ■❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 28 - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ 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 $ Waiver Fee $
ic? (c �. Date of Payment
Date of Payment
COSA # C J� �' 5LI I Waiver #
COSA Application_Apr2025.doc
COSA Checklist.docx
COSA Checklist
Legal Description: PROSPECT HEIGHTS #5 BLOCK 1 LOT 5 Parcel ID: 015-135-05
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 10/11/1997 Total depth 205 ft
Cased to 124 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 6/9/26
Static water level at beginning of test 123 ft.
Well production at time of test 5+ gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 4.99 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 6/9/2026 & 7/1/2026
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 48"
Date of pumping 6/8/26
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) 9/17/1997
ALL standpipes present per record drawing
Total measured depth from grade 10.9 ft (max)
Measured depth to pipe invert from grade 3.3 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective (ED).
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 6/9/2026
Results Pass
Fluid depth prior to test 13 in
Water added 750 gal
New fluid depth 16 in
Elapsed time 1440 min
Final fluid depth 10 in
Absorption rate 750 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 90 in (MOA 7.56’ ED)
Effective depth (ED) used 10 in (Final Fluid Depth)
Effective depth remaining 80 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 07/02/2026
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 &
07/02/26
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC261218
Subdivision: Prospect Heights #5 Block:1, Lot: 5
The septic tank for this property is 29 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
Steel septic tanks utilizing "Coal Tar Pitch" coatings are subject to corrosion as the
steel reacts to water and rusts. These tanks have a finite lifespan buried in the
ground. These tanks can become structurally compromised and pose a health risk.
They could collapse and/or leak untreated wastewater directly into groundwater.
In the interest of protecting public health and the environment, the Municipality of
Anchorage Development Services Department has issued Policy W.05 Standard of
Care Regarding the Inspection of Steel Septic Tanks when Performing COSA
Inspection. Please request a copy of this policy from the Department if interested.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address: P. O. Box 396650 * Anchorage, Alaska 99519-6650 * www.muni.org
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTFI & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519~6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
--/.~ ~0~ NAA #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: -~
TYPE OF WATER SUPPLY:
Individual well ~
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA #21
STATEMENT OF INSPECTION Ry ENGINEER
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 application 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..
Alaska Water & Waste(water
Name of Firm "~"" ~"t C~°°~'"r Hf.d. ICLrcle ~7-
, .,,~,, ,.,,,,. ~...,--- · - Phone
A~h-~r aee~ Xlas~/9~504
Address -/ I ,b'l/ / Ilv \
Engineer's signature ~ .... ~'~,~,~/~z/t~ ~ Date
DHHS SIGNATURE
~ Approved for ~-/~'~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
AdditiOnal Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 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.
72-025(Rev. 1/91) E~ck MOA~21
~uu~lc~P,~uT'y
Municipality of Anchorage AP~ ~ 199~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Se~ices Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: /~O'T ~ i ~/-/~/r ~
/]~o~pE~__.¥ /"/-T,~ ~ Parcel I.D.:
A. WELL DATA
Well type
Log present (WN)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter, ADEC water system number
Date completed
Cased to /,~,c/' ~
Casing height (above ground) /¢~ , t¥
Wires properly.protected (Y/N) ]~//~,~'
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~
Date of sample: /~/Z~/~
FROM WELL LOG
AT INSPECTION
i
I1~
g.p.m.
Nitrate
Collected by: ,~'~t
g.p.m.
Other bacteria - ~ --
B. SEPTIC/HOLDING TANK DATA
Date installed c~/16-iq-j~"~ Tanksize l~00 Number of Compartments ~ Cleanouts(~]~,J)~-.
Foundation cleanout ~tN) ~'~'_~ Depression (Y/~_)~ ~o High water alarm (Y/N)
Date of Pumping /~/~ Pumper I~/~ ~
C. ABSORPTION FIELD DATA
Date installed o'[Ill-iq-
Length ~ [ ~ Width
Soil rating (.p.~. ~ or fF/bdrm) J,),, System type
Gravel thickness below pipe t~,r./._~ ' Totaldepth
Effective absorption area '~r-~°ro S'F Monitoring Tube present (~N) ~/Es Depression over field (Y~) I%)°
Date of adequacy test ~//'~ ~Y:S Results(Pass/Fail) ~/~ For
Fluid depth in absorption field before test (in.);
Fluid depth 0v~//~ (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/~
Immediately after b/~.l- gal. water added (in.):
Absorption rate = /v'///- g.p.d.
If yes, give date
bedrooms
72-026 (Rev. 3/96)*
D. LIFT STATION
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /00 ~-f On adjacent lots
Absorption field on lot /00 ~ On adjacent lots lbo
Public sewer main ~//:I- Public sewer manhole/cleanout
Sewer/septic service line ~//~ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation /0 f.(- Property line ,/0 /-/- Absorption field
Water main/service line /0 ~ Surfacewater/drainage ! O0 ~Y-- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /~ ~'/- Building foundation ' /~ ~4- Water main/service line
Surface water /C)d ' + Driveway, parking/vehicle storage area
Curtain drain ~,~E ~l,~O~,,~ Wells on adjacent lots /O~
F. ENGINEER'S CERTIFICATION//
I certify that I ha~ de~mine~ru eld inspections and
in conforman,~e w~h ~DA_ .l~l~[gui ~.lines in effect on this date.
Signature ~~'~!~"~_.~ ~
Engineer,sNarn~e~' ~ J~ A' ~./~c~
HAAFee $ ~ ~3~
Date of Payment
Receipt Number ,~ ~"7~ (~/-'7/'~
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number