HomeMy WebLinkAboutFEJES LT 2B
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251253 PID Number: 018-181-25
Dwelling: 0 Single Family (SF) F] with ADU El Duplex (D) R Two Single Family Project: F1 New 0 Upgrade
Name
SHANE & VIRGINIA DOCHERTY
ABSORPTION FIELD
R Deep Trench E Wide Trench R Bed El Mound
Site Address
14501 FEJES ROAD, ANCHORAGE
El Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
1 3
0.8 GPD/SF1
2.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.5 Ft.
Gravel depth beneath pipe
1 Ft.
Subdivision Block Lot
FEJES 213
Fill added above original grade
VARIES 1.9'— 2.6 Ft.
Gravel length
100 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
i
Toi SepticAbsorption Holding Sewer
. I
Total absorption area
Number of trenches
Dist. between trenches
From Tank i I Lift Station
Field li Tank Linet2
563 F
2
10+ Ft.
+
Well ;100'+ 100'+ 1 100' 25'+
TANK ED Septic 2 S.T.E.P. ❑El Holding El Other
Manufacturer
ANCHORAGE TANK
Capacity
1500 Gal.
Surface Water 100'+ 100'+ 100'+
Material
EPDXY STEEL
Number of compartments
2
1+ 1 O�+ i NA
Lot Line 5 51+
Foundation j 10'+ 10'+ 10'+ i
LIFT STATION
Manufacturer
ORENCO / GREER
Capacity
1500 Gal.
Remarks
Alarm location
Electrical installed by
IN BASEMENT
BRICKWELL
to
PIPE MATERIAL House to tank 3034 Tank drainfield 3034
Installer MIKE N ANDERSON, PE (MNA)
--1 ------- —
Drainfield 3034 CO/MT 3034
Inspector MNA & FWCS
BENCH MARK (Assumed elevation) 100 It
Inspectes:tion 2
08108/2025 �d 08/09/25
da
Location and description
3`d 08/11/25 4"' 08/19/2025
ITOP OF MANHOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Conditional Approval: Date
------- ----- -- ----- - —
7H
-------
Huffman
CCE
Septic System
Approved -
Date
E 128991 .0
J
p8/28/25. . Aw
ote: this approval does not include well permit requirements.
(Rev 05/02/18)
18.1
24
.
0
9.9
12
.
2
44
.
1
32
.
2
63.
6
11
.
9
26.
1
57.
6
2.0
5.9
26.
1
9.7 8.9
26.
8
FIRST WATER CONSULTING
FEJES LOT 2B
PID:018-181-25 PERMIT: OSP251253
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: OSP251253
Work Type: Septic Upgrade
Tax Code Number: 01818125000
Site Legal Address: FEJES LT 2B G:3035
Site Mailing Address: 4006 De Armoun RD, Anchorage
Owner: DOCHERTY SHANE P & VIRGINIA A
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
7/31 /2025
7/31 /2026
49020
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:
1. Confirm well location on T12N R3W SEC 33 LT 31 prior to construction of septic system.
2. The existing septic tank is to be decommissioned as part of this project.
3. Prior to any future COSA action, the 1985 well that is not in use is to be decommissioned per MOA 15.55.
Received By: Date:
Issued By: � Date:
(� L a i .2,3 z s-
ON -SITE SEPTICMELL PERMIT APPLICATION
Parcel I.D. 018-181-25
Property owner(s) SHANE & VIRGINIA DOCHERTY Day phone
Mailing address 14051 FEJES ROAD, ANCHORAGE, AK 99516
Site address 14051 FEJES ROAD, ANCHORAGE, AK 99516
Legal description FEJES LOT 2B
Number of Bedrooms 3
Engineering Firm FIRST WATER CONSULTING
Building Permit Number Not Applicable RN
APPLICATION IS FOR:
APPLICATION IS AN:
(Z all that apply)
Absorption Field
FX1 Initial 0
Septic Tank
FX1 Upgrade El
Holding Tank
D Renewal 0
Privy
El
Well
0
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
Permit/Rush Fees: Waiver Fees:
Date of Payment: 712 I Date of Payment:
Permit No. CS P9 5-11dSZ6 Waiver No.
