HomeMy WebLinkAboutELMORE #1 BLK 5 LT 12Elmore #1
Block 5
Lot 12
#018-172-26
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251007 PID Number: 018-172-26
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
ALLAN DANIEL W & PAULA D
ABSORPTION FIELD - EXISTING
El Deep Trench El Wide Trench El Bed ❑Mound
Site Address
4201 RIVERTON AVENUE
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
3
GPD/SF
JTotal
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Fill added above original grade
Ft.
Gravel length
Ft.
ELMORE #1 5 12
Township Range Section
Gravel width
Ft-
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To Septic Absorption LiHolding
ft Station
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From Tank Field Tank
Line
Ft z
Ft.
Well 100,+ ',, --
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1500 Gal.
Surface Water 100'+ --
Material
HDPE
Number of compartments
2
Lot Line 10'+ --
NA
Foundation 1 0'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Deep-burial HDPE tank.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 d 3034
Installer MNA (Michael N Anderson)
ainnfield
- -
Drainfield CO/MT
Inspector FWC
BENCH MARK (Assumed elevation) 100 ft
Inspection1S1 1/27/2025 nd 2/5/2025
Location and description
dates:2
3b 4'h
TOP OF MANHOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Conditional Approval: Date
Septic Sys#
low
if!* -' 49TM ....•:* l�
" " "" " '
.. • Curtis Huffman �
.�
Approved - �`
�r �'E�,• CE 128991 •��
�� ��'lF
Dat _�
• . ,2�6//202� . •� i
,,XNote: this approval does not include well permit requirem nts.
l,il PROFES510N��C
(Rev 05/02/18)
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'
N 89°52'00" E 208.71'
2-STORY
3BR
HOUSE
LOT 12
41,185 sq. ft.
CANTILEVER
DECK
ASPHALT
DRIVEWAY
CONCRETE
30
'
G
A
S
L
I
N
E
E
A
S
E
M
E
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T
UTILITY
POLE
RIVERTON AVENUE30
'
REBAR
OV
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H
E
A
D
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30
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EO
24
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'
24.0'
8.
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'
24.0'
13
.
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'
2.0'
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'
2.0'
18
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'
24.0'4.
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24.0'
24
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CA
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CANTILEVER
STAIRS
PID:018-172-26 PERMIT:OSP251007
FIRST WATER CONSULTING
ELMORE #1 BLOCK 5 LOT 12
50'
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I 50' o REBAR
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N 89052'00" E 208.71'
--RIVERTON AVENUE
S
SIP`
S 89046'30" W 208.71'
10' UTILITY EASEMENT _
---rt---- -- -- —
MAINTENANCE -
I I
20'
EASEMENT /
\
K
\
RABBIT GRE /
/
/ 20' MAINTENANCE /
o
EASEMENT /
I
\
I
LOT 12
q I
41,185 sq. ft.
D
� I
SEE
m I
BUILDING
>
l
DETAIL
m
57.5'
I
SEPTIC
Z I SEPTIC
MANHOLE
I STANDPIPES
_
m
ro
I
p WELL l
I 50' o REBAR
I
_ _ o
M
0
N 89052'00" E 208.71'
--RIVERTON AVENUE
BUILDING DETAIL
NOTES
1. DRIVEWAY LOCATION IS
APPROXIMATE DUE TO SNOW
AND ICE COVER.
2. CREEK LOCATION IS
APPROXIMATE DUE TO STEEP
TERRAIN AND ICY CONDITIONS.
1"=20'
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (P -635A) 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
ii
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0
0
0
Co
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V1
UTILITY
POLE
LOT 11
N0 25' 50'
*: 4 TH
...... ........................
01.302..
i u Sahz �o
i� s� •. LS -14837
rrrf f
ill
lt ESSIONP�_ _
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 12, BLOCK 5, ELMORE SUBDIVISION ADDITION No. 1
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE IMPROVEMENTSAS DEPICTED HEREON EXISTAS
SHOWN IN RELATION TO THE PROPERTY LINES.
DATED THIS 28th DAY OF JANUARY, 2025, AT
ANCHORAGE, ALASKA.
ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT LLC
HEIGHT, C.O.A. 122554
Land Surveying Services WWW.FIXEDHEIGHT.COM
JOB # 250056 NO CORNERS SET THIS DATE SCALE 1" = 50' 1 600 W 41st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949
S
SIP`
CANTILEVER
v 24.0'
24.0'
0
o
C0
Uj
N
2 -STORY
Q
FRAME 2.0. DECK
HOUSE o
24.0'
2.0'
CONCRETE•'-•'
o O
m
ro
24.0'
CANTILEVER• '
F
ASPHALT
DRIVEWAY
BUILDING DETAIL
NOTES
1. DRIVEWAY LOCATION IS
APPROXIMATE DUE TO SNOW
AND ICE COVER.
2. CREEK LOCATION IS
APPROXIMATE DUE TO STEEP
TERRAIN AND ICY CONDITIONS.
1"=20'
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (P -635A) 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
ii
0
0
0
0
0
Co
(o
v
V1
UTILITY
POLE
LOT 11
N0 25' 50'
*: 4 TH
...... ........................
01.302..
i u Sahz �o
i� s� •. LS -14837
rrrf f
ill
lt ESSIONP�_ _
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 12, BLOCK 5, ELMORE SUBDIVISION ADDITION No. 1
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE IMPROVEMENTSAS DEPICTED HEREON EXISTAS
SHOWN IN RELATION TO THE PROPERTY LINES.
DATED THIS 28th DAY OF JANUARY, 2025, AT
ANCHORAGE, ALASKA.
ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT LLC
HEIGHT, C.O.A. 122554
Land Surveying Services WWW.FIXEDHEIGHT.COM
JOB # 250056 NO CORNERS SET THIS DATE SCALE 1" = 50' 1 600 W 41st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949
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: OSP251007
Work Type: SepticTank Upgrade
Tax Code Number: 01817226000
Site Legal Address: ELMORE #1 BLK 5 LT 12 G:3036
Site Mailing Address: 4201 RIVERTON AVE, Anchorage
Owner: ALLAN DANIEL
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
1 /16/2025
1 /16/2026
41222
❑ Disposal Field 2 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
3
Received By: !' �J-� �=' �— L�-r L Date:
S
Issued By: __ �. Date:
MUNICIPALITY OF ANCHORAGE
-907 Development Services Department Phone. -343-7904
On -Site Water & Wastewater Section
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 018-172-26
Property owner(s) ALLAN DANIEL W & PAULA D Day phone
Mailing address 4201 RIVERTON AVENUE ANCHORAGE, ALASKA 99516
Site address 4201 RIVERTON AVENUE ANCHORAGE, ALASKA 99516
Legal description ELMORE #1 BLOCK 5 LOT 12
Number of Bedrooms 3
Engineering Firm FIRST WATER CONSULTING
Building Permit Number Not Applicable F0
APPLICATION IS FOR: APPLICATION IS AN:
(Z all that apply)
Absorption Field EJ Initial El
Septic Tank FX1 Upgrade El
Holding Tank EJ Renewal El
Privy ❑
Well ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
Permit/Rush Fees:. 2 Z Waiver Fees:
Date of Payment: 1 q 1-6,5r Date of Payment:
Permit No. S- / 0 -Waiver No.
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / FirstWaterAK@gmail.com
!
!!
January 10, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: ELMORE #1 BLOCK 5 LOT 12
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the
attached design to serve the existing 3 -bedroom residence. We would recommend a 1500-gallon
HDPE deep-burial or concrete tank be installed for current functionality and future consideration
or flexibility.
MOA records note a 38’L x 3’W x 7’ED trench with 125 sq/ft soils & a total absorption area of
375 sq/ft or SAS. The site investigation along with the as-built survey indicates an approximate
length of 28’ and thus with the noted 7’ED and soils rating would be 392 of SAS. So it appears
this is a length typo in the MOA records from the 1979 MOA inspection report.
No groundwater was noted in the MOA on-site file, but if groundwater is encountered during
installation a different tank or design change may be required. The lot and area are served by
private water and any encroaching wells, easements, … must be staked prior to construction.
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
OSP251007, Curtis Townsend, 01/16/25
N
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7
'
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0
"
W
1
9
7
.
51
'
N 89°52'00" E 208.71'
2-STORY
3BR
HOUSE
LOT 12
41,185 sq. ft.
20' MAINTENANCE
EASEMENT
CANTILEVER
DECK
ASPHALT
DRIVEWAY
CONCRETE
30
'
G
A
S
L
I
N
E
E
A
S
E
M
E
N
T
UTILITY
POLE
RIVERTON AVENUE30
'
REBAR
RABBIT
30
'
EO
24.0'
24.0'
8.0'
24.0'
13
.
