The URL can be used to link to this page

Home My WebLink AboutMONTGOMERY LT 3o4- Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 201406 PID Number: 051 193 04 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New O Upgrade Name Trojano ABSORPTION FIELD ❑ Deep Trench 0 Wide Trench ❑ Bed ❑ Mound site Address 22650 SHERMAN ❑ Other Phone lNumber of Bedrooms Soil Rating depth from original grade 3 JTotal 1.2 GPD/SF 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.9 Ft.4.1 Gravel depth beneath pipe Ft. Subdivision Block Lot MONTGOMERY LOT 3 Fill added above original grade 0.4 Ft. Gravel length 40 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines - Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 400 FF 1 -Ft. Well +100 +100 _ - +25 TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water +100 +100 - - Material Number of compartments Lot Line +10 +10 - - NA PLASTIC 2 Foundation +10 +10 - - LIFT STATION Manufacturer Capacity Remarks old tank disposed of per moa code _ Gal. Old field abandoned in place. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Guaranteed Services Drainfield 3034 CO/MT 3034 Inspector Charles Balzarini BENCH MARK (Assumed elevation) 100 ft Inspection ection 15` 10/27/20 2�e 10/28/20 Location and description 3'° 10/29/26 411 btm siding ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF AL, kI Conditional Approval: Date %* TH *��r �r�. G BALZARINI j Septic System t Approved Date 1( x 2 o L �CHARLES ��i�CE-13854 ,;��' �1�, Note: this approval does not include well permit requirements. pROfE551�NP,�� C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System at Montgomery Lot 3 Dear Reviewer, When the septic system was installed, a monitor tube was not placed at the angle point of the drainfield. During construction we confirmed that the field was constructed as shown on the submitted drawings. Unfortunately, the monitor tube was installed at the end of the field instead of the angle point. This does not have any impact whatsoever on the functionality of the system. The requirement for monitor tubes at angle points of trenches was relatively new at the time and the contractor and inspector didn't note the discrepancy during construction. Sincerely, Charles Balzarini, PE _-- o 9/11/25 CHARLES G BALZARINI CE13854 i i SHER� AN STREET FENCE SWING TIES A 8 C 21.7 24 D 26.1 25.7 *..,49 TH *' CHARLES G BALZARIW CE-13854 %1 A- 'w ? V3-51;Z5 E 27.2 26.2 F 28.8 G 35.9 26.8 23.9 Lli H 37.6 27.2 1 28.3 45.2 ry MONTGOMERY LOIT 3 MONTGOMERY / / LOT 2 _ NEW 1000 GAL I , VOLY TANK 7777 ANGLE POINT CONFIRMED A TO BE OUTSIDE 3 B / EDROOM NEIGHBORING WELL FUSE RADII C E F Bl// NEW 5t4Ox4) EFF. G H SHALLOW TRENCH LEGEND 100' WELD' RADIUS 0 CLEANOUT FLAB., PRIOR TO -CONSTRUCTION o MONITOR TUBE I--,- Zr\XALE-- M TEST HOLE - --- - - - - - - - -- -- -- - - - - - - - - - Ua - SIC �-� — — — 2' BURIAL RATED INSULATION Bm:+100.0' BOTTOM SIDING AT HOUSE OVER TANK