HomeMy WebLinkAboutDELUCIA LT 27I)elucl*a
Lot 27
#051- 141-45
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP241348 PID Number: 051-141-45
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
FRANK BLAVKA &THOMAS BLAVKA
ABSORPTION FIELD
El Deep Trench ®Wide Trench El Bed ❑ Mound
Site Address
19741 OLD GLENN HIGHWAY, CHUGIAK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1.2 GPD/SF
7 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3 Ft.
Gravel depth beneath pipe
4 Ft.
Subdivision Block Lot
DELUCIA 27
Fill added above original grade
VARIES -0.42 to +0.33 Ft.
Gravel length
(25' x 2) 50 Ft.
Township Range section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To', Septic Absorption Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From Tank Field Lift Station Tank
Line
500 Ft2
2
8 Ft.
Well 100'+ 100'+ 100'+
25+
TANK ® Septic ® S.T.E.P. [:1Holding ElOther
Manufacturer
GREER
Capacity
1500 Gal.
Surface Water 100'+ 100'+ 100'+
Material
HDPE
Number of compartments
2
Lot Line 5'+
10'+ 5'+
I'I
NA
Foundation 10,+ 10'+ 10'+
LIFT STATION
Manufacturer
GREER
Capacity
1500 Gal.
Remarks Deep Burial Tank & insulated.
Alarm location
Electrical installed by
INTERIOR BACK ROOM
DRS
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Installer ,JRS
................
Drainfield 3034 CO/MT 3034
Inspector FIRST WATER CONSULTING
BENCH MARK Assumed elevation) 100 ft
Inspdection 1" 12/31/2024 2nd 01/02/2025
Location and description
3'd 1/2/2025 4" 1/21/25
TOP OF MANHOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
M
.:� 'k
Conditional Approval: Date
JAI
r�Q •'�
% *•49 TH
- -
Septic System
Approved -,'.,/e. ' G
Dat
Curtis Huffman%
..0- lie
�� �c<6,•,• CE 128991
1/31/25,
f�s�F��
- --
%,fOION
p�r4�
ROFESS�..
nZ
Note: this approval does not include well permit require ents.
1\\FE11W
(Rev 05`02118)
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LOT 25
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LOT 27
LOT 26
SEPTIC AREA
PID:051-141-45 PERMIT:OSP241348
FIRST WATER CONSULTING
DELUCIA LOT 27
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241348
Work Type: Septic Upgrade
Tax Code Number: 05114145000
Site Legal Address: DELUCIA LT 27 G:1259
Site Mailing Address: 19741 OLD GLENN HWY, Chugiak
Owner: BLAVKA THOMAS &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
10/25/2024
10/25/2025
21780
Q Disposal Field R1 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�Close!=on
subsurface soil absorption system under construction during freezing weather
sha��.
a. he sameor
b�eredsealed, and heated to preven eezing
Special Provisions:
• If the existing septic system is found near the proposed field, please contact the Onsite Section. A
change order may be required.
-Received-By: tc,
Issued By:
Date:
Date: 2 Z
4
MUNICIPALITY OF
Air
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 051-141-45
ON-SITE SEPTICMELL PERMIT APPLICATION
Property owner(s) BLANVKA FRANK & BLAVKA THOMAS Day phone
Mailing address 30405 108TH AVE, SE AUBURN, WASHINGTON 98092
Site address 19741 OLD GLENN HWY, CHUGIAK, ALASKA 99567
Legal description (Sub'd., Block & Lot) DELUCIA LOT 27
Legal description (Township, Range & Section)
Lot Size 21,780 Sq. Ft. Number "cif Bedroom 4
Phone: 907-343-7904
Fax: 907-343-7997
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
®
Initial ❑
Single Family (SF)
(w/wo ADU)
Septic Tank
®
Upgrade ®
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature -of {property owner or authorized agent)
Permit/Rush Fees:Waiver Fees:
Date of Payment: Z Date of Payment:
Receipt Number: 3 l I I zo Receipt Number:
Permit No. Oopz� 15 916 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
October 10, 2024
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: DELUCIA LOT 27
The property owner has requested we obtain a permit to upgrade the undocumented septic
system of the above referenced lot. We propose to install two pressurized shallow trenches and
1500-gallon deep-burial STEP tank to serve the existing 4-bedroom residence. The design is
based on the recent test hole conducted on October 3, 2024 & the attached soils sieve analysis.