0'
2.0'
5.0'
2.0'
18.0'
24.0'4.
0
'
24.0'
24.0'
CANT
I
LE
VER
CANTILEVER
ST AI RS
CREEK
FIRST WATER CONSULTING
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC TANK
ELMORE #1 BLOCK 5 LOT 12
DESIGN DETAILS:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251007, Curtis Townsend, 01/16/25
01/12/25
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251007, Curtis Townsend, 01/16/25
· f MUNICIPALITY OF ANCHORAGE
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
~ . 825 L Street. Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL [IESCRI~TION
L~TION NO. OF
,Li?~y in gallons i F HOME~D~i~ Inside length W4dth Liquid depth
~ ~ DISTANCE ~O: Well ~weUing PERMIT NO.
< ~ Type of crib Crib diemeter Crib depth Total eflecti~ absorption a~ea
m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller O~sta~ce to lot line PERMIT NO.
m Building foundation S~r line Septic tank Absorptlo~ area(sD
~ DISTANCE
INSTALLE
(Rev. 3178!
~ e~'
PERMIT NO.
RPF'LI CRNT JOHN HENSLEY
LOCRTIQN CORNER ELMORE &
LEGRL El2 B5 ELHORE
· l-lLIr-.I I ,.7- I
DEF' ,:Tr'IEr.;T Cf" .E LTH Er.r./iRor.;rlEr!T L ( ,'ECT ,N
· , 8,=,., L _TF. EET, RH.HJRAJE.,
'" ~" 264-4720 ~,o~-'~"l -- /Y~ ~ -
LOT SIZE 4997~ SQURRE FEET
TYPE OF SOIL RBSORBTIQN SYSTEH IS: TRENCH
HR>,'II.1ur.1 NUMBER OF BE[:,ROOHS = ~
SOIL RRTIHG
THE REQUIRE[> SIZE OF THE SOIL RBSORPTIOH SYSTEM IS:
DEPTH= '1:1. LE~-I¢-~TH = 27 6 F-.' ~R %-' E L DEPTH= 7
THE LENGTH DIMEUSION IS THE LEHGTH <IH FEET) OF THE TREI~'.;CH OR DRRIHFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRi".;CE E:ETI. IEEN THE SURFRCE OF THE
GROUHD RHD THE BOTTOH OF THE EXCRVRTIOI,..; (Ii'-,; PEET).
THERE IS NO SET HIDTH FOR TRENCHES.
THE GRRYEL DEPTH IS THE MINIMUM DEPTH OF GRIRVEL E:ETI.,.IEEI,..; THE OUTFFILL PIPE
Ri',iD THE BOTTOM OF THE EXCFIVRTION (IN FEET).
REQI_I I [;.:ED SEPT I C TR[-II.~ ~ I -ZE 10L---~£'~ GRLLC~r-t--S
F'ERHIT RPPLICRNT HRS THE RESPONSIBILITY TO II,,IFORM THIS DEPRRTr'IENT DJPING THE
INSTFILLIRTIOI',I II,.;SPECTIONS OF FINY MELLS RDJFICEI'..;T TO THIS PROPERTY RN[> THE
I~~IUHBER OF RESIDEHCES THRT THE HELL HILL SERVE.
TI-lO ( 2 ." I I'-.ISPE[.--'_-T I 0 I'--I_'!:; ARE REQI_I I RED-.
BRCI(FILLING OF JC:II'.;'T' S"r'$TEH HITHOUT FINAL II'.;SPECTION Ri',l[> AF'PROVRL E:Y THIS
DEF'RRTI'"IENT HILL BE SUBJECT TO PROSECLITIOr~I.
rtll,..;ir.lijH DISTRNCE BETHEEN R HELL RND RNY ON-SITE SEHRGE DISPOSRL.S'-/STEM IS
.100 FEET FOR FI PRIYATE HELL; OR
'15~ TO 200 FEET FROM R PUBLIC MELL DEPENDING I_IF'OI,..; THE TYPE OF PUBLIC HELL
HELL LOGS RRE REC!UIRE[> FIND HLIST BE RETURNED TO THE DEPFIRTMENT HITHII,.,I -?.0 DFIYS,
OF THE HELL COMPLETION.