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
July 26, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: FEJES LOT 2B
The property owner has requested we obtain a permit to upgrade the failed septic system of the
above referenced lot. The existing septic encroaches or is in groundwater. We propose to install
two shallow trenches and an epoxy steel STEP tank to serve the existing 3 -bedroom residence.
The design is based on the recent test hole conducted by June, 2025 by Mike N Anderson.
Groundwater was observed at test hole excavation and monitoring.
The slopes are flat at the proposed upgrade location. The STEP tank may require anchoring or
other action if determined necessary. 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
OSP251253, Curtis Townsend, 07/31/25
18.1
24
.
0
9.9
1
2.2
44.1
32.2
63.6
11
.9
26.1
57.6
2.0
5.9
2.0
26.1
9.7 8.9
26.8
FIRST WATER CONSULTING
DESIGN CALCS:
NO SLOPES >25% WITHIN 50'OF PROPOSED FIELD.
STAKE PROPERTY LINES, WELL RADII, ESMTS,
OR OTHER SEPARATIONS... PRIOR TO CONST.
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC TANK OR FIELD.
FEJES LOT 2B
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251253, Curtis Townsend, 07/31/25
18.1
24
.
0
9.9
1
2
.
2
44.1
3.6
11.9
26.1
57.6
2.0
5.9
2.0
26.1
7 8.9
26.8
FIRST WATER CONSULTING
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC TANK OR
FIELD.
FEJES LOT 2B
DESIGN DETAILS:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251253, Curtis Townsend, 07/31/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251253, Curtis Townsend, 07/31/25
OF.A
CO 49 R `9
h'Ae�—
s SHANE A. HOLT �� G
LS-6914
,\,°fessiona� �-Qo
THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE
OWNER OFRECORD AS OF THEDATE OF THIS SURVEY.
ANY USEOF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS
WRITTEN PERMISSION IS PROVIDED.
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOD/ ANY
CONFLICTS BETNEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO SE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES-
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOYN
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWNG ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHONN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNON AND/OR ICE.
LINK FENCE
AS-BUILTSURVEY I" = 30'
NO CORNERS SET THIS DATE
/ HEREBY CERTIFY THAT / HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 2 B FEJES SUB.
A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE
VIS13L E IMPRO VEMEN IS SITUATED THEREON ARE WITHIN
THE PROPERTYLINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATEDATANCHORAGE,ALASKA THIS 14 TH DAYOF
OCTOBER , 2024
16158 239-21
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
223-8615
FEJES LT 2B
Notes written Oct 2024 based on conversation with homeowner
1985 - the drill bit broke off in the well and couldn’t go deeper. This was used
for a time but water was not sufficient.
1998 well was drilled to a deeper depth. This is the one that is in use at
present day.
The 1985 well casing is still in place. This will need to be decommissioned in
the future. A well decommission log will be required to be submitted at time of
future COSA.
MUNICIPALITY OF ANCHORAGE
DF.. RTMENT OF HEALTH AND HUMAN SER, ES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
TANKS
A SEPTIC ~ HOLDING
Matorml No. of Compartments
TYPE OF SYSTEM
~TRENCH ~] BED ~ W. DRAIN [] OTHER
Depth to pg~e boltom Irom ]olal depth Irom original grade
Gravel lengg~ ~[~vel w~Oth
8,'7.Z so n
WELLS
ilVATE [] OTHER fldentifvl
Classd~cahon
V~P_-/',/
REMARKS:
] ottu L)eplh Cased to
IqO FT Il'JO
Io, ii, IZ.~
FT
DISTANCES
WELL
LOT LINE
FOUNDATION
SEPTIC
TANK
Io7
No-C
ABSORPTION
FIELD
/o 7
WELL
AS-BUILT DIAGRAM tShow Iocabon of well, seplic system ploperty hnes, Ioundahon,
driveway, water bodies, utc)
Municipal and Slate ~uidelines in effect on Bis date:
Health Department Approval:
Scale: ENGINEER'S SEAL
Insp tions Performed by:
certily that Bio inspection was pedormed according to all
/2-0~3 (3/85)