No groundwater was observed at test hole excavation or monitoring.
The slopes are moderate - flat 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
OSP241348, Deb Wockenfuss, 10/25/24
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LOT 27
IRON
PIPE
WELL
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LOT 26
LOT 19
LOT 25
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BLM LOT 164
S 89°59'00" E 188.30'
S
45
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2-STORY
4-BR
HOUSE
SEPTIC AREA
FIRST WATER CONSULTING
DELUCIA LOT 27
DESIGN CALCS:
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC SEPTIC.
NO SLOPES >25% WITHIN 50'
OF PROPOSED FIELD.
IF THE EXISTING FIELD
IS NEAR THE PROPOSED
FIELDS ONSITE IS TO BE
CONTACTED & A POSSIBLE
CHANGE ORDER REQUIRED.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241348, Deb Wockenfuss, 10/25/24
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WELL
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LOT 26
LOT 19
LOT 25
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BLM LOT 164
S 89°59'00" E 188.30'
00
"
W
1
1
6
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2
0
'
2-STORY
4-BR
HOUSE
SEPTIC AREA
FIRST WATER CONSULTING
DESIGN DETAILS:
DELUCIA LOT 27
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241348, Deb Wockenfuss, 10/25/24
3030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 FirstWaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL: DELUCIA LOT 27
PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10/10/2024
DEPTH
FEET OG
SOILS
1
2
ORG/OL-FILL
3
4
5
6
SP
7
8
GRAB SAMPLE
9
10
11
12
13
14
15
BOH
16
17
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
10/03/24 2 min 6” 6”
“ 6” 6”
“ 6” 6”
PERCOLATION RATE <1 (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: 10/10/2024
TESTHOLE # 24-1 DATE PERFORMED: 10/03/2024
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERY RAPID PERCOLATING SOILS – SEE SIEVE
INSITU MATERIAL SUITABLE FOR FILTER.
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: FRANK BLAVKA
10/10/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241348, Deb Wockenfuss, 10/25/24
% GRAVEL 37.3 USCS SP-SM
% SAND 53.2 USACOE FC N/A
% SILT/CLAY 9.5 % PASS. 0.02 mm N/A
% MOIST. CONTENT 13.5 % PASS. 0.002 mm N/A
N/A
N/A
N/A
SIEVE SIEVE TOTAL % SPECIFICATION
SIZE (mm) SIZE (U.S.) PASSING (% PASSING)
152.40 6"
76.20 3"
38.10 1.5" 100
19.00 3/4" 94
12.70 1/2" 85
9.50 3/8" 79
4.75 #4 63
2.00 #10 48
0.85 #20 35
0.43 #40 27
0.25 #60 22
0.15 #100 16
0.075 #200 9.5
ELAPSED DIAMETER
TIME (MIN) (mm)
0
1
2
5
8
15
30
60
250
1440
SOUNDNESS OF AGG.
(ASTM C88)
DEGRADATION
(ATM T-313)
LA ABRASION
(ASTM C131/C535)
SP. GRAV. COARSE AGG.
(ASTM C127)
CLASSIFICATION:
DATE RECEIVED:
TESTED BY:
REVIEWED BY:
UNIFORMITY COEFFICIENT (Cu)
COEFFICIENT OF GRADATION (Cc)
ASTM D1557 (uncorrected)
ASTM D4718 (corrected)
OPTIMUM MOIST. CONTENT. (corrected)
PROJECT CLIENT:
PROJECT NAME:
PROJECT NO.:
SAMPLE DESC.:
NGE-TFT ID #: 52.8
0.9
First Water Consulting Services
HYDROMETER RESULT
N/A
SIEVE ANALYSIS RESULT
Delucia L27
7068-24
Silty Sand w/ Gravel
24-S-3
Poorly-graded sand w/ silt and gravel
10/4/2024
Paul Santillana
Sean Totzke
TOTAL %
PASSING
11301 Olive Lane ∙ Anchorage, Alaska 99515 ∙ Phone: 907-344-5934 ∙ Fax: 907-344-5993 ∙ www.nge-tft.com
N/A
N/A
The testing services reported herein have been performed to recognized industry standards, unless otherwise noted. No other warranty is made. Should engineering
interpretation or opinion be required, NGE-TFT will provide upon written request.