ONITOR TUBE 8.7 jFlLFABRI., 7.4 NISHED TESTHOLF I GRADE 97 4.1' COVER 3.8' 97 � L COVER ORIG. GRADE 94. SEPTIC TANK 3.8 eq. 3.1 INVERT 4 �'j .. '0 DISTRIBUTION PIPE 9.0 4.1' EFFECTIVE SEWER ROCK NO GWT (10/25/20) SCHEMATIC PROFILE VIEW SHOWS ELEVATIONS OF INSPECTED 83 ELEMENTS BUT DOES NOT DEPICT SYSTEM IN ITS ENTIRETY. INSPECTION FOR GENERAL CONFORMANCE TO DESIGN AND MOA REQUIREMENTS ONLY. LEGAL DESCRIPTION: MONTGOMERY LOT 3 C&M ENGINEERING SERVICE OWNER: TROJANO -TD-ATE- 11 /4/2 907-854-5558 1 SEPTIC RECORD DRAWING z WELL N Lot 4 k= oE 0 Z SHERMAN STREET \ EAST 132.00' ' x CHAIN -LINK FENCE �2' ELECTRIC EASEMENT I x ' - _ ' Q I 100' PROTECTIVE RADIUS I x Lot 3 20.3' 13,464 S.F. I 0 N SHED 5.8'xfi.0' x 0 PORCH ` I = Lot 2 x 20.3' -1 31.0' 1n %' �,- SEPTIC PIPES CHAIN -LINK FENCE I `2 STORY c+ / ry RESIDENCE N '`=�'`�� '��z x 51.7' 31.0' MANHOLE N WEST 132.00 I Lot 9 Lot 18 � I \ Lot 10 I Lot 17 \ PLOT PLAN AS BUILT _X_ SCALE 1 " = 30' GRID NW 1159 Project No 19-58 fA2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors ken0langsurvey.com OF A Jonathan 0long survey.com 1 hereby certify that I have surveyed the following described property: 49TH LOT 3, MONTGOMERY SUBDIVISION (PLAT No. P-348) (J st Anchorage Recording District, Alaska, and that the improvements situated thereon are"'""'""""'"" """"""� within the property lines and do not encroach onto the property adjacent thereto, that (J no improvements on the property lying adjacent thereto encroach on the surveyed Q NG KENNETN o� � G premises and that there are no roadways, transmission lines or other visible ra-, easements on said property except as indicated hereon. dog �c�2►i dd i .�S-5202.-• yJ�,J Dated this the !---_ Day of _ ��_� I _�_I—=---, at Anchorage, Alaska 04 d o _ �4p�FesslaNA+-�� It is the responsibility of the owner to determine the existence of any easements, Oppgoa covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 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: OSP201406 Work Type: Septic Upgrade Tax Code Number: 05119304000 Site Legal Address: MONTGOMERY LT 3 G:1159 Site Mailing Address: 22650 SHERMAN ST, Chugiak Owner: TROJANO KAREN D REVOCABLE Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: IJ c DeI)artill ell t 10/9/2020 10/9/2021 13464 Z 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: The well is to meet all code requirements. Received By: Issued By: Date: Date: /C 2 9 3 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051 193 04 Property owner(s) TROJANO Mailing address Site address 22650 SHERMAN Day phone Legal description (Sub'd., Block & Lot) MONTGOMERY LOT 3 Legal description (Township, Range & Section) Lot Size 13,464 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank 0 Upgrade ❑ Duplex (D) El Holding Tank ❑ Renewal❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: none Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: 1q4?