OTHER REQLIIRErIENTS HFIY FIPPL"r'. SPECIFICRTIOHS RI,~ID COI~,ISTRUCTIOI".; DIRGRRr,IS RRE
RVRILRBLE TO INSURE PROPER INSTRLLFITIOI.-L ..
F'ERr-11 T E,XP I RES D, ECEr'IBER --?-- 1.. 197'9
I CERTIFY THRT
l: I RM FRMILIFIR HITH THE REQUIREHENTS FOR OH-SITE SEMERS RN[) HELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I HILL INSTRLL THE SYSTEM Il".; RCCOF?.DRI'.;CE HITH THE CFC'ES.
2.: I UNDERSTAND THRT THE ON-SITE SEHER SYSTEr'I HRY REQUIRE EHLRRGEHEI,'.IT IF THE
RESIDENCE IS REHODELED TO INCLUDE I'I3RE THAI,.; 2. BEDROOMS.
SIGNED:___..~
RPPI~
ISSUE[> ¢
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6.6~0, Am:~or~e, AJmka 99602 276-2221
SOILS LOG -- PERCOLATION TEST
,~ SOILS LOG
r-I PERCOLATION
TEST
PERFOR.EDPOR:
DATE PERFORMED: ~V~A'~ /~' /~:~'79
1
2
3
~4
5
6-
7-
8-
9-
10
12
13
14.
15
16-
17-
18-
19-
20-
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BET1NEEN
, FT AND
(minutes/inch)
FT
CHUGIAK*, ALASKA
O~I~IOFLAND. ! ~,k .~, t'/ ,,, ,.,-. ] . ,, ' . -., '
ADDRI~ '
WELL - SITE ...... " .... "" -'
/
DATE - STARTED ....... '~.:.
_
DATE ENDED !
.DRILLING
KINDOF FORMATION: _,
FROM ..... FT. TO
I
FROM ...... .?. ............ FT. ........... :..
............ FT. .......... -
FROM ....:'..?.......~.... FT. TO .....:L..T..'~ ........ FT. ~..~:::(:,,:..t.....~f'~..f.~..:.,:... L
FROM ............................................................................
~c/- · ",./?'-~.
FROM ..................... FT. TO ......................................................
FROM ...................... FT. TO ......................
FROM ...................... FT. TO ...................... FT ....................................
FROM ..................... ~' FT. TO ...................... FT ....................................
FROM .....L ................ FT. TO ...................... FT .........
FROM ...................... FT. TO ..................... FT .............. ... .......... .........
KODIAK, ALASKA .
"' :..~llSCL INFORMATION: '
WE SERVE At.L ALASKA .
OFFICE BOX 42 -. CHUGIAK, ALASK~ ~9~7 . . ': '~... ·
DEPTH OF WELL ....................................................................................
STATIC LEVEL OF WATER Fl' ............................................................
'-;-' ' ..... ,
DRAW DOWN FT..:....;...:...;..;;.;::;....'..~.; ...................................................
I , x';, ., ,.c- - ../
GALS. PER HR ........................................... ~. ............................................
~ "";' ~' c" -M , · .
Kind OF CASING :..:..;.~.:..;.: ......... :~-.~...2:g:.........-d...~......~... , ...............
· . FROM .............. Z.....~ FT. TO ...L......:. .......... FT ...............................
.oM ':-'.' _
................. ..... ~. T['~ .......... ; ............ ~ .................................
~.oM ....................... er:To ........
. FROM ....................... FT. T¢~ .....: ................. FT ..................................
' FROM ....... ....... '......... FT. TO ...:...~........~: ...... FT ................................
FROM ....................... FT. TO ....................... FT .................................
FROM 2d:.:.; ............. FT. TO ........................ FT ............................. .-,..
FROM ¢ ................. -'~. FT. TO ........................ Fl' ............. ......... ...........
FROM ..................... FT. TO ........................ FT ................................
FROM ....................... IT. TO ........................ FT .................................
,_. FROM ....................... FT. TO .................... FT.' .................................
'. FROM ....................... ET. TO ........ :.:. .......... :.'FT..;...::......: ..................