N/A
125
130
135
140
145
150
0 2 4 6 8 10 12 14 16
DR
Y
D
E
N
S
I
T
Y
(
p
c
f
)
MOISTURE CONTENT (%)
MOISTURE-DENSITY RELATIONSHIP ASTM D1557
SILT or CLAYCOBBLES
GRAVEL
Coarse Fine
SAND
Coarse Medium Fine
0
10
20
30
40
50
60
70
80
90
100
0.0010.01 0.11 10 100
FI
N
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R
B
Y
M
A
S
S
(
%
)
GRAIN SIZE (mm)
PARTICLE SIZE ANALYSIS ASTM D6913 / C136 / D422
#200#40 #101.5 1/23 6 3/4 #4 #20 #60 #100 3/8
U.S. SIEVE OPENING IN INCHES U.S. SIEVE NUMBERS HYDROMETER
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241348, Deb Wockenfuss, 10/25/24
I
50'
I
50'
BLM LOT 164
S 89059'00" E 188.30'
IRON _1
PIPE UTILITY
N SEPTIC POLE
co STANDPIPE
C0 \
23.7,
LOT 19
LOT 27
0.50 ACRES
�2
2 -STORY \
26°
HOUSE coti���
F-4
o
W ti
WELL t��
/ Op NOTE
0 100' WELL RADIUS SHOWN
o� FOR REFERENCE ONLY.
�O LOT 26 OTHER WELLS, NOT ON
THIS PROPERTY, COULD
HAVE 100' RADII THAT
AFFECT THIS PROPERTY.
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (P-684) 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.
THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY
TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR
ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A
VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE
LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED
FOR SERVICES IN PREPARATION OF THIS PRODUCT.
JOB # 24125 I NO CORNERS SET THIS DATE I SCALE 1" = 40'
U)
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O O
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LOT 25
*: 49 TH
............................
,
......
4 . B U Saliz �o
LS -14837
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 27, DELUCIA SUBDIVISION
ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
DATED THIS 16th DAY OF JULY, 2024, 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
THOMAS F. BLAVKA
(907) 688-2219
HC~ Box ]239, Old Glenn Highway,
Chugiak, Alaska 99567
June 6, 1990
Pepartment of Health and Human Services
Municipality of Anchorage
Attention: Mr. John Smith, P.E.
Dear Sir:
Subject: Reply to letter dated May 31, 1990
MUNICIPALITY OF ANCNO~A~
OEP[, O~ ~EAL~rH &
~-NVIRONM~.NI AL I~ROFECTION
JUN 1,1
RECEIVED
I have read your letter over several times. It is hard to believe that this is
the product of our tax dollars at work. From what you say you will act on
information that is grossly inaccurate and out of date unless we reply to
your letter. I read between the lines that you are attempting to upgrade
your files after many years of neglect at our expense.
We did apply for an upgrade permit on our septic system in July 1986. This was
a single family two and one half bedroom home with a piano studio in the home.
This has been a single family residence for twenty years.
Was the permit issued to us for a six bedroom duplex? Was the criteria furnished
to S and S Engineering based on the assumption that this is a six bedroom duplex?
Thomas F. Blavka
] unicipality of Anchorage
Department of Health and Human Services
825 "L" Street
Torn Fink,
Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650
May 31, 1990
Thomas Blavka
SR 3 Box 1239
Chugiak, Alaska 99567
Subject: On-site Wastewater Disposal System
Lot 27 Delucia Subdivision, PID #051-141-45
On July 7, 1986 you were issued a permit (#860235) by this
office to upgrade your existing on-site wastewater disposal
system. The permit was issued on the basis of an engineering
design submitted by S & S Engineering. Apparently this work was
never completed and the permit expired on December 31, 1986.
During our file search on this matter, it was discovered that
the dwelling on the subject lot is classified as a 6 bedroom
duplex. Assuming this to be correct, and unless you provided
information to the contrary, this office will void all existing
permits for the well and septic system serving the subject
lot. In order for the well and septic system serving this lot
to be legal, permitted and recorded (assuming that the residence
is multifamily) you must request the appropriate permits from
the Alaska Department of Environmental Conservation (ADEC).
Your contact at ADEC should be Mr. Mike Lewis whose phone number
is 563-6775.
Should you desire additional information form '[his of'fice,
please call Robby Robinson at 343-4744. If we have received no
response from you by June 30 1990, we will assume that our file
information is correct and the existing permit will be voided
accordingly.