%��a?0 Receipt Number: ON 5 3J Permit No. 0S P'o101 � 0 � «) Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System replacement for Montgomery Lot 3 Dear Reviewer, The above referenced property is currently served by an older failed septic system. The owner would like to install a new septic system to go with the new home. The subject parcel and adjacent parcels are served by private well and septic system. We are proposing to install a new 1000 gallon septic tank, and a new drainfield. The drainfield will be sized for 3 bedrooms. There is an existing septic system on the lot.The existing tank will be demolished per moa requirements and the drainfield will remain for future use. Included with this letter is a permit application and design package, including plans, and calculations. A test hole was excavated and revealed good soils with no groundwater encountered. The drainfield is being installed cross-slope. We are requesting a waiver to allow this as detailed on the drawings. In the event that changed conditions result in deeper than anticipated topsoil layer or other subsurface issues, the design will be revised via change order. With additional soils exploration, moving the trench deeper, and/or lengthening it both appear to be viable options if necessary. As the slopes are not steep, we anticipate no adverse impacts related to approval of this waiver. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. No significant impacts to adjacent properties are likely as the adjacent lots are already developed. Sincerely, Charles Balzarini, PE 9/20/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201406, Deb Wockenfuss, 10/09/20 Residence: number of bedrooms 3 br Water usage/bedroom 150 gpd/br Water Usage 450 gpd type: SHALLOW Application Rate 1.2 gpd/sqft required absorption area 375 sqft width (W) 5 ft minimum effective depth 3.5 ft below distribution pipe Shallow Trench Factor 0.5384615 Min Required Length: 40.3846154 ft Effluent Pipe: Calc By: CGB Date: 9/5/2020 C&M ENGINEERING SERVICES 907-854-5558 Septic Design Calculations RESIDENCE/LOT INFO DRAINFIELD 4" ASTM 3034 CALCULATIONS ARE FOR REFERENCE PURPOSES ONLY USE DIMENSIONS SHOWN ON PLANS CALCULATIONS ARE FOR REFERENCE PURPOSES ONLY USE DIMENSIONS SHOWN ON PLANS Montgomery Lot 3 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201406, Deb Wockenfuss, 10/09/20 �✓ � VM Yj.+a�. L / SP201406 Db Ae Co 9/,' / / . ... • t;HARLES G BALZARIj M / \ \ �+��'F •• CE -13854 .• �/ SEE SITE PLAN FOR DESIGN `,iF�pROFESSIONP� � INFORMATION / SHERAN STREET \ FENCE EXTEND WELL CASING, INSTALL NEW SANITARY SEAL, AND TRAFFIC BOLLARDS/BARRIERS MONTGOMERY LOT 4 OLD DRAINFIELD TO REMAIN I% DEMOLISH OLq TANK PER - r MOA REQUIREMENTS / MONTGOMERY LOT 3 / � o / NEW 1000 GAL OLLY TANK , // % I MON T OMERY � LOT � 3 BEDROOM NE 5x40x4' EFF. HOUSE SHALLOW TRENCH LOCE AND TIE O 1 INTNE AT HOME 100' WELLJZRADIUS / FLO PRIOR TO -CONSTRUCTION /CLIVI IAIC N11,AI y ,1 / I / I I