DIEF:'ARTMEN*I" OF' HEAL.'TH AND EI'4VIRONIqEIqTAL F'F~OTE. Cl'IOI'4
825 L.. STREE'T', ANCH[)RAGE, AK 995() 1.
264-4'72.()
F:'EI::~ M I '1"
DA'I*'E I ,S!i3LIE:I) :'
850579
09/11185
AF"'F'L I CAN'r:
ADDRESS:
E:ONT'AC'f F'HONE:
SHANE AND GINA DOCHERTY
4:S4 "HJRP I N
ANCHORAGE., AK 995()4
· ]~33..,-30 18
I....EGAL DESCR .'1: P ..
LOT SIZE:
MAX BEDROOMS:
LOT: 2B
RANGE:
BLOCK: NA
SLIBDIVISION: FEJES
SE[]'T'ION: 35 '¥[)WNSHIF': :t2N
:1.. 2.5A (SQ. F'T. [)R ACRES)
:."!.';
I..,isted below are the t::~ptic~ns available t.o you in designing your sept:~c:
s;yst, em,, Choose the option that best fits your' sit. e.
'"ir- lf::'~ E: N CZ: I-*-.] :IE~ E: :[) W . 1-} F;:: ¢::~ ][ !NI
DIEF:'TH '1"0 PIF:'IE BO"F'I"OM (I::'T.) 4.0 '. 4. () 4.., ()
GRAVEL:. DEF"'T'H (FT.) 8.0 0.5 3.5
'I"OTAL DEF']"H (FT.) 12]. 0 4.5 7,, 5
GRAVEL, WID]'H (FT.) 2.5' 24,,() 5.0
GRAVEL L.ENG'I"H (F"I".) 54.0 47.0 9:];. () **.
GRAVEl.... VOL. UME (CU. YDS,, ) 42.5 4 1.8 68.9
]"ANI< SIZE (GAL. S) :L,000.0 ** 1,000.0 ** 1,()00,,0 **
.SOIl... IRA'TING (SQ.FT. /BR) 287 250 2.87
-~"~' GRAVEL LENGTH > '75 F'I". REC4UIRES MULTIF:'LE RUNS (NO'I" EXCEEDING 75 F'I". EACH)
~¢'~' TAI'.II'.:: MUST HAVE AT L, EAST TWO (:X)MPARTMIENTS
I certify 'Lhat:
~.. I am familiar' w:Lth t. he r'equ:Lrement, s; for on.,...site sewers and we:Lis as set
fonth by the Munic:ipal. ity of Anchorage (MOA) arid the State of Alaska.
2. I wilI install the system in accordance with all MOA codes ancl regulat:i.c~ns;,
and ir'~ c:ompliance with the design criteria of th:ts permit.
3. I will adhere to ali, MOA and State of Alaska Pequirements for the set bac:l-::
distances from any e~..'isting well., wast, ewater disposal system or pub].:i,c
sewe:*.rage system on th'i.s or any adjacent c)r' nearby lot.
Zl.,; I understand that t. his permit., is vaIid for a maximum o4' ::"-"; bedrooms and
any enlargement wiI1 require an adclitic)r~aI permit,.
IF:' A L. IF*'I" STATION IS INSTAI....I_ED IN AN AREA C, OVERED BY MOA BUII.~.DING CODES,
"I"HEN (].) AN EL..E:C'T'RICAL PERMI'¥ AND INSF'ECTION MUST BE OBTAINED; (2) AS""'BLIII....TS
WILl... Iq[Yf' BE: AF'PRC:iVED WITHOUT AN EL.EC*TRICAI.... INSF'ECTION REPORT; AND (::5) ]"HIE
EI...EC"FF~I[:AL WL3RK HUST BE DONE BY A LIC, E:NSED ELEC"FRICIAN.
,.:~ 1. GNE, D DATE:
AI::'F:'I....ICgNT: SHANE: AND GINA
:1: SSUED BY :.._...