4
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
OSC251040
Parcel ID 018 -172-26
Legal description ELMORE #1 BLK 5 LT 12
Site address 4201 RIVERTON AVE
Current property owner(s) ALLAN DANIEL
Expiration Date: 1/9/2026
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:
2/10/2025
This Ce tificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
syste�ry (s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Dev¢lopment Service Department (DSD) issues COSAs based upon representations provided by an
i dependent professional engineer. The Municipality of Anchorage is not responsible for errors or
missions 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 DepartmentJ 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. 018-172-26
Complete legal description ELMORE #1 BLOCK 5 LOT 12
Location (site address) 4201 RIVERTON AVENUE ANCHORAGE, ALASKA 99516
Current property owner(s) ALLAN DANIEL W & PAULA D Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 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 NEW - 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: ❑
stance:
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 $ _yJ�� Waiver Fee $ _
Date of Payment Date of Payment
COSA # 0�C 251 D 9 D Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: ELMORE #1 BLOCK 5 LOT 12 Parcel ID: 018-172-26
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 6/11/1979 Total depth 155 ft
Cased to 155 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 23 in.
Date of flow test for COSA 1/9/2025
Static water level at beginning of test 16 ft.
Well production at time of test 3.9 gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 0.84 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 1/9/2025
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank NA
Date of pumping NA – NEW TANK
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/4/1979
ALL standpipes present per record drawing
Total measured depth from grade 11.2 ft (max)
Measured depth to pipe invert from grade 6.2 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 5.9 ft
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 1/9/2025
Results Pass
Fluid depth prior to test 3 in
Water added 450 gal
New fluid depth 8 in
Elapsed time 1440 min
Final fluid depth 1 in
Absorption rate 450 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 84 in (MOA 7’ ED)
Effective depth used 14 in (Missing ED + Final Fluid Depth)
Effective depth (ED) remaining 70 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximately 13 inches or 1.1’ of ED is missing – not measurable.
COSA Checklist.docx
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’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/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 Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 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 > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private 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 2/5/2025
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 &
02/05/25
50'
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0
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4
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0
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4
Co
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LL
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tt
11i11a
I 50' o REBAR
I
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M
0
N 89052'00" E 208.71'
--RIVERTON AVENUE
S
SIP`
S 89046'30" W 208.71'
10' UTILITY EASEMENT _
---rt---- -- -- —
MAINTENANCE -
I I
20'
EASEMENT /
\
K
\
RABBIT GRE /
/
/ 20' MAINTENANCE /
o
EASEMENT /
I
\
I
LOT 12
q I
41,185 sq. ft.
D
� I
SEE
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BUILDING
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DETAIL
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57.5'
I
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Z I SEPTIC
MANHOLE
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I 50' o REBAR
I
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M
0
N 89052'00" E 208.71'
--RIVERTON AVENUE
BUILDING DETAIL
NOTES
1. DRIVEWAY LOCATION IS
APPROXIMATE DUE TO SNOW
AND ICE COVER.
2. CREEK LOCATION IS
APPROXIMATE DUE TO STEEP
TERRAIN AND ICY CONDITIONS.
1"=20'
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (P -635A) 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
ii
0
0
0
0
0
Co
(o
v
V1
UTILITY
POLE
LOT 11
N0 25' 50'
*: 4 TH
...... ........................
01.302..
i u Sahz �o
i� s� •. LS -14837
rrrf f
ill
lt ESSIONP�_ _
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 12, BLOCK 5, ELMORE SUBDIVISION ADDITION No. 1
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE IMPROVEMENTSAS DEPICTED HEREON EXISTAS
SHOWN IN RELATION TO THE PROPERTY LINES.
DATED THIS 28th DAY OF JANUARY, 2025, AT
ANCHORAGE, ALASKA.
ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT LLC
HEIGHT, C.O.A. 122554
Land Surveying Services WWW.FIXEDHEIGHT.COM
JOB # 250056 NO CORNERS SET THIS DATE SCALE 1" = 50' 1 600 W 41st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949
S
SIP`
CANTILEVER
v 24.0'
24.0'
0
o
C0
Uj
N
2 -STORY
Q
FRAME 2.0. DECK
HOUSE o
24.0'
2.0'
CONCRETE•'-•'
o O
m
ro
24.0'
CANTILEVER• '
F
ASPHALT
DRIVEWAY
BUILDING DETAIL
NOTES
1. DRIVEWAY LOCATION IS
APPROXIMATE DUE TO SNOW
AND ICE COVER.
2. CREEK LOCATION IS
APPROXIMATE DUE TO STEEP
TERRAIN AND ICY CONDITIONS.