C&M ENGINEERING SERVICES 907-854-5558 I SKYLINE VIEW 3LOCK 1 nT in RAD SCALE: 1" = 40' LEGAL DESCRIPTION: MONTGOMERY LOT 3 DATE: 9 AREA PLAN MM EX DEPTH 8' 2TIE THOLE / O TIONAL DIVERTER IID VLVE TO OLD AINFIELD ROFI'OFI PLE VIEW NOTE X,Y LABELS I FOR DIRECTION — ,N—BLOCK SKYLINE �IEW 1 COT 18 SKYLINE VIEW 1 BLOCK 1 \ \ LOT 17 SCALE: 1" = 40' LEGAL DESCRIPTION: MONTGOMERY LOT 3 DATE: 9 AREA PLAN LEGEND o CLEANOUT OLD DRAINFIELD� TO REMAIN • MONITOR TUBE DEMOLISH OLD TANK PER - Z TEST HOLE I V SHER AN STREET � FENCE � \ EXTEND WELL CASING, INSTALL NEW SANITARY SEAL, AND TRAFFIC BOLLARDS/BARRIERS MONTGOMERY LOT 4 * ; 4911-I •• * � I • • rprHARLES G BALZARIM • • �O CE -13854 • . AWW l>>��PROFESSIONP� w � IX MOA REQUIREMENTS �\ MONTGOMERY LOT 3 � I NEW 000 GAL L�J OLY TANK MONTGOMERY / LOT 2 3 EDROOM NEW 5X4OX4' EFF �6USE X LOC/VfE AND TIE / INTO LINE AT HOME 100' WELIIRADIUS2 FLAG'PRIOR TO 2 CONSTRUCTION - - SKYLINE VIEW BLOCK 1 LOT 9 THE PROPOSED SEPTIC IS GREATER THAN: 100' FROM ANY PRIVATE WELLS 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER 10' TO ANY PROPERTY LINE OR FOUNDATION C&M ENGINEERING SERVICES 907-854-5558 SKYLINE VIEW BLOCK 1 LOT 10 \ 100' WELL RADII 5DALELM f LEGAL DESCRIPTION: MONTGOMERY LOT 3 OWNER: TROJANO I DATE: 9/15/: SITE PLAN SHALLOW TRENCH MEX DEPTH 8' TE THOLE i OPTIONAL DIVERTER V LVE TO OLD D AINFIELD SEE PROFILE VIEW NOTE X,Y LABELS — — — FOR DIRECTION SKYLINE �IEW BLOCK 1 LOT 18 SKYLINE VIEW \ BLOCK 1 LOT 17 OLD DRAINFIELD� TO REMAIN DEMOLISH OLD TANK PER - w � IX MOA REQUIREMENTS �\ MONTGOMERY LOT 3 � I NEW 000 GAL L�J OLY TANK MONTGOMERY / LOT 2 3 EDROOM NEW 5X4OX4' EFF �6USE X LOC/VfE AND TIE / INTO LINE AT HOME 100' WELIIRADIUS2 FLAG'PRIOR TO 2 CONSTRUCTION - - SKYLINE VIEW BLOCK 1 LOT 9 THE PROPOSED SEPTIC IS GREATER THAN: 100' FROM ANY PRIVATE WELLS 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER 10' TO ANY PROPERTY LINE OR FOUNDATION C&M ENGINEERING SERVICES 907-854-5558 SKYLINE VIEW BLOCK 1 LOT 10 \ 100' WELL RADII 5DALELM f LEGAL DESCRIPTION: MONTGOMERY LOT 3 OWNER: TROJANO I DATE: 9/15/: SITE PLAN SHALLOW TRENCH MEX DEPTH 8' TE THOLE i OPTIONAL DIVERTER V LVE TO OLD D AINFIELD SEE PROFILE VIEW NOTE X,Y LABELS — — — FOR DIRECTION SKYLINE �IEW BLOCK 1 LOT 18 SKYLINE VIEW \ BLOCK 1 LOT 17 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Section 4700 Etmore St. P.O. Box 196650 Anchorage, AK 99519_6650 www.muni.org/onsite (907) 343_7904 Soils Log - Percolation Test (ENGtNEER'S SeRt) Performed For: Legal Description: ftut- t1o pf 0,e rttEAY CeT 7 Township, Range, section: Site Plan !u,r/9,,< De*e LrzpveutY 5*u o 1 1 1 1 WAS GROUND WATER ENcoUNTERED? UC IF YES, AT WHAT DEPTH? M0/VE Depth to Water AfterMonitoring?@ out",Wb S L P E 14- 15- 16- 17- 18- 19- 20- coMMENrs LAqT futcqA PERFoRMED BY: I CH$Z (B44LZfrayH#tFy rHAr rHr o Depth (Feet 1. 2. 3. 4- 5- 6- 7- 8- 9- 0- 1- 2-l l', l(?