~'t .JNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
826 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SLOPE SITE PLAN
0-1
20-
4
5
6
7
8
9
10
11
12
13
t4
15
16
1'7
18
COMM[
PERFORMED B~':
[k~ PERCO LATION
TEST
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
DATEPE. FORME"; l'z.-t
Reading Date Time
Juno 22, 1968
PERCOLATION RATE
. (m nutes/inch)
FT
DATE:
72-008, (6/79)
r~oM .o~
DIRECTION
WATER WELL RECORD
STATE OF ALA~'KA
OEPARTMENT OF NATURAL RESOURES
Division of Geologicol B Geophysico) Surveys
A.D.L. No.
Townlhlp N~) J Renal E~ Meridian
sDJ wD
OWNER OF WILL: ~J_
?.USE:~OomeJtic ~ Public Supply ~ I~duJtry
~ Irfioetlon ~ Recharge ~ Commlricol
8. CAGING: [] Threaded (~] Welded
9. FINISH OF WELL:
Type: Dlomlter~
Backfilling . grovel pack
STATIC WATER LEVEL:
II, PUMPING LEVEL below land euHooe and YIELD
__ft. offer __hrs. pumpln0 g,p.m
13.GROUTING Well grouted: Kal [] NO
Material; [] Neat Cement ~:] Other',
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological ~ Seophysicol Surveys
Drilling Permit NO. ~ ()~L~79
LOCATION OF WELL (Please complete either la~ lb or lc.) A.D.L. No.
Jbdivision Lot Block I/4qtr$. Section No. Township N~] Range EEl Meridian
ejes 2B __of__of--of -- SD wE]
DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL; Shana Docherty
Address:
end Area of Well Location
Feet Below 4. WELL DEPTH: (final} 5, DATE OF COMPLETION
Material Type Top 8ottom
)oulder 11 ~ 12 50 ~Au~er ~efted ~Bored ~01her:
~& ~r~vel ~1 121 ~ Irrigation ~ Rech.rge ~ Commerlcal
9. FINISH OF WELL:
Type: open he)} f~ Diameter:
__~ Slot/Meah Size: Length:
Set between ft. and ft.
BockfilHng Gravel pock
m. STATm WaTE. LEVEL: ". / /
-- ~ Above or ~ Below land surface Dote
........ ft. after hrs. pure ping ~ g.p.m.
~ft. ~fter .~hrs. pumping.~.p.m.
IZ.GROUTING Well Grouted: ~ Yes ~ No
................ Materiel: ~ Neet Cement ~ Other:
13, PUMP: (if available) HP
.......... Length of Drop Pipe ft. copocity ~g.p.m.
14. REMARKS: perforated 121- 12~/~
gallons per. day
)
gpm
CONTRACTOR'S CERTIFICATION: 15. Wafer Temperature o ~ F ~ C
drilled under my jurisdiction end this report is true to the besl of my knowledge ond belief;
-Well/Vein's [~illing & ~t ~ 332?
2~1 Ayion St. Anchorage: AK 99516
Authorized Represent¢llve
Il} Copy Distribution: WHITE-State DGGS, PINK-Driller, CANARY-Customer
~:~nch I F_
Streel /~ddres5
2 WELL t. OG
brn silty
hard pan
hard_gr
uma. er wi
2 gpm
16. WATER WELl..
Alaska
Form 02 WWR {II/UI}
PAGE 1 OF 1
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 SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW980070
DESIGN ENGINEER:
OWNER NAME:DOCHERTY SHANE P & VIRGINIA A
OWNER ADDRESS:4006 DEARMOUN ROAD
ANCHORAGE, AK 99516
DATE ISSUED: 4/21/98
EXPIRATION DATE: 4/21/99
PARCEL ID:01818125
LEGAL DESCRIPTION:
FEJES LT 2B
LOT SIZE: 49020 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
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 (18AAC80).