1"=20'
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (P -635A) 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
ii
0
0
0
0
0
Co
(o
v
V1
UTILITY
POLE
LOT 11
N0 25' 50'
*: 4 TH
...... ........................
01.302..
i u Sahz �o
i� s� •. LS -14837
rrrf f
ill
lt ESSIONP�_ _
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 12, BLOCK 5, ELMORE SUBDIVISION ADDITION No. 1
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE IMPROVEMENTSAS DEPICTED HEREON EXISTAS
SHOWN IN RELATION TO THE PROPERTY LINES.
DATED THIS 28th DAY OF JANUARY, 2025, AT
ANCHORAGE, ALASKA.
ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT LLC
HEIGHT, C.O.A. 122554
Land Surveying Services WWW.FIXEDHEIGHT.COM
JOB # 250056 NO CORNERS SET THIS DATE SCALE 1" = 50' 1 600 W 41st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lo?'IZ,
Location (address or directions)
(b) Applicant Name Z)AI~I~L A I~l~J Telephone: Home ~ Business ~
ApplicantAddress ~ ~ 0 ! I~I VE~ I'O~J., Al~lcl~l ol'~6 ~/ ~-. ~Jg ~ I G
(c) Applicant is (check one): Lending Institution I"1; Owner/builder ·; Buyer I'-I; Other I-1 (explain);
(d) Lending Institution (,/AJ'I 7'~'~) g,~g/~' ~,~' ~CA<~/Ga~'elephone ~ --I~11
Address _~ ~ ~. ~G ~ ~ V~ ~C~,
(e) Real ~tate Company and Agent ~/~
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family Ill Multi --a_.j:~fil~
NUmber of Bedrooms '"f' '~\~
Other
3. WATER SUPPLY
Individual Well I~ Community [] Public []
Note: I! community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL . ',, ,'. '
Onsite [] ' Public I-1 ' 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.
~2-025 (11/84)
Page I of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
AS certified by my seal affixed hereto and as of Ihe validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm _v4~)l/~'/~/"
Address ,,~ ~- ! 7"1,'1/I f.. I ~; ~ 7' ~.-,'V ·
Date .,~'u:~'/'" b"-.. /~,
Telephone
Approved for (..,//~ ~--~' bedrooms b
Approved V.. Disapproved
Conditional
Terms of Conditional Approval
,'" ,, %) CAUTION
The Muncipality of Anchorage Department of. H. ealth and Environmental Protection (DHEP) issues Health Authority
Approval certificates based aolely upon the representations giv, e? ir{ paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending'
institutions in order to satisfy certain federal and stat~ i*~q'uirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality (~f Anchorage is not responsible for errors or omissions in the
professional engineers work. .
Page 2 of 2
130
NOli3;lo~,:l 'Tv~IANa
WELL I~EII1;II;
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY lg84
264-4720
Legal Description:
Well Classification /~'~C~l V'/D ~4 ~. If A. B. C. D.E.C. Approved (Y/N) ~/~
Well Log Present (Y/N) ~'/ Date Completed ~ -' II- ~Tq Yield ~'-~':, -~1'~'~, ~
Cased
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Tota,
Static Water Level /~I~" ·
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 EON6
CleanouVManhole
Water Sample Collected by
/'/10 /
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Water Sample Test Results
/Oo / -/-
5'a 'r'/~ ~'A crony
; Date
Comments
SEPTIC/HOLDING TANK DATA
Date Installed /~- 7¢~, ~ )':, Siz~"~/OOO~410-/.._ "iNo. of Compartments .
Standpipes (Y/N) '"":: Y Air-tight Caps (Y/N)
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/Sen, ice Line
:Course /OO / ~,-
Foundation Cleanout (Y/N)
Date Last Pumped
~/A ~ ; for '
Temporary Holding Tank Permit (Y/N)
To Building Foundation /~ I
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I 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 -
Separation Distance from Absorption Field;
To Water-Supply Well r/~, /
To Building Foundation
Lot /VO/'V ~
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
/,~E'~;~, Type of System Design -' '"'r'~'N
Length of Field ~,~
Depth of Field :I //
Gravel Bed Thickness ~'~
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line /4:~ / V-
To Existing or Abandoned System on
; On Adjoining Lots ~ I ¥'
To Cutbank (if present) /V~o/V'~~' ~'~/V,1~'
Io0 ¥-
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (WN)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
*' Check Permitt~d//~droom Rating Against HAA Request
I certify t hat,,~l/~necked, veri/~r conformed to all._MOA and HAA guidelines in effect on the dateo, lhis inspection.