-. l I d', I bl Reading Date Gross Time Net Time Depth to Water Net Drop , 8/ts ): ot O" A _t 7' tg 4 ^?1t 4-Me 3 \ 3'. tq o' u 7: lq q - 1/lt 4 -511 6 6 ltb o"- 6 1:4c '{ - Slta n-t/f 6/ PERCOLATION RATE m.nutes/inch) PERC HOLE DIAMETER A'- 9/30/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201406, Deb Wockenfuss, 10/09/20 0IL_ WELL O N Lot 4 0 O Z CHAIN—LINK SHERMAN J Q w3 . >w. y C p 20.3' SHED STREET — CHAIN—LINK FENCE--\ ADIUS I i 5.8'X6.0' / PORCH 2ELECTRIC EASEMENT ASEPTIC PIPES i I Lot 2 .. ` 20.3' L I�l•J /8.9' " D o N 31.0' / 2 STORY RESIDENCE � / Lot 3 51.7' 1 31.0, Y_ 13,464 S. F. \ WEST 132.00 / Lot 9 / Lot 10 \ \ \ Lot 18 \ Lot 17 \ \ PLOT PLAN AS BUILT X SCALE 1" 330' GRID NW 1159 Project No. 19-589/Al 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in c . (907) 522-6476 Phone 00000ppQ Professional Land Surveyors (907) Sgt-46surveYcom 5 Fax kenOlan OF q��o�4 ,( jonathanOlangsurvey.com I hereby certify that I have surveyed the following described property: LOT 3. MONTGOMERY SUBDIVISION (PLAT No. P-348) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the [-71 �' Da of e- 'C,l U` ,1-c� , �� h Day at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 491H }.:.......................... �;•.. KENNETFi�G. LAy<� c leM�19 V , ..LS -5202.•'' S�o� 0 a ... apo 40naR.��SSI0NA1. �o .~ 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 PHONE~ [~ NEW NAME LOCATION DISTANCE TO: Well Manufacturer Liq. cap~city in gallons ~ u~=~.~ ............. Manufacturer ' No, of I~s_ Length of eac~lin~ Top of tde to fimsh grade Length Width ~ I Type of crib , / ~r, ibdiameter , DISTANCE ~ ~el~ DISTANCE TO: Building fou dado Absorption er6 IDwelling F°un dati°n, lt-- Depth Crib depth Building foundation Driller Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS Dwelling ~]dth Materia] Nearest lot line Trench wid~/' 4~) [¢:~ riches q~ inches NO. OF BEDIMS .ERMITNO. No. of comments Liquid depth PERMIT NO. Liquid capacity in gallons PERM'T NO'7 O7 Distance bet~..~e~ ~_ Total effective al~r~o~rea PERMIT NO. I T otal effective absorption area Nearest lot line Distance to lot line PERMIT NO. Septic tan~ [~_f Absorption area(s) APPR~ED 72-013 (Rev. DATE LEGAL ';' t:.'!;2!5 '" 1... '" S't-'F:EIZT., F!I'.4C:H(]IF.:fzt(]iEL, RI'(. Sd~n!Sek]. ;:2 E, 4..... 4 7 ;7.: ;~ ~':~;' ~'-4!. ........ ::El!; ]E '"'~"-EifE :5!;;EE'tL,..~ii'E:f F'j LIt F::'E?3i~:zC"~:::zlI!E;::, ~.7.E ~:::::"!::ii]'.: ~:;;;::~*"1% PIEFe. H ]: T NO. ( 7'S07'4Z:: ', F;IF'PL I C:I::It"4T L C 'f FI'I" :!: Z N LEGFtL L.OT S ]: 2'7E T'?'F'E OF SOZI.... I::I[i~:SC~F4:E:'TIEdq S"?STEH ]:S' I"IFIi:.:',!PIlJM i'.4.t'!EER CII::' E['EIZ,F"ZZZM'j:j; = SC ]: L. F:F!'T' ]: NG ,:: '.:;6, F'T',-."Eff.;: :: THE .R':Eb-.!t_I ]:I:;i:EE:, S I ;;!:':E: OF' TI'-I['E so'r.. F:t[~:~:;CiI:;:.I::'T ]: Ot'.,1 S"r'STIEH :[ S: THE LEI"4GTH E:, ! F1F~I'.,tS I L-II',I :1: S THE: LENGTH ,:: :£ r.,! FIEET Z:, (:)F THE' "r't;,I:ZH'7 H Eft;i: THE [::,EF"f'H OF FI TF?E"..!."'H OR F:']:T IS TH[E