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 SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
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 ID 018 -181-25
Legal description FEJES LT 2B
OSC251383
Expiration Date:
7/22/2026
Site address 14051 FEJES RD
Current property owner(s) DOCHERTY SHANE P & VIRGINIA A
X The On-site system(s) is/are approved for 3 bedrooms
By:
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
Original Certificate Date
9/5/2025
This Sprfificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
sys m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
evelopment 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
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 018-181-25
Complete legal description FEJES LOT 2B
Location (site address) 14051 FEJES ROAD ANCHORAGE, ALASKA 99516
Current property owner(s) DOCHERTY SHANE & VIRGINIA
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: F* 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: ❑ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEr! -IC 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 ❑® Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By app, ing for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 296 Waiver Fee $
Date of Payment 8/271�S
COSA ,': 05C2513g 3
Date of Payment
Waiver #
COSA Application Apr2025.doc
COSA Checklist_May2025 copy 2.docx
COSA Checklist
Legal Description: FEJES LOT 2B Parcel ID: 018-181-25
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 5/4/1998 Total depth 180 ft
Cased to 180 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 7/22/25
Static water level at beginning of test 98 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 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Mike N Anderson Date 7/22/25
Comments: 1985 Well has been decommissioned – see attached.
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 EPOXY STEEL
Comments: NEW STEP
D. DISPOSAL FIELD DATA
Which system tested (date installed) NEW FIELD
ALL standpipes present per record drawing
Total measured depth from grade 5.1 ft (max)
Measured depth to pipe invert from grade *3.4 ft (min)
N/A – pressurized field. *PER INSPECTION REPORT
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 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
Effective depth (per record drawings) 12 in (MOA 1’ ED)
Effective depth used 0 in (Missing ED + Final Fluid Depth)
Effective depth remaining 12 in
Comments/Deficiencies:
COSA Checklist_May2025 copy 2.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 08/28/2025
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 &
08/28/25
CO 49 R `9
s SHANE A. HOLT �� G
LS -6914
,\,°fessiona� �-Qo
THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE
OWNER OFRECORD AS OF THEDATE OF THIS SURVEY.
ANY USEOF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS
WRITTEN PERMISSION IS PROVIDED.
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOD/ ANY
CONFLICTS BETNEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO SE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES-
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOYN
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAYING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHONN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNON AND/OR ICE.
• SEWER SYSTEM PIPE
.4S:BUILTSURVEY 1" =301
NO CORNERS SET THIS DATE
LINK FENCE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
L 0T 2 B FEJES SUB.
A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE
VIS13L E IMPRO VEMEN IS SITUATED THEREON ARE WITHIN
THE PROPERTYLINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DA TED ATANCHORAGEA LASKA THIS 14 TH DAYOF
AUGUST 2025
16158 239-21 242-77
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
223-8615
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT0e*
907-343-7904
On -Site Water and Wastewater Section
Fax: 343-7997
www.muni.org/onsite
Well Decommissioning Lo
Legal Address:
Subdivision FEJES Block Lot 26
T R Section Lot
On-site Water & Wastewater Section certified contractor performing the well decommissioning:
Name:
Signature:
MIKE ANDERSON
Company:
SAME
Well decommissioning date 2 Method of decommissioning: AMC 15.55.0601-1 a.
❑ b. ❑ C. X
Location: Use the space below to provide a drawing of the property showing the following items:
• North arrow
• Decommissioned well location
• Location of other water wells on the property
Two separate swing -tie distances for each well shown on the drawing
Note: The swing -tie distances shall be measured from either permanent structures or the property comers.
�Vae4 __� 4i -1er.,
a4
G:\Development Services\Building Safety\On Site Water and Wastewate6Forms\Client Forms\Well Decommisioning form.doc
MIXAPSIRY OfArrl a
On, b vvatw and V*Bkwmter
REVWVVW FOR CODE
DESIGN CALM 0901M,,0.tsT O7i31ae
3BR X 150 GPD = 450 GPD
450 GPD/0.8 GPD/SF = 563 SF SAS
563 SF / 5'W W/ 1/ED (O.BBRF) = 100 FT. TRENCH
USE 2 TRENCHES - 50'(L) X 5'(W) X 1'(ED)
TOTAL MAX DEPTH FROM EXISTING GRADE: -2.5' NO SLOPES >25% WITHIN 50'OF PROPOSED FIELD.