Sincerely, / /
J~nn Smith,YP.E., 'J
P~ogram Manager, On-site Services
RWR/ljm: 244
cc: Mike Lewis
Alaska Department of
Environmental Conservation
3601 C Street
Anchorage, Alaska 99503
l~zds~e OurFutu~
t-unicipai y
Anchorage
P.O. E ,196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES.
MA YO R
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 9, 1987
Mr. Blavka
SR 3 Box 1239
Chugiak, Alaska 99567
Subject: Lot 27 Delucia Subdivision
On-site Sewer Permit ~860235 Upgrade
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1986.
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 264-4744.
Sincerely,
~'R.W. Robinson
Program Manager
On-site Services
RWR/ljw
enc: copy of permit
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
5
6
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18
19
2O
Z2 7
Township, Range, Section:
SLOPE
Ii' AD /E'/c.~
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT /k I//J.. SL
DEPTH? pO
E
Depth to Water kJ~.. ~'Z~/~4
Monitoring? y Date:
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE __ (m~/~nch) PERCHOLE DIAMETER
, /./~-
FT AND
TEST RUN BETWEEN __ FT
COMMENTS- -
PERFORME~I ~ D~ V ~O~ ~~/~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE W TH ALL STATE AND MUNICIPAL GUI EFFECT ON THIS DATE. DATE'. Jl,~..l~ 2 2 ~ ,<i
72-008 (Rev. 4/85)
.OL~
'o
0
0
0
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U
.0 ..~ ~
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00~
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0
0
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-$
'0
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
OSC251009
Parcel ID 051 -141-45
Legal description DELUCIA LT 27
Site address 19741 OLD GLENN HWY
Current property owner(s) PICKETT WAYNE
Expiration Date: 9/5/2025
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
By:
Original Certificate Date:
2/4/2025
This Cef/tificate of On Site Systems Approval (COSA) is intended to demonstrate the subject
syste/m(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 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 I.D. 051-141-45
Complete legal description DELUCIA LOT 27
Location (site address) 19741 OLD GLENN HIGHWAY
Current property owner(s) THOMAS & FRANK BLAVKA Day
phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass
Age 0 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
sta
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 $ 2_0
Date of Payment
COSA # 0S
u. 5
Waiver Fee $
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: DELUCIA LOT 27 Parcel ID: 051-141-45
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 UNKNOWN Total depth UNK ft
Cased to UNK ft (ASSUMED 40’+)
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 9/18/2024
Static water level at beginning of test 87 ft.
Well production at time of test 2+ gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 2.64 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 9/5/2024
Comments Sullivan extended casing & installed new sanitary seal & conduit.
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NEW STEP TANK
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station NEW years
Lift station material HDPE
Comments:
D. NEW ABSORPTION FIELD DATA
Which system tested (date installed) NEW
ALL standpipes present per record drawing
Total measured depth from grade 7.33 ft (max)
Measured depth to pipe invert from grade 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 NEW FIELD
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 – POST RECOVERY – NOT TESTED
Effective depth (per record drawings) 48 in
Effective depth used 0 in
Effective depth (ED) remaining 48 in
Comments/Deficiencies: Approximate total measured depths from existing grade.
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Community Sewer Main > 75' ® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
® Yes
if No
❑ N/A — Served by Community
Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot
to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes
if No
ft
Surface Water > 100' ® Yes
if No
Tank to Property Line > 5' ® Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10' ® Yes
if No
ft
Private Wells > 100' ® Yes
if No
Water Main > 10' ® Yes
if No
ft
Community Wells > 200' ® Yes
if No
Water Service Line > 10' ® Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
ft
ft
ft
ft
ft
ft
ft
ft
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 1/3112025
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 & FWrJr
COSA Checklist.docx
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LOT 25
NOTE
100' WELL RADIUS SHOWN
FOR REFERENCE ONLY.
LOT 26 OTHER WELLS, NOT ON
THIS PROPERTY, COULD
HAVE 100' RADII THAT
AFFECT THIS PROPERTY.
0 20' 40'
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (P-684) 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.
THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY
TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR
ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A
VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE
LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED
FOR SERVICES IN PREPARATION OF THIS PRODUCT.
JOB # 24125 I NO CORNERS SET THIS DATE I SCALE 1" = 40'
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 27, DELUCIA SUBDIVISION
ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
DATED THIS 10th DAY OF JANUARY, 2025, 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