E:,I:!F:;TF:II'.,ICE: E~EFr'I4EEt'.,! THE-: 5;t F'FF 7E.: O1::: THE: GF::OUHE, FII'.,IE:, THE: E: C TT ::: M OF THE: IZF.':E:I::I',,,'FtT ]: O1'.,! ,:: 1' t'.,I FEF:ZT ', TFIEFi:E IS I'.,IO SET !.,.I ]: E:,TH Fr:F: T~?EI'.,tZ::HE'.:~;. THE '"'. ....... ,~:~l;.t ,El.... DIZF'TH ]:S THE I',I:[NIHLtPI E:,EF'TH OF EiF::F:I',,,'FL'L. E',E;"I"HEEN THE OI...rT'F'RI..L. I::IND THE E:r'j TT ::i',1 ,':'F TH£( ['fF:iC:FI',,.'F:I"t'iOI'.4 ,.':if.,, FEEiT ). ___~_ ....... FEE GE_, IL_~ % F;~: EEL: D, :'J-:E; .F....i':..':: F" '-IF' % E::: T' ~:::~ Ifl-,,,~ F:::~ ~ff!; :IE ;,:..'~:: E:'£ ....... C.*'~ ' "%_ ~.E~. ~;ii~, ,, .) r..~i~i F'E:F.:i"I :I: 'T F:II::'F'L ].' C:f::II',!T l...ll::!S THE F::IESI:::'ON!5 ~ B 'f t... 'JZ "i""r' T ['1 :[ f",!FOFd"I TH :( :5 [:'EF:'Fff;~FI'."/:ZI",F." DI. ~,:-' 1; IqO THE{ I NSTFII...LFIT ]:. ON I NSF'IECT ]' Ed"IS Eft: Ft!'q"r' HELL. S FID..:rF;:Ct~;NT TO TH :I::E; I:::'F:' E PlEI:;:T'.? t::INt) THE 1'.41..Ii-,'iE:EF: OF F~:E:51'[:,EI',ICES TFtf::IT THE t-,.IEL.L hlEL. L. DFIE:t.::ZFIL. LIi'.,IL-4 7¢:' FtN'.r' :'-~;'.r'L:;"t"EH I.,.t:[TI~!E~UT !::' :t: I",IRL. t: t',1:,1- ~. ...'] iuiq FIt',ID I::iI::'I::'RC',,,'t::tL l?'d TH:tiS DEF'fflRTP1Ei'.,IT t.,.I Z LL DE SIJ[:.:L:rECT TEl F'F'Z '.:: E'C . T '[ Ot',t. I"I I i'.,1 .T. HUI"I D ]: .':.;TFINC:E: BE'T'HEE:I'-,I R HELL.. F:tND FIN"r' ON-S I TE SEHI::iGE: D ! SF'OSFIL S"r'S"fE:t"I ]: :!5 :LOE~ FEET FOF: tR F:'I;:Z',,,'I::I"I"E: t.,.!E;L.L.; :t.~5E~ TEl ;'.:::E~E~ FEE:T FFi'OM F:I F'LIE=L. ].' C: I.'.IE:LL. DE:F'E:blD:[I',IG UF'I.'.':t['-,! THE T"r'PE' CIF PL.II.:%.ZC: HEL.i... ()THE[?. I:?.[.:::b-~LIZF?.EI"IEiqTS l"ll::l"r' FIF:'PLS". ':5F:'[i:-C.IF.'.t'CFITZL3!"4S FIND COt'.,i!i:':;T.r-,;:LIE:TZ()I'.,! DZF:IEiI:?.I:::!t,!!~; F];,,'F~ :[ LFIDLE "['O Z NSLIF:tF: F:'F'.OPEF.: Z I'.,I:i.;TF!Li. FTT' :[ O1',1. ! CER"I"I FV TI-'-IRT :!.' I RM F'F!HILII::h~:~: ,H:["f'H THE t:;:E6!UZF-':FJ':HENTS F'Cfi;;: Of,t-SITE SIZb.tlEi:,::S l::iblt)I.,.tt!!i:L..L..S I:::IL-'; SET. FOI:~:TH Eft' THE; MUN 1' C I F'FIL I T';.' OF RI'qCHOF::F:I(3E. 2 I I-,.IILL. ]:t",ISTFILt... THE --, r::, F,..:! t It',l F:tC:C:OI:;i:DF!I",fC:E: H.:[TH THE L';:ODIES. 7.::' ! Ut',!DEFi:STI:::IN[:' THFIT 't'1'"1[.:.: Eff',I"q.'.SiTE: SEiJ.'.IE:I:~': :5"r'STEH MFI"r' I;4:E~5:!I...IZI:;~:IjE 'EI'.,IL..F:!i:;.:TiE",'.EI?.~ ]:1:::' "r'Hl~.~: FIF'F'L )J F:FIt'-,IT FILI::II",I [...I::IFitSOI'.,I C� r r t ifirb, TO[vig by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 OWNER OF LAND av,.; k Ca j)L r ADDRESS LEGAL DESCRIPTION DATE, - Started Ended PERMIT NUMBER KIND OF FORMATION: // DEPTH OF WELL x & `% STATIC LEVEL OF WATER FT. ' DRAW DOWN FT. �. GALS. PER HR KIND OF CASING - . From Ft. to Ft. - _ From Ft. to Ft. From Ft. to —I-_ Ft. ' - <- ' .. From Ft. to Ft. From "a Ft. tom Ft. - From Ft. to Ft. From , Ft. to Ft. i ' From Ft. to Ft, From Ft. to____: • Ft (, From Ft. to Ft. From Ft. to ' _ Ft. From Ft. to Ft. From Ft. to Ft. •`y `' S r��=c_ From Ft. to Ft. From '. Ft. to Ft. c, c: 41 OE- A"-r -- ` = From Ft. to Ft. From ti Ft. to Ft. > ri From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. ~From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft_ MISCL. INFORMATION: DRILLER'S NAME DE]:::'FII:;i:THE'I'.,IT L3Fi~_,L'-.F1L. TH FII",ID F'' 1' ::, .. ...... -. . ~: .....RONhl,r."