100 LF 1.25' PVC W/ A- HOLES 0 3' SPACING STAKE PROPERTY LINES, WELL RADII, ESMTS,
17 HOLES PER LINE. OR OTHER SEPARATIONS... PRIOR TO CONST.
s
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC TANK OR FIEL)2A
Il/G�/
LOT
6
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NO RECORDS — LOT 37
VERIFY ANY WELLS
PRIOR TO CONST.
FEJES LOT 2B
PREPARED FOR: SHANE & VIRGINIA DOCHERTY FLrr..
14051 FEJES ROAD
ANCHORAGE, AK 99516
FIRST WATER CONSULTINGDATE: 07/26/2
SURVEY: HOLT
13030 SUES WAY DRAWN: FWCS
ANCHORAGE, AK 99516 SCALE: 1' = 50'
907-350-9566 FirstWaterAK@gmail. COM
PAGE: 1 of 2
Aw i<,5 F� �
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` `C xtii Huffman fir/
cE > 6/25 /
,, � �p0�7/26/25 �
'�83910N�
I'400° O'Z' ~c1"~ - I Co~b.O0'
I HEREBY CERTIFY THAT THE INFORMATION SHOWN HEREON IS TRUE AND CORRECT
AND HAS BEEN ESTABLISHED BY ACCEPTABLE SURVEYING TECHNIQUES.
DRAWN BY CZ,L..~. LEGEND
CHECKED BY
SCALE III
BATE
JOB NO. ~Z"~
Dofum Engineering ~ Surveying, Inc.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property Owner (~('~a~-?t'~, -*¢~"~ ~/~'/~'¢~l~ne: Home '~'-~--~"~J Business
Mailing Address - - ~ /"~ ¢0 ~ J ~ A'¢~4.,~0~.2 ~ .
(c) Lending Institution ~'~11~:~m44~ ~ Telephone
(d) Real Estate Company and Agent ~%,1 I~
Address
Telephone
(e)
Mail the HAA to the followino address: or: Check here~ if hold for pick up.
List contact person and day phone number below, f '
i '
TYPE OF RESIDENCE
Single-Family'~
Number of Bedrooms
WATER SUPPLY
Individual Well~ Community [] Public []
Note: Jf community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 fRev 8/86~ Front
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 flies 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
Name of Firm {,/o ~ Telephone
AddressDate ~ I~~
Engineer's Seal
DHHS APPROVAL
Approved for -~
Approved X
Disapproved
Conditional
Terms of Conditional Approval
CAUTION
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.
Page 2 of 2 72-025 (Rev 8/86) Back
O6 ~:~\O~ MUNICIPALITY OF ANCHORAGE (MOA)
-~-~'~o~ ~,~r- -~'~--~%O HEALTH AUTHORITY APPROVAL (HAA)
~.O~ C~c~'X~ 264-4720
Well Classification
Well Log Present (Y/N)
Total Depth / ~'VD Cased to
Static Water Level
Casing Height Above Ground .,~
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
If A, B, C, D.E.C. Approved (Y/N)
Date Completed J~ °/~" ~'-~ Yield
Depth of Grouting
Pump Set At ~D '~ ~-/
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
ll~ 7 ; On Adjoining Lots
/ {~ -7 ; On Adjoining Lots · /~'~
_ To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ,,'~/~::~
; Date ///"~'//'~' 7
B. SEPTIC/HOLDING TANK DATA
Date Installed 1~ : //: ~ $
Standpipes (Y/N) T'
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~ ~
To Property Line
To Water Main/Service Line
Course
Comments ~'
Size I~f..~ _ No. of Compartments T
Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
Date Last Pumped ~
tY'//~A, ;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation '~ {
To Disposal Field ~
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field J iD ~
Depth of Field ~;~
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well I
TO Building Foundation
Lot /'~ 0 I"~
To Water Main/Service Line ~'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Y
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~ ~'~)
To Cutbank (if present) /'~/
oh/
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to alI. MOA//and HAA guidelines in effect on the date of this inspection.
Signed --~, ~ J~,~'~'~ Date
/
Company MOA No.
Receipt No. /
Date of Payment //--
Amount: $ ,'/~.') ~')
Page 2 of 2
72-026 (11/84)
Engineer's Seal