Signed~=~=~/_~L~v',-~..~ (.]("~¢ ~ Date
Company ~O~ ~I~A NO
Receipt NO. ~ ~ / ~
Date of Payment ~--~ ~
Amount:
Page 2 of 2
72-026 (11~84)
· ' APPLIC"%IT FILLS OUT UPPER HAL"~ONLY
Buyer
Phone
Ty~esl~nce
S~ngle
Family
~ ~er
~ Public Utility
~ Holding Tank
NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESStNG CAN BE INITIATED.
Time Time Time Time
Date
Da,a Date Date C'~..~.~_h~1'-
Inspector Insp~tor tnsp~tor ~.~
Field Notes: ~UN~IPALI~ OF AN~O~GE
[:[B 8 i983
RECEI. ED
~ APPROVED BEDROOMS 'CONDITIONg OF APPROVAL
(
~ ) ms~.~ovEo
~lls Rating Date ~wer Install~ Well To ~sorption Area Well L~ R~elved
Well to Tank Septic T~k Size
CONSULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
John Mensley
P. O. Box 10-2157
Anchorage, AK 99501
February 3, 1983
I%~JNICIPALITY OF ANCHORAGE
ENViR D; 4:,.~t.,,~..~. ~'..TION
,--- zilg83
.~,b -
RECEIVED
SEWER AND WATER SYSTEM INSPECTION
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WATER:
SEWER:
DATE OF INSPECTION:
Lot 12, Block 5, Elmore
Corner of Elmore and Riverton
John Hensley
Three-bedroom, single family
On-site well
From Municipal Records.
Tank - 1,000 gallon Greer Steel, two com-
partments
Absorption System - Trench, 38 X 7 X 3
Absorption Area - 375 square feet (from
file)
Soil Rating - 125
Installation Date - June 1979
February 1, 1983
This system is less than four years old.
An adequacy test is not required. In-
spection of the system reviewed that there
was less than 18 inches of liquid in the
sump, indicating that the system was op-
erating properly. The tank was pumped on
February 2, 1983. The cap was missing on
the tank vent, caps in place on cleanouts
and sump.
Well cap in place, power
minimum distances okay.
lected from outside tap.
negative.
cable in conduit
Water sample col-
Test for coliform
~'~ ~ · DAIERECEIVED
.TIME TIME TIME
)ATE DATE DATE
NSPECTOR INSPECTOR INSPECTO~ ~,
~NIClPALI~ OF AN~O~GE
MUNICIPALITY OF ANCHORAGE DEPT. CF I
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~NtZENTAL ~.;~T;~ION
825 L Strut - A~or~, Al~a ~1
( ENVIRONMENTAL SANITATION DIVISION I~PR 2 9 19~
REQUEST FOR APPROVAL OF INDIVIDUAl. WATER AND
MAILING ADDRESS
PHONE
PROPERTY RESIDENT (If differen~ from ebon)
PHONE
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
;TREET LOCATION ~*~-*'~ ~_~.~..~ ,~/~.,~
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
.~ SINGLE FAMILY
[] MULTIPLE FAMILY
I-1 One .r-I Four
[] Two [] Five
~ Three [] Six
[] Other
7. WATER SUPI~LY
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.)
SEWAGE DISPOSAL SYSTEM J~ INDIVIDUAL/ON-SITE'*
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
1. TYPE OF REsIDENcE
r-I SINGLE FAMILY
[] MULTIPLE FAMILY
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS 'o
[] ONE [] THREE [] FIVE [] OTHER
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON [SITE
[]PUBLIC UTILITY
Connection Verified
J[]Septic Tank or []Holding Tank
' [ ~,r ,~ If Tank is homemadt
Size:
give dimensions:
TYPE OF TANK
INSTALLER
SOILS RATING
TOTAL ABSORPTION AREA
4. DISTANCES
WELLTO:
Absorption Area to nearest Lot Line
MANUFACTURER
MATERIAL
Septic/Holding Tank Absor[;
Line
Line
5. COMMENTS
[~APPROVEDFOR 3 BEDROOMS
[] CONDITIONAL APPROVAL(lettermustaccompanycertlficate)
[] DISAPPROVED
DATE
72.010 (Rev. 6/79)