-::NTI::IL t [~./I:': _. :. ur,t ',E:;?.5 '" L '" ?FF.'.'EET., FII'.,!I'.3FIOF?.FtEiE., Ftl.:::. P,..~ E!E b..~ .... E:::' EE IF.E:: it'd] % T' [:, i::t'T' E: L".iF ]: L.EGF:iL. L.:Z: HONTGOHEF.:"r' F'O _E~OX :t. 97 EI":~EiLE L. OT L:!; i' ZE H .f. N Z MIJH E) ! ::'?FRI"4CEE BETHEEN fl I.,.IEL. L fll",lB, t::IN'-¢ CIt'.,i-':E; Z TE ~];E!.qF4GE: E:, I St:::'Cd::;i::~l_ ':-:;"r'%'1"EP'I :[. :5 !E~E~ FEET FOR FI PRIVFI"FIE t.,.IELL. OR 2E'~E~ FEET f:'OF~: F':t PUBL]:C !.,.tEI_L. t-,4EL. L L. OL:r:-.: F~F.:E.: [;..'E6!U]:I;?.E[> I:::iND HU:.:.;T DE F.:E"!"LE~:NE[:, TO THE [.':,EPflRTHEI'-,IT !4:[TH]:N ::~:EI DFI'T':5 OF TFIE HELL COP'IPLETZOI'-,I. EE;PEC ]: F I CI::i'T' ;[ Olg,% R['.,I[:, COI'.,IS'I'F:<I..IE:T :( ON D ]: FIGRF4!"l% I":IRE R'v't::t l [..F!BL..E '1'O I t'.,tSURE F'ROF:'ER I NSTFILLRT I ON. I CERT]:F"r' THITr i: Z laH FRHZLZFIR I.,.IZTH TH[.:: RIEC-.¢JZF.-'.EMEN'F?'..:, FOR ON-'L:,]:TE :::E:!.,.IERS; FIN[':, .t.,.IEL.L::--; F:!'.'5 S;ET F:ORTH B'.F THE HUN:[C.T.F'FIL. I T'¢ OF' F~t'.,!CHOF::F¥3E. 2: Z P.I]:L.L ZNSTF:ILL THE L"~;'T"L;TIEH IN I::ICCOR['.',P'~NCE: [4I'TH THE S I GNE[:,: RPF'L :1: CRI';IT LEE: Sl~.lbL I 'v'F.:l.i'.~ :[ $:~UE[:, E:'T' ................................................................................ [':,RTE ......................................... tN2';PFCTION HI:.:.;TI3F.:'~ ..... 2;EI.,.IE:R .1_ E~ '..'5.,Et.,.tER 2 b]ELL II'.4L:.;F' lEI I.,.!ELL. LOG [:,FI"FE: O DF?.:[L. LEI.7..: D_PARTM~./OF HEALTH AND ENVIRONMENW..~ PROTECTION 825 L Street, Anchoraa~o Alaska' 99501 264-4720 Date Received:March 28, 1978 #1: Time 10:30 a.m. #2: Time #3: Time Date 3-29-78 Wednesday Date Date Insp Pratt Insp ~ Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: 4449 Business Park Boulevard 2. Property Owner: Kenneth J. Roderick Mailing Address: Box 38 Chugiak 99567 4: e o Lomas and Nettleton Company Phone: 274-7661 Phone: 688-2622 Legal Description: Lot 3 Montgomery Subdivision Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: Well System: Permit # Construction Individual well (x) Community/Public System ( ) Depth of Well 260' Well Log on File Bacterial Analysis n~ Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (x) Public Utility ( Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 3 Montgomery Subdivision Comments: ~ ~ ~.~ Affadavit Attached Disapproved: ~ ) Letter Attached: ( ) ~Q~ .. ,~ Date: ~'-- ~ ~F~~ ~' Department Worksheet: IlV~ 1VNOIIVN~NI ~OJ XON [z6t '~¥ --O]OlAOUd ]gV~]A03 ]3NVUflSNI ON 009£ BOg ...................................................... A]N0 ]3S$3~8~V Ol a~AJ]3~ S8 ............ XlUO aasseJppg 01XjeAlep~ GE "PO~eAIIOp e~aq~ pug elep 'm6q~ ol'smoqs '~ · S;31AaaS (8~elsod snld i~O£--'llVl~ Ci31JI1~:13 ~0.-I 1dl333~ · ~' ''",_ ' ~-o L'~/MUNICIPALITY OF ANCHORAG~~ "' est for Approval of Indivi 1. Property Owner: . · .~.~ , , _ % ( Mailing Address: ~ ~ ~~k ~/ Phone: 2~ Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Phone: Phone: o Realtor/Agent: '~, Mailing Address: Street Location: Single Family Residence: ~ Number of Bedrooms: Phone ~7~- ~- ~ Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply:~ *Individual Well '~ If Individual Well, well depth ~ L~) If Community System, name of system Public/Community System (,~.~) ~.~'"'2'\ 81 Sewage Disposal System: *~n-site System ~) Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy · test is required by this department. A fee of $25.00 must accompany each request b~fore processing can be initiated. 3/77 14, 1979 ~Cenn et h Ro.~%erick Syndic Realty 2603 D~ali ~treet for the foito~{in%l~ (1) Installation of a 1,000 gallon, two(2) co.part%tent (~) A ~rcolation t~st. Test ca~ be p~for~ by If there ~ any further quostions, please contact this offic~ at 2~4-4720. ~incere y~ S~ttaria~ RCP/ljh 4449 Dusines~ Park ~ulevard 99503 COSA Checklist_May2025 .docx COSA Checklist Legal Description: MONTGOMERY LOT 3 Parcel ID: 051-193-04 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 1/26/1978 Total depth 270 ft Cased to UNKNOWN ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/9/2025 Static water level at beginning of test 143 ft. Well production at time of test 4 gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 3.75 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 9/4/25 Comments Sullivan extended casing and installed new sanitary seal with conduit. B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 9/5/25 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 2020 ALL standpipes present per record drawing Total measured depth from grade 8.9 ft (max) Measured depth to pipe invert from grade 6.3 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 3.6’ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 9/8/25 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 9/9/2025 Results Pass Fluid depth prior to test 1 in (300 Gallons added prior at test) Water added 450 gal New fluid depth 7 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 49 in (MOA 4.1’ ED) Effective depth used 6 in (Missing ED + Final Fluid Depth) Effective depth remaining 43 in Comments/Deficiencies: Total measured depths from existing grade. ED per measurements, visual observations, MOA records & appears approximately 6” or 0.5’ ED is unmeasurable - missing. Existing foundation clean out (FCO) is not shown on survey. COSA Checklist_May2025 .docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below. F. ENGINEER’S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 09/16/2025 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